Bumping cause I'm recovering from ORIF surgery for a Grade III ankle sprain/syndesmosis injury and the dorisflexion (DF) in my left foot is quite limited, but it has improved fairly quickly.
I had a Maisonneuve fracture on 10/20/16 and my ankle was immobilized completely from 10/20/16 to 11/15/16 (a Maisonneuve fracture is complete disruption of the ankle syndesmosis ligaments with a concomitant proximal fibula fracture). The fibula fracture healed quickly with nothing significant to report and in any case is not relevant to the ankle discussion here.
On 11/15 I was put into a walking boot and encouraged to begin range of motion (ROM) exercises on my own. That ankle was LOCKED, I could only move my toes. I did ankle pumps, circles, and the "alphabet" drill as best as I could while lying on the couch RICEing. Not much improvement from that.
On 12/15/16 I was given the go ahead to weight bear as tolerated (WBAT) and started gingerly walking on the boot using two crutches. On 12/20 I went to my first PT session and received solid advice on a home exercise program (HEP) using resistance bands. I do those exercises twice a day, in addition to the range of motion exercises described above. The PT sessions are (still going to them) pool therapy 2x a week and a gym session 1x a week.
On 12/21 I was down to one crutch and on 12/23 I shitcanned the crutches entirely, walking slowly on the boot but being sure to walk with as normal of a gait as possible and not trying to compensate for the boot. By Christmas I was going up and down stairs almost normally (bringing the trailing foot to the next step rather than putting it next to the other foot if that makes sense). DF and plantarflextion (PF) were still severely limited by the boot so it still wasn't quite a normal gait and when walking without the boot at home I had to shorten my steps to accommodate for the lack of DF/PF.
On 12/27 I began getting scar a tissue massage, and this is one of the things that I believe jump-started the flexion improvement. The day after the massage I noticed swelling was down and DF was a bit better, especially in the pool therapy session when my bodyweight was less of a load.
On 12/30 (after 2x massage, 4x pool sessions, 2x gym sessions, HEP 2x/day) I said fuck it and wanted to try using normal shoes. I taped the shit out of my ankle, put on a compression sock followed by a thick wool sock and stuck all that into a high, fairly rigid hiking boot. I had originally planned to take it easy and stay in the boot until followup on 1/12/17, but I really believe that the continued boot immobilization was contributing to the delay in regaining ROM. I walked around doing errands and stuff normally, my ankle was sore at the end of the day but not painful. I RICEd before going to bed, and did the same thing the next day.
After 72 hours of tape+socks+hiking boot+normal activity the swelling has noticeably reduced, DF/PF are waaaaaay better and I have a more positive outlook since I can go about things (almost) normally. I really believe getting the ankle back into DF/PF through walking while protecting the ankle from lateral movement via the tape and boots was instrumental in the heightened recovery. I still can't run nor jog (I haven't tried but I can tell that's a no go for right now) but my gait is becoming more normal. I have upped the icing throughout the day to keep any swelling at bay but there's no pain, just soreness.
I plan to continue PT and HEP as much as possible, there's still a lot of improvement to go. I was curious about why protected movement seemed to help recovery versus RICE to infinity and came across
this study regarding aggressive syndesmosis rehab in Division I athletes. Basically the patients were kept immobilized until 1 week post-op, at which time there were put into a boot and given the go-ahead to WBAT. Return to sports was 8 weeks median time, I believe.
Now granted these were high-level athletes and followup reporting on them is limited to a median of 34 months (I think) but it makes sense to me that if a patient is athletic, not overweight, has a healthy diet/supplementation history, and isn't a smoker the body is capable of healing very fast. Not to 100% return to sports very fast, but capable of independent normal daily tasks.
If anyone else has any experience dealing with/treating Grade III ankle sprains/syndesmosis injuries I would love to hear about it. Thanks.