Patient: 20-year-old male, rugby player
Injury Mechanism: A twisting ankle injury occurred during a tackle in competition play
Initial Presentation
During a rugby game, the patient reported that he was tackled while his foot was planted. This led to a sudden twisting mechanism at the ankle. He was unable to continue the game and was immediately placed in a moon boot and given crutches to protect the joint and prevent further injury.
Two days later, he presented to Access Ortho with ongoing pain and difficulty weight bearing. On examination, there was swelling and tenderness over the lateral ankle ligaments, but no obvious deformity.
Investigations
Standard X-rays were obtained, and these confirmed that there was no fracture. Therefore, the injury was consistent with an isolated ligamentous injury. Given the clinical findings, the decision was made to manage conservatively in the short term and monitor progress before considering advanced imaging such as MRI.
Early Management
The patient was instructed to remain in the boot and on crutches, although he could progress to weight bearing as pain allowed.
- Protection of the ankle was maintained in the moon boot.
- Swelling management with rest, elevation, and ice was strongly recommended.
A referral for early physiotherapy was made, focusing on gentle range of motion, swelling control, and isometric strengthening, consistent with the acute (Phase 1) guidelines for ankle sprain rehabilitation.
The patient was booked for a two-week review with the orthopaedic surgeon at Access Ortho to monitor the injury closely. The orthopaedic medical team was concerned about a high ankle sprain, which has a higher incidence of needing surgery, hence the need for close monitoring.
Two-Week Review
At follow-up two weeks later, the patient reported a gradual improvement in pain and swelling and was progressing towards full weight bearing in the boot. Examination confirmed improving stability.
A letter was written to his physiotherapist advising them that they could advance his therapy to include:
- Range of motion work.
- Light strengthening with resistance bands.
- Balance and proprioceptive retraining.
The orthopaedic team were happy with the progress and discussed with the patient that, given their progress to date, the chance of needing surgery was less.
Five-Week Review
At five weeks, the patient was mobilising independently without the boot, had regained near full ankle motion, and was tolerating strengthening and proprioceptive drills. He had commenced gentle running under physiotherapy supervision, consistent with the strengthening and return-to-activity phases of rehabilitation.
Outcome
This case illustrates a typical recovery pathway for a moderate lateral ankle ligament sprain in a young athlete. With early protection, close orthopedic review, and structured physiotherapy, the patient progressed to functional rehabilitation without complications. With orthopedic involvement, the patient avoided unnecessary scans that often occur when seen by general practitioners.
The patient was confident with their management, allowing them to progress through their rehabilitation goals, knowing they were getting the specialist care they needed. Having a skilled orthopaedic team also ensured that the patient was monitored closely for the need for surgery. Should surgery have been required, there would have been no delay in arranging this.
Despite missing the finals rounds, this patient had an excellent outcome and will return to the field next year.