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
