Complex Ankle Fracture with Syndesmotic Injury ORIF: Your Journey from Preparation to Full Recovery
Stop anti-inflammatory medicines, blood thinners and herbal supplements one week before surgery. Avoid smoking/alcohol and prepare your home for several weeks of non-weight-bearing, including securing crutches or a knee scooter and ensuring safe access to bathroom and sleeping areas.
Do not eat or drink after midnight. Wash the operative leg and ankle with antiseptic soap, avoid shaving, remove nail polish/jewelry, and lay out loose-fitting clothing for the next day.
Shower and cleanse the surgical leg again. Wear loose clothing and easy-to-remove footwear, take only surgeon-approved medications with small sips of water, and arrive early for check-in.
After surgery, your leg will be placed in a posterior splint. Keep the ankle elevated above heart level and apply ice to control swelling. Use crutches and do not bear weight on the foot. Keep the splint clean and dry, and perform gentle toe and isometric leg exercises as instructed.
Non-weight bearing for the first 6 weeks with a splint for 2 weeks followed by a removable boot for 4 weeks; you may remove the boot for non-weight-bearing range-of-motion exercises. From weeks 2–4, progress from toe-touch to full weight bearing in the boot. Weeks 4–6 allow full weight bearing in the boot, and weeks 6–8 begin weaning out of the boot into a shoe. After 8 weeks, weight bearing progresses as tolerated with ankle brace support, but high-impact activities are deferred until at least 12–16 weeks.
Continue strict non-weight bearing with crutches. Elevate the foot (“toes above the nose”) and ice frequently to reduce swelling. Do not get the dressing wet. Contact your surgeon for fever, redness or drainage. Your first postoperative appointment is typically at 10–14 days for wound check and to transition into a removable boot.
Follow-up visits are usually scheduled around 2 weeks for suture removal and transition to a boot, at 6 weeks to evaluate healing and begin progressive weight bearing, and at 12 weeks to check X-rays and discuss weaning out of the boot. Additional visits at 4–6 months monitor recovery.
Physical therapy typically starts 2–4 weeks after surgery, focusing on gentle ankle range-of-motion and lower-extremity strengthening. At 6–12 weeks, begin partial weight bearing as tolerated, continue ROM and proprioceptive exercises, and progress to stationary bike, pool exercises and closed-chain strengthening. By 12–16 weeks you may start elliptical, treadmill walking and light circuit training, with continued brace use.
Most patients walk normally by 3–4 months, though swelling may persist and strenuous activity or sports typically wait 6–12 months depending on healing and strength. Complex ankle fractures with syndesmosis injury may require up to a year to fully resolve swelling and achieve pre-injury function.