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Ankle fracture recovery protocol

Article written by: ANDREI BOGDAN, MD, Orthopedics-traumatology doctor

Ankle fracture recovery protocol

General principles

  • The patient will move in crutches, without stepping on the operated limb, for 4-6 weeks postoperatively
  • The patient will have his foot immobilized in a leg-foot splint for 6 weeks, maybe even longer, depending on the radiological evolution.
  • Avoid unnecessary walking or prolonged standing for the first 2-3 weeks to control local edema and pain.
  • Apply ice for 15 minutes 3-5 times a day to monitor pain and inflammation
  • Raise the foot above the heart level as much as possible to prevent local edema and inflammation.
  • No ankle mobilization exercises for 4 weeks postoperatively - isometric ankle exercises, inside the splint, should be performed daily
  • No impact exercises in the first 3 months post-surgery.

Rehabilitation protocol

Phase I: Weeks 1 - 4
  • Isometric ankle exercises, under immobilization, immediately postoperatively. Perform 5 contractions of 5 seconds, 5 times a day.
  • No ankle mobilization exercises in the first 4 weeks.
  • Walking with crutches to minimize compensation
Exercises
  • Active finger movements
  • Lifting movements of the lower limb with the knee extended
  • Quadriceps / gluteal muscles exercises
  • Cycling (using only your healthy foot)


Phase II: Weeks 4 - 6
  • Radiological control at 4 weeks to monitor healing
  • Depending on the radiological control, partially progressive loading is allowed, with the help of crutches, and the foot still immobilized in a foot-leg splint
  • Start easy ankle mobilization exercises and isotonic ankle exercises without/with partial load
  • Soft tissue treatments to control local swelling, mobility, and healing
Phase III: Weeks 6 - 8
  • Radiological control at 6 weeks
  • Depending on the radiological control, you can progress the degree of loading, giving up a crutch
  • You can give up immobilization by switching to an ankle orthosis instead
  • Walking exercises to normalize the movement pattern
  • Seek to achieve a full range of motion
  • Start strengthening exercises and balance exercises

Phase IV: Weeks 8 - 12
  • Progress the exercises and functional activities, with the full load of the operated limb. Avoid impact activities until week 12.
  • The patient can give up the ankle orthosis if he has dynamic control and satisfactory stability of the ankle.
  • The goal is the full range of motion at 12 weeks postoperatively
Phase V: After week 12
  • Start the exercises specific to the sport you practice
  • Increase the intensity of strengthening, balance, coordination exercises for the gradual return to sports activities
  • After a careful evaluation by the physical therapist, you can return to the sport you practice
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