This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Specific changes in the program will be made by the physician as appropriate for the individual patient.
****Please fax initial assessment and subsequent progress notes directly to IBJI at 847-234-2090***
REMEMBER: It can take up to a year to make a full recovery, and it is not unusual to have intermittent pains and aches during that time! Swelling may be on-going for 6 months to a year following surgery.
Recovery at a glance:
- No casting during recovery
- Begin moving your ankle up and down (range of motion) out of the boot to prevent your ankle from becoming stiff.
- 2 weeks non-weight bearing in a boot.
- Return to the office at 2 weeks for suture removal.
- Begin heel wedge protocol and protected weight bearing in the boot for 4 weeks.
- Follow up 6 weeks post op. Transition out of the boot and into regular shoe wear. Begin physical therapy.
- You may begin gentle biking and swimming after 6 weeks.
- 12 weeks post-op you may begin elliptical trainer and progress to advanced strengthening
- At 16 weeks post-op you may begin gentle running and higher impact activities.
- Once you can come up and down on your toes (single heel rise) on the surgical side, or you can hop on the surgical foot (single leg hop), you may return to sports and all activities. This may take 6 months to a year.
FOR PHYSCIAL THERAPISTS
Detailed recovery / rehabilitation protocol:
Phase I: Weeks 1-3
- Rest and recovery from surgery
- Control swelling and pain
- Gradual increase of ADL (activities of daily living)
- NWB (non-weight bearing) for 2 weeks. Use knee-walker or crutches for safety all times.
- May rest foot down when standing or sitting
- Begin ankle motion as tolerated
- Hip AROM: lying and standing
- Knee AROM: lying and standing
- Ankle AROM: seated only
- Sutures removed at 14-21 days
Phase II: Weeks 3-6
- Maintain hip and knee ankle ROM
- Improve core, hip and knee strength
- Gradual increase weight bearing with boot at 2 weeks after surgery (as directed by surgeon or staff)
- Progressive weight bearing in walker boot (see heel wedge protocol)
- Transition to regular shoe at 6 wks
- Shower when sutures out and wound healed
- Massage of foot to decrease edema (light massage start from toes and work towards ankle)
- Control swelling with elevation
- Core and whole body exercises and strengthening
- AROM ankle and gentle resistance band strengthening with dorsiflexion limited to first point or resistance
Phase III: Weeks 7-10
- Swelling control with elevation and modalities as required
- AROM at ankle: PF (plantar flexion), inversion/eversion, DF (dorsiflexion) to first point of resistance
- Manual mobilization of foot as required
- Gentle mobilization subtalar joint
- Try to control knee hyperextension (knee hyperextends to compensate for lack of DF at ankle)
Phase IV: Weeks 10-12
- Increase DF and strength
- Regular shoes by 6 weeks as tolerated
- Stationary bicycle: start to add tension
- Sitting: active PF exercises, DF to tolerance
Phase V: Weeks 13-16
- Full weight bearing
- Swelling and pain resolution
- Good proprioception in single leg support
- Theraband: inversion/eversion, DF
- ROM exercises
- Gentle calf stretches
- Manual mobilization as required
- Calf press and leg press
- Proprioceptive exercises
- Single leg support
- Progress to wobble board
- Gait retraining
- Eccentric drops
- Progress to advance dynamic drills 16 + weeks
- hopping – skipping – progress to sport specific drills 16 + weeks
Phase VI: Week 16+
- Full lower extremity strength and maximum function
- Work or sport specific activity
- Work to control arch
- Strength training through running; band work; heel rise
- Progression from double to single heel rise strengthening
Phase VII: Weeks 26
- Return to competitive sport
- Single heel rise and single leg hop intact