Intermediate Ankle and Foot Acute Injury Rehabilitation

Pain at rest < 2/10 on VAS scale,Ankle swelling reduced by 25% from initial assessment,ATFL and CFL integrity confirmed via stress testing,Weight-bearing as tolerated with assistive device,Plantar fascia tenderness < 3/10 on palpation,Peroneal tendon provocation test negative

→ Advance to: Early Motion (Week 2)

Pain with walking < 3/10,Active ankle dorsiflexion ≥ 5° beyond neutral,Active ankle plantarflexion ≥ 15°,No increase in Achilles tendon pain with gentle stretching,Peroneal tendon resistance test grade 4/5 or greater,Weight-bearing without assistive device in controlled environment

→ Advance to: Early Strengthening (Week 4)

Single-leg stance ≥ 30 seconds without compensation,Calf raise tolerance without increased Achilles pain,Plantar fascia stretching tolerance without pain flare,Eccentric loading of Achilles tolerated at low load (< 50% body weight),Peroneal eversion strength ≥ 4/5,Ankle proprioception: joint position sense error < 5°

→ Advance to: Intermediate Strengthening (Week 6)

Single-leg heel raise ≥ 10 repetitions,Eccentric Achilles loading at 70% body weight without pain,Functional balance testing: STAR Excursion Balance > 95% limb symmetry,CFL stress test negative for laxity,Running progression initiated at 50% speed, 10 minutes maximum,Plantar fascia night splinting initiated

→ Advance to: Advanced Strengthening (Week 9)

Running progression: 80% speed, 20 minutes continuous,Single-leg hop test > 90% limb symmetry,Achilles tendon load tolerance: eccentric loading at 100% body weight,PTFL stress test negative,Plantar fascia pain < 1/10 with daily activities,Peroneal tendon strength ≥ 5/5 on resisted eversion

→ Advance to: Sport-Specific Training (Week 12)

Figure-8 running at full speed without pain,Cutting maneuvers tolerated without ankle instability,Agility drills: 45° and 90° cuts completed,Plantar fascia loading: return to running footwear without pain,Achilles tendon: isokinetic plantarflexion peak torque > 90% contralateral side,Return to sport training: contact drills tolerated

→ Advance to: Return to Sport (Week 16)

Full training participation without restrictions,Single-leg hop test > 95% limb symmetry,Ankle instability episodes: zero in past 4 weeks,Achilles tendon: full eccentric loading program completed,Plantar fascia: pain-free full weight-bearing activities,Peroneal tendon: no pain with eversion under resistance

→ Advance to: Maintenance (Week 18)

Full competitive match/play tolerance,Isokinetic testing: eversion/inversion ratio 1:1.5 normal,Landing mechanics: valgus collapse < 15°,Fatigue-related performance maintained at 90%,Patient subjective outcome: 85% or greater on ankle outcome score,No recurrent swelling post-activity

→ Advance to: Discharge (Week 22)

Patient discharge criteria met: full return to prior activity level,Ankle outcome score > 90%,No compensatory gait patterns,Home exercise program compliance demonstrated,Prevention program: calf strengthening and proprioception 3x/week,Patient education on footwear and training load management completed

→ Advance to: Complete