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Background: Blood flow restriction (BFR) training offers a way to improve muscular strength without overloading healing tissue or bone. Ankle fractures can result in pain, stiffness, and strength reduction leading to altered mechanics of the talocrural joint during gait. When an ankle fracture occurs an individual's gastrocnemius strength decreases. Calf strength allows for functional walking during activities. BFR applies an external pressure to partially occlude the arterial inflow and fully restrict venous outflow of that working musculature. This restriction causes hypoxia, increased blood pooling and an increase in pressure beneath the cuff which further disrupts blood flow. BFR is a training method to perform exercises with reduced blood flow to enhance muscular hypertrophy earlier in the rehabilitation process. Thus, the purpose of this case report is to highlight BFR training to improve strength earlier in the rehabilitation stages. Case Description: The patient is a 34-year-old woman suffering from a tibial pilons fracture. She underwent surgery to stabilize the fracture, but was left with decreased motion and strength, swelling, and pain. Intervention: Physical therapy focused on increasing range of motion, strength, incorporating balance, while transferring those skills into functional tasks. By the end of my time with the patient, she was able to perform 25 heel raises, have a functional gait pattern with increased ankle range of motion, and demonstrate improved functional strength. Outcome Measures: There were multiple outcome measures utilized to assess patient progress. These measures included: open and closed chain range of motion measurements, manual muscle testing, unilateral heels raise, unilateral squats gravity eliminated, and step ups. Discussion: This case report demonstrates an example of positive outcomes following BFR strengthening after a fracture.