Musculoskeletal Physiotherapy Outpatient Department

Information Following Your Ankle Fracture

This information leaflet has been provided by the
Physiotherapy department to assist you in
returning back to normal following your ankle
injury. The following information will give you
some advice and exercises to do while you wait
to start your physiotherapy sessions. If you have
any queries about the information provided in this
leaflet, please call the Physiotherapy department
Monday – Friday between 09.00 – 16.00.

Removal of Cast/Boot
Following your injury, you may be required to have a period of immobilisation in a
cast or a removable boot. When your Consultant thinks you are ready, they will allow
this to be removed and you can start moving your ankle. Occasionally you will be
told by the consultant you should avoid certain activities or reduce the amount of
weight you put through your ankle – your physiotherapist will guide you through this.
If you have not been given any restrictions, you may use your ankle as pain allows.

Early movement of the ankle and foot is important to promote circulation and reduce
the risk of developing a DVT (blood clot). Early weight bearing (putting weight
through your injured foot) helps increase the speed of healing. Try to walk as
normally as possible as this will help with your recovery.

It is common for your ankle to feel uncomfortable when your plaster cast is initially
removed, and your skin may be dry and flaky. Soaking your ankle in warm water will
help with this, as well as gently massaging the area with a plain/non-perfumed
moisturiser.

In addition to this, warm water can help to reduce your pain and can make
movement feel easier. Therefore, doing some of the exercises below in the water or
after a bath/shower may be a more comfortable way of doing the exercises.

Pain Relief
Sometimes it is necessary to take pain relief to help you to move your ankle more
comfortably. You may have been prescribed some by a doctor or you may wish to
discuss your needs with a pharmacist. You may also wish to try heat and ice as
described below to help reduce your pain.
Application of ice: Place a wet tea towel directly over your skin, and then place
a bag of frozen peas on top of the towel. Keep the peas on for 15 – 20 minutes,
checking your skin from time to time. Repeat up to 3 times a day.

Application of Heat: Wrap a hot water bottle in a towel and place over the area.
Keep it on for 15 – 20 minutes, checking your skin from time to time. Repeat up to
three times a day.

Patient Information Leaflet for: Information Following your Ankle Fracture

Author/s: Sarah Court and Charlotte Harrison Author/s title’s: Senior Physiotherapists
Approved by: PIF Date approved: 24/07/20 Review Date: 24/07/23
Available via Trust Docs Version: 6 Trust Docs ID: 328 Page 1 of 6
Managing Swelling
When you are not walking, you should elevate your ankle to help reduce swelling.
This is important, as swelling can reduce the range of movement in your ankle and
can make it feel more stiff and sore. Elevate your ankle above the level of your hips
using pillows or a stool to keep your foot up. It is common for the ankle to swell at the
end of the day, and if you have been on your feet for a long time. Try to gradually
increase the amount of time you’re spending on your feet and take regular breaks to
elevate the ankle throughout the day.
Driving
You may return to driving once your boot has been removed and when you feel
confident that you can safely control your vehicle and perform an emergency stop. It
is advisable to inform the DVLA and your insurance company that you are returning
to driving.
Smoking Cessation
Evidence has shown that smoking prolongs fracture healing time. It is important that
you consider this information with relation to your recent injury. Stopping smoking
during the healing phase of your fracture will help ensure optimal recovery from this
injury. For advice on smoking cessation and local support available, please refer to
the following website: http://smokefree.nhs.uk or discuss this with your GP.
If you experience any of the following:
 Severe unrelenting or worsening pain
 Worsening hot/red/swollen wound or calf
 Fever or temperature
 A wound that is oozing or smells
 Throbbing/cramping sensations in your calf

Contact your GP and ask for an urgent appointment or call 111 as it is

important to rule out a wound infection or a DVT (a blood clot).
Exercises
The exercises overleaf are aimed at helping you to regain range of movement in your
ankle and to prevent your ankle from becoming stiff. We would advise that you
complete your exercises 3-4 times a day.
It is important that you do not push through pain that you would describe as being
more than a 5/10. Any pain or discomfort after you have stopped exercising should
settle down within 1 hour of you stopping the exercises. If your pain is still worse as a
result of the exercises, you could be overdoing them, try moving your ankle more
gently and slowly and consider doing fewer repetitions.
Try to gradually increase the amount of time you are spending on your feet.
Swimming/ cycling can be a good way of rebuilding cardiovascular fitness without too
much strain through the ankle. However, return to running/contact sport is not
encouraged until stage 3 exercises can be completed with ease and good control.

