Post Operative Physiotherapy
Protocol for Hindfoot Fusions

Ankle, Subtalar, TTC, and Triple Arthrodesis Procedures

Warren Latham MD, FRCSC

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 Birchmount fracture Clinic

Pre-operative gait analysis required

Phase I: Date of Surgery – 6 weeks

Objective: Healing, protection of fusions

Immobilization: Splint; After 2 week follow-up visit IN FRACTURE CLINIC: nwb below knee cast

WB Status: Flatfoot WB for balance only

Phase II: Week 6-8

Objective: Healing, protection of fusions

Immobilization: Removable aircast (foam walker)


Therapy: May be initiated towards the end of this phase, 1-2 x per week with a focus on swelling reduction, pain control, and early return of AROM, home care/exercise instructions for motion, pain/swelling control

SUBTALAR FUSION: Ankle ROM starting 6 weeks post-operatively

Phase III: Week 8-16

Objective: Swelling reduction, increase in ROM, neuromuscular re-education, develop baseline of ankle control/strength

Immobilization: None

WB Status: WBAT, progressive reduction in crutch use, *NOTE – WB status and gait progression determined by physician

Therapy: 1-2 x per week based on patient’s initial presentation, frequency may be reduced as the patient exhibits good recovery and progress towards goals, instructions in home care and exercise to complement clinical care

Phase III: Week 8-16 (cont.)

Rehab Program

Strength: Techniques should begin with isometrics in four directions with progression to resistive band/isotonic strengthening for dorsiflexion and plantarflexion. Due to joint fusions, eversion and inversion strengthening should continue isometrically, bands should progress to heavy resistance as tolerated, swimming and biking allowed as tolerated

Proprioception : May begin with seated BAPS board and progress to standing balance assisted exercises as tolerated

PHASE IV: Week 16-24

Post operative gait analysis

Objective: Functional ROM, good strength, adequate proprioception for stable balance, normalize gait, tolerate full day of ADLs/work, return to reasonable recreational activities

WB status: Full, patient should exhibit normalized gait

Therapy: 1x every 2-4 weeks based on patient status and progression, to be discharged to an independent exercise program once goals are achieved, patient to be instructed in appropriate home exercise program

Rehab Program

Strength: Progression to body weight resistance exercises with goal of ability to perform a single leg heel raise

Proprioception: Patient should be instructed in proprioceptive drills that provide both visual and surface challenges to balance

Agility: cone/stick drills, leg press plyometrics, soft landing drills

Sports: Prior to return to any running or jumping activity the patient must display a normalized gait and have strength to perform repetitive single leg heel raises