Chronic Ankle Instability Rehab…

Chronic Ankle Instability Rehab…

Chronic Ankle Instability Rehab...

Brostrom procedure rehab protocol

General considerations

  • Time frames mentioned in this article should be considered approximate with actual progression based upon clinical presentation. Careful observation and ongoing assessments will dictate progress.
  • No passive or active inversion or eversion for 6 weeks.
  • Avoid plantar flexion greater than resting position for 4 weeks.
  • Carefully monitor the incisions and surrounding structures for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization) to decrease fibrosis. Hold off on scar mobilizations x 4 weeks or per MD.

“No touch zone” around portals x 4 weeks

  • No running, jumping, or ballistic activities for 6 months.
  • Aerobic and general conditioning throughout rehabilitation process.
  • M.D./nurse appointments at day 2, day 14, 1 month, 2 months, 4 months, 6 months, and 1 year post-operatively.

Weeks 0 — 3

  • Posterior splint immobilizer for 3 weeks.
  • Non weight bearing for 3 weeks—no push off or toe-touch walking.
  • Pain and edema control / modalities as needed (i.e.cryotherapy, electrical stimulation, soft tissue treatments).
  • Effleurage, gentle soft tissue mobilization to ankle avoiding incisions. Keep 2 inch “no touch zone” around portals x 4 weeks.
  • Toe curls, toe extension, toe spreads, hip and knee strengthening exercises.
  • Well-leg cycling, well body weight training,
  • Minimal edema.
  • Closed incision sites.
  • Increased core/gluteal strength.

Weeks 3 — 6

  • Progress from posterior splint to pneumatic walking boot. Be sure to wear a heel lift in opposite shoe to offset the leg length discrepancy caused by the boot.
  • Progress to full weight bearing in walking boot. Walking boot weight bearing for 3-6 weeks post-op.
  • Aircast splint for sleeping at night (make sure sheets/covers are not pushing foot down into plantarflexion).
  • Continue with effleurage and soft tissue mobilizations. Regular mobilization of intermetatarsal and midtarsal joints. Caution with talocrural and subtalar mobilization.
  • Isometrics in multiple planes and progress to active exercises in protected ranges.
  • Proprioception exercises, intrinsic muscle strengthening, manual resisted exercises.
  • Cycling with boot, aerobic machines in splint as tolerated, and pool workouts in splint once incisions closed. No fins in pool until 12 weeks.
  • Initiate gentle dorsiflexion- slow progression to full range of motion.
  • No edema.
  • Gait full weight bearing, good mechanics.

Weeks 6 — 12

  • Progress from boot to aircast at 8 weeks post operatively.
  • Continue with soft tissue mobilization, mobilization of ankle/foot as needed for range of motion.
  • Gradually increase intensity of exercises focusing on closed-chain and balance / proprioception.
  • At 8 weeks post op- gradual and slow progression of passive and active range of motion exercises into inversion and eversion cautiously.
  • Initiate stationary cycling, no clip ins, light to no resistance, and slow cadence.
  • Full passive/active range of motion by end of 12 weeks.
  • Normal gait mechanics.
  • Able to do single leg heel raise.
  • Able to do single leg balance >30 sec.

Months 3 — 6

  • Progress from aircast to ASO lace-up ankle brace.
  • Progress back into athletics based upon functional status.
  • Wear a lace-up ankle support for athletics.
  • Pool work outs, weaning out of splint.
  • Able to perform 3 and 6 month Sport Tests.
  • Begin plyometric training and initiate return to run program with lace up brace.

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