Quick Questions and Answers
When can I start hydrotherapy after an ankle fracture?
Following surgery, we can sometimes start hydrotherapy from around 3 weeks, provided the wounds have completely healed, there are no complications and your consultant has cleared you. Patients who've been managed without surgery may start around 6 weeks, although this depends on the fracture and weight-bearing instructions.
Can I come into the pool while I'm still wearing a boot?
Yes, in some circumstances. We can work with patients in or out of their protective boot, depending on the fracture, stage of healing and consultant's instructions. If a boot is required in the water, we will use one of ours.
Why is my ankle still so swollen?
Swelling is extremely common following ankle fractures, particularly after surgery or a period of immobilisation. The natural hydrostatic pressure of the water can help reduce swelling while allowing us to work on movement and muscle activation.
Can I damage my ankle by walking on it?
Once your consultant has confirmed that you're allowed to start weight-bearing, progressive loading is an important part of rehabilitation. We need to make sure you're loading the ankle appropriately for your stage of healing, rather than avoiding weight through it because you're frightened of causing damage.
Will hydrotherapy help me get back to sport?
Hydrotherapy can help restore movement, reduce swelling and rebuild strength, balance and confidence. These are important foundations before progressing to running, jumping and changing direction on land.
Why Is My Ankle Still So Swollen After a Fracture?
This is probably one of the most common things we see when patients first come to AquaPhysio following an ankle fracture. They may be three, four or six weeks after their injury, and their ankle is still very swollen. Some patients tell us their ankle looks relatively good first thing in the morning but becomes increasingly swollen as soon as they've been standing or walking.
This can be particularly frustrating because the swelling makes the ankle feel stiff, uncomfortable and difficult to move.
Following a fracture, the body produces an inflammatory response as part of the healing process. Surgery, soft tissue injury and reduced movement can all contribute to swelling, and the ankle is particularly prone to it because of its position at the bottom of the leg. When you're spending long periods sitting or standing, fluid can accumulate around the ankle and foot. If you've also spent several weeks in a boot, the normal muscle activity that helps move fluid back up the leg may have been reduced.
We want to manage this swelling because it can affect how comfortably you move your ankle, activate your muscles and walk.
How Does Hydrostatic Pressure Help Swelling?
One of the biggest advantages of hydrotherapy following an ankle fracture is the natural pressure that water applies to the body.
This is called hydrostatic pressure.
When you're standing in the pool, the water applies pressure around your foot, ankle and leg. This pressure increases with depth and can help encourage fluid to move away from the swollen tissues. We also encourage movement in the water because activating the calf and ankle muscles helps support circulation and the return of fluid from the lower leg.
The combination of hydrostatic pressure, movement and muscle activation can make hydrotherapy particularly useful for patients struggling with persistent swelling. Many patients find their ankle feels less swollen and moves more comfortably following a session, although swelling can return and we still need to manage activity levels outside the pool.
We've explained this in more detail in our article Still Swollen After an Ankle Fracture? How the Pool's Natural Compression Can Help.
Getting Your Ankle Moving Again
The second big challenge we see is stiffness.
Following several weeks in a plaster cast or protective boot, patients often struggle to move their ankle upwards and downwards. Turning the foot in and out may also feel restricted, depending on the fracture and what movements have been permitted.
One movement we're particularly interested in is dorsiflexion, which is when you bring your foot upwards towards your shin.
You need this movement when walking, going downstairs, squatting and eventually running. If your ankle is very stiff, you might notice that you walk with your foot turned outwards, take shorter steps or struggle to move your knee forwards over your toes.
In the pool, we can start working on controlled ankle movement with less weight going through the joint. This might involve gentle ankle movements, stepping, walking and gradually encouraging the ankle to move through a greater range as permitted.
Our pool is kept at approximately 34°C, and patients often find that the warm water makes moving their stiff ankle more comfortable.
We're not trying to force the ankle to move before it's ready. We want to restore movement gradually, taking account of fracture healing, surgical fixation and any restrictions you've been given.
Why Are Patients So Frightened of Putting Weight Through Their Ankle?
Something we see quite regularly is that patients are nervous about walking on their injured ankle, even when they've been told they can start putting weight through it.
