This is a standard program; any unusual circumstances noted by MD or therapist should be clarified and protocol modified as warranted.

Pre-op Assessment

NWB on fractured foot.

  • Assess current level of function (ADLs/Mobility), ability to manage post-op restrictions, use of assistive devices.
  • Screen PMH, condition of UEs and contralateral LE
  • Home Environment: Modifications needed, assistance available, SNF or HH needs.
  • Teach post-op mobility restrictions.
  • Gait training: NWB/TDWB* (10-15 lbs max) on surgical foot unless otherwise indicated. Must be able to transfer and walk maintaining precautions.

Examples of potential gait devices:

  • Crutches, walker, wheelchair, knee scooter,
  • “Peg-leg”.
  • Patient to obtain equipment and bring to hospital.
  • General post-op exercise program: ROM, strengthening for UEs, uninvolved leg; AROM/Isometrics gluts, hip, knee, toes of surgical leg unless contraindicated by procedure or condition.

Relaxation techniques, edema management:

  • Avoid excessive elevation; arterial circulation may be compromised leading to compartment syndrome. 6-10 inches above heart (1-2 pillows) is sufficient.

Family/Caregiver training as needed.


NWB on surgical foot.

  • Bed exercise with leg elevated 8-10 inches until 2rd post-op day.
  • Foot in posterior foot splint.
  • POD 1: Bed exercises for joints above surgical sites. Toe AROM to tolerance.
  • POD 2-3: Gait: NWB affected leg. May be up in chair for limited time at MD discretion. Keep foot elevated while sitting. Limit time with extremity dependent
  • POD 4: Early ankle AROM.
  • POD 7: Gentle sub-talar AROM when surgical incision sealed (clear with M.D.) Gentle PROM/AAROM toes
  • Stretch into dorsiflexion at MTPs with MTs stabilized.
  • Family/caregiver training as needed.

Sample exercises for home program:

  • Ankle pumps
  • Alphabets
  • Figure eights, inv/ev.

3-6 weeks

NWB on surgical foot.

3 week MD visit:
  • Sutures out.
  • Pt. teaching: Edema control. Desensitization techniques prn. Gentle scar massage.
  • Measure range of motion.
  • Continue HEP with hip, knee, UE exercises and isometrics/general body strengthening and conditioning.
  • Continue early AROM ankle, STJ, toes. PROM/AAROM forefoot/ toes.
  • NWB until at least 12 weeks post-op.

6-12 weeks

NWB on surgical foot.

6-7 week MD visit:
  • X-ray.
  • Pt. teaching: Scar mobilization. Jobst stocking.
  • Continue/reinforce H.E.P. AROM ankle, STJ, toes.
  • AAROM/PROM forefoot, toes. Measure range of motion.
  • Continue NWB gait, foot in posterior splint.
  • Home exercise program, strengthening, conditioning uninvolved extremities.
  • Swimming OK but not walking in water. No aggressive kicking.

12 weeks

Progressive WB begins.

13 week MD visit.
  • Ankle, subtalar, forefoot, toe AAROM (gentle stretch) and isometrics. OK to use light weight resistance band.
  • Scar tissue mobilization. Desensitization techniques.
  • Gait training: Gradual increase in weight bearing (in shoe) starting at 20lbs, increase 20 lbs every 2-3 days over 1 month period to FWB. Joint depression type calc. fracture may hold at 40 lbs for 1 month before progressing.
  • OK to slow progression if painful. Over the counter orthotic (Spenco, Superfeet) may be helpful.
  • Begin balance and proprioceptive training.
  • Wean off assistive device when comfortably FWB with good gait pattern (by 16-17 weeks). Shoe modification if needed.
  • Home exercise program.
  • Conditioning: Pool therapy, stationary bike, low impact endurance training. Home exercise program.

4-6 months

4 months:

  • Progression of gait, advanced balance and proprioception activities.
  • Ankle, subtalar isometric, isotonic strengthening with tubing/elastic band resistance (no free weights).
  • Soft tissue mobilization

Sample exercises for home exercise program:

  • Progressive calf stretching.
  • Progressive strengthening using elastic band.
  • Single leg stance activities.
  • Step-ups, stairs.
  • Foam standing/ wobble board/Baps.

6 months:

  • Ankle, subtalar stretching.
  • Joint mobilization.
  • Advanced balance & gait training, maximize quality of gait.
  • Higher impact activities O.K.
  • Ankle, STJ, strength-endurance training.
  • Functional assessment: e.g. Timed single leg stance balance and reach, heel raise, squats, step ups.
  • Assess shoes/orthotics.