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Phase I- Maximum Protection (Weeks 0 to 6)

  • Cast x 4-6 weeks
  • Non-weight bearing x 6 weeks
  • Elevate the ankle above the heart
  • Multi-plane hip strengthening
  • Core and upper extremity strengthening

Phase II- Range of Motion and Early strengthening (Weeks 6 to 12))

  • Progressive weight bearing in boot with heel wedges
  • Weaning out of the boot and full weight bearing by 10-12 weeks
  • Active/passive dorsiflexion gradually working to neutral weeks 6-8, 5-10˚ DF by week 10 and gradual progression to full DF by week 12.
  • Isometric and early isotonic ankle all planes of motion
  • Foot intrinsic strengthening
  • Deep water cycling

Phase III- Progressive Strengthening (Weeks 12-16)

  • Restoration of full range of motion all planes
  • Advance ankle and foot intrinsic strengthening
  • Bilateral progressing to unilateral gatrocnemius/soleus strengthening
  • Normalize gait mechanics
  • Stationary bike, elliptical, walking and swimming
  • Bilateral progressing to unilateral closed chain progressing
  • Proprioception training

Phase IV- Advanced Strengthening (Weeks 16-24)

  • Advance strengthening program
  • Advance functional progression; linear progressing to lateral and rotational
  • Bilateral progressing to unilateral plyometrics

Phase V- Return to Sport (6-12 months)

  • Progress during this time is gradual; continue to progress and increase intensity as tolerated
  • It is common to take 12 months to return to previous performance levels
  • Sport test and release to full activity 6-12 months

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