Ankle Fracture Exercises: Rehabilitation After a Broken Ankle

An ankle fracture is a break in one or more of the bones that make up the ankle joint—the tibia, fibula, or talus. Recovery requires patience, as the ankle bears your entire body weight with every step. Proper rehabilitation exercises are essential for regaining mobility, strength, and the ability to walk normally again.

Understanding Ankle Fractures

Types of Ankle Fractures

• Lateral Malleolus: Outer ankle bone (fibula)—most common
• Medial Malleolus: Inner ankle bone (tibia)
• Bimalleolar: Both inner and outer malleoli
• Trimalleolar: All three malleoli (most severe)
• Pilon Fracture: Involves the tibial weight-bearing surface

Treatment

• Non-surgical: Cast or boot for stable fractures (6-8 weeks)
• Surgical (ORIF): Plates and screws for displaced or unstable fractures

Healing Timeline

• Bone healing: 6-12 weeks
• Weight-bearing progression: Per surgeon's protocol
• Full recovery: 3-6 months (longer for complex fractures)

During Non-Weight-Bearing Phase (Week 0-6)

Goals

• Maintain toe and knee mobility
• Prevent muscle atrophy where possible
• Control swelling
• Prepare for weight-bearing

Toe Exercises

Keep toes mobile even in cast/boot:

Toe Curls and Spreads:

1. Curl toes down
2. Spread toes wide apart
3. Lift toes up
4. Move through full range

Perform: 15-20 reps, hourly when awake

Knee Exercises

Maintain quad strength:

Quad Sets:

1. Sit with leg extended
2. Tighten quadriceps
3. Push knee down
4. Hold 5-10 seconds

Straight Leg Raises:

1. Lie down, other knee bent
2. Tighten quad, lift leg 12 inches
3. Hold 3-5 seconds, lower

Perform: 15-20 reps, 3-4 times daily

Hip Exercises

Maintain hip strength:

Hip Abduction (lying on side):

1. Lie on uninjured side
2. Lift top leg toward ceiling
3. Lower with control

Hip Flexion:

1. Sit on edge of bed
2. Lift knee toward chest
3. Lower slowly

Perform: 15-20 reps each, 2-3 times daily

Core Work

1. Gentle core exercises
2. Avoid movements that stress ankle
3. Seated or lying exercises

Upper Body

Continue normal upper body training to maintain fitness.

Swelling Management

1. Elevate leg above heart level
2. Ice if accessible (around cast)
3. Toe pumps (curl and release)

Phase 1: Early Weight-Bearing (Week 6-10)

Goals

• Progress weight-bearing as directed
• Begin ankle ROM exercises
• Strengthen foot muscles
• Normalize gait pattern

Weight-Bearing Progression

Follow your surgeon's specific protocol:

Touch-down Weight-Bearing:

• Toes touch floor for balance only
• No weight through foot

Partial Weight-Bearing:

• Gradual increase (25% → 50% → 75%)
• Use crutches or walker

Full Weight-Bearing:

• Complete weight through leg
• May still need walking aid

Ankle Range of Motion

Start gently once cleared:

Dorsiflexion/Plantarflexion:

1. Sit with foot off floor
2. Pull toes toward shin (dorsiflexion)
3. Point toes down (plantarflexion)
4. Move through available range

Ankle Circles:

1. Draw circles with big toe
2. Clockwise, then counterclockwise
3. Make circles as large as possible

Alphabet:

1. Trace A-Z with big toe
2. Full range of motion

Perform: 15-20 reps each, 4-6 times daily

Calf Stretches

Towel Stretch:

1. Sit with leg extended
2. Loop towel around ball of foot
3. Gently pull toes toward you
4. Hold 30 seconds

Wall Stretch (when standing):

1. Face wall, hands on wall
2. Step back with injured leg
3. Keep heel down, lean forward
4. Hold 30 seconds

Perform: 3-4 reps, 3 times daily

Towel Scrunches

Rebuild foot muscles:

1. Place towel flat on floor
2. Scrunch towel with toes
3. Spread towel back out

Perform: 15-20 scrunches, 3 sets

Marble Pickups

1. Place marbles on floor
2. Pick up with toes
3. Place in container

Perform: 10-15 marbles, 2-3 sets

Phase 2: Strengthening (Week 10-16)

Goals

• Build ankle and calf strength
• Improve balance
• Progress to normal walking
• Return to daily activities

Calf Raises (Bilateral)

1. Stand with support available
2. Rise onto toes (both feet)
3. Lower slowly
4. Keep weight even on both sides

Perform: 15-20 reps, 3 sets

Resistance Band Exercises

Dorsiflexion:

1. Loop band around foot, anchor to sturdy object
2. Pull toes toward shin against resistance

Plantarflexion:

1. Hold band, loop around foot
2. Push foot down against resistance

Eversion:

