Early Mobility after Ankle Fracture: Is It Beneficial?

Ankle mobility after fracture is essential.
When should you start moving your ankle after ORIF surgery for fracture?. Photo Alto/Michele Constantini/Getty Images

If you have fractured your ankle, you may benefit from physical therapy to help get you moving again. Your physical therapist will work with you to improve your ankle and leg range of motion (ROM), strength, and mobility in order to help you return to your normal activities and function.

If your ankle fracture was severe, you may need a surgical procedure called an open reduction and internal fixation (ORIF) to help stabilize the fracture.

After your procedure, you doctor will likely have you wear a cast on your ankle until adequate healing has taken place.

When Can I Start PT after Surgery for My Ankle Fracture?

It can be difficult wearing a cast and waiting for healing to occur in your ankle after a fracture. You may want to rush the process and get physical therapy started as soon as possible. The quicker you get your ankle moving again, the sooner you'll be up and and about and back to your normal activities.

There is some debate about when to start physical therapy after ankle ORIF. Immobilization after surgery has some benefits. It can help protect surgical wounds, decrease post-operative pain, and limit stress to your healing bones. Negative effects of long term immobilization include significant loss of ankle ROM and strength and loss of function related to walking and mobility.

The standard time frame for wearing a cast after ankle ORIF is 6 weeks.

Some surgeons start early mobility at 2-4 weeks after surgery and allow you to wear a removable brace on your ankle. Others may wait 8 weeks before allowing any weight bearing or mobility.

So when should you start moving your ankle and bearing weight through your leg after ankle ORIF?

What Does the Research Show?

A recent study published in the Journal of Orthopedic and Sports Physical Therapy analyzed data from many different studies (called a meta-analysis) to examine the benefits and risks associated with early ankle mobility after ORIF versus full immobilization for 6 weeks or more.

Eleven studies were included in the analysis.

The researchers concluded that the overall quality of evidence on the subject of mobility after ankle fracture is poor. They did find that there was no significant difference in functional outcomes between early or late mobilization after ankle ORIF surgery.

Early ankle motion decreased the overall risk of developing a post-operative deep vein thrombosis, a potentially deadly condition. This benefit was small and not statistically significant.

There were some negative effects of early ankle mobility after ORIF. These risks included surgical site infections and failure of the metal fixation hardware (and subsequent need for removal or another surgery).

Overall, the evidence comparing early mobilization of your ankle 2-4 weeks post-op versus full immobilization for 6 weeks or greater suggest that early mobility may protect against DVT. Early mobility after ankle fracture may increase the likelihood of hardware failure and surgical site infections.  

These risks and benefits should be discussed with your doctor to help you decide when the most appropriate time to start PT should be. Currently, there is no clear evidence on the best time frame to start rehabbing your ankle after fracture and ORIF.

Physical therapy after ankle fracture and ORIF surgery can be helpful to get you back to your normal lifestyle after the injury. By working closely with your doctor and PT, you can be sure to start your rehab at the most appropriate time to quickly and safely get back to optimal function.

Source:  Keene, D, etal.  Early ankle movement versus immobilization in the postoperative management of ankle fracture in adults: a systematic review and meta-analysis.  JOSPT, 44:9.  690-701.

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