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
