Ankle Strengthening Following Broken Ankle

Ashley in England asks:

"I recently had an operation after breaking part of my Tibia in the ankle. I have had two pins placed into the bone. The injury was to the inside of my ankle and I have now had a cast on for 3 weeks. I am due to have another cast put on next week. I understand it is normal for a cast to stay on for about 8 weeks depending on how well the bone fuses. The doctor said the best physio would be to move my foot around myself and get the joint functional again. As a keen footballer I just wanted to know whether you have dealt with cases like this before and the time scale involved in building my ankle back to full strength and the best techniques for that."

David Wales, Clinical Specialist Physiotherapist responds:

"Obviously we can't give a specific reply to your injury and we recommend that you follow the advice of your orthopaedic consultant and Chartered Physiotherapist. The good news is that you should make a full recovery following this type of injury, provided you follow the advice of your treating doctor. In high level soccer players the average time out is about six months.

"Generally it takes about 3 months of immobilisation in a cast for the bone to heal adequately to do full weight bearing activities. You should wait for the go ahead to do this from your orthopaedic doctor. During the immobilisation period your ankle will get stiff and your Calf and Thigh muscles will waste. These problems can be addressed by physiotherapy treatment. To give a rough guide of the rehabilitation:

8 – 12 weeks in plaster and using crutches until the orthopaedic doctor is satisfied there is sufficient healing. Once your doctor is satisfied that there is a sufficient degree of bone healing he may allow you to wear a removable plastic cast , instead of a plaster cast. Once out of the plaster cast hydrotherapy (exercises in the swimming pool) will help to restore ankle range of motion and general fitness. Pool running using a bouyancy belt is an excellent non impact form of exercise. Once you have been given permission to put partial weight through the injured leg then an exercise bike can also be used for fitness work.
3 – 4 months. So long as there is evidence of fracture healing on x-ray, your doctor will give you permission to begin full weight bearing activities such as walking without a removable plastic cast or crutches. It is usually possible to begin strengthening and proprioception exercises.

Exercise 1

This exercise strengthens the muscles at the front of the shin that pull the foot back towards the knee.

Sitting on the floor, a low resistance band is tied around the foot, with the other end attached to a fixed object that is out in front of the foot.

Lateral Ankle Sprain rehab exercise

Slowly the foot is pulled back towards the knee.

Lateral Ankle Sprain rehab exercise

20 repetitions, 5 times daily.

As this becomes easier, the resistance band is changed to one that provides more resistance.

Tip: doubling up the elastic is an easy way to achieve more resistance.

Exercise 2

Sitting on the floor, with the legs out straight, a resistance band tied around the foot, and the other end held in the hand. Slowly, the foot is pushed forward and then relaxed.

Lateral Ankle Sprain rehab exercise

20 repetitions, 5 times daily.

As this becomes easier, the resistance band is changed to one that provides more resistance.

Exercise 3

This exercise is a progression of the previous Calf strengthening exercises.

The patient stands with their hands resting against a wall so that it is taking some of their body weight. With both feet, the patient pushes up on the toes so the heels rise up off the floor. This position is held for 2 seconds and then the heels are slowly lowered.

20 repetitions, 5 times daily.

Once this becomes easier, the same exercise is done but without any hands against the wall. Once this has been mastered, the patient progresses to doing the exercise with the toes positioned on a block, so that the heels have to come down lower before pushing up.

The final progression to this exercise is to do it on the affected ankle alone.

"Strength can be progressed using a Calf press resistance machine and Thigh strengthening should be progressed under the supervision of your physiotherapist. Muscle strength should be equal to the unaffected side before plyometric exercises (jump training) and running are resumed.

"Proprioception exercises enhance neuromuscular control around a joint and are very important if you would like to return to sporting activities.

A Guide to Proprioception

"5 – 6 months. If range of motion, strength and proprioception are returned to pre injury levels, then functional activities can be resumed with a gradual return to sport.

"You should be guided at every stage by the orthopaedic doctor and all rehab should be done under the supervision of a Chartered Physiotherapist. Good luck with your recovery."

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Article published: February 2007