Ankle Fracture (ORIF) Rehab Protocol

By Dr. Shayne Kelly, DO — Fellowship-Trained Sports Medicine Surgeon · Tri-City Orthopedics, Kennewick, WA

The written protocol Dr. Kelly provides to his patients and their physical therapists in the Tri-Cities. Time frames are guidelines — progression is criteria-based, and your own post-op instructions always govern.

⬇ Printable protocol (PDF)Request an appointment →

Educational information, not medical advice. This is not a substitute for the specific instructions Dr. Kelly and your physical therapist give you. Your timeline depends on your surgery, your body, and your progress. Follow your own care team's directions. In an emergency, call 911.

WEEKS 0–6

PROTECT FIXATION

WEEKS 6–8

MOTION & GAIT

WEEKS 9–12

BUILD STRENGTH

MONTHS 3–6

RETURN TO ACTIVITY

WEEKS 0–6PROTECT FIXATION

•Patient will be non-weight bearing for 6 weeks.
•The first 2 weeks, the patient will be in the postop dressings and splint.
•At 10–14 days post op, patient will see Dr. Kelly and be placed in a CAM boot. • Range of motion: AROM in all planes as tolerated by the patient • Exercises:
•Scar care/massage as needed o Gastrocnemius, soleus, hamstring stretches on the table o Work up to 4-way ankle vs. Theraband
•ROM board to restore range of motion and proprioception o Alphabet ROM in open and closed chain positions to work on motion and proprioception. Start with eyes open and transition to eyes closed.
•Modalities as needed for pain and swelling.

GOALS WB per protocol

WEEKS 6–8MOTION & GAIT

•Increase ROM as tolerated, working towards normal ROM.
•At week 6, advance to weight bearing as tolerated • Patient will wean out of the boot during weeks 8–10 • Exercises:
•Continue with all stretching exercises. o Advance to BAPS board. o Initiate stationary cycle.
•Weight bearing exercises: step ups, calf raises, partial squats, SLB training o Continue to progress ankle strengthening exercises as tolerated.
•Modalities as needed for pain and swelling.

GOALS Progress WB

WEEKS 9–12BUILD STRENGTH

•Continue to progress towards full ankle range of motion.

EXERCISES

•Continue to progress ankle proprioceptive training and strengthening exercises o Add in hip strengthening exercises if weakness is present.
•May progress from cycle to elliptical as tolerated; modalities as needed for pain and swelling.

GOALS Normal gait

MONTHS 3–6RETURN TO ACTIVITY

•Advance to jogging program; continue to advance hip and ankle strengthening program
•At 16 weeks, may start work or sport specific drills; start with bilateral plyometrics and advance to unilateral

GOALS Graduated impact

Return to Sport & Discharge Criteria

•Healing confirmed by Dr. Kelly; full functional ROM
•Strength ≥90% of opposite side; graduated return to impact after clearance

Time frames are guidelines — progress when phase goals are met, per Dr. Kelly and the treating therapist.

When to call

Increasing pain, numbness, redness, drainage from the wound, or fever/chills — call (509) 460-5588. After hours, the answering service can reach Dr. Kelly. If your issue feels emergent, call 911 or go to the nearest emergency department.

Physical therapists

Treating one of Dr. Kelly's patients? Download the printable protocol for your clinic, and call (509) 460-5588 with questions about an individual patient's progression.

⬇ Protocol PDF

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