Once your surgeon or fracture clinic lets you take the cast or boot off to exercise, the first job is getting the ankle MOVING, especially bending it up toward your shin. Then you rebuild the calf, then your balance, then a normal walk.
Expect the ankle to be stiff, weak and swollen.
That’s normal after weeks in a cast or boot, with or without surgery. Most people make steady gains over the first couple of months, and strength keeps improving well beyond that.
Your surgeon’s instructions come first: when you can put weight through the foot, when the boot comes off and which movements are allowed. See weight bearing after surgery if the terms are confusing.
For many people, a good home program does about as well as lots of supervised sessions. Doing it every day is what counts.
For the full timeline after an operation, see broken ankle surgery recovery.
While you’re still in the cast or boot
- Toe wiggles and curls: move all your toes as far as they go, often through the day. It helps the swelling and stops the foot stiffening
- Thigh squeezes and leg lifts: lying down, tighten the front of your thigh, then lift the straight leg a few inches. About 10 of each, two or three times a day
- Knee bends: sitting or lying, bend and straighten the knee through its full range. The knee and hip stiffen too if you let them
- Leg up: raise the foot above the level of your heart whenever you rest
- Out of the boot, only if allowed: many people with a removable boot are told to take it off a few times a day for gentle up-and-down ankle movement. Check first
Phase 1, the first 2 to 4 weeks out of the boot: get it moving
- Ankle pumps: point your foot down, then pull it up as far as it goes, slowly. 10 to 20, several times a day. Pulling UP is the direction that matters most for stairs and squatting
- Ankle alphabet: sitting with the leg out, trace the letters A to Z with your big toe. Once through, two or three times a day
- Towel calf stretch: sitting with the leg straight, loop a towel around the ball of your foot and pull gently. Hold about 30 seconds, 3 times
- Seated knee-over-toe rocks: sitting with the foot flat, slide it back under the chair and let the knee drift forward over your toes, heel down. 10 to 15 slow rocks
- Walking: heel down first, roll through the foot, push off the toes. Use your crutches or cane until you can walk without a limp
Many people find the first session of the day easier after a warm shower, once the wound has fully healed.
Phase 2, about weeks 2 to 6: calf strength and a normal walk
- Two-leg heel raises: holding a counter, rise onto your toes and lower slowly over about 3 seconds. Start with 2 or 3 sets of 10
- Knee-to-wall lunge: facing a wall with the injured foot in front, bend the knee toward the wall, heel down. Hold 5 seconds, 10 times. Move the foot back a little as it gets easier
- Standing calf stretch: hands on the wall, injured leg behind, heel down. Hold 30 seconds with the knee straight, then with it slightly bent
- Step-ups: step up onto the bottom stair with the injured leg, holding the rail, and step down. Start with 10
- Supported single-leg stand: hold a counter and stand on the injured leg. Build up to 30 seconds
- Stationary bike: gentle pedaling for 10 minutes is a good start, building to 20
The American Academy of Orthopaedic Surgeons has an illustrated foot and ankle conditioning program if you want pictures to follow. Check it against what your own team has told you.
The cast protected the bone. The exercises give you back the ankle.
Phase 3, from about 6 weeks out of the boot: single leg and balance
- Single-leg heel raises: on the injured leg, slowly. Work toward matching your good side. A weak calf is a common reason for a lingering limp
- Single-leg stand, no hands: 30 seconds, then with eyes closed, then on a cushion
- Step-downs: stand on the bottom stair and slowly lower the other heel to the floor, then straighten back up. 8 to 10
- Real-world walking: slopes, grass, uneven ground and stairs without the rail, a little more each week
- Back to running: only once your surgeon or physio clears you, and single-leg heel raises and hopping feel easy. The hopping and landing steps in ankle sprain exercises work well here too
Swelling and stiffness: what helps
- End-of-day swelling is normal and often lasts 6 months to a year. It should go down overnight
- Raise the leg after exercise and in the evening, above the level of your heart
- A compression sock during the day helps many people. Check with your team first if you’ve had a clot or have circulation problems
- Little and often: stiffness is worst first thing and after sitting. A few ankle pumps before you stand up make the first steps easier
- Cool pack after exercise: wrapped in a towel, 15 to 20 minutes, if the ankle is puffy. Not on skin that is numb
How much pain is OK?
- During the exercise: aching and a firm stretch are fine. Sharp pain at the break site means stop that exercise
- After the exercise: discomfort should settle within an hour or two
- The next morning: this is the real test. If the ankle is more swollen, stiffer or sorer than the morning before, you did too much. Ease back for a day. Don’t stop
- When to move up: when the current level is easy and there’s no next-morning reaction, add one harder exercise at a time
- When to stop and call: new sharp pain over the bone, a crack or pop, or you can no longer put weight on a foot that was taking it
Go to the emergency department if
- Your calf or thigh is suddenly painful or swollen: possible blood clot
- You have chest pain or sudden shortness of breath
- Your toes look blue or white, or feel cold and numb
Call your surgeon today if
- The wound is red, hot, swollen, spreading or leaking
- You have a fever or chills, or feel unwell
- Pain keeps getting worse, at rest as well as with activity
Mention it at your next review if
- The ankle barely bends up several weeks after the boot comes off
- You’re still limping badly at 3 months
- The plate or screws rub on your shoes
The bone heals by itself. The movement you have to earn every day.