Physical Therapy for a Broken Ankle

A broken ankle can severely limit your ability to perform basic functional tasks like running and walking. This painful injury can cause loss of lower extremity strength, range of motion, and pain. These impairments can make performing your normal everyday activities difficult or impossible. You may benefit from physical therapy after a broken ankle to help you fully recovery functional mobility and to return to your previous level of activity.

Your ankle is a joint where the talus bone of the foot and the tibia (shin bone) and fibula of the leg connect and move. Trauma here can cause a break in any or all of these bones and significant pain usually results immediately after the injury. If you suspect you have a broken bone in your ankle, your first step should be to seek medical attention immediately. Failure to do so may result in significant loss of function.

Ankle fractures almost always occur during a traumatic event to the body. Automobile accidents, falls, and sports injuries can all lead to ankle fractures. Common signs of an ankle fracture include pain, swelling, bruising, and an inability to bear weight on the broken ankle.

While at the hospital following an ankle fracture, your doctor will attempt to reduce the fracture.

The pieces of bone must be put in close proximity to one another so that healing can occur. Fracture reduction is essential to ensure that the bone heals properly and that permanent functional loss or deformity is avoided.

After your ankle fracture is reduced, your ankle will most likely be placed in a cast. This immobilizes the ankle and allows the bones to heal properly. Many times after an ankle fracture, you will require some sort of assistive device to walk. You may also be under specific weight-bearing restrictions. Be sure to ask your doctor how much weight you are allowed to put on your ankle as it heals.

Once your fracture is reduced and immobilized, you may be referred to physical therapy to learn how to use your assistive device like crutches, a cane, or a walker. Your physical therapist should also be able to help you understand your weight-bearing restrictions. Gentle exercise for the muscles of the knee and hip may be performed to ensure that the muscle groups that help you walk do not get too weak while the fracture heals. If you are in a cast or a brace, most likely you will not be performing exercises for your ankle.

After your fractured ankle has healed, your doctor will remove the cast and allow you to bear more weight on your ankle. You still may be using an assistive device like a quad cane or crutches to walk.

At this point, your physical therapist can fully evaluate your ankle to help provide the proper treatment. Components of the ankle evaluation may include:

• Gait
• Range of motion
• Strength
• Swelling
• Pain
• Scar assessment (if you had an ORIF surgery)

After a thorough evaluation, your physical therapist can begin providing treatment. He or she may use therapeutic modalities like heat, ice, or electrical stimulation to help treat swelling or pain around your ankle.

An ankle fracture exercise program should be the main component of your ankle rehabilitation following a fracture. Exercises may include:

• Exercises for ankle range of motion
• Ankle strengthening exercises
• Hip and knee exercises (to help improve walking ability)
• Balance and proprioception exercises
• Exercise to improve functional mobility and walking ability

Wolff's law states that bone grows and remodels in response to the stress that is placed upon it. Your physical therapist can help prescribe exercises that apply the right stress in the correct direction to ensure that maximal bone healing occurs and that your fractured ankle will function properly.

Gait training will also be important following an ankle fracture. Your physical therapist can help you progress from using an assistive device to walking independently. Typical progression for walking after an ankle fracture includes:

• Using a standard or wheeled walker
• Using two crutches for walking
• Using one crutch
• Using a standard cane
• Walking with no assistance

If you have had surgery to reduce your ankle fracture, there may be scar tissue around the incision. Your physical therapist can perform scar tissue massage and mobilization to help improve the mobility of the scar. He or she can also teach you how to perform scar massage techniques on your own.

Everyone heals differently, and everyone's ankle fracture injury is different. Your PT should discuss with you your overall prognosis with your ankle fracture rehab. This prognosis typically depends on how well your ankle is moving when your first start rehab.

An ankle fracture can lead to significant loss of function and limit your ability to walk, run or participate fully in work and recreational activities. Physical therapy after an ankle fracture can help you improve mobility and help you safely return to normal activity and function.