Brostrom Procedure Rehab Protocol

General notes:

  • No passive inversion or forceful eversion for 6 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 1 months
Aerobic and general conditioning throughout rehabilitation process
  • Driving is permitted once your leg is strong and coordinated to react safely to avoid an accident. Driving is often resumed after the first week or two and when all pain medications/narcotics are no longer needed. Also, surgical leg and type of car are considered before being cleared to drive. Ask your PT if you are ready to safely return to driving.

Note, if done WithOUT Arthrex Internal Brace Suture Tape Augmentation

  • Begin weight bearing at 2 weeks. instead of 1.
  • Boot use during the day until week 6, instead of transitioning out based on patient preference/comfort.
  • Return to sport no sooner than 3 months.
  • Otherwise, protocol is the same as below.

0 – 1 Weeks:

  • 90Ε immobilizer for 1 weeks
  • Non-weightbearing for 1 week–no push off or toe-touch walking
  • Toe curls, toe spreads/extension, gentle foot movements in splint, 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

1 – 6 Weeks:

  • Progress to full weight bearing in walking boot. Walking boot weight bearing until feeling comfortable enough to start using the brace only.
  • Boot for sleeping for 3 weeks postop, then lace-up/figure 8 or Malleoloc brace during the day for at least 6 weeks postop (if NO Internal Brace suture augmentation, then boot during the day until week 6 postop).
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. Mild caution with talocrural and subtalar mobilization
  • Cycling, aerobic machines in splint as tolerated, and pool workouts in splint.

6 – 12 Weeks

  • Malleoloc splint for day-to-day activities for 6-12 weeks post-op. Ok to begin coming out of it if feeling totally stable and comfortable.
  • 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 Malleoloc ankle support for athletics and high risk activities
  • Time frames mentioned in this article should be considered approximate with actual progression basedupon clinical presentation. Careful observation and ongoing assessments will dictate progress.