Repair and Reconstruction of :
Deltoid ligament/Syndesmotic Ligament/Ankle ligament/Peroneal Tendon
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
Phase I: Weeks 1-2
Goals
- Rest and recovery from surgery
- Control swelling and pain
- Increase ADL (Activities of daily living)
Guidelines
- PWB (partial weight bearing) in cast.
- Sutures removed @ 10 -16 days. AIRcast for another 4 weeks
- Education: surgery, healing time, anatomy, rehab phases
- Encourage ADL
- Rest and elevation to control swelling
- Control pain
- Hip and knee AROM
Phase II: Weeks 3-6
Goals
- Allow healing while maintaining upper body, core, hip/knee strength and ROM
Guidelines
- WB as tolerated with or without crutches in Air Cast Boot
- Massage for swelling
- Elevation to control swelling
- @ 6 weeks:
after being removed from the cast: begin gentle AROM (Active range of motion)ankle PF(plantar flexion)/DF(dorsiflexion)/eversion and toe flexion/extension Stationary bicycle with Air Cast boot - Core exercises
- – Abdominal recruitment
- – Bridging on ball
- – Ball reach
- – Arm pulleys or theraband using diagonal patterns
- Hip: AROM
- – Strength: clam, sidelift, glut max, SLR (straight leg raise)
- Knee: AROM
- – Strength: SLR, theraband press or leg machine
- Stretching: glut max, glut med, piriformis, rectus femoris, hamstrings
Phase III: Weeks 7-10
***WILL BE DETERMINED WITH YOUR PHYSICAL THERAPIST***
Goals
- WB with pain and swelling controlled.
Guidelines
- Will be provided with an ankle brace and can start rehab
- Stationary bicycle
- AROM: – begin inversion/eversion
- – Continue with ankle PF/DF, toe flex/extension
- Continue with
- – Core exercises – progress to standing exercises
- – Hip strength exercises
- – Knee strength exercises
- Manual mobilization to joints not part of ligament reconstruction
Phase IV: Week 11-12
Goals
- Full ROM
Guidelines
- In regular shoe
- Still wearing the ankle brace
- Control swelling +/- pain with elevation or modalities as required
- AROM in WB
- Manual mobilization as required
- Muscle stimulation
- – Intrinsics
- – Invertors/evertors if required
- Gait training
- Continue strengthening core, hips and knees
- Proprioceptive training: single leg stance on even surface
Phase V: Week 13-16
Goals
- Full ROM
- Good single leg balance
- Near full strength lower extremity
Guidelines
- Still to use the ankle brace for certain sport specific activities (ie: basketball)
- Proprioceptive training
- – Single leg stance on even surface with resistance to arms or WB leg
- – Double leg stance on wobble board (wb), Sissel, fitter
- – Single leg wb, Sissel, fitter with resistance to arms or NWB leg
- Strength
- – Toe raises, lunges, squats
- – Hopping, skipping, running @ 14+ weeks
- – Manual mobilizations if required
Phase VI: Week 16+
Goals
- Full functional return to work +/or activity
Guidelines
- Continue to build endurance
- Work specific or activity specific training
- Plyometric training