Phase I: Protection and Early Recovery (0–2 Weeks)

Immobilisation:

• Back slab for 2 weeks

• Removed for wound review only

Precautions:

• Touch weight bearing for 2 weeks

• Avoid ankle range of motion until wound review

• Avoid twisting or pivoting through the operated limb

• Avoid impact activities

Therapy:

• Oedema management and elevation

• Gait retraining with walking aids

• Active knee and hip range of motion

• Toe and foot intrinsic exercises

Criteria to Progress:

• Wound healed

• Pain controlled

• Minimal swelling

• Independent mobilisation with walking aids

Phase II: Restore Motion and Progressive Loading (2–12 Weeks)

Immobilisation:

• Transition to CAM boot

• Wean CAM boot toward the end of this phase

Precautions:

• Weight bear as tolerated in CAM boot

• Avoid impact activities

• Avoid twisting and pivoting through the ankle

• Progress loading gradually according to symptoms

Therapy:

• Commence active ankle range of motion

• Progress dorsiflexion and plantarflexion

• Commence inversion and eversion as tolerated

• Gait retraining and calf activation

Criteria to Progress:

• Functional ankle ROM

• Minimal swelling

• Improving lower limb strength

• Independent gait

Phase III: Strength and Functional Recovery (12–16 Weeks)

Precautions:

• Progress loading following evidence of fracture healing

• Avoid high-impact activities initially

• Avoid abrupt increases in training volume

Therapy:

• Progressive strengthening

• Balance and proprioception exercises

• Functional lower limb rehabilitation

• Endurance exercises

Criteria to Progress:

• Clinical and radiographic progression toward union

• Functional ROM restored

• Improved strength

• Normalising gait

Phase IV: Return to Function and Endurance (4–6 Months)

Precautions:

• Gradual return to unrestricted activity

• Avoid abrupt progression into impact loading

Therapy:

• Progressive strengthening

• Functional rehabilitation

• Occupation-specific rehabilitation

• Sport-specific rehabilitation

Criteria to Progress:

• Radiographic union achieved

• Functional strength restored

• Full ankle ROM

• Return to unrestricted activity

General Recommendations

Work:

• Office and sedentary work may resume after approximately 2–4 weeks depending on comfort and mobility

• Manual labour is commonly delayed until approximately 4–6 months depending on fracture healing and occupational demands

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

Sports and Leisure:

• Upper-limb exercise and non-impact activities may resume as comfort allows.

• Progressive return to gym and functional lower limb activities from approximately 3–4 months.

• Running, jumping, pivoting, contact sport, and impact activities are typically introduced from approximately 4–6 months or longer with full recovery and surgeon clearance.

Thromboprophylaxis

A combination of mechanical and pharmacological thromboprophylaxis is generally recommended following lower limb orthopaedic surgery. The selection of the specific agent (e.g., aspirin, low molecular weight heparin, or a direct oral anticoagulant) and the duration of prophylaxis will be discussed and determined in consultation with A/Prof Ernstbrunner and his medical team, based on the individual patient's risk profile and comorbidities.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.