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Ankle dislocation rehab protocol

Distal fibular fracture and deltoid ligament repair

General considerations

  • 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.

Exercises:

  • 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.
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