* 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.
- 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 or limited by pain.
- Family/caregiver training as needed.
- Relaxation techniques
- Elevation for edema management.
- Non WB for 2 weeks then WBAT.
- AROM toes only
- Cast change Gentle scar massage.
- Edema management.
- Gentle isometric inversion, eversion, dorsiflexion, no plantarflexion
- Usually reach FWB by 4 weeks.
- PTALs may start AROM before 6 weeks at MD discretion.
- AROM: maybe
- Stretch: no
- Resisted: no
- Cast off at 6 weeks. Scar massage. Retrograde massage for edema prn.
- AROM ankle: Gentle, slowly increase power over 6 weeks.
- Light theraband OK at 6 weeks.
- Stationary bike OK with pedal at midfoot until 8 weeks post op then ok to move to forefoot.
- Stretch: OK Start with towel stretch.
- AROM: yes
- Stretch: gentle
- Resisted: gentle
- Progress to standing stretch.
- Progressive resistance OK.
- Eccentric strengthening of calf muscles.
- Progress closed chain, single leg stance exercises.
- AROM: yes
- Stretch: yes
- Resisted: yes
- F/U visit with MD.
- Functional strength/ ROM eval.