* 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 or limited by pain.
• Family/caregiver training as needed.
• Relaxation techniques

Post-op

• Elevation for edema management.
• Non WB for 2 weeks then WBAT.
• AROM toes only

3-6 weeks

• 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

6-12 weeks

• 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

12 weeks

• 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

4-6 months

• F/U visit with MD.
• Functional strength/ ROM eval.