Syndesmosis Repair Protocol


Goals: Wound healing and edema control

Day 1

1. Foot wrapped in ace wrap, and placed in a boot.

2. Elevate above the level of the heart, and take multi-modal pain medication protocol.

3. Expect numbness in leg for 4-72 hours depending on the type of anesthesia used.

Day 7-14 days

1. First follow-up in the office, dressing is changed. Sutures removed when wound healed.

2. Continue to wear boot when not seated at home.

3. Start plantarflexion (downward movement of the foot), dorsiflexion (upward movement

of the foot) motion 4-5x per day out of the boot

4. May shower when sutures are removed but do not submerge in swimming pool, hot tub,

bathtub, lake, ocean.

5. Non-weight bearing.


Goals: Improve AROM, Control edema

2-4 Weeks

1. Initiate physical therapy

2. Edema control

3. Continue active motion exercises

4. Towel curls with toes

5. Standing hamstring curls.

6. Upper body conditioning.

7. Sleep in boot

4-6 Weeks

1. Start scar massage if needed and wound fully healed.

2. Continue AROM and start gentle inversion/eversion

3. Initiate light resistance bands all planes

4. Initiate seated toe and heel raises

5. Non-weightbearing


Goals: Normal ROM. Initiate gait

6-8 Weeks

1. Advance to full weightbearing while in boot.

2. Wean from crutches

3. May start pool activities if available and wound fully healed

4. Advance graduated resistance exercises

5. Advance AROM activities. May initiate AAROM/PROM as needed.

6. Begin proprioception/balance exercises when able to full weight bear

7. Initiate stationary cycling out of boot.

8-12 Weeks

1. Advance proprioception exercises.

2. Wean from boot into ASO

3. Gait training

4. Continue cycle. Initiate elliptical/stair climber as able


Goals: Return to normal recreational/ sporting activities

>12 Weeks

1. Initiate walk to run program.

2. Continue to retrain strength, power, endurance

3. Continue proprioception

4. Plyometric training and full weightlifting.

5. Sport Specific drills

6. Sprints

7. Wean out of ASO

8. Return to sport when functional progression passed.

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