Physical therapy for post-operative lateral ankle ligament repair patient with increased fear of re-injury: a case report

Background: Ankle sprains are a commonly occurring injury, which have been proven to be successfully treated both conservatively and surgically. Whether conservative or surgical measures are taken, treatments focusing on early mobilizations has resulted in positive and lasting outcomes. However, fear of movement during rehabilitation can become a serious limiting factor to recovery. Case description: A 47-year-old, Caucasian female who had undergone a right ankle scope with anterior-talofibular and calcaneofibular ligament repair was referred for physical therapy. The patient exhibited severe anxiety with movement and high fear of re-injuring her ankle. She demonstrated significant limitations in dorsi-flexion, plantar-flexion, inversion and eversion compared to her non-surgical ankle. She scored very low on the Lower Extremity Functional Scale and high on both the Fear Avoidance Belief Questionnaire and the Tampa Scale of Kinesiophobia at the initial evaluation. The following therapy sessions focused on improving strength and ankle range of motion while providing encouragement and therapeutic interventions to decrease her fear. Outcomes: The patient completed eight total therapy sessions after the evaluation and improved significantly. She was able to regain full ROM of her ankle and return to 100% of her normal activity participation. As well, she significantly improved in each of her objective outcome measures, including the NPR, LEFS, FAAM, FABQ and Tampa Scale of Kinesiophobia. Discussion: In summary, this case report demonstrated that early, functional mobilizations are valid interventions and address patients’ physical limitations successfully. However, this case report also demonstrates the severe limitations that fear of movement and re-injury can inflict on a patient without the proper encouragements, reassurances and attention from their physical therapist.