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.
All Surgeries Require a 2 week follow up at Scarborough Birchmount fracture Clinic
Phase I: Date of Surgery – 6 weeks
Objective: Healing, protection of joint replacement
Immobilization: Cast, splint; After 2 week follow-up visit: removable boot
WB Status: Partial weight bearing
Phase II: Week 6-8
Objective: Healing, protection of joint replacement
Immobilization: Use of removable walker boot as needed
WB Status: Weight bearing
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
Phase III: Week 8-16
Objective: Swelling reduction, increase in ROM, neuromuscular re-education, develop baseline of ankle control/strength
Immobilization: Use of removable walker boot from 8-14 weeks
WB Status: WBAT, *NOTE – WB status and gait progression determined by physician based on radiographic evidence of implant incorporation
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:
ROM: AROM, PROM, patient directed stretching, joint mobilization, *NOTE – joint mobilization should focus on techniques for general talocrural distraction and facilitating dorsiflexion and plantarflexion. Techniques for inversion and eversion should be minimized and may be contraindicated if the patient has had ancillary procedures such as subtalar fusion or triple arthrodesis. The distal tibiofibular syndesmosis should not be mobilized. Soft tissue techniques may be used for swelling reduction and scar tissue mobilization. Goals for ROM are ≥ 10° of dorsiflexion and ≥ 40° of plantarflexion
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
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:
ROM : patient to achieve ≥ 10° of dorsiflexion and ≥ 40° of plantarflexion
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