Ankle dislocation rehab protocol
Distal fibular fracture and deltoid ligament repair
- Patient will be walking with crutches and touchdown (toe-touch) weight bearing on the surgical leg for 4 - 6 weeks post-op.
- Patient will be in a removable boot for 6 weeks or longer, pending x-rays.
- Avoid unnecessary walking or standing for the first 2-3 weeks to control swelling and pain.
- Ice ankle/foot 3-5 times (15 minutes each time) per day to control swelling and inflammation.
- Elevate leg above the heart as much as possible to control swelling and inflammation.
- Come out of boot twice daily for 20 minutes each time to allow skin to breathe and to promote skin healing.
- Clean skin with wipe while out of boot.
- Keep cast and liners very clean to avoid infections. Wipe down inside plastic of boot daily with alcohol and wash the liner every other day.
- No ankle range of motion exercises for 4 weeks. Ankle isometrics inside the boot should be done daily.
- No impact or cutting exercises/activities for 3 months post-op.
- M.D. follow-up visits at Day 1, Month 1, Month 6 and Year 1 post-op.
Weeks 1 - 4:
- M.D. visit at day 1 post-op to change dressing and review home program.
- Start ankle isometrics inside the boot immediately post-op. Do 5 repetitions of 5 second contractions. Repeat this 5x per day.
- No ankle range of motion exercises for 4 weeks.
- Nurse appointment at day 14 for suture removal and check-up.
- Gait training with crutches to minimize compensations and to enforce touchdown weightbearing status on the surgical leg.
- Toe curls and toe spreads
- Quad-sets with straight-leg raises
- Gluteal sets
- Well-leg biking
- Upper body training
Weeks 4 - 6:
- Follow-up x-ray at week 4 to monitor healing.
- Pending x-ray findings, may start partial weightbearing still using crutches and walking boot.
- Can start using AirCast Stirrup splint for sleeping only instead of the walking boot.
- Start ankle partial range of motion (ROM) and non-weightbearing to partial weightbearing ankle isotonic exercises.
- Soft tissue treatments for swelling, mobility and healing.
Weeks 6 - 8:
- Follow-up x-ray at week 6.
- Pending x-ray findings, may start weightbearing as tolerated and progressive weaning of assistive devices (single crutch to cane to no device, if necessary).
- Can wean off boot and use AirCast Stirrup instead.
- Gait training to normalize movement patterns.
- Start to seek full ankle range of motion per patient tolerance and without flare-ups.
- Start weightbearing strength and balance exercises.
- Begin joint mobilizations to seek full range of motion.
Weeks 8 - 12:
- Increase functional weightbearing exercises and activities. Avoid impact and cutting activities until week 12.
- Can start to wean off AirCast Stirrup if the patient has enough dynamic control and stability of the ankle.
- Aim for ankle range of motion to be full by week 12.
- Continue with mobilizations.
Weeks 12 and beyond:
- Start sport-specific training.
- Increase the intensity of strength, balance, coordination and functional training for gradual return to activities and sports.
- Return to specific sports is determined by the physical therapist through functional testing specific to the targeted sport.