Ankle Fracture Rehabilitation Protocols

9 Ankle Fracture rehabilitation protocols from 9 institutions, published 2021–2024. Weight-bearing progressions vary by institution — compare them in the table below before selecting a protocol.

Compare by institution

Institution	Weight-Bearing	Key Restrictions
Dr. Megan Wolf MD — Non-Operative	NWB initially; progressive WB per surgeon; varies by fracture stability and pattern	Cast or boot immobilization; early AROM once wounds healed (~2 wks); edema control and scar massage at 2 wks…
iOrtho — The Orthopedic Institute — ORIF	WB status per surgeon; boot/cast per surgeon	No joint mobs near fracture site; no IASTM over fracture sites until 6 wks; avoid pressure on healing…
Massachusetts General Hospital — ORIF	WB status per surgeon; boot/cast per surgeon; typically NWB initially progressing per…	No joint mobs near fracture site or stabilizing over fracture; no IASTM over fracture sites until 6 wks…
Mountain Orthopedics — Ankle/Foot Fracture Rehabilitation…	Strict NWB x 6 wks after surgery; advance WB over 4 wks	Complete immobilization in boot/cast wks 1-6; boot for out of bed wks 7-10; boot for work/school wks 11-12…
Orthopedic & Sports Medicine Specialists (OSMS) — ORIF	Functional WB exercises initiated wk 8; CAM walker may transition to removable ankle…	Do not overstress healing structures; progression is time- and criterion-based per patient impairments; with…
Orthopedic Specialists of Seattle — Non-Operative	FWB as tolerated in walking boot; D/C crutches/AD as quickly as possible; boot x 4 wks…	Boot is protective not immobilizing — remove when seated/lying; alphabet exercises 2x/day; towel Achilles…
South Bend Orthopaedics — Non-Operative	NWB until allowed by physician; progressive WB in boot (25% increments every 1-2 wks)…	Cast or boot to immobilize; Weber/AO and Lauge-Hansen classification systems explained; wean boot to air cast…
Sutter Health / Palo Alto Medical Foundation — ORIF	NWB wks 0-6; WBAT wk 6+ (progress over 2-4 wks)	Splint on at all times wks 0-2; transition to CAM boot wks 2-6; wean out of boot over 2-4 wks after wk 6…
University of Colorado Anschutz (CU) — ORIF	NWB 0-3 wks; WB advancement per MD/fracture type wks 3-6; WB status and restrictions per…	Boot/cast per MD; no impact or torsional exercises/activities wks 6-12; WB advancement and activity…