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 following surgery.

FOR PATIENTS
Recovery at a glance:

  • Come out of the boot and immediately begin moving your ankle up and down (range of motion) to prevent your ankle from getting stiff.
  • 2 weeks non-weight bearing in boot, followed by 4 weeks of protected weight bearing in the boot
  • Physical therapy to start 2 weeks post op
  • At 6 to 8 weeks post-op, slowly transition to regular shoe wear
  • Wear CAM boot sleeping until 2-4 weeks post op
  • You may begin driving at 6-8 weeks if surgery on right foot, automatic transmission only for left post op
  • Use a lace up ankle brace for any cutting sports or uneven surfaces for 6 months following surgery
  • At 8 to 12 weeks post-op you may begin swimming and gently begin an elliptical trainer; progress to advanced strengthening as tolerated
  • 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.

FOR PHYSICAL THERAPISTS
Phase I: Weeks 1-2

Goals

  • Rest and recovery from surgery
  • Control swelling and pain
  • Incision care-keep clean and dry. Shower boot or saran wrap with showers until closed. If concern of wound, please take a picture and call Dr. Vora’s office.
  • Increase ADL (Activities of daily living)

Guidelines

  • Non weight bearing in boot 2 wks
  • Sutures removed @ 14 to 21 days
  • Back into a CAM boot for another 2-4 weeks
  • Can get out of the boot to shower, but should also start active ROM
  • Stationary bike, walk, use elliptical trainer etc in the boot
  • Rest and elevation to control swelling
  • Control pain

Phase II: Weeks 2-6 
Goals

  • Allow healing while maintaining upper body, core, hip/knee strength and ROM and ankle strengthening

Guidelines

  • WB as tolerated without crutches in Air Cast Boot
  • Massage for swelling
  • Elevation to control swelling
  • At 2 weeks: after being removed from the cast: begin gentle AROM (Active range of motion) ankle PF(plantar flexion)/DF(dorsiflexion)/eversion and toe flexion/extension
  • Can bike, walk, use elliptical trainer etc in the boot
  • At 6 weeks after surgery can proceed with these activities without the boot
  • Core exercises – abdominal recruitment – bridging on ball – ball reach – arm pulleys or theraband using diagonal patterns

• Hip: AROM – strength: clam, sidelift, glut max, SLR (straight leg raise)
• Knee: AROM – strength: SLR, theraband press or leg machine
• Stretching: glut max, glut med, piriformis, rectus femoris, hamstrings

Phase III: Weeks 7-10
***WILL BE DETERMINED WITH YOUR PHYSICAL THERAPIST***
Goals

  • All and any activity with pain and swelling controlled

Guidelines

  • Regular shoe gear
  • Will be provided with an ankle brace and can start full rehab
  • Stationary bicycle
  • AROM: – begin inversion/eversion
  • Continue with ankle PF/DF, toe flex/extension
  • Continue with core exercises – progress to standing exercises ◦ hip strength exercises ◦ knee strength exercises
  • Manual mobilization to joints not part of ligament reconstruction
  • Proprioception activities
  • Gait training

Phase IV: Week 8-9
Goals

  • Full ROM in WB
  • Good single leg balance
  • Near full strength lower extremity

Guidelines

  • Use the ankle brace for certain sport specific activities involving side to side activity or cutting (ie: basketball; tennis)
  • Proprioceptive training
  • Single leg stance on even surface with resistance to arms or WB leg – double leg stance on wobble board (wb), Sissel, fitter – single leg wb, Sissel, fitter with resistance to arms or NWB leg
  • Strength – toe raises, lunges, squats – hopping, skipping, running @ 14+ weeks – manual mobilizations if required

Phase VI: Week 10+ 
Goals

  • Full functional return to work +/or activity

Guidelines

  • Continue to build endurance
  • Work specific or activity specific training
  • Plyometric training

Request an Appointment with Dr. Vora