Ankle fracture rehabilitation: from boot or cast to normal walking

Ankle fractures vary from small avulsion breaks that need little more than a supportive boot to unstable injuries where more than one part of the joint is damaged. The NHS describes the range as a special boot, a plaster cast, manual realignment, or surgery, and says minor breaks may need no treatment at all. Because of that range, two people with a broken ankle can have very different rehabilitation.

The most useful thing to establish at the fracture clinic is what the ankle may do and when: how much weight, whether the boot may be removed, and when the next X-ray or review will be. Write the answers down, because later stages are decided at those reviews.

During the protected stage the aim is to let the bone and any damaged ligaments settle while avoiding the complications of immobility. The NHS says doctors will specify how much weight to put on the ankle, and that crutches or a walking frame may be provided to take stress off it.

Gentle movement of the toes and knee is encouraged while the ankle is immobilised, according to the NHS, to prevent stiffness. Swelling is normal and tends to be worse when the leg hangs down for long periods, so resting with the foot supported is common advice.

• Practise with your crutches or frame before leaving hospital, including on stairs.

• Wiggle the toes and move the knee regularly within what your cast or boot allows.

• Report any numbness, blue or white toes, or a cast that feels tight.

When the boot or cast comes off, the NHS describes physiotherapists helping with exercises to get the foot and ankle gently moving again. The ankle is usually stiff, the calf thinner and the foot swollen at the end of the day. Early exercises focus on range of movement in all directions, followed by balance and strength work.

The NHS page does not set a timetable for this stage. Pain guidance from NHS inform for soft tissue injuries can help in judging activity: discomfort during exercise is acceptable if it settles quickly and is no worse the next morning, and activity should be reduced if pain climbs above about 6 out of 10.

NHS inform describes an ankle sprain as passing through three phases, with movement and swelling improving in weeks 0 to 2, normal walking returning in weeks 2 to 6, and daily activities back to normal in weeks 6 to 12, with full recovery typically 8 to 12 weeks. That is a sprain, not a fracture, so it should not be used as a timetable for a broken ankle, but it shows the usual shape of recovery: early swelling control, then walking, then function.

The same page notes recovery is not always straightforward and setbacks are normal. That is also true after fractures, and a bad week does not necessarily mean damage. Persistent, worsening or changing symptoms are what to bring to the clinic.

The NHS lists worsening pain, a high temperature, numbness, a cast that is tight with swelling or discolouration, rubbing from the cast, and a bad smell or discharge from under the cast as reasons to use NHS 111. An ankle at an odd angle, exposed bone, severe wounds, severe pain, or toes that look blue, white or numb need A&E.

After surgery, wound problems, hardware that irritates, long-term stiffness and persisting swelling are possibilities that the surgical team can discuss. A painful, swollen calf with breathlessness after an injury needs 999 because it can indicate a clot.

The pages used here give no dates for driving, work or sport after an ankle fracture. Whether you drive an automatic or manual car, which foot is affected and how much your job demands of the ankle all change the answer, and your insurer's terms also apply.

For sport, return is usually discussed once the bone has healed and there is good strength, balance and confidence on uneven ground. Rehabilitation is complete when the ankle copes with the activities you want to do, rather than at a fixed date.