This is completely understandable. They've spent several weeks being told to protect the fracture, avoid weight-bearing or keep their boot on, and suddenly they're expected to start walking again.
Patients often ask whether putting weight through the ankle could move the fracture or damage the plates and screws. This is why we think explaining the rehabilitation process is so important. Once your consultant has confirmed that your fracture is ready for progressive loading, we need to help you understand what you're allowed to do and how to build up safely.
Avoiding weight through the ankle for longer than necessary can contribute to ongoing weakness, stiffness and difficulties with walking.
Using Water Depth to Reintroduce Loading
One of the advantages of our specialist pool is that we can change how much weight you're putting through the injured leg by changing the depth of the water.
In deeper water, more of your body weight is supported. As we move into shallower water, your legs gradually take more load. This allows us to work on standing, transferring weight and walking at an appropriate level for your recovery.
For someone who's frightened of putting weight through their ankle, this can be a really useful way to start rebuilding confidence. We can also work with patients who still require a protective boot, where their consultant's instructions and suitable equipment allow.
We've written more about how this works in How Much Weight Really Goes Through the Leg in a Hydrotherapy Pool?
The important thing is that we don't assume the pool makes every movement safe. We still need to respect the weight-bearing restrictions and the stage of fracture healing.
Improving Blood Flow and Muscle Activation
Following an ankle fracture, particularly if you've spent several weeks in a boot, the muscles around your ankle and calf can become noticeably weaker. You may also have spent much less time walking, which means the normal muscle activity that helps support circulation in the lower leg has been reduced.
In the pool, we can introduce ankle movements, walking and gentle strengthening exercises that activate these muscles.
The movement of the ankle and contraction of the calf muscles help support venous return and circulation, while the warm water can encourage local blood flow. We want patients moving appropriately as soon as their injury allows, rather than waiting until they're completely out of their boot before starting rehabilitation.
Of course, improving circulation isn't the same as making the bone heal more quickly. The aim is to make the most of the recovery period by managing swelling, maintaining movement and reducing the effects of immobilisation.
Getting Your Balance Back
One of the things patients often don't realise is how much their balance can change following an ankle fracture. Your ankle contains sensory receptors that provide information about joint position and movement. This is called proprioception, and it's an important part of helping your body respond when you stand, walk or change direction.
After an ankle injury and a period of immobilisation, your balance and ability to control movement may be reduced. You might find standing on your injured leg difficult or feel unsteady when walking on uneven ground.
In the pool, we can practise controlled weight transfers, single-leg standing when permitted and stepping in different directions. We can also use the resistance and movement of the water to challenge balance as patients become stronger and more confident.
This becomes particularly important when we start thinking about returning to sport, where your ankle needs to respond quickly to changes in position and direction.
When Can I Start Hydrotherapy After an Ankle Fracture?
We see patients at different stages following an ankle fracture, and the programme will depend on how the fracture has been managed.
Following Surgery: Sometimes From Around 3 Weeks
For patients who've had their fracture fixed with plates and screws, we can sometimes introduce hydrotherapy from around 3 weeks after surgery, provided the wounds have completely healed, there are no signs of infection and the consultant has cleared them for pool rehabilitation.
Some patients will still be in their protective boot, while others may have permission to remove it for appropriate exercises.
At this stage, we're particularly interested in managing swelling, restoring permitted movement and gradually introducing loading according to the surgeon's instructions.
Non-Operative Fractures: Often Around 6 Weeks
For patients whose fractures have been managed without surgery, we may first see them around 6 weeks, when they've had their follow-up appointment and been advised to start increasing movement or weight-bearing.
These patients can still have considerable swelling and stiffness, particularly if they've spent several weeks in a boot. Hydrotherapy can be a useful way to introduce movement, walking and balance exercises while gradually increasing loading.
There isn't one particular week that's right for everyone. The fracture, healing progress and consultant's instructions will determine when it's appropriate to begin.
From Walking Again to Getting Back to Sport
Once your ankle movement is improving, swelling is becoming more manageable and you're confident putting weight through the leg, we can start working towards more demanding activities.
This is where we begin looking at calf strength, single-leg balance and your ability to tolerate greater loads. Walking normally is an important milestone, but returning to football, tennis, padel or running requires considerably more.
