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 Lateral Ankle Instability Surgical Rehabilitation (Brostrom Gould)

Phase I (0-6 weeks)


  • Home exercise program will begin after surgery

  • 1-3x/wk. from 2-6 wks.

Rehabilitation Goals

  • Edema control/reduction

  • Protect healing tissue, foot is placed in neutral in short leg cast

  • Independent transfers and ambulation, non-weight bearing on

    involved lower extremity with use of optimal ambulatory assistive device.


• Non weight bearing until the first visit following surgery with the surgeon, then toe touch weight bearing in boot or cast

Suggested Therapeutic Exercise

  • Proximal LE, Upper extremity, and core muscle strengthening

  • Transfer and gait training

  • Abdominal strengthening

Cardiovascular exercise

• Upper body circuit training or upper body ergometer (UBE)

Progression Criteria

  • Decrease pain

  • Decreased edema

  • Independence with HEP

  • Independence with transfers and ambulation NWB on involved

    lower extremity


Phase II (weeks 6-8)


• Rehabilitation appointments are 1-3 times per week

Rehabilitation Goals

  • Protect healing tissue. To protect the CFL from inversion and the ATFL from plantarflexion, the ankle is kept in a cast set in neutral for 6 weeks and then transitioned to a pneumatic walking boot

  • Progressive protected normalization of gait: after the initial 6 week immobilization period, progressive weight bearing is initiated as tolerated, first with the involved ankle in a pneumatic walking boot and then transitioned to protected ankle weight bearing in a semi-rigid ankle stirrup orthotic

  • Edema control and pain reduction

  • Prevention of deconditioning

• Prevention of scar adhesions and myofascial restriction


  • No passive, active assisted or active inversion exercises

  • No active assisted or passive stretching into plantarflexion

  • Avoid standing or walking for extended periods of time

Suggested Therapeutic Exercise

  • Progressive weight baring as tolerated

  • Edema control with use of modalities

  • Joint mobilizations avoid tensioning of the CFL and ATFL

  • Stretches for gastrocnemius and soleus

  • Submaximal isometrics (except inversion)

  • Proprioception with activities involving bilateral stance

  • Soft tissue mobilization as indicated

Cardiovascular exercise

• Cross training, UBE, aquatics

Progression Criteria

  • Normalized gait without pain, with involved ankle protected in semi-rigid ankle stirrup, with or without appropriate assistive ambulatory device

  • Pain free eversion against gravity


Phase III (week 8-12 weeks)


• Rehabilitation appointments 1-3xwk

Rehabilitation Goals

  • Restoring full ROM

  • No edema

  • Normalized, pain free gait on all surfaces

  • 5/5 strength of all muscle groups


  • No jumping, hipping or sports

  • ASO or semi-rigid brace to protect repair outside of therapy

Suggested Therapeutic exercises

  • Ankle AROM in all planes of motion, BAPS board

  • Gait training on level and inconsistent surfaces

  • Mobilization as indicated

  • Stretches

  • Proprioceptive activities

  • Strengthening: foot intrinsic, progressive resisted ankle

    exercises in all planes, core stabilization, bilateral heel raises

  • Week 10: progress to closed and open chain exercises,

    unilateral eccentric heel raises, rhythmic stabilization

  • Week 11: plyometric with bilateral and unilateral jumps

Cardiovascular exercise

• Stair stepper, elliptical, treadmill, and climber

Progression Criteria

  • Full active and passive ROM

  • No residual edema or pain

  • Normalized gait without assistance on all surfaces


Phase IV (week 12-16)


• Rehabilitation appointments 1-3xwk

Rehabilitation Goals

  • Patient to demonstrate stability with higher velocity movements and change of direction movements that replicate sport specific patterns

  • No apprehension or instability with high velocity change of direction movements

  • Improve core and hip strength as well as mobility to eliminate any compensatory stresses to the ankle

  • Cardiovascular endurance for specific sport or work demands.


  • Continue to use brace during sports for 6 months

  • Patient to be independent with activity progression and or


Suggested Therapeutic exercises

  • Initiate jogging with progression to running

  • Strengthening- increase workload, resistance and intensity in

    progressive resisted exercises

  • Endurance

  • Proprioception

  • Plyometric

  • Return to activity testing

Cardiovascular exercise

• Design to use sport specific energy systems

Return to work/sport

• Patient may return to sport after receiving clearance from the orthopedic surgeon and the physical therapist/athletic trainer .

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