Ankle rehab. exercises

I had a non-displaced fibula fracture that did not require surgery. While I was in my boot and NWB I was told to do my ankle range of motion exercises three times a day. My exercises were:

1) Flex the toe up as far as it would go and then point my foot as far as I could get it. I did 3 sets of 10 (small pause after each 10) 3 times a day.

2) Circles clockwise. 3 sets of 10 (small pause after each 10) 3 times a day.

3) Circles counter-clockwise. 3 sets of 10 (small pause after each 10) 3 times a day.

4) Alphabet writing with my toes - one set of the 26 letters, 3 times a day

These were super exercises! I did them faithfully and I think they contributed to my speedy recovery. My dorsiflexion was at nearly 100% at my 6 week appointment (other directions ranged from 80-90%). At my 12 week appointment my ortho doc told me that my ankle ROM was amazing... better than hers and she's never broken any bones in her foot!

Vicky,

Sorry to hear you joined our ankle club.

Range of motion (ROM) exercises are very important to prime your healing but busted ankle for demands of weight-bearing and walking later.

I suffered a medial bimalleolar fracture with sprain, and of course I started these exercises as soon as my attending doctor allowed it. If x-rays show your fracture is mending well enough these gentle ROM movements are not going to hurt you.

As far as how much ROM exercises to do, I would say it all depends. It depends primarily on any collateral soft tissue (that is, connective tissue intimately involved with and all around ankle joint: ligaments, tendons, muscles, nerves, fascia, joint capsules) damage you sustained (along with the fractures) in your accident.

When you are non-weight-bearing in a CAM boot or cast these soft tissue issues, if they exist, usually are not readily apparent. They will make their presence loudly known when you add the stress of weight and movement later.

I would suggest doing limited reps of ROM routines, and then slowly work up the rep counts until you feel too much discomfort or pain, then back off. You don't want to put ankle in too much distress too soon. But if it feels good and there is little or no pain then simply do more.

Icing may help with any discomfort and swelling. Remember that an injured ankle is still in an inflammatory state as healing processes are underway.

The more exercise you do now, and later when you are in weight-bearing status, will pay off in spades with a speedier and more complete recovery.

It is vitally important to implement appropriate and extensive ankle rehab exercises for as long as it takes to rebuild strength and stability in ankle joint. Failure to get joints and supporting soft tissue like ligaments back to normal function could spell trouble later in form of degenerated cartilage/joints (the end state which could be chronic ankle dysfunction and arthritis). You can see this eventual progression play out in so many sad stories on this forum.

In your rehab program, don't forget knee and hip exercises-- they are important in getting back your normal walking gait after being out of action for so long.

Also, balance and proprioception exercises are just as important in getting ankle biomechanics back to normal.

Best of luck to you. 

Vicky,

Glad to be of some small help to you.  On this forum we have altogether a wealth of experience to share.

Don't be bashful about calling your doctor's office to get more guidance on what exercise and movement is advisable right now, and later on. Doctors usually have assistants to field patient calls between appointments. That's their job. Remember, the doctor is supposed to be working for you and you have every right to get all your questions answered,

I can't stress enough the importance of continuing ankle rehab through weight bearing and walking stages and beyond. Chances are your ligaments were affected by your multiple fractures (you didn't mention an ankle sprain, but that usually is the case in these circumstances). If ligaments and tendons are stretched or even torn they need special attention to get them strong and toned. Ankle recoveries can fail if ligaments remain lax and don't provide needed support for joints-- this can lead to ankle joint misalignments/instability and arthritis later.

Later on you will up the ante by doing more intense physiotherapy under advice of physician. They should recommend a competent and sympathetic physiotherapist to further your rehab regimen.

Even as your recover and get back to normal walking it is important to protect ankle against reinjury. You may need to wear an ankle brace temporarily as you work on strengthening ankle. Wear strong supportive footwear meanwhile (say goodbye to high heels, flip flops, and flats, at least until your complete recovery is confirmed over time).