A broken ankle disrupts daily life, demanding a period of immobilization. Regaining the ability to walk is a necessary, gradual process that requires patience and a structured approach. The goal is to restore the coordinated, efficient motion of a healthy gait, not simply to move the foot. Understanding the required steps, from medical clearance to re-training movement mechanics, provides a clear roadmap for a safe return to full mobility.
Clearance and Weight-Bearing Status
The absolute requirement before attempting to walk is official medical clearance, typically from an orthopedic specialist. This permission is confirmed through follow-up X-rays demonstrating sufficient bone healing. Placing weight on the ankle too soon risks displacing the fracture site, delaying healing or necessitating further intervention. The physician assigns a specific weight-bearing status, dictating the amount of force safely applied to the injured limb.
The initial status is Non-Weight Bearing (NWB), meaning no pressure should be placed on the foot. The next phase is Touch-Down Weight Bearing (TDWB) or Toe-Touch Weight Bearing, allowing only the weight of the limb or a small percentage of body weight. This progresses to Partial Weight Bearing (PWB), where a specific, gradually increasing percentage of body weight is permitted, often monitored with a scale. Finally, Full Weight Bearing (FWB) indicates the bone is healed enough to bear the entire body weight, though temporary assistive devices may still be required.
Re-Learning Gait: Techniques and Aids
Transitioning from non-weight bearing to independent walking is known as gait retraining. Assistive devices are initially required to manage the weight-bearing progression and maintain balance. Crutches or a walker are used during the NWB and early PWB phases, allowing the patient to control the pressure placed on the healing ankle. Progression involves gradually shifting more weight onto the injured foot while reducing reliance on the aids.
When using crutches, the injured foot is advanced alongside the crutches, followed by the uninjured foot. As strength improves, the patient moves to a single cane, held in the hand opposite the injured ankle for maximum support and balance. The goal is to move away from the asymmetrical, compensatory movements that develop while limping or using aids. A physical therapist helps restore the natural heel-to-toe pattern, emphasizing that the heel of the injured foot should strike the ground first to ensure proper loading mechanics.
Maintaining an upright posture and avoiding the tendency to favor the uninjured side is important for long-term recovery. Developing an incorrect gait pattern, even briefly, can lead to pain and alignment issues in the knee, hip, or back. The controlled movement of a proper step helps rebuild confidence in the ankle’s stability. Patients should monitor their walking to ensure they are not rushing the push-off phase with the injured foot, which indicates residual weakness or pain avoidance.
Restoring Function Through Targeted Exercises
Simply walking is insufficient to restore the function lost during immobilization; targeted exercises are necessary to rebuild strength, flexibility, and proprioception. Proprioception, the body’s sense of its position in space, is diminished after an ankle injury and must be retrained to prevent future instability and falls. Range-of-motion exercises are introduced early, often starting with the “ankle alphabet,” where the patient traces letters in the air with their foot to encourage movement in all directions.
Strength training focuses on rebuilding the atrophied muscles surrounding the ankle, particularly the calf and smaller stabilizing muscles. Specific actions include seated or standing heel raises to strengthen the calf. Resistance band exercises, such as pushing the foot against the band for eversion (outward) and inversion (inward) movements, target the muscles responsible for lateral stability. These exercises support the ankle joint during dynamic activities like walking on uneven ground.
Balance drills are introduced once weight-bearing is safe. They start with simple single-leg stands while holding onto a stable surface. As balance improves, the challenge increases by standing on softer surfaces, such as a pillow or foam pad, or attempting the single-leg stand without external support. The tandem walk, where one foot is placed directly in front of the other, also improves coordination and challenges the ankle’s stabilizing mechanisms. Consistent execution of these drills supports the mechanics of the retrained gait.
Long-Term Considerations and Prevention
Even after returning to independent walking, the recovery continues with long-term management of residual symptoms. Stiffness and swelling (edema) can persist for many months. Managing swelling involves elevating the foot and ankle, especially after activity, and using compression garments as recommended. Consistent, gentle stretching remains important for combating stiffness and maintaining the range of motion gained through rehabilitation.
Patients should be mindful of the long-term risk of developing post-traumatic arthritis, especially with fractures that extended into the joint surface. Monitoring for persistent, unexplained pain or chronic instability is important, and a return to the physician or physical therapist is warranted for these issues. Appropriate footwear plays a preventative role in reducing the risk of re-injury and managing residual discomfort.
A supportive shoe features a firm heel counter (the rigid part that cups the back of the heel) and a sole with adequate cushioning and a moderate rocker bottom to assist with a smooth transition from heel strike to toe-off. Shoes with adjustable straps or laces provide a secure fit, accommodating residual swelling and ensuring the ankle is well-supported. Choosing stable, supportive footwear for all activities helps protect the ankle against future strain and promotes lasting mobility.