BROSTROM REPAIR: REHABILITATION PROTOCOL

<H1>BROSTROM REPAIR: REHABILITATION PROTOCOL</H1>   <H2>FOR CHRONIC ANKLE INSTABILITY</H2> 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 inversion or forceful 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. •    No running, jumping, or ballistic activities for 3 months. •    Aerobic and general conditioning throughout rehabilitation process. •    M.D. appointments at day 1, day 8-10, 1 month, 2 months, 4 months, 6 months, and      1 year post-operatively. 0 – 3 Weeks: •    90° immobilizer for 3 weeks. - Nonweightbearing for 3 weeks--no push off or      toe-touch walking. •    Progress from posterior splint to pneumatic walker once most of swelling is gone. •    Pain and edema control / modalities as needed (i.e. cryotherapy, electrical stim, soft      tissue treatments). •    Toe curls, toe spreads / extension, gentle foot movements in boot, hip and knee       strengthening exercises. •    Well-leg cycling (bilateral once in walker with light resistance), weight training, and      swimming in posterior splint after 10-12 days post-op. 3 – 6 Weeks: •    Progress to full weight bearing in walking boot. Walking boot weight bearing for 3-6      weeks post-op. Aircast splint for day-to-day activities for 6-12 weeks post-op. -      Immobilizer for sleeping for 4weeks, then Aircast splint for 4-6 weeks. •    Isometrics in multiple planes and progress to active exercises in protected ranges. •    Proprioception exercises, intrinsic muscle strengthening, manual resisted exercises. •    Soft tissue treatments daily and regular mobilization of intermetatarsal and midtarsal      joints. Cautious with talocrural and subtalar mobilization. •    Cycling, aerobic machines in splint as tolerated, and pool workouts in splint. 6 – 12 Weeks: •    Gradually increase intensity of exercises focusing on closed-chain and balance /      proprioception. - Passive and active range of motion exercises into inversion and      eversion cautiously. 3 – 6 Months: •    Progress back into athletics based upon functional status. - Wear a lace-up ankle      support for athletics.