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Phase I- Maximum Protection (Weeks 0 to 6)

  • Cast or boot for 6 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 6 to 8)

  • Restoration of normal gait mechanics
  • Full active and passive ROM all planes
  • Strong emphasis on restoring full dorsiflexion
  • Isometric and early isotonic ankle
  • Foot intrinsic strengthening
  • Bilateral progressing to unilateral squat, step and matrix progression
  • Proprioception training
  • Non-impact cardiovascular work

Phase III- Progressive Strengthening (Weeks 8 to 12)

  • Restoration of full range of motion all planes
  • Advance ankle and foot intrinsic strengthening
  • Pool running progressing to dry land
  • Linear progressing to lateral and rotational functional movements
  • Bilateral progressing to unilateral plyometric activity

Phase IV- Advanced Strengthening (Weeks 12-16)

  • Advance impact and functional progressing
  • Sport specific drills on field or court with functional brace
  • Sport test at 3-4 months based on progress
  • Compete first year with functional brace

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