Update on my Weak Ankles post
As a PT, I am not always the best at doing what I tell others to do. And after that ankle fracture, I was not the best at wearing the boot all the time, or initially doing my rehab as I should.
But as my JMT hike loomed ever closer (August 2014) I started to panic and did so much to try to rehabilitate my very unstable ankle – to not much avail. But stubborn as I can be, I went on my hike anyway.
I spent a good 5-10 days in near misery: every time I would try to step on a rock with only my forefoot for support, my ankle would collapse – and more than once so did I. I fell so many times during that first week or so I nearly broke my new tripod. And my pride……
But then something amazing happened: I stopped falling. I started being able to support my weight with my forefoot balancing precariously on a pointy rock. I started going faster downhill. And it didn’t hurt.
So what happened?
Despite literally MONTHS of aggressive PT trying to improve both my ankle strength (from being immobilized in the boot for 2 months) and my proprioception, I really wasn’t in hiking form. But the intensity of 15-mile days through the rocky high Sierra was the perfect rehab! I came away from that trip with a nearly perfect foot and ankle – yes, I’m still a lot slower on the descents than I used to be – but I’m back to running and hiking with only the slightest hint than I ever had an injury, let alone one as severe as a fracturing 2 bones and dislocating my mid-foot (all treated non-surgically, too).
My takeaway from all this as both a PT and as a hiker is the importance of proprioceptive training in the rehab of an ankle injury (and likely any injury of the lower extremity). All the strengthening I did all summer long, including plyometric jumps and hops, were nothing compared to those first 10 days on the trail.
So once you are stable enough after an ankle injury (meaning no more swelling, able to walk without limping), then go for a hike. A nice, slow hike in the most minimal shoes you can be comfortable in, staring at your feet, maybe even use trekking poles…just get out there and hike. But do it slowly (I don’t actually recommend running right out and hiking 221 miles in the Sierra Nevada), gradually increase how fast you walk OR how long/far – never both at the same time – and just hike.
backpackerPT
backpackerPT 
Cool! Found your posts from last year…and thought you got busy and weren’t coming back. My wife and I are heading to Patagonia to hike Torres del Paine. I’m trying top get an ankle injured in a very nasty sprain a year ago ready. Your observations are encouraging, since just gettng out there and putting it through it’s paces is a pleasant way to rehab it. Thx for sharing!