[fusion_builder_container hundred_percent=”no” hundred_percent_height=”no” hundred_percent_height_scroll=”no” hundred_percent_height_center_content=”yes” equal_height_columns=”no” menu_anchor=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” status=”published” publish_date=”” class=”” id=”” background_color=”” background_image=”” background_position=”center center” background_repeat=”no-repeat” fade=”no” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ video_mp4=”” video_webm=”” video_ogv=”” video_url=”” video_aspect_ratio=”16:9″ video_loop=”yes” video_mute=”yes” video_preview_image=”” border_size=”” border_color=”” border_style=”solid” margin_top=”” margin_bottom=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” admin_toggled=”no”][fusion_builder_row][fusion_builder_column type=”1_1″ layout=”3_4″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” border_radius=”” box_shadow=”no” dimension_box_shadow=”” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”no”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]
Phases of rehabilitation and objectives
The following exercises may be used to rehabilitate ankle fractures. Typically with ankle fractures patients must remain toe touch weight bearing and may rest only the weight of the leg on the ground (no pressure or push-off) for the first 6 weeks. A patient with a syndesmotic injury or factors that contribute to poor healing may have to wait longer to begin any weight bearing.
Unstable fractures and fractures with poor quality bone frequently require a cast to protect the ankle while it heals as ankle bones are small and fragile. Some patients may need to undergo open reduction internal fixation surgery. The implanted plates and screws are meant to hold the bones in place while they heal and are not designed to support weight.
The first week to 10 days after surgery consist only of rest, and elevation while the skin and wound heal. The patient may gently flex and extend his or her toes in the splint.
In stable injuries a CAM Boot can be used and removed for Phase 1 rehabilitation exercises and showering. No soaking until the wound is completely healed.
[yellowbox]Phase 1: Weeks 2-6[/yellowbox]
- Ankle Pumps: Point toes, then flex the foot 15 times, repeat 3 sets.
- Towel Gather: Spread out a small towel on floor. Pull toward you with your toes until the towel is fully gathered around foot. Repeat 10-15 times.
- Ball Pick-up: Grasp a marble-size ball between the 1st and 2nd toes; pick up and transfer to the right or left while the heel remains in place. Alternate and repeat 15 times.
- Gentle Towel Stretches (start at 3-4 weeks): Sit on a hard surface with your injured leg stretched out in front of you. Do 10 sets of these.
- Loop towel around the ball of the foot and pull back to get a mild stretch for 20 seconds. Relax for 20 seconds. This is a slow and gentle stretch. Do not pull hard or the fracture can move requiring more surgery.
- Pull the towel so that the foot turns to the outside (eversion); hold for 20 seconds, then pull to the inside (inversion); hold for 20 seconds.
- Ankle range of motion: You can do this exercise sitting or lying down. Pretend you are writing each of the letters of the alphabet with your toes. This will move your ankle in all directions. Do this twice in capitals, then small letters, then cursive. This is the most important of all the exercises. Do this deliberately and try to “write neatly” even if you have “Doctor Handwriting”.
[yellowbox]Phase 2 Week 6-12:[/yellowbox]
- Slant-board Stretch:
- Stand with your heels on a board and lean forward.
- Turn your toes in with your heels on the board and lean forward.
- Stand with your knees bent and your heels down.
- Stand with your knees bent, point your toes inwards and keep heels down on the board.
- Wall Stretch: Facing a wall, put your hands against the wall at about eye level. Keep the injured leg back, the uninjured leg forward, and the heel of your injured leg on the floor. Lean into wall and hold for 15-20 seconds. Repeat 3 times.
- Knee straight; toes straight ahead.
- Knee straight; toes pointed in.
- Calf Stretch: Stand facing a wall with your hands at about chest level. With both knees slightly bent and the injured foot back, gently lean into the wall until you feel a stretch in your lower calf. Once again, angle the toes of your injured foot slightly inward and keep your heel down on the floor. Lean into the wall and hold a gentle stretch for 15-20 seconds. Repeat 3 times.
- Knees bent; toes straight ahead.
- Knees bent; toes pointed in.
- Dorsiflexion – Sitting with your leg out straight and your foot near a door, wrap the Thera-Band around the ball of your foot. Anchor the other end of the Thera-Band to the door by tying a knot in the Thera-Band, slipping it between the door and the frame, and closing the door. Pull your toes toward your face. Return slowly to the starting position. Repeat 10 times. Do 3 sets of 10.
- Plantarflexion – Sitting with your leg outstretched, loop the middle section of the Thera-Band around the ball of your foot. Hold the ends of the Thera-Band in both hands. Gently press the ball of your foot down and point your toes, stretching the Thera-Band. Return to the starting position. Repeat 10 times. Do 3 sets of 10.
- Inversion – Sit with your legs out straight and cross your uninjured leg over your injured ankle. Wrap the Thera-Band around the ball of your injured foot and then loop it around your uninjured foot so that the Thera-Band is anchored at one end. Hold the other end of the Thera-Band in your hand. Turn your injured foot inward and upward. Return to the starting position. Repeat 10 times. Do 3 sets of 5.
- Eversion – Sitting with both legs outstretched and the Thera-Band looped around both feet, slowly turn your injured foot upward and outward. Hold this position for 5 seconds. Repeat 10 times. Do 3 sets of 5.
- Heel raises: While standing, balance yourself on both feet. You may use a chair to stabilize yourself if needed. Rise up on your toes, hold for 5 seconds and then lower yourself down. Repeat 10 times. Do 3 sets of 10.
- Heel/Toe Walking:
- Walk on heels only, for 30 steps.
- Walk on toes only, for 30 steps
- Toe Raises: Stand in a normal weight-bearing position. Rock back on your heels so that your toes come off the ground. Hold this position for 5-10 seconds. Repeat 10 times. Do 3 sets of 10.
- Single leg balance: Stand and attempt to balance only on your injured leg. Begin with your eyes open and then try to perform the exercise with your eyes closed. Then try it with your knee bent. Hold the single-leg position for 30 seconds. Repeat 3 times.
- Tiltboard (when bones are healed after week 8-12 and at a gym or your PT office): Place your foot in the center of a tilt board. Rotate your foot so that the board draws a complete circle. Repeat 10 clockwise then 10 counterclockwise each of the following: Seated, then standing with knees bent, then standing with knees straight.
- Ankle Weights (when bones are healed on x-ray at 6-12 weeks and with doctor approval): Attach 3lb weight to your forefoot. When 3lbs is easy advance to 5lbs.
- Lying on your back, pull your toes toward you; 3 sets of 10 reps.
- Lying on your injured ankle side, rotate your toes toward the ceiling, 3 sets of 10 reps.
- Lying on your stomach, point your toes away from you, 3 sets of 10 reps.
- Lying on your uninjured side, pull your toes toward the ceiling, 3 sets of 10 reps.
[/fusion_text][fusion_separator style_type=”none” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” sep_color=”” top_margin=”50px” bottom_margin=”” border_size=”” icon=”” icon_circle=”” icon_circle_color=”” width=”” alignment=”center” /][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]