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General guidelines

Elevate the lower leg on 2-3 pillows for 3-5 days.

X-ray control after reduction confirms the position, but must be repeated after 3-5 days. Redisplacement usually occurs during the early days, as the swelling subsides, and if diagnosed early enough, can often still be corrected non-operatively.

Analgesics and anti-inflammatory drugs should be prescribed, as necessary, during the first few weeks. If analgesia consumption is unexpectedly high, suspect redisplacement, or cast pressure on the skin.

If a cast becomes loose, it should be removed and replaced with a new one. If possible, wait until the fracture has become sticky (+/- 4 weeks) so that the reduction is not lost during the replacement procedure, but check regularly for redisplacement.

Fractures which did not initially have significant displacement are probably relatively stable and are unlikely to displace in a cast if patients take weight through that limb.


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In fractures that required reduction, the plaster cast should not be removed before 9-12 weeks, or before the patient manages to walk pain-free with the cast. In fractures that did not require reduction, the period in the cast can be reduced at the discretion of the surgical decision-maker.

After removal of the cast, rehabilitation should involve dedicated ankle and foot mobilization for a prolonged period. At this stage, it is also advisable to give a non-steroidal anti-inflammatory preparation for several weeks.