Calcaneus Fracture Small Incision ORIF and Percutaneous Fixation

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

RN Pre-Screen for “Red Flag” Patient Referral to PT Pre-Op

PT Pre-Op Visit

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 on surgical foot unless otherwise indicated. Must be able to transfer and walk maintaining precautions.

Examples of Potential Gait Devices

Verbally Review/Educate

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 and edema management.
Avoid excessive elevation; arterial circulation can 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

NWB on surgical foot.
Bed “rest” with leg elevated 8-10 inches*. Up as tolerated.
CAM boot or posterior foot splint.
Exercise training for HEP:
POD 1: Bed exercises for joints above surgical sites. Toe AROM to tolerance.
POD 2: Early AROM ankle, toes.
Up in chair with nursing assist for lunch and dinner not to exceed 1 hour. Limited time with extremity dependent. Keep foot elevated while sitting and during transfer.
Gait training (NWB surgical foot). Family/caregiver training as needed. D/C from hospital.
POD 4-7: Patient to begin early subtalar AROM when surgical incision sealed (clear with M.D.) Begin gentle PROM toes. Continue with previous exercises. *Excessive elevation may increase risk of compartment syndrome; 6-10 inches above heart is sufficient.

NWB on Surgical Foot

Sutures out.
Pt. teaching: Edema control.
Desensitization techniques prn. Beginning scar massage.
Continue with previous exercises for HEP
AROM ankle, STJ, toes, gentle active assist, passive ROM (stretch) toes with MT stabilized. Can swim (but not walk in water) as soon as wound is healed. No aggressive kicking.

NWB on Surgical Foot

X-ray.
Pt. teaching: Scar mobilization.
Continue/reinforce previous exercises for home exercise program. Monitor range of motion.
Home exercise program, strengthening, conditioning uninvolved extremities. *Small incision repair may begin 50% WB as early as 6 weeks post-op. (Extensile ORIF: NWB until 12 weeks).

Doctor Visit

Exercise training for HEP:
Ankle, subtalar, forefoot, toe ROM. OK to use lightweight resistance band .
Ankle, subtalar isometrics.
gentle towel calf stretch
Scar tissue mobilization. Desensitization techniques. Measure range of motion ankle, STJ, toes.
Gait training (ORIF) in CAM boot: Progressive weight bearing over one month- 50lbs for 2 weeks followed by 2 weeks @ 100 lbs until FWB. OK to slow progression if painful.
Wean off assistive device. Wean off CAM walker when comfortably FWB (by 16-17 weeks). Shoe modification if needed.
Begin balance and proprioception training when FWB.
Conditioning: Pool therapy, stationary bike, low impact endurance training. Home exercise program.

Progression of gait.
Ankle, subtalar, forefoot isometric, isotonic strengthening with tubing/theraband resistance (no free weights).
Soft tissue, gentle joint mobilization 5 months:
Advanced balance, proprioceptive work, closed chain exercises. Sample exercises for home exercise program: Progressive stretching. Single leg stance activities. Step-ups, stairs. Foam standing/wobble board/Baps. 6 months:
Ankle, subtalar stretching.
Joint mobilization.
Advanced gait training, maximize quality of gait.
Higher impact activities O.K.
Ankle, STJ strength-endurance training.
Functional LE testing: Timed SLS. SL squat
measure knee angle. SL heel raise
measure distance of heel to floor, count reps. Timed walk.
Assess shoes/orthotics.