Non-operative Treatment of an Ankle Fracture

  1. You will remain immobilized in the walking boot until 4 weeks post-injury.
  2. You are allowed to fully weight bear as tolerated in the walking boot. I would like you to discontinue use of the crutches or any other assistive walking devices as quickly as possible.
  3. You may remove the walking boot whenever seated or lying down, in a safe controlled environment. The walking boot is in place to protect rather than immobilize the fracture.
  4. I would like you to come out of the boot/brace to work on the following exercises, twice daily:
    • Write the alphabet with your foot. Do two repetitions.
    • Stretch the Achilles by placing a towel across the ball of your foot and pulling up. Hold the stretch for a five-count and do 5 repetitions.
  5. At 4 weeks post-injury, you will gradually transition to regular shoes. An ankle brace should be used to facilitate the process.
  6. Once you have returned to regular shoes, you may gradually ramp up your activities in a step-wise manner as tolerated.
    • I would like you to first become comfortable with activities of daily living before reintroducing straight-line, low-impact activities (walking, bicycling, using an elliptical trainer, weight training).
    • Once you are comfortable at this level, you may reintroduce higher-impact, straight-line activities (jogging, running).
    • The final step will be the addition of activities involving lateral movement and uneven ground.
  7. I would like to see you back in 4 weeks for a follow-up appointment. We will obtain new x-rays upon return.
  8. Ankle fractures typically take 10-12 weeks to fully heal.

Morton’s Neuroma Excision: 1st Post-op

  1. You may shower tonight, letting soapy water run over your incisions(s) and patting them dry with a towel. You should avoid submerging the leg (bath, pool, hot tub, etc.) for at least one week.
  2. You may begin to transition out of the post-op shoe as swelling and sensitivity allow. Once you have fully transitioned out of the post-op shoe, you may begin to reintroduce activities in a step-wise fashion.
  3. Using your thumb, begin massaging around the incision to desensitize the area and break up any scar adhesions.
  4. In 2 weeks, you may begin applying a scar cream (vitamin E based, such as Mederma) or silicone sheets.
  5. I would like to see you back in 4 weeks for your next follow-up appointment.

Ludloff Bunion Correction: 1st Post-op

  1. You may shower tonight, letting soapy water run over your incision(s) and patting them dry with a towel. You should avoid submerging the leg (bath, pool, hot tub, etc.) for at least one week.
  2. You will be heel-weight bearing for the next 4 weeks.
  3. I have showed you in clinic today how to perform a bunion wrap to fine-tune the position of the toe. You should continue to perform this wrap daily. If you notice any drifting of the great toe towards the second toe, you may use tape as added fine-tuning. The bunion wrap should ALWAYS be in place unless you are showering.
  4. You will continue to ice and elevate the leg as much as possible. Elevating the leg above the level of the heart will reduce the amount of time required to bring down the swelling.
  5. I would like to see you back in 4 weeks for your next follow-up appointment. We will obtain new x-rays at that time. If there is appropriate evidence of healing, we will likely transition you to full-foot weightbearing in a flat post-op shoe.

Lisfranc Repair: 1st Post-op

  1. You may shower tonight, letting soapy water run over your incision(s) and patting them dry with a towel. You should avoid submerging the leg (bath, pool, hot tub, etc.) for at least one week.
  2. You will be strict non-weightbearing in the boot for 4 more weeks.
  3. Use an ace bandage or a thick sock to prevent the boot from rubbing on the incision(s).
  4. You will wear the boot at all times (including sleeping), except for the following:
    • Bathing, showering
    • Exercises
    • In a completely controlled environment, for the purpose of icing
  5. You will start doing exercises for the ankle to maximize your post-op flexibility. You will do these twice daily, once in the morning and once in the evening:
    • Write the alphabet with your foot. Do two repetitions.
    • Stretch the Achilles by placing a towel across the ball of your foot and pulling up. Hold each stretch for a five-count and do five repetitions.
  6. You will continue to ice and elevate the leg as much as possible. Elevating the leg above the level of the heart will reduce the amount of time required to bring down the swelling.
  7. You should continue taking the blood clot prevention medication (aspirin or equivalent) as prescribed until you are at least 4 weeks post-op.
  8. I would like to see you back in 4 weeks for a follow-up appointment. We will obtain new x-rays at that time. If there is appropriate evidence of healing, we will likely have you begin progressive weightbearing in the boot.

Ankle Lateral Ligament Reconstruction with Peroneal Repair: 1st Post-op

  1. You may shower tonight, letting soapy water run over your incision(s) and patting them dry with a towel. You should avoid submerging the leg (bath, pool, hot tub, etc.) for at least one week.
  2. You may begin progressive weightbearing in the walking boot. Please refer to the separate handout.
  3. Use an ace bandage or a thick sock to prevent the boot from rubbing on the incision(s).
  4. You should come out of the walking boot/brace and perform exercises to maximize your post-op ankle flexibility. You should perform the following exercises twice per day, once in the morning and once in the evening:
    • You should work on 3 sets of 15 reps of dorsiflexion (up), eversion (out) but avoid plantarflexion (down) and inversion (in) for now.
    • Stretch the Achilles by placing a towel across the ball of your foot and pulling up. Hold each stretch for a five-count and do five repetitions.
    • Plantarflexion (down) and inversion (in) may begin at 4 weeks post-op.
  5. You should continue taking the blood clot prevention medication (aspirin or equivalent) as prescribed until you are at least 4 weeks post-op.
  6. Physical therapy may begin at 4 weeks post-op. A referral will be provided today.
  7. I would like to see you back in 4 weeks for a follow-up appointment.