Ankle protocols

In this section you will find the protocols that relate to foot and ankle operations that we see in lower limb therapy. 

A large proportion of our workload and an area we specialise in is the rehabilitation of patients who have recently had operations on the foot and ankle.

Our rehabilitation protocols have been devised in conjunction with the orthopaedic surgeons to ensure the patients are receiving the best possible care after surgery.

Achilles tendon rupture

Achilles tendon rupture can be managed with a surgical (operative) or conservative (non-operative approach). See below for the protocol and exercises that relate to both of these methods when treating someone after an Achilles tendon rupture.

Achilles tendon exercises


Ankle debridement/micro fracture

The latest research suggests that early weight bearing has similar outcomes to delayed weight bearing after microfracture to ostoeochondral lesions. It is suggested that early weight bearing encourages the healing process and helps the clot to develop with normal functional stress. Approximately 15% do fail and poor outcomes are said to be associated with location and size of the lesion (>1cm2). Patients BMI and age are also said to be a factor but the evidence regarding this is conflicting.

0-2 weeks

Patient is most commonly advised to weight bear as tolerated on the ward and told to use crutches if this helps with pain or improving gait pattern. Occasionally, weight bearing status may be altered depending on consultant preference and the size of lesion.  Emphasis is on swelling management through elevation and spending only short periods of time on their feet at home. The in-patient therapy team usually recommend about 10 minutes in each hour. Physiotherapy out-patient appointment will be made within 2 weeks.

2-6 weeks

Patient to gradually wean off walking aids and normalise gait pattern. Pt is encouraged to gradually work on range of movement and strength. Open chain initially and gradually increasing weight-bearing exercises as pain allows. Consider OT appointment and ankle class if appropriate. Light resistance bike work should commence and consider hydrotherapy if struggling with pain and ROM.

6-12 weeks

Will be seen in orthopaedic clinic around 6-8 weeks. Continue to work on ROM and strengthening exercises, more emphasis on proprioception/balance exercises and working towards full AROM. Heel raise progression (bilateral to unilateral).

12 weeks onwards

Can start gentle impact, walk to jogging/running program progression if meets criteria:

  • Full active ROM – no pain or swelling
  • SEBT  - Anterior and Posterior reach directions symmetrical
  • Leg press 10 Reps = 100% body weight
  • Single leg squat x 10 reps (QASLS 0-1)
  • 25 pain free single leg heel raises

Sport specific training will normally be gradually introduced 4-6 weeks after running commences but it may take as long 1 year to fully assess the success of surgery.

If pain is significant and is the main barrier to return to work/function then consider a referral back to consultant around 3 months. Patient may require imaging or respond to an injection at this point.

Lateral ligament reconstruction

See below for the post operative protocol that relates to having your lateral ankle ligament's reconstructed.