Nathan WM. Skelley, M.D.

Phase I (0-6 weeks)

Appointments

• Home exercise program will begin after surgery

• 1-3x/wk. from 2-6 wks.

Rehabilitation Goals

• Edema control/reduction

• Protect healing tissue, foot is placed in neutral in short leg cast

• Independent transfers and ambulation, non-weight bearing on

  involved lower extremity with use of optimal ambulatory assistive device.

Precautions

• Non weight bearing until the first visit following surgery with the surgeon, then toe touch weight bearing in boot or cast

Suggested Therapeutic Exercise

• Proximal LE, Upper extremity, and core muscle strengthening

• Transfer and gait training

• Abdominal strengthening

Cardiovascular exercise

• Upper body circuit training or upper body ergometer (UBE)

Progression Criteria

• Decrease pain

• Decreased edema

• Independence with HEP

• Independence with transfers and ambulation NWB on involved

  lower extremity

 

Phase II (weeks 6-8)

Appointments

• Rehabilitation appointments are 1-3 times per week

Rehabilitation Goals

• Protect healing tissue. To protect the CFL from inversion and the ATFL from plantarflexion, the ankle is kept in a cast set in neutral for 6 weeks and then transitioned to a pneumatic walking boot

• Progressive protected normalization of gait: after the initial 6 week immobilization period, progressive weight bearing is initiated as tolerated, first with the involved ankle in a pneumatic walking boot and then transitioned to protected ankle weight bearing in a semi-rigid ankle stirrup orthotic

• Edema control and pain reduction

• Prevention of deconditioning

• Prevention of scar adhesions and myofascial restriction

Precautions

• No passive, active assisted or active inversion exercises

• No active assisted or passive stretching into plantarflexion

• Avoid standing or walking for extended periods of time

Suggested Therapeutic Exercise

• Progressive weight baring as tolerated

• Edema control with use of modalities

• Joint mobilizations avoid tensioning of the CFL and ATFL

• Stretches for gastrocnemius and soleus

• Submaximal isometrics (except inversion)

• Proprioception with activities involving bilateral stance

• Soft tissue mobilization as indicated

Cardiovascular exercise

• Cross training, UBE, aquatics

Progression Criteria

• Normalized gait without pain, with involved ankle protected in semi-rigid ankle stirrup, with or without appropriate assistive ambulatory device

• Pain free eversion against gravity

 

Phase III (week 8-12 weeks)

Appointments

• Rehabilitation appointments 1-3xwk

Rehabilitation Goals

• Restoring full ROM

• No edema

• Normalized, pain free gait on all surfaces

• 5/5 strength of all muscle groups

Precautions

• No jumping, hipping or sports

• ASO or semi-rigid brace to protect repair outside of therapy

Suggested Therapeutic exercises

• Ankle AROM in all planes of motion, BAPS board

• Gait training on level and inconsistent surfaces

• Mobilization as indicated

• Stretches

• Proprioceptive activities

• Strengthening: foot intrinsic, progressive resisted ankle

  exercises in all planes, core stabilization, bilateral heel raises

• Week 10: progress to closed and open chain exercises,

  unilateral eccentric heel raises, rhythmic stabilization

• Week 11: plyometric with bilateral and unilateral jumps

Cardiovascular exercise

• Stair stepper, elliptical, treadmill, and climber

Progression Criteria

• Full active and passive ROM

• No residual edema or pain

• Normalized gait without assistance on all surfaces

 

Phase IV (week 12-16)

Appointments

• Rehabilitation appointments 1-3xwk

Rehabilitation Goals

• Patient to demonstrate stability with higher velocity movements and change of direction movements that replicate sport specific patterns

• No apprehension or instability with high velocity change of direction movements

• Improve core and hip strength as well as mobility to eliminate any compensatory stresses to the ankle

• Cardiovascular endurance for specific sport or work demands.

Precautions

• Continue to use brace during sports for 6 months

• Patient to be independent with activity progression and or

  modification

Suggested Therapeutic exercises

• Initiate jogging with progression to running

• Strengthening- increase workload, resistance and intensity in

  progressive resisted exercises

• Endurance

• Proprioception

• Plyometric

• Return to activity testing

Cardiovascular exercise

• Design to use sport specific energy systems

Return to work/sport

• Patient may return to sport after receiving clearance from the orthopedic surgeon and