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Nonoperative Ankle Fracture Protocol
Page 2 of 3
Last Updated September 3, 2020
WEEK 2: Cast Change (if applicable)
Phase II – Early Range of Motion/Gait Training (4 to 8 weeks)
WEEK 4: X-rays, transition to boot if casted
- Weightbearing as determined by physician. Depends on fracture pattern and healing, may be longer; your surgeon will
xray your ankle and tell you when it is safe to begin putting weight on your foot
- Come out of the boot and begin to move your ankle up and down for 5-10 minutes, 5 times per day to maintain range of
motion
- Compression stocking to be worn to control swelling along with ice/elevation
- May remove boot to sleep
WEEKS 0-6: Weight Bearing Begins
- Depends on fracture pattern and healing, may be longer; your surgeon will xray your ankle and tell you when it is safe to
begin putting weight on your foot
- Progressive weight bearing in boot, using crutches/walker, starting with 25% weight and increasing by 25% every 1-2
weeks until fully WB in boot
- Use a scale if available to estimate weight bearing. Put most of your weight on the crutches and opposite leg, then load
the scale with the operative leg until it reads 25% of your weight. This is a rough guide that should be used for the first
week, then increase to 50%, etc
- when you hit 75%, begin to use one crutch in the OPPOSITE arm
WEEKS 6-8 (FRACTURE HEALED):
- Wean out of boot – fit with air cast or ASO in normal shoe. When transitioning to regular shoe, ambulate first around the
house and then progress to outside.
- Increase weightbearing to full
- Advance daily stretching
- Ankle isometrics progressing to open chain isotonics
- Closed chain exercise (weight machines, weight shifts, seated BAPS)
- Proprioception exercise (SLB, diagonal doming and foot intrinsic strengthening)
- Joint mobilizations to increase talocrural and subtalar ROM
Phase III – Return to Function (8 to 12 weeks)
WEEKS 8-10:Progress closed chain exercises (Sportcord, lunges, heel raises etc, standing BAPS, exercise bike, swimming)
- Dynamic balance progression (mini tramp, SLB on uneven surfaces, Star excursion, steamboats, lunges)
- Advanced proprioception exercises
- Continue to advance weight machine exercises, stretching, ROM and joint mobilizations
- Treadmill walking program
WEEKS 12-16:
- May return to jogging program, running, and higher impact activities
- Fit for orthotics if needed
- Progress previous strengthening, stretching and proprioception exercises
- Sport and agility drills/tests
PHYSICAL THERAPY: start between 2-6 weeks post injury, focus on motion and swelling at first, then gait training and
strengthening. At 12 weeks begin gentle running / higher impact activities.
DRIVING: You may begin driving when you are fully weight bearing on right foot without crutches if right ankle. Be
certain to practice in a parking lot or lightly used road before getting on the major roads. DO NOT DRIVE WITH BOOT
ON RIGHT ANKLE. If left ankle, may drive automatic transmission car when off narcotic pain.
RETURN TO PLAY/ACTIVITIES: once you can come up and down on your toes (single heel rise) on the surgical side, or
you can hop on the surgical foot (single leg hop), you may return to sports and all activities. This may take 6 months to a
year. There is no guarantee on outcome. All conservative management options have risk of worsening pain, progressive
irreversible deformity, and failing to provide substantial pain relief. All surgical management options have risk of infection,
skin or bone healing issues, and/or worsening pain. Our promise is that we will not stop working with you until we maximize
your return to function, gainful work, and minimize pain.
