• Non weight bearing with bilateral axillary crutches and the post op splint. In some cases after surgery, you may be placed in a cast boot, skipping the splint altogether. Therefore, please take the cast boot to the Hospital when you go for surgery. This will be at the discretion of the Doctor.
  • Instruct in exercise to be performed two days post op.
  • Issue compression stocking.
  • Review weight bearing status: in cast boot WBAT with bilateral crutches or NWB in splint.

Acute Post-op:

2 Days:

  • Remove dressing and reapply telfa pad or 4x4 gauze pad, if incision is still draining.
  • Cover with large Band-Aid if dry, no drainage.
  • Apply compressive stocking/tensogrip issued.
  • Remove splint and apply cast boot.
  • Begin WBAT ambulation, attempting a smooth gait pattern.
  • Begin AROM and flexibility per hand out.
  • AROM DF (dorsiflexion) in sitting, AROM PF (plantarflexion) in sitting, AROM DF/PF not elevated, AROM DF/PF elevated, Gastroc stretch with towel, hamstring stretch in long sitting (per handout.)

7-10 Days to 4 Weeks:

  • You will follow up with your physician and sutures will be removed.
  • Continue to use the cast boot for up to four weeks post op.
  • Continue passive and active post op exercises.
  • Wean off crutches to tolerance:
    • try one crutch on uninvolved side.
    • progress to no crutches.

Subacute (4-6 Weeks):

At 4 weeks you will follow up with your MD, at this time you may be referred to Physical Therapy.


  • Normalize ROM.
  • Decrease edema and scar sensitivity.
  • Normalize gait pattern.
  • Begin non-dynamic balance/ proprioception.


  • Flexibility: DF, PF, eversion, hamstring, quadriceps, and groin.
  • Full AROM NWB and WB.
  • Ankle alphabet.
  • Double leg knee bends in standing.
  • Single leg knee bends in standing.
  • Wall slides (to increase DF ROM.)
  • RROM: DF, PF, and eversion from neutral with theraband.
  • Isometric inversion.
  • Closed chain lower extremity strengthening: Wall squats, step-ups, leg press, walking lunges.
  • Endurance: Stationary bike, pool program, treadmill walking, stair climber.
  • Stationary balance (Progressive): Single leg standing, single leg standing with resistance (biodex, tubing), single leg balance board/ trampoline, single leg balance with perturbation.

Advanced Phase (6-8 weeks):


  • Full ROM 4+/5 to 5/5 ankle strength.
  • Ambulation without a limp.
  • -No pain or swelling.
  • Begin sport specific strengthening drills.


  • Continue closed chain strengthening.
  • Begin jogging interval on treadmill.
  • Begin non-twisting/ cutting plyometrics.
  • Begin dynamic balance drills.
  • Add cutting and sprinting (with use of an active ankle brace.)

Return Phase (8-12 Weeks):

Return to sports/full activity with physician approval.