Ankle dislocation rehab protocol

• 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.