1. Band around both feet
2. Push feet apart against resistance

Inversion:

1. Cross legs, band around injured foot
2. Turn sole inward against resistance

Perform: 15-20 reps each direction, 3 sets

Step-Ups

1. Stand facing 4-inch step
2. Step up with injured leg
3. Bring other foot up
4. Step down with control

Perform: 12-15 reps, 3 sets

Step-Downs

Eccentric strengthening:

1. Stand on step with injured leg
2. Slowly lower other foot toward floor
3. Tap heel, return to start
4. Control descent

Perform: 10-12 reps, 3 sets

Balance Training

Single-Leg Stance:

1. Stand on injured leg
2. Hold 30-60 seconds
3. Use support as needed initially

Progress to:

• Eyes closed
• Unstable surfaces (pillow, BOSU)
• Adding arm movements

Perform: 3-5 reps, 30-60 seconds each

Walking Program

Week 10-12:

• Short distances on flat surfaces
• Use support if needed
• Focus on normal gait pattern

Week 12-14:

• Increase distance
• Varied surfaces
• Reduce use of support

Week 14-16:

• Normal walking distances
• Add stairs, inclines
• Build endurance

Phase 3: Return to Function (Week 16+)

Goals

• Full strength restoration
• Sport-specific training
• Complete activity return
• Injury prevention

Single-Leg Calf Raises

1. Stand on injured leg only
2. Rise onto toes
3. Lower slowly with control
4. May need support initially

Perform: 12-15 reps, 3 sets

Lateral Movements

Side Steps:

1. Step sideways
2. Keep hips and feet forward
3. Maintain control

Lateral Band Walks:

1. Band around ankles
2. Step sideways against resistance
3. Keep tension throughout

Perform: 15-20 steps each direction, 3 sets

Plyometric Progression

Two-Leg Hops:

1. Small hops in place
2. Progress to forward/backward
3. Then side-to-side

Single-Leg Hops (When Ready):

1. Start with small hops
2. Progress distance and direction
3. Stick each landing

Box Jumps:

1. Low box initially
2. Land softly
3. Step down first

Perform: 10-15 reps, 2-3 sets

Running Progression

Week 1: Walk-jog intervals on treadmill Week 2: Continuous jogging, 10-15 minutes Week 3: Increase duration, add gentle turns Week 4: Figure-8 running Week 5: Cutting drills at reduced speed Week 6: Progress to full speed, sport-specific

Sport-Specific Training

Return to your activity:

• Gradual reintroduction of demands
• Agility and cutting last
• Consider ankle brace initially
• Full clearance before competition

Gait Retraining

Common Gait Deviations

• Limping or favoring injured side
• Shortened stride
• Reduced push-off
• Hip hiking

Correction Techniques

Mirror Walking:

1. Walk toward mirror
2. Watch for asymmetry
3. Focus on even steps

Metronome Walking:

1. Set metronome to comfortable pace
2. Match steps to beat
3. Ensures even cadence

Heel-Toe Pattern:

1. Focus on heel strike first
2. Roll through foot
3. Push off with toes

Special Considerations

Hardware Prominence

If screws or plates are bothersome:

• May cause discomfort with certain shoes
• Sometimes removed after healing (typically 1+ year)
• Padding can help

Arthritis Risk

Fractures involving the joint surface:

• Higher risk of future arthritis
• Stay active to maintain mobility
• Weight management helps
• Monitor for increasing symptoms

Syndesmosis Involvement

If high ankle ligaments were affected:

• Recovery takes longer
• Rotation returns last
• Follow surgeon's specific restrictions

Sample Schedule (Phase 2)

Daily (Multiple Times)

• Ankle ROM: 15-20 reps each direction
• Calf stretches: 3x30 seconds
• Towel scrunches: 20 reps

Monday/Wednesday/Friday

• Resistance band exercises: 3x15 each direction
• Calf raises (bilateral): 3x15
• Step-ups: 3x12
• Balance training: 3x45 seconds

Tuesday/Thursday

• Walking program: 15-30 minutes
• Step-downs: 3x10
• Toe/foot strengthening

When to Seek Help

Contact your provider if:

• Increasing pain or swelling
• Hardware feels like it's moving
• New numbness or tingling
• Unable to progress despite effort
• Significant limp persists beyond 12 weeks

Key Takeaways

Ankle fracture rehabilitation requires patience and consistency:

1. Follow weight-bearing restrictions - Rushing causes problems
2. Move early within limits - Toe and knee exercises while casted
3. Progress ROM before strength - Mobility first
4. Rebuild balance - Often neglected but crucial
5. Expect 3-6 months - Full recovery takes time

Your ankle will feel different for months, but most people achieve excellent function after ankle fracture. The key is respecting the healing timeline while consistently working on exercises.