Pre-OP
- Non weight bearing with bilateral axillary crutches and the post op splint. In some cases after surgery, you may be placed in a cast boot, skipping the splint altogether. Therefore, please take the cast boot to the Hospital when you go for surgery. This will be at the discretion of the Doctor.
- Instruct in exercise to be performed two days post op.
- Issue compression stocking.
- Review weight bearing status: in cast boot WBAT with bilateral crutches or NWB in splint.
Acute Post-op:
2 Days:
- Remove dressing and reapply telfa pad or 4x4 gauze pad, if incision is still draining.
- Cover with large Band-Aid if dry, no drainage.
- Apply compressive stocking/tensogrip issued.
- Remove splint and apply cast boot.
- Begin WBAT ambulation, attempting a smooth gait pattern.
- Begin AROM and flexibility per hand out.
- AROM DF (dorsiflexion) in sitting, AROM PF (plantarflexion) in sitting, AROM DF/PF not elevated, AROM DF/PF elevated, Gastroc stretch with towel, hamstring stretch in long sitting (per handout.)
7-10 Days to 4 Weeks:
- You will follow up with your physician and sutures will be removed.
- Continue to use the cast boot for up to four weeks post op.
- Continue passive and active post op exercises.
- Wean off crutches to tolerance:
- try one crutch on uninvolved side.
- progress to no crutches.
Subacute (4-6 Weeks):
At 4 weeks you will follow up with your MD, at this time you may be referred to Physical Therapy.
Goals:
- Normalize ROM.
- Decrease edema and scar sensitivity.
- Normalize gait pattern.
- Begin non-dynamic balance/ proprioception.
Exercises:
- Flexibility: DF, PF, eversion, hamstring, quadriceps, and groin.
- Full AROM NWB and WB.
- Ankle alphabet.
- Double leg knee bends in standing.
- Single leg knee bends in standing.
- Wall slides (to increase DF ROM.)
- RROM: DF, PF, and eversion from neutral with theraband.
- Isometric inversion.
- Closed chain lower extremity strengthening: Wall squats, step-ups, leg press, walking lunges.
- Endurance: Stationary bike, pool program, treadmill walking, stair climber.
- Stationary balance (Progressive): Single leg standing, single leg standing with resistance (biodex, tubing), single leg balance board/ trampoline, single leg balance with perturbation.
Advanced Phase (6-8 weeks):
Goals:
- Full ROM 4+/5 to 5/5 ankle strength.
- Ambulation without a limp.
- -No pain or swelling.
- Begin sport specific strengthening drills.
Exercises
- Continue closed chain strengthening.
- Begin jogging interval on treadmill.
- Begin non-twisting/ cutting plyometrics.
- Begin dynamic balance drills.
- Add cutting and sprinting (with use of an active ankle brace.)
Return Phase (8-12 Weeks):
Return to sports/full activity with physician approval.
