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Our user asked: "I have a patient who was in a car accident resulting in bimaleolar fractures with ORIF, external fix actors and severe infection. She was on IV antibiotics and almost had foot amputated. I am repeating her outpatient but she has developed RSD to the foot and ankle and I don't know what to do to address this aspect. I learned to avoid cold/ice and I don't have access to warm bath/aquatic therapy. Do I over stimulate the affected area to desensitize or do I avoid stim to the area? Will a TENS unit help? Anything else? I am working on mobility exercises and stretching the ankle. It does not seem to be a severe case of RSD."
Ask a PT Response: "My sister in law developed this condition after participating in hurdles in track and it has been a battle to try to help control her pain. We tried a TENS unit which was somewhat effective for a few days but then became effective. She was unable to tolerate the habituation on her leg as the stimulki was too painful. She could tolerate aquatic aquatic therapy in a warm water pool but did not achieve any long lasting relief. She also tried accupuncture and chiropractor afer PT which was ineffective. Finally, she received a spinal cord stimulator which was able to significantly decrease her pain. She still has pain, but at least it is tolerable now. This is a very difficult condition to treat for PT's. If your patient only has a mild case, perhaps the various interventions you mentioned may be effective. I would try desensitization with various stimuli, mirror box therapy (motor programming), edema control, progression with weight bearing, and functional trianing. I hope this helps and best of luck to your patient."
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