Table 2 Detailed treatment protocol

1

▪ Pain at rest

▪ Reduction of pain and swelling

▪ Swelling and hematoma

▪ Improvement of perfusion

▪ NSARDs

▪ Pain during weight bearing

▪ Partial weight bearing

▪ Pain-dependent weight bearing +/- crutches

▪ Pain-dependent mobilization of the foot

▪ No tape or brace (due to swelling)

2

▪ Foot can actively be put into neutral position

▪ Restoring function

▪ NSARDs

Frequency 10Hz / 16 Hz

▪ Reduction of swelling

▪ Restoring full weight bearing

▪ Pain-dependent weight bearing +/- crutches

Amplitude: s. below

▪ Partial weight bearing without complete heel-to-toe movement

▪ Arch of foot / leg axis

Duration: 5min

▪ Possible fear of movement

▪ Training of symmetrical gait and regular foot strike

Exercises, vibration:

▪ Exercises to improve ROM, active stabilization, coordination and regular walking pattern

 ▪ Gymnastic ball, feet parallel to mark 1 or 2, patient rolls forth and back, in order to Flex/Ext. in the upper ankle joint

▪ Brace

 ▪ Gymnastic ball, injured foot placed transverse on the WBV platform (ankle in-between mark 0 and 1), patient rolls forth and back, in order to flex/extent in the upper ankle joint

Exercises, general:

 ▪ Pain dependent weight bearing +/- Crutches

 ▪ Walking motion training

3

▪ Residual hematoma

▪ Improving muscular strength, and active/ functional ankle stability, and ROM

▪ Information on preventive measures (Brace)

Frequency: >10Hz, 18-24Hz

▪ Normal heal-to-toe movement

▪ Training regular walking pattern and climbing stairs

▪ Exercises to improve balance, ROM, muscle strength, walking pattern, running and climbing the stairs

Amplitude: 1-2,5mm

▪ Pain and fear of movement under load

▪ Dynamic stability: stepwise increase of training intensity; switching from static to dynamic exercises

Duration: 3 Sets a 3 Min with 2 Min break each

▪ Guidance for home training

Exercises, vibration:

 1) Dynamic squatting (warm-up)

 2) Dynamic squatting (increasing depth)

 3) Two leg stance with slightly bend knees, slow weight transfer (right ←→ left)

 4) One-leg squatting, transverse to WBV plate +/- support of the non-injured leg

Exercises, general:

 ▪ Guidance for home training

4

▪ No hematoma

▪ Improvement of resistance during walking, running, climbing stairs

▪ Exercises to improve coordination (skipping, jumping, …)

Frequency: >10Hz, 18-24Hz

▪ Dorsal flexion possible

▪ Improvement of work/sports specific tasks

▪ Stepwise load increase and switching from static to dynamic / from simple to complex / from cyclic to non-cyclic exercises

Amplitude: 2-3mm

▪ No more pain or fear of movement during sports

▪ Guidance for home training

Duration: 3 Sets a 3 Min with 2 Min break each

Exercises, vibration:

 1) Dynamic squatting (warm-up)

 2) Side-skipping with flexed knees

 3) Calf raises

 4) Vibration on a tilted surface, elevated leg = uninjured leg

 5) Static squats (45° / 90°); Frequency 18+, Amplitude 2+

Exercises, general:

 ▪ Guidance for home training