Table 1.
Comprehensive analysis of early vs. Delayed Weight-Bearing following ankle fracture surgery
| Author, Year | Study Design | Sample Size (n) | Fracture Type | Intervention Group (Early) | Control Group (Delayed) | Functional Outcomes | Range of Motion | Complications | Return to Work/Activities | Key Findings |
|---|---|---|---|---|---|---|---|---|---|---|
| Jansen et al., [24], 2018 | RCT | 50 | Weber B/C | Active ankle motion device (Camoped©) starting 2–5 days post-op | Standard PT, NWB for 6 weeks | VAS FA at 12w: 77.7 ± 13.8 vs. 61.4 ± 16.3 (p < 0.01) < br > AOFAS at 12w: 87.5 ± 7.9 vs. 75.2 ± 11.7 (p < 0.01) | Total ROM at 6w: 49°±11.1° vs. 41.3°±8.1° (p < 0.05) | No major complications in either group | RTW: 10.5w vs. 14.7w | Early ankle motion significantly improved functional scores and ROM, with earlier return to work |
| Merkle et al., [25], 2025 | RCT | 84 | Weber B/C | Early PWB (15–30 kg) with biofeedback-controlled insole | Standard PWB without biofeedback | No significant difference in FAOS/KOOS scores at 6 weeks | Not measured | Minor wound complications: 9.5% vs. 11.8% (NS) | Not reported | Biofeedback increased orthosis wearing time (57.4% vs. 29.1%) and weight-bearing compliance |
| Buker et al. [26], 2019 | Cohort | 108 | Isolated ankle fractures | Supervised exercise with WB at two weeks | Home exercise with standard WB | AOFAS at 27 m: 76.63 ± 17.46 vs. 83.75 ± 15.15 (p = 0.036) | Dorsiflexion: 11.29 ± 8.89° vs. 14.40 ± 7.80° (NS) | Not reported | 3 months for both groups | The supervised exercise group had higher satisfaction scores despite lower AOFAS scores |
| Matthews [27], 2020 | RCT | 157 | Weber B | Early motion and directed exercise after 2 weeks, NWB for 6 weeks | Cast immobilization for 6 weeks | OMAS at 12w: 62.0 ± 20.88 vs. 48.8 ± 22.52 (p < 0.001) | At 6 weeks: significantly better in early motion group (p < 0.001) | No significant differences between groups | Not specifically reported | Early motion significantly improved functional outcomes with no increase in complications |
| Bretherton et al., [28], 2024 | RCT | 561 | Mixed ankle fractures | Unrestricted WB from 2 weeks post-op | NWB for 6 weeks post-op | OMAS at 4 m: 65.9 ± 22.2 vs. 61.2 ± 22.8 (p = 0.024) | Not reported | Complications: 16% vs. 14% (NS) < br > Reoperation: 8% vs. 6% (NS) | Earlier return to activities (qualitative) | Early WB improved early function without increased complications; differences diminished at 12 months |
| Dehghan et al. [29], 2016 | RCT | 110 | Mixed ankle fractures | Immediate WB as tolerated in orthotic boot | NWB for 6w | OMAS at 6w: 45±? vs. 32±? (p = 0.0007) | ROM at 6w: 41° vs. 29° (p < 0.0001) | Superficial infection: 4 vs. 3 (NS) < br > Reoperation: 2% vs. 19% (p = 0.005) | RTW: 51.2d vs. 47.8d (NS) | Early WB improved ROM and function with significantly lower reoperation rates |
