Kinesiophobia Post Bimalleolar Ankle Fracture: A Case Report

Background: Poor recovery and pain can occur in patients after acute fractures. Fear avoidance can be predictive of poor outcomes and chronic pain. It is also more common in those whose injury occurred in a traumatic way, such as a fracture. Fear avoidance is a psychosocial factor that can be difficult to address in the treatment of patients in the clinic. The purpose of this case report is to identify things to consider regarding patients with kinesiophobia and a way to address the condition. Case Description: The patient is a 55-year-old female who was referred for outpatient physical therapy a little over 6 weeks after a right bimalleolar ankle fracture and almost 4 weeks after she underwent a surgical internal fixation. She presented with kinesiophobia related to fear of reinjury and minimal pain. She reported no comorbidities or history of injury. Evaluation and Treatment: At evaluation percent impairment was measured utilizing Foot and Ankle Ability measure. The patient demonstrated guarded movements and hypervigilance at evaluation and throughout treatments. A cognitive behavioral approach was utilized to address the kinesiophobia and treat the patient’s impairments with a focus on screening, education, and exposure. Outcomes: The patient was assessed at evaluation which was at 3.8 weeks and reevaluated at 7.1 weeks status post open reduction internal fixation. There was improvement noted in percent impairment, range of motion, and edema. Discussion: The patient had a unique presentation in that there was not a lot of pain associated with the fear, most fear avoidance in the literature involved chronic pain. She was demonstrating catastrophizing and hypervigilance despite the lack of pain. One thing that could have been done differently in the treatment of and assessment of this patient would be to have utilized an outcome measure that looks specifically at kinesiophobia rather than percent impairment. The patient demonstrated improvement during treatment though the cause of improvement is hard to determine. Cognitive behavioral therapy has been shown to reduce fear but needs more research to examine its role in the treatment of fear avoidance.