* NOT usually done in isolation – Always default to the most restrictive protocol*

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

Pre-op Assessment

  • Patient goals
  • Screen medical/mobility history.
  • Current level of function: ADLS, mobility, measure range of motion
  • Home environment: Equipment/ Modifications needed. (Patient to obtain)
  • Assistance available?
  • Home health PT eval. needed?

Train home exercise program for after surgery:

  • General exercise program: AROM hip, knee and toes; quad/glut sets; U.E. exercises.
  • Instruction in exercises specific to particular surgery: no activation of gastroc-soleus until 6 weeks post-op, no progressive resistance until 12 weeks post-op)
  • Gait training with device-Will either be NWB at lest 2 weeks, limited by pain.
  • Family/caregiver training as needed.
  • Relaxation techniques


Cast in neutral for 6-8 weeks. NWB for 2 weeks, then WBAT Elevation for edema management.

3-6 weeks

  • Cast change.
  • Gentle isometric inversion, eversion, dorsiflexion, no active plantarflexion.
  • AROM: no
  • Stretch: no
  • Resisted: no

6-12 weeks

  • Cast off at 6-8 weeks (want to be FWB for 2 weeks before cast removed).
  • Scar massage.
  • Retrograde massage for edema management prn.
  • May be in a CAM boot.
  • AROM ankle: Gentle, increase over 6 weeks.
  • Light theraband OK at 10 weeks.
  • Stationary bike OK
  • AROM: yes
  • Stretch: no
  • Resisted: no

12 weeks

  • Stretch: OK
  • Start with towel stretch progress to standing stretch.
  • Gradual progressive resistance OK.
  • 16 weeks: Eccentric strengthening of calf muscles.
  • Closed chain, single leg stance exercises.
  • AROM: yes
  • Stretch: yes (gradual)
  • Resisted: yes (gradual)

4-6 months

  • F/U visit with M.D. Functional strength ROM eval.