| Schubert et al. [30], 2020 | RCT | 50 | Mixed ankle fractures | WB from 2 weeks post-op in CAM boot | NWB for 6w | OMAS at 6w: 36 ± 19 vs. 27 ± 13 (p = 0.05) < br > OMAS at 12w: 65 ± 18 vs. 66 ± 19 (NS) | At 12 weeks: No significant difference | Wound complications: 1 vs. 0 < br > DVT: 3 vs. 1 (NS) | Not reported | Early WB showed a trend toward better early functional outcomes without increased complications |
| Henkelmann et al. [31], 2020 | RCT | 73 | Mixed ankle/tibial plateau | Anti-gravity treadmill (20 kg) immediately post-op | Standard rehab with 20 kg PWB | FAOS/KOOS at 6w: 52.5 ± 18.3 vs. 47.6 ± 17.7 (NS) | Not measured | Minor complications: EWB 4 vs. DWB 4 | Not reported | Anti-gravity treadmill training did not significantly improve outcomes compared to standard rehab |
| Zyskowski et al. [32], 2021 | RCT | 52 | Weber B | Full WB at 3w in medical boot | NWB for 6w | OMAS at 6w: 56.05 ± 12 vs. 45.22 ± 18 (p = 0.02) < br > OMAS at 12w: 69.47 ± 14 vs. 59.79 ± 16 (p = 0.04) | DF at 6w: 8 ± 3° vs. 5 ± 2° (p < 0.05) < br > PF at 6w: 17 ± 4° vs. 15 ± 4° (NS) | Minor: 10% vs. 16%< br > Major: 5% vs. 8% (NS) | Not reported | Early WB significantly improved functional outcomes and ROM without increased complications |
| Chen et al., [33], 2024 | RCT | 52 | Lauge-Hansen PER III/IV | Standing bed + anti-gravity treadmill | Standard rehabilitation | AOFAS at 8w: 91.46 ± 6.09 vs. 75.73 ± 6.49 (p < 0.001) | DF at 8w: 17.61 ± 4.72° vs. 13.73 ± 5.36° (p < 0.05) < br > PF at 8w: 39.35 ± 5.86° vs. 32.35 ± 5.83° (p < 0.05) | No significant complications in either group | Not reported | Combined standing bed and anti-gravity treadmill significantly improved function and ROM |
| Baji et al., [34], 2024 | RCT | 243 | Not specified | Removable boot with WB as tolerated for 2 weeks | Cast immobilization for 6 weeks | OMAS change at 12w: 39.7 vs. 35.5 (NS) | Not objectively measured | Wound complications: slightly higher in boot group (7% vs. lower) | No difference | No significant functional differences, but better patient satisfaction and cost-effectiveness in the boot group |
| Smeeing et al., [35], 2020 | RCT | 115 | SE II-IV ankle fractures | 3 groups: UNWB, PWB, UWB | Comparison of 3 protocols | OMAS at 6w: UWB 61.2 ± 19.0 vs. PWB 51.8 ± 20.4 vs. UNWB 45.8 ± 22.4 (p = 0.011) < br > OMAS at 12w: No significant differences | Not reported | No significant differences between groups | RTW: UWB 4.1 ± 3.3w vs. PWB 5.7 ± 4.9w vs. UNWB 7.0 ± 5.3w (p = 0.028) < br > RTS: UWB 8.9 ± 4.7w vs. PWB 12.7 ± 8.4w vs. UNWB 14.1 ± 5.7w (p = 0.005) | Unprotected WB showed significantly better early functional outcomes and earlier return to work/sports |
RCT: Randomized Controlled Trial; WB: Weight-Bearing; PWB: Partial Weight-Bearing; NWB: Non-Weight-Bearing; UNWB: Unprotected Non-Weight-Bearing; UWB: Unprotected Weight-Bearing; ROM: Range of Motion; DF: Dorsiflexion; PF: Plantarflexion; OMAS: Olerud-Molander Ankle Score; AOFAS: American Orthopaedic Foot and Ankle Society score; VAS FA: Visual Analog Scale Foot and Ankle; FAOS: Foot and Ankle Outcome Score; KOOS: Knee Injury and Osteoarthritis Outcome Score; RTW: Return to Work; RTS: Return to Sport; NS: Not Significant; PER: Pronation-External Rotation; SE: Supination-External Rotation