Post Operative Physiotherapy
Protocol for Forefoot Reconstruction

Hallux Valgus Correction/Carttva/1st MTP fusion /Forefoot Reconstruction

This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Specific changes in the program will be made by the physician as appropriate for the individual patient.

REMEMBER: It can take up to a year to make a full recovery, and it is not unusual to have intermittent pains and aches during that time!

All Surgeries Require a 2 week follow up at Scarborough GRACE fracture Clinic

Forefoot Surgery Post-op Instructions


  • Use crutches when walking to the bathroom. DO NOT put foot on the floor
  • Use ice machine 3 times a day
  • Take two tablets of Percocet (Oxycodone) every 4 hours
  • Some bleeding through the dressing may occur. This is normal
  • Numbness is normal in the operated limb for up to 24-36 hours.
  • Headaches following epidural analgesia can occur. Lie down with your head
    flat and you may take aspirin. A single cup of coffee can also alleviate this
    spinal headache.
  • Post-operative FEVER or elevation in body temperature is normal for the first
    48 hours. You may take aspirin for this

DAYS 2-10

  • Continue non-weight-bearing on foot using crutches but try and keep the foot elevated at most times
  • You may use heel or outside of foot walking around the house
  • Continue with percocet (oxycodone) one tab every 4-6 hours for four or five days
  • You may take Advil or similar NSAID from day 2 -14
  • You should use ice over the bandage for twenty minutes three times a day for 10 days
  • Do not get wound wet

DAYS 10-14

  • Removal of sutures + wound check
  • X-rays of foot
  • You MAY get a 2nd bunion dressing for swelling
  • You may begin to put some weight on your foot as dictated by Dr Latham
  • Expect the wound to look red and bloody! This is normal


  • Increase the amount of weight through the foot by 10% of your body
    weight per day
  • You may still have to use the post-op shoe to manage swelling
  • You may use a wide shoe (sneaker) as the swelling permits
  • You must keep toe spacer in situ
  • You may shower if wound is well healed


  • F/U appt at Dr. Latham’s office
  • X-rays
  • Begin Physical Therapy
  • You can now be 100% weight-bearing


Physical Therapy Treatment:

• 2-6 weeks:

  • Progressive PWB with crutches on heel predominantly.
  • Daily active and passive ROM: especially abduction/flexion/extension of great toe MPJ
  • Control edema
  • Strengthening and balance exercises to tolerance

• 6-12 weeks:


  • Full ROM (range of motion)
  • Normal gait


  • Wean from boot as tolerated. Full weight bearing into shoe (wide toe box, heels less than one inch)
  • AROM (active range of motion) in all directions:
    • – NWB
    • – WB ROM as tolerated
  • Massage for edema
  • Strengthening
    • Ankle – theraband resisted training in all directions
      • – Progress to WB exercises as tolerated
      • – Inversion/eversion on wobble board
    • Hip – against resistance in standing
    • Knee – wall sits, squats as tolerated
    • Core – activate abdominals
      • – bridging
      • – standing: upper extremity diagonals
      • – use core when on wobble board
  • Gait retraining
  • Manual mobilization if required

*If patient had additional 2-5th ray surgery (for hammertoe or MPJ dislocation),

need to also do PF exercises of the MTP joint (at base, not middle or end of toe)