Ankle fractures: What can help get you back on your feet again?

Researchers from the Cochrane Collaboration – an international network of researchers – wanted to find out which forms of rehabilitation best improve recovery from an ankle fracture. For example: When should you start moving and putting strain on the ankle again? What are the best ways to do this? Could treatments such as electrotherapy or hypnosis help?

To find out which interventions could help people move their ankle again sooner, and how they compare with other treatments, the researchers looked for studies known as randomized controlled trials. The Cochrane researchers included a total of 38 studies in their analysis. But some of the studies involved very few participants and weren't designed well or carried out well. This makes their conclusions less reliable. The participants were men and women of all ages. The individual studies looked at the advantages and disadvantages of

• Interventions done during the immobilization phase (while the ankle was kept still): When looking at these studies, the researchers did separate analyses for people who had ankle surgery before the ankle was immobilized and people who did not. The interventions that were studied included different types of splints as well as hypnotherapy.
• Interventions done after the immobilization phase: These studies looked at interventions such as physical therapy, stretching or electrotherapy. The interventions were only started once the splint, brace or cast had been removed. Some of the people in these studies had had surgery, others had not.

Three studies looked into the question of which conservative (non-surgical) interventions help best. In two of the studies, two different kinds of splints were compared to see whether they had any pros and cons. The third study compared hypnotherapy with physical therapy. Physical therapy is the standard treatment for ankle fractures. The research results did not show any clear differences between these interventions.

Thirty studies looked at various interventions after surgery, such as wearing a brace or splint, sometimes also combined with either exercises or electrotherapy. It is not possible to assess the advantages and disadvantages of all of the interventions because many of the studies were very small and some of them compared very different treatments.

Ten of these studies looked into how effective exercises were when done at an early stage. They suggest that the ankle becomes more mobile again somewhat sooner in people who wear a removable brace or splint after surgery and start doing exercises sooner. Doing exercises earlier also lowered the risk of thrombosis. In some studies, participants who had removable braces or splints were also able to get back to everyday activities sooner than participants who wore non-removable splints and started the exercises later. But both groups of participants were similarly active and mobile by the end of the studies.

Moving the foot soon after surgery also led to minor problems, though – usually associated with wound healing.

• Without early physical therapy, about 7 out of 100 participants had these problems.
• The participants who had early physical therapy started doing gentle exercises a few days after surgery. Of those people, about 16 out of 100 had these problems.

In other words, about 9 out of 100 participants had problems because they started moving their ankle sooner. But serious adverse effects like new ankle fractures were rare.

Five studies looked at whether particularly intensive physical therapy – combined with stretching, electrotherapy or exercises – has any advantages over conventional physical therapy. None of these approaches made the joint more mobile than conventional physical therapy did. The studies included both people who had had surgery and people who had not.