Rehabilitation of Acute Soft Tissue Injuries of the Foot and Ankle in the Handball Player

Abstract

Foot and ankle injuries are among the most common injuries in handball, comprising between 15 and 35% of all injuries. Lateral ligament sprains of the ankle are most frequently seen and less commonly injuries to the syndesmosis, medial ligaments, peroneal tendons and midfoot sprains. High recurrence rates, residual symptoms and functional decrease are present in approximately one-third of players after ankle sprain injury. Rehabilitation should be started directly after an acute injury with the aim to support the healing process and gradually increase tissue capacity and load tolerance of the injured tissue, regain function and ensure as quick and safe return to play as possible. Functional and sensorimotor deficits may be present several months after injury and are targeted during the rehabilitation. Proprioception and balance training, range of motion exercises and strength training are essential parts of the rehabilitation. A battery of tests is required to evaluate physiological and psychological function needed for a safe return to handball. The use of an external support is advocated and allows for an earlier return to play. Evidence-based non-surgical treatment, including external ankle support and neuromuscular control training, balance and proprioception exercises, is first-line treatment for most acute soft tissue injuries of the foot and ankle for the handball player. Surgery should be considered on an individual basis and only after a period of non-surgical management has failed, in patients with persistent symptoms.