Recovery from ankle fracture surgery can be difficult, with 20% of patients having ongoing restrictions 6 months after the injury. In this study, the authors randomized 157 patients with fixed Weber B ankle fractures. Patients were randomized to an early motion and directed exercise (EMADE) physiotherapy program versus usual care in a plaster cast. Outcomes were measured at 12 weeks, and were as follows: Olerud-Molander ankle score (OMAS) and EuroQol 5 Dimensions 5 Levels (EQ-5D-5L). Of 130 patients analyzed, mean OMAS score significantly favoured EMADE group. There were no adverse events. Overall, EMADE may represent a preferred option in post-surgery rehabilitation after ankle fracture fixation.