* 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
Pot-op
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.
