What is the treatment for ankle strain causing or exacerbating pes planus?

Treatment of Ankle Strain Causing or Exacerbating Pes Planus

Functional treatment is superior to immobilization for ankle strains that cause or exacerbate pes planus, with a comprehensive rehabilitation program that includes range of motion exercises, proprioception training, strength training, and neuromuscular control exercises. 1, 2

Initial Management (First 72 Hours)

• PRICE Protocol:

  • Protection: Use a semi-rigid ankle brace (preferred over elastic bandages or tape) 2
  • Rest: Limit weight-bearing for up to 72 hours 1
  • Ice: Apply cryotherapy to reduce edema and pain 1
  • Compression: Use compressive device to limit swelling 1
  • Elevation: Keep the ankle elevated to reduce swelling 1

• Pain Management:

  • NSAIDs (e.g., piroxicam, celecoxib, naproxen) for pain control, improved function, decreased swelling, and faster return to activity 1
  • Paracetamol (acetaminophen) is an alternative with fewer side effects 2

Functional Rehabilitation (48-72 Hours Post-Injury)

• Begin exercises within 48-72 hours of injury 1, 2
• Three-phase approach:

  1. Initial Phase (Days 1-3):

     • PRICE protocol
     • Gentle range of motion exercises
     • Pain-free isometric strengthening

  2. Intermediate Phase (Days 4-14):

     • Progressive strengthening exercises
     • Proprioception training
     • Balance exercises

  3. Advanced Phase (2+ weeks):

     • Sport-specific drills
     • Endurance training
     • Advanced balance and proprioceptive exercises

Ankle Support

• Semi-rigid ankle support is more effective than tape or elastic bandages 1
• Provides better functional outcomes and faster return to activities 2
• Continue support use especially in individuals with recurrent sprains 2

Special Considerations for Pes Planus

• Evaluate whether the ankle strain has caused or exacerbated flexible or rigid pes planus 3

• For flexible pes planus (arch appears during non-weight-bearing):

  • Conservative treatment with foot orthoses
  • Focus on strengthening foot intrinsic muscles
  • Maintain healthy weight

• For rigid pes planus (arch remains collapsed regardless of weight-bearing):

  • Refer to foot and ankle specialist 3
  • May require more specialized interventions

Monitoring and Follow-up

• Re-examine 3-5 days after injury to distinguish partial tears from complete ligament ruptures 1
• If pain persists beyond 6 weeks, consider other causes such as:
  • Osteochondral lesions
  • Impingement syndrome
  • Lateral instability 2

Return to Activity Criteria

• Pain-free walking
• Full range of motion
• Restored strength
• Ability to perform sport-specific movements 2
• Patients with functional treatment return to sports 4.6 days earlier and to work 7.1 days earlier than those with immobilization 1, 2

Common Pitfalls to Avoid

• Excessive immobilization: Delays recovery and can worsen outcomes 2
• Using RICE protocol in isolation: Not shown to be effective on its own 2
• Inadequate rehabilitation: Increases risk of recurrent injury 2, 4
• Premature return to full activity: Can lead to re-injury or chronic instability 4
• Ignoring posterior tibial tendon dysfunction: Most common cause of acquired pes planus in adults 3

By following this evidence-based approach, you can effectively manage ankle strains that cause or exacerbate pes planus, minimize recovery time, and reduce the risk of recurrent injury or chronic instability.