Prior to your foot or ankle injury, you may have been running 3-6 miles or going to exercises classes twice per week. Then, you injured your foot and had to wear a CAM walker (boot) for the next 1-3 months.
Hopefully, your doctor referred you to work with a physical therapist for ankle rehab to increase strength, mobility, and reduce pain in your ankle or foot. Now, you may be out of the boot, but you still have questions about what to expect.
How long will it take to have full motion and strength in the ankle? When can you start running again? Why is your ankle still swollen or painful?
How did you end up in a walking boot?
Before we can discuss how long it will take you to recover, let's briefly travel back in time to understand why you ended up in a walking boot?
Here are several injuries that may have put you in a walking boot:
- Fractured ankle
- Fractured 5th metatarsal
- Severe ankle sprain
- Plantar fasciitis
- Peroneal tendonitis
- Ligament reconstruction surgery
- Ankle fusion surgery
- Sesamoid injury
- Os trigonum syndrome
These injuries may have been acquired over time due to repeated strain on the foot such as stress fracture to the base of your 5th metatarsal. Or they may have been the result of a one-time traumatic injury such as a fall.
In many cases, there are underlying factors that may have contributed to these injuries such as tight calf muscles, poor balance, weakness in the calf muscles and hips, poor training methods, or a previous history of injuries.
For example, you may have a history of reoccurring ankle sprains. After an ankle sprain, ligaments stretch out resulting in an increased risk of spraining the ankle again. Severe ankle sprains are often accompanied by a fracture of the fibula, often requiring a boot to heal.
If you are someone who sprains their ankle often, then it becomes vitally important to work on exercises that improve the proprioception and strength of the ankle joint. In simple terms, proprioception is the unconscious detection of movement at the ankle. It helps to keep your ankle from rolling inward or outward when you walk on uneven surfaces or unexpectedly step on something.
Actually, improving proprioception will likely help everyone transitioning out of a boot to minimize arthritis in the ankle joint and potentially lower the risk of another ankle injury.
Ideally, you can recover faster and get back to your normal activities and sports if you improve the underlying factors that caused your injury. For some of you, the injury was unavoidable and there was nothing you could have done to prevent it. However, since your ankle may be stiff and hurting, we still need to find out what exercises, stretches, and strategies you can implement to recover faster.
How long will it take to fully recovery?
The recovery time is based on several factors such as:
- The severity of the injury - Ex. Did you fracture a bone or tear a ligament?
- The length of time you wore a boot - Ex. 1 month vs. 3 months
- The complexity of the surgery - Ex. Were ligaments or muscles repaired?
- Your fitness level before wearing the boot - Ex. Could you run 3 miles?
- Your current fitness level - Ex. Do you get cardiovascular exercise?
- Your body weight - Ex. Higher body weight puts more stress on the ankle
- Your motivation and effort - Ex. Those who are motivated do better
After removal of a walking boot, it usually takes 2-3 months to restore basic function to the foot. In general, people will do one month of physical therapy while wearing the boot to maintain mobility and flexibility. It’s important to keep the leg and hip muscles strong while wearing the boot because muscle atrophy and deconditioning can set in very quickly.
After your doctor clears you to remove the boot, you will typically continue physical therapy for another 2-3 months to restore motion and strength to your foot/ankle.
Once the boot is removed, your doctor may give you weight-bearing precautions such as instructions to walk with 50% body weight on the foot for 2 weeks then transition to using a laced up ankle brace for one month with supportive shoes. You should always listen to your surgeon's guidelines when transitioning out of the boot to avoid another injury.
These precautions are in place to allow for a gradual transition back to your normal activities without aggravating the foot/ankle; however, full recovery can take a year or longer.
Two reasons for delayed healing include chronic pain and inflammation. Chronic pain can develop when the nervous system including the brain, nerve endings, and spinal cord become hypersensitive. Certain movements that were not painful can become painful due to maladaptive changes occurring at a cellular and neurological level.
Unlike other areas of the body, the foot is challenging to rest due to bodyweight placed onto the foot with every step. This could potentially lead to overstimulation of the injured area resulting in pain and inflammation.
Acute inflammation begins right after the initial injury or after surgery. It may persist for 1-2 weeks but eventually, acute inflammation subsides. If inflammation persists then it would be classified as chronic inflammation which can occur due to cellular adaptations at the site of injury and due to physical inactivity.
Curcumin, the active ingredient in turmeric is shown to help reduce pain related to arthritis and inflammation. You can learn more about the optimal dose of turmeric for inflammation here:
What should you expect with rehab after removal of your boot?
As mentioned above, you should expect to complete several months of physical therapy during the early and middle stages of your recovery. During this time, your physical therapist will help you to:
- Increase motion in the ankle joint
- Increase strength of the foot and calf muscles
- Increase strength of your hip and core muscles
- Learn proper foot mechanics when walking
- Improve motion in the big toe
- Transition back to basic activities
During the early stages of physical therapy, time may pass by slowly due to your precautions. There may be limitations on the type of exercises you can do, but this process is normal. The foot/ankle are adjusting to these new exercises and you don’t want to do too much too soon.
Once you are cleared by your doctor, you’ll be able to place full weight onto the foot again. At this point, your rehab exercise will become more challenging and you should feel significant improvements in your function.
If your doctor cleared you to place full weight on the ankle, it may be a month or two before you can get back to running because the foot and ankle needs to increase in bone density.
When wearing a boot, the bones in the foot may decrease in bone density as shown by the X-ray. Therefore, standing and weight bearing exercises like squats and lunges will be helpful to stimulate the small bones in the foot to improve bone density.
Most of your physical therapy visits will be used to restore motion and basic function to your foot and ankle. Due to weakness, pain, or decreased bone density, you may still feel reluctant to return to running, hiking, exercise classes, or other challenging activities you did prior to your surgery.
Once you stop physical therapy, your recovery has not ended. Now, you need to transition back to running and doing all your normal activities without discomfort.
What is your next step after physical therapy ends?
It will be beneficial to start going to the gym again. Strength training will help you build muscle mass in your foot and calf.
After wearing a boot, the calf can atrophy and decrease in size. There is no need to worry because you can increase muscle size with a progressive resistance training.
Although strength training is highly recommended, most people are not certain what exercises they should be doing after a major ankle injury. You may be worried that you will aggravate your pain, injure your tendons, or do the wrong movements.
If this sounds like your situation, it’s a smart decision to being a post-rehab program. A post-rehab program will help you transition back to strength training after an ankle or foot injury.
Traditional strength training exercises will help you get stronger, but you may need accessory exercise and stretches if you continue to have impairments in your foot and ankle.
How long does it take to complete a post-rehab program?
Over several months, a post-rehab program will significant improve your confidence, decrease any fear with working out again, and help you feel strong like you did before your ankle or foot injury.
The entire recovery process may seem like it takes a long time because it does take a while to bounce back from major foot and ankle injuries.
However, investing in the long-term health of your foot will be worth all the effort when you are still enjoying your favorite activities 15 years from now.