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
