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Brostrom procedure rehab protocol

General considerations

  • Time frames mentioned in this article should be considered approximate with actual progression based upon clinical presentation. Careful observation and ongoing assessments will dictate progress.
  • No passive or active inversion or eversion for 6 weeks.
  • Avoid plantar flexion greater than resting position for 4 weeks.
  • Carefully monitor the incisions and surrounding structures for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization) to decrease fibrosis. Hold off on scar mobilizations x 4 weeks or per MD.

“No touch zone” around portals x 4 weeks

  • No running, jumping, or ballistic activities for 6 months.
  • Aerobic and general conditioning throughout rehabilitation process.
  • M.D./nurse appointments at day 2, day 14, 1 month, 2 months, 4 months, 6 months, and 1 year post-operatively.

Weeks 0 - 3

  • Posterior splint immobilizer for 3 weeks.
  • Non weight bearing for 3 weeks--no push off or toe-touch walking.
  • Pain and edema control / modalities as needed (i.e.cryotherapy, electrical stimulation, soft tissue treatments).


  • Effleurage, gentle soft tissue mobilization to ankle avoiding incisions. Keep 2 inch “no touch zone” around portals x 4 weeks.


  • Toe curls, toe extension, toe spreads, hip and knee strengthening exercises.
  • Well-leg cycling, well body weight training,


  • Minimal edema.
  • Closed incision sites.
  • Increased core/gluteal strength.

Weeks 3 - 6

  • Progress from posterior splint to pneumatic walking boot. Be sure to wear a heel lift in opposite shoe to offset the leg length discrepancy caused by the boot.
  • Progress to full weight bearing in walking boot. Walking boot weight bearing for 3-6 weeks post-op.
  • Aircast splint for sleeping at night (make sure sheets/covers are not pushing foot down into plantarflexion).


  • Continue with effleurage and soft tissue mobilizations. Regular mobilization of intermetatarsal and midtarsal joints. Caution with talocrural and subtalar mobilization.


  • Isometrics in multiple planes and progress to active exercises in protected ranges.
  • Proprioception exercises, intrinsic muscle strengthening, manual resisted exercises.
  • Cycling with boot, aerobic machines in splint as tolerated, and pool workouts in splint once incisions closed. No fins in pool until 12 weeks.


  • Initiate gentle dorsiflexion- slow progression to full range of motion.
  • No edema.
  • Gait full weight bearing, good mechanics.

Weeks 6 - 12

  • Progress from boot to aircast at 8 weeks post operatively.


  • Continue with soft tissue mobilization, mobilization of ankle/foot as needed for range of motion.


  • Gradually increase intensity of exercises focusing on closed-chain and balance / proprioception.
  • At 8 weeks post op- gradual and slow progression of passive and active range of motion exercises into inversion and eversion cautiously.
  • Initiate stationary cycling, no clip ins, light to no resistance, and slow cadence.


  • Full passive/active range of motion by end of 12 weeks.
  • Normal gait mechanics.
  • Able to do single leg heel raise.
  • Able to do single leg balance >30 sec.

Months 3 - 6

  • Progress from aircast to ASO lace-up ankle brace.
  • Progress back into athletics based upon functional status.
  • Wear a lace-up ankle support for athletics.
  • Pool work outs, weaning out of splint.


  • Able to perform 3 and 6 month Sport Tests.
  • Begin plyometric training and initiate return to run program with lace up brace.

Time frames mentioned in this article should be considered approximate with actual progression basedupon clinical presentation. Careful observation and ongoing assessments will dictate progress.

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