For further information please contact: Musculoskeletal Physiotherapy Outpatient

Department Telephone: 01603 286990 Monday to Friday between 09.00 -
16.00.

Patient Information Leaflet for: Information Following your Ankle Fracture

Author/s: Sarah Court and Charlotte Harrison Author/s title’s: Senior Physiotherapists
Approved by: PIF Date approved: 24/07/20 Review Date: 24/07/23
Available via Trust Docs Version: 6 Trust Docs ID: 328 Page 2 of 6
 Stage One Ankle Exercises (from removal of cast)
If you have any queries/concerns about your exercises, please call the
physiotherapy department on: 01603 286990.

Sitting/Lying with your legs out straight.

Point your foot up and down within a comfortable range.

Repeat 5 - 10 times.

Sitting/Lying with your legs out straight, turn your foot

inwards leading with your big toe and then the outwards
leading with your little toe.

Repeat 5 - 10 times.

Sitting or lying.
Rotate your ankle clockwise and then anti-clockwise.

Repeat 5 - 10 times.

Sit with your leg straight out in front of you. Put a towel
around your foot. Gently pull the towel and feel the
stretch in your calf. Do not push through pain.

Hold approx. 20 secs. Repeat 3 times

Sit on a chair. Cross the ankle to be stretched over the

other knee. Place your hand on the top of your foot and
gently bring your ankle towards you.

Do not push through pain.

Hold approx. 20 secs. Repeat 3 times

Patient Information Leaflet for: Information Following your Ankle Fracture

Author/s: Sarah Court and Charlotte Harrison Author/s title’s: Senior Physiotherapists
Approved by: PIF Date approved: 24/07/20 Review Date: 24/07/23
Available via Trust Docs Version: 6 Trust Docs ID: 328 Page 3 of 6
 Stage 2 Ankle Exercises (approximately 6-8 weeks post injury)
If you have any queries/concerns about your exercises, please call the
physiotherapy department on: 01603 286990.

Before moving onto further strengthening exercises, it is

important that you are completing stage 1 exercises with
ease, and that you feel comfortable and confident with
normal daily activities, such as walking and completing the
stairs unaided (if this was your baseline). See below for
some tips on how to progress with these tasks.

Walking Practice
Try to walk as normally as possible even if you need to use
a crutch / crutches to enable you to do this. It is better to
walk well with crutches than to limp without.

Unless you have been specifically told otherwise, try to

walk in a normal heel - toe rhythm with your heel touching
the ground first.

As you start to feel more comfortable, and less dependent

on the crutches for support/balance, you try first using one
crutch in your opposite arm – placing the crutch out in front
of you at the same as your injured leg, before progressing
to using no aid if you feel that you no longer need the
support.

Stairs
Initially, you would have been advised to ascend the stairs
using your uninjured leg to go up first, and to descend the
stairs using your injured leg to go down first.

To build strength and return to doing the stairs normally, try

on the bottom stair, going up with your injured leg – just
doing one stair/step at a time with both feet on the same
step. Use the banister rail/wall for support.

Again, on the bottom stair, try stepping down with your

uninjured leg first. This will help you to improve your
confidence to complete the stairs as you did before.

Cycling/Swimming
At this point, you can start gentle cardiovascular exercise
such as cycling or swimming to help build your fitness and
your strength in a way that does not put too much strain
through your ankle. It is important that you start this
gradually, e.g. cycling for 5 – 10 minutes initially, not
pushing through pain and gradually increasing if you
experience no adverse effects/increase in pain afterwards.

Patient Information Leaflet for: Information Following your Ankle Fracture

Author/s: Sarah Court and Charlotte Harrison Author/s title’s: Senior Physiotherapists
Approved by: PIF Date approved: 24/07/20 Review Date: 24/07/23
Available via Trust Docs Version: 6 Trust Docs ID: 328 Page 4 of 6
 Stage 2 Ankle Exercises (approximately 6-8 weeks post injury)
If you have any queries/concerns about your exercises, please call the
physiotherapy department on: 01603 286990.

Hold on to a stable surface in front of you. Stand with

feet hip-width apart, with toes pointing forwards. Rise up
onto your toes and lower down in a controlled manner.

The aim is to have 50% weight on each foot. However, if

this is too sore/too difficult, rise up taking more weight
through the uninjured foot. Repeat 5 - 10 times.

Standing in front of a stable surface. Try to balance by

standing on your injured leg.
Remember to stand tall, with weight evenly on your foot
and toes pointing forwards.

Repeat 3 times.

Take support from a stable surface in front of you. Stand

with the leg to be stretched straight behind you and the
other leg bent in front of you.

Lean your body forwards and down until you feel the
stretching in the calf of the straight leg.

Hold approx. 20 secs. Repeat 3 times

.
If the standing calf stretch feels easy, then stand on a
step with both heels over the edge. Hold on to a support.

Let your body weight stretch your heels towards the

floor. Hold for 30 seconds. Repeat 3 times.

You may also wish to rise up onto your tiptoes in this

position.

Stand in a walking position with the leg to be stretched

behind you. Hold on to a support.

Bend the leg to be stretched and let the weight of your

body stretch your calf without lifting the heel off the floor.

Hold approx. 30 secs. - relax. Repeat 3 times.

Patient Information Leaflet for: Information Following your Ankle Fracture

Author/s: Sarah Court and Charlotte Harrison Author/s title’s: Senior Physiotherapists
Approved by: PIF Date approved: 24/07/20 Review Date: 24/07/23
Available via Trust Docs Version: 6 Trust Docs ID: 328 Page 5 of 6
 Stage 3 Ankle Exercises (approximately 8-12 weeks post injury)
If you have any queries/concerns about your exercises, please call the
physiotherapy department on: 01603 286990.
Balance on one leg on a folded pillow/a cushion.
Remember to stand tall, with weight evenly distributed
between forefoot and heel and toes pointing forwards.
Hold your balance for approximately 20-30 seconds.
Repeat 3 times.

Stand on your injured foot. Squat down on your injured ankle

and at the same time point the toes of your good leg
alternatingly in five directions: front, 45 degrees, side, 135
degrees and back. Between the directions straighten back to
the starting position.
Repeat 3 times

Stand with a stable surface in front of you. Stand tall on one

leg, with weight evenly on your foot and toes pointing
forwards.
Balance and rise onto your toes. In a controlled manner
return to the starting position.
Repeat 5 - 10 times.
Stand in front of a stable surface holding on to the support
with both hands.
With both feet pointing forwards, slowly crouch keeping your
back straight and heels on the floor.
Repeat 5 - 10 times.

Stand tall with feet hip-width apart.

Take one long step forward and squat down so that your rear
knee is almost touching the floor, the shin of the front leg and
trunk is upright. Stand back up pushing through your heel,
bringing your front foot back to the starting position.
Note: Keep hips, knees and toes aligned in both legs.
Repeat 5 - 10 times.
Stand on one leg on a step facing down. Slowly lower
yourself by bending your knee and keeping your heel down
for as long as possible. Return to starting position.

Repeat 5 - 10 times.

Patient Information Leaflet for: Information Following your Ankle Fracture

Author/s: Sarah Court and Charlotte Harrison Author/s title’s: Senior Physiotherapists
Approved by: PIF Date approved: 24/07/20 Review Date: 24/07/23
Available via Trust Docs Version: 6 Trust Docs ID: 328 Page 6 of 6