Your ankle needs to cope with repeated impact, pushing off, landing and changing direction. We can introduce appropriate strengthening and more dynamic exercises in the pool before progressing to higher-load activities on land. However, returning to sport isn't simply about reaching a particular number of weeks after your fracture. We need to know that your ankle has sufficient movement, strength and control, and that it responds well as you increase activity.
You can read more about the wider benefits of water-based rehabilitation in What Are the Benefits of Hydrotherapy for Sports Injuries?
The Pool Is Only Part of Your Recovery
At AquaPhysio, we're very clear that hydrotherapy is one part of your rehabilitation.
It's particularly useful during the stages when swelling, stiffness and reduced confidence in loading are making exercises difficult on land. As your recovery progresses, we need to build strength and control under full body weight and prepare you for the demands of your chosen sport.
That's why we work closely with orthopaedic consultants and land-based physiotherapists, including our sister clinics, Wimbledon Physiotherapy & Sports Injury Clinic and Epsom & Ewell Physiotherapy & Sports Injury Clinic.
We want your rehabilitation to be joined up, with a clear plan for progressing from protected movement to walking confidently and eventually returning to sport.
Frequently Asked Questions About Ankle Fracture Rehabilitation
Why is my ankle still swollen 6 weeks after a fracture?
Swelling is very common at this stage, particularly following surgery or several weeks in a boot. Hydrostatic pressure in the pool, gentle movement and muscle activation can help manage swelling, although persistent or worsening symptoms should be assessed.
Can I start hydrotherapy 3 weeks after ankle surgery?
Sometimes, yes. At AquaPhysio, we can consider hydrotherapy from around 3 weeks if your wounds have fully healed, there are no complications and your consultant has cleared you. This will depend on your particular fracture and surgery.
Can I have hydrotherapy while I'm still in my boot?
Potentially. Some patients can begin suitable exercises while still following a boot protocol, provided their consultant agrees and the equipment is suitable for use in water. Others will need to wait until they can safely remove the boot.
Will walking damage the plates and screws in my ankle?
Once your surgeon has cleared you for weight-bearing, progressive loading is generally an important part of rehabilitation. The amount of loading and how quickly it should increase depend on your fracture and fixation, so it's important to follow your specific instructions.
Why is my ankle so stiff after being in a boot?
Immobilisation reduces joint movement and can contribute to stiffness in the surrounding soft tissues. Hydrotherapy allows us to work on permitted movement with reduced loading, helping gradually restore ankle mobility.
How does hydrotherapy help ankle swelling?
The natural hydrostatic pressure of the water applies compression around the ankle and lower leg, which can help encourage fluid return. Movement and muscle activation in the pool can provide additional benefits.
When can I return to football, tennis or running?
This depends on fracture healing, ankle movement, strength, balance and your ability to tolerate impact. We recommend progressing through rehabilitation milestones rather than relying on a fixed timeline.
Broken Your Ankle and Want to Get Back to Sport? Let's Talk.
If you've recently fractured your ankle, are still struggling with swelling and stiffness or are nervous about putting weight through your leg, please get in touch.
At AquaPhysio, we regularly help patients following ankle fractures, both surgical and non-surgical, and understand how frustrating it can be when you're desperate to get moving again. We want you to understand what your ankle is ready for, why certain exercises matter and how we're going to help you progress.
Our specialist hydrotherapy centre in Lower Morden welcomes patients from Wimbledon, Sutton, Epsom, Ewell, New Malden and across Surrey and South West London.
Whether your goal is walking comfortably without your boot, getting back to the gym, running, football, tennis or padel, we'd be delighted to discuss how we can help.
Getting the fracture to heal is the first part of your recovery. Managing swelling, restoring movement and rebuilding confidence in loading are the next steps towards getting back to sport.
Get in touch with AquaPhysio and let's see how we can help you move forward.
Rehabilitation following an ankle fracture varies depending on the injury, surgical treatment and individual recovery. Hydrotherapy should only begin once wounds have healed, any necessary equipment is suitable for pool use and your treating team has confirmed that it is appropriate. New calf pain, marked warmth or redness, sudden swelling or breathlessness requires prompt medical assessment.