Stable Syndesmotic Ankle Sprain
Phase 1 (1-4 days)
- Nonweightbearing with crutches
- Posterior splint in neutral position
- Modalities to reduce pain and inflammation
- Electrical stimulation
- Cryotherapy
- Manual resistance exercises in 30 degrees of plantar flexion
- Resisted dorsiflexion (30N)
- Light passive dorsiflexion stretching with a towel
Phase 2 (day 4-5+)
- Partial weightbearing with crutches
- Daily wear of ALPII brace
- Postacute modalities
- Manual resistive exercises
- Dorsiflexion/plantarflexion full ROM
- Initiate weightbearing exercises, walking and double toe raises
- Light proprioceptive exercises
- Stretching
Phase 3 (day 6+)
- Full weightbearing
- Modalities
- Continue manual resistive exercises with inversion/eversion added
- Functional exercise
- Double toe raises, double-legged hopping, single toe raises, and single-legged hopping
- Progressive sport-specific drills
- Proprioceptive exercises
- Walk, jog, run, cutting, explosive maneuvers
- ALPII/taping for return*
*Athlete may return to activity when able to complete 15 single-legged hop off toes, has passes functional testing, and is mentally ready to return