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Phase I- Maximum Protection (Weeks 0 to 6)

  • Cast or boot for 8 weeks
  • Elevate the ankle above the heart
  • Non-weight bearing x 6 weeks
  • Multi-plane hip strengthening
  • Core and upper extremity strengthening

Phase II- Range of Motion and Early strengthening (Weeks 8 to 12)

  • Partial weight bearing based on healing and physician instruction
  • Passive and active dorsi/plantarflexion (anticipate 10-15% loss DF/PF ROM;50-100% inversion/eversion ROM)
  • Isometric inversion/eversion ankle strengthening
  • Isometric progressing to isotonic dorsi/plantarflexion
  • Hip, quadriceps and hamstring strengthening
  • Foot intrinsic strengthening

Phase III- Progressive Strengthening (3 to 6 months)

  • Gradually wean out of boot and progress to full weight bearing
  • Continue and gradually advance phase II ankle ROM and strengthening
  • Normalize gait mechanics
  • Proprioception training
  • Gradual progression to non-impact cardio-vascular and fitness activities

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