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The sub-acute stage begins by bearing weight on the ankle to pain tolerance. This is graduated from partial weight-bearing with a Plastic Cast Walker and crutches to full weight-bearing without crutches. A normal walking pattern should be encouraged and there should be no limping.

Ice therapy can be continued so long as there is pain. Compression using the Plastic Cast Walker is continued during walking to encourage the dispersal of swelling. The inflatable air cells of the Plastic Cast Walker have a massaging effect during walking, which helps to resolve swelling. When possible the ankle should be elevated to allow the effect of gravity to help drain swelling away from the injury site. Gentle massage to further encourage the dispersal of swelling towards the back of the knee can also be implemented.

Ankle pumping exercises can be continued and progressed to being done in water. Exercises in water are effective because they involve only partial weight-bearing and because the hydrostatic pressure provided by the water has the effect of encouraging the swelling to disperse.

Exercises in water involve only partial weight-bearing and are effective in helping to disperse swelling.

General fitness is maintained by using a static exercise bike and resistance weight machines in a gym. Exercise bands (Resistance Bands) may also be used to start to encourage range of movement and gentle strengthening exercises. Different levels of resistance can be used so “light” bands are used at first then as pain, swelling and function all improve the level of resistance can be increased.




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