I am about 10 weeks into the healing of a broken ankle. I want to start a fitness program again but am not sure how to go about it. Before the injury I was doing aerobics 20 minutes three times a week and lifting weights. Now I have lost all the benefits I had from those two activities. I have gained weight and have gotten lazy. The crutches and air splint are gone, but I am still limping. How do I get going safely?

There are two issues we have to deal with here: 1.) rehabilitating the ankle so you are no longer limping, and 2.) getting your fitness program up and running.

Let's deal with the ankle first. Since the air cast is gone, you have to do what you can to increase range of motion in the joint and strengthen both the muscles supporting the ankle and the other lower-leg muscles that have been atrophying during the healing period.

If you're still having some pain and swelling, you should be applying ice regularly (ice massage using a Dixie cup is ideal; simply peel it down as it melts) and do so before beginning the following exercise.

First, flex your toes toward you as far as you can and hold the position for 10 seconds. Then point your toes away from you, extending as far as you can, and hold for 10 seconds. Repeat each 10 times. Finish by writing the alphabet in the air with your toes. (Capital or lowercase letters; the choice is yours.)

If you aren't feeling pain, you should also begin some strengthening exercises. Start with these:

• Towel Bunches (place a towel on the floor and use your toes to bunch up the towel and pull it toward you)
  
• Calf Raises (lift yourself up on your toes so your heels move upward, and then lower yourself down again)
  
• Toe Raises (sitting or standing, lift your toes up off the ground, keeping the rest of your foot stationary)
  
• Inward and Outward Rotation (press the inner and outer edges of your foot against the wall for three-second increments)

Stretch your ankle afterward by standing at arm's length from a wall and leaning toward the wall, keeping your heels down on the floor, and by doing the range-of-motion exercises above. If you're feeling some soreness afterward, ice it.

As far as your overall fitness goes, no matter how far you've fallen, you've got to get started again. Your limiting factor is pain. If it hurts, stop and ice. You'll go longer before it hurts the next day. For lots of reasons, concentrate on cardio work for the first few weeks. If your ankle hurts and you have access to a gym, try out the upper body ergometer (UBE) or the rower. If you're not having pain, get on the bike or start walking (indoors or out); both will help build strength and mobility. If you are walking, stay off of hills and inclines to start, as that will tend to over-stretch the ankle. By the same token, refrain from wearing high heels, which will shorten up the Achilles tendon. Most important of all, continue to stretch the ankle after your workout or after a long day of walking around.

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