Ankle Fracture Recovery: Weight Bearing and Exercises Guide

Ankle fractures require careful rehabilitation to regain full function. Understanding weight bearing progression and doing the right exercises at the right time is crucial for optimal recovery.

Understanding ankle fractures

Ankle fractures involve breaks in one or more of the bones that form the ankle joint. Treatment and recovery depend on severity and stability.

Treatment types

• Conservative: Boot or cast for 6-8 weeks
• Surgical (ORIF): Plates and screws to stabilize

Recovery timeline

Weeks 0-6: Non-weight bearing phase

• No weight on injured ankle
• Use crutches or wheelchair
• Exercises for toes, knee, hip
• Swelling management crucial

Weeks 6-8: Partial weight bearing

• Gradual weight bearing begins
• Still using crutches
• Ankle exercises start
• Swelling still present

Weeks 8-12: Full weight bearing

• Progress to walking without aids
• Increased exercise intensity
• Functional activities
• Gait retraining

Months 3-6: Advanced rehabilitation

• Strengthening and balance
• Return to normal activities
• Sport-specific training if needed
• Full recovery by 6-12 months

Exercises during non-weight bearing

Toe exercises

• Wiggle toes: Hourly
• Toe curls: 20 reps, 3 times daily
• Toe spreads: 20 reps, 3 times daily
• Prevents stiffness

Ankle pumps

• Point toes down
• Pull toes up
• 20 reps every hour while awake
• Reduces swelling
• Maintains circulation

Knee and hip exercises

• Knee bends: 10 reps, 3 times daily
• Straight leg raises: 10 reps, 3 times daily
• Hip exercises: Maintain strength

Weight bearing progression

Touch weight bearing

• Toes touch ground for balance only
• No actual weight through leg
• Use crutches for full support

Partial weight bearing (25-50%)

• Gradually increase weight
• Still using crutches
• Pain should not increase
• Progress over 1-2 weeks

Weight bearing as tolerated

• Put as much weight as comfortable
• Reduce crutch use gradually
• Progress to one crutch
• Then walking stick if needed

Full weight bearing

• No aids needed
• Normal walking pattern
• May take several weeks
• Limp may persist initially

Early mobilization exercises

Ankle alphabet

1. Sit with leg extended
2. Use ankle to "write" alphabet in air
3. Do twice daily
4. Improves range of motion

Ankle circles

1. Make circles with ankle
2. 10 clockwise
3. 10 anticlockwise
4. 3-4 times daily

Towel stretches

1. Sit with leg straight
2. Loop towel around foot
3. Pull gently towards you
4. Hold 30 seconds
5. Repeat 3 times, twice daily

Strengthening exercises

Resistance band exercises

Plantarflexion (pointing down)

1. Band around foot
2. Push foot down against resistance
3. 10-15 reps, twice daily

Dorsiflexion (pulling up)

1. Band around foot, anchored
2. Pull foot up against resistance
3. 10-15 reps, twice daily

Inversion/eversion

1. Move foot in and out against band
2. 10-15 reps each direction
3. Twice daily

Calf raises

1. Stand holding support
2. Rise up on toes
3. Lower slowly
4. Start with both feet
5. Progress to single leg
6. 10-15 reps, twice daily

Balance and proprioception

Single leg balance

• Stand on injured leg
• Hold support initially
• Progress to no support
• Hold 30 seconds
• Repeat 5 times, twice daily

Balance board exercises

• Stand on wobble board
• Maintain balance
• Progress difficulty gradually
• 5 minutes, twice daily

Gait retraining

Normal walking pattern

• Heel strikes first
• Roll through foot
• Push off with toes
• Equal step length
• Practice in front of mirror

Common gait problems

• Limping: Normal initially, should improve
• Toe walking: Avoid, work on heel strike
• Short steps: Gradually increase stride
• Turning out foot: Keep foot pointing forward

Managing swelling

Elevation

• Elevate above heart level
• 20-30 minutes, 3-4 times daily
• Especially after activity
• Use pillows for support

Ice therapy

• 15-20 minutes after exercises
• Wrap ice pack in towel
• 3-4 times daily
• Reduces inflammation

Compression

• Compression sock or bandage
• Not too tight
• Remove at night
• Check circulation regularly

Returning to activities

Driving

• Right ankle: 6-8 weeks minimum
• Left ankle: Earlier if automatic
• Must have full control
• Check with doctor and insurance

Work

• Sedentary: 6-8 weeks
• Standing/walking: 8-12 weeks
• Manual labor: 3-6 months
• Phased return helpful

Sports

• Swimming: 8-10 weeks
• Cycling: 10-12 weeks
• Running: 3-4 months
• Contact sports: 4-6 months
• Get medical clearance

Preventing complications

Stiffness

• Do exercises consistently
• Frequent gentle movements
• Heat before exercises
• Professional therapy if severe

Chronic swelling

• Continue elevation
• Compression stockings
• Regular exercise
• May persist for months

Re-injury

• Complete full rehabilitation
• Strengthen adequately
• Balance training crucial
• Ankle support for sports initially

When to seek help

Contact healthcare professional if:

• Severe pain not improving
• Increasing swelling or redness
• Unable to weight bear as expected
• Numbness or tingling
• Not regaining movement
• Wound problems if surgical

The role of physiotherapy

Fracture / Broken Bones Rehabilitation (18+) provides:

• Weight bearing progression guidance
• Personalized exercise programme
• Gait retraining
• Hands-on treatment for stiffness
• Balance and proprioception training
• Return to sport planning

The bottom line

Successful ankle fracture recovery requires:

• Following weight bearing restrictions
• Consistent daily exercises
• Gradual progression
• Swelling management
• Gait retraining
• Balance work
• Patience — full recovery takes 6-12 months

Most people regain good ankle function with appropriate rehabilitation. The key is starting exercises early, being consistent, and progressing gradually through the phases of recovery.

About the author

Lizzie Thornton is a specialist community physiotherapist with over 15 years of experience in fracture rehabilitation. She is HCPC registered and a member of the Chartered Society of Physiotherapy. Lizzie provides home physiotherapy visits across Staffordshire Moorlands and Cheshire East, helping people recover from fractures and return to full function.

View Lizzie's profile