From the Research
After an ankle fracture, early weight bearing is a safe and recommended approach, as it results in superior short-term outcomes, including improved ankle function scores and range of motion, without increasing the risk of complications, as supported by the most recent and highest quality study 1.
Key Considerations
- The decision to start weight bearing should be made based on the individual patient's fracture type, stability of the osteosynthesis, and overall health status.
- A removable ankle support may also provide better outcomes, including improved ankle function and health-related quality of life, compared to a non-removable support 2.
- Physical therapy interventions, such as active controlled motion and enhanced physiotherapy, may be beneficial in improving ankle function and range of motion, but the evidence is limited and more research is needed 2.
Management Approach
- Patients with ankle fractures should be advised to follow a gradual weight-bearing program, starting with partial weight bearing and progressing to full weight bearing as tolerated.
- Assistive devices, such as crutches or a knee scooter, may be necessary to reduce weight bearing on the affected ankle.
- Elevation of the affected leg, ice application, and pain management with prescribed medications are also important components of the management approach.
Evidence Summary
- A systematic review and meta-analysis of randomized controlled trials found that early weight bearing resulted in improved short-term ankle function scores, without increasing the risk of complications 1.
- Another study found that early weight bearing and mobilization did not increase the complication rate, but resulted in superior short-term outcome scores, including Olerud and Molander Ankle Score (OMAS) and range of motion (ROM) 3.
- The Cochrane review of rehabilitation interventions for ankle fractures found that early weight bearing may improve outcomes in the first six months after surgery, but the difference is likely to be small and may not always be clinically important 2.