* 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


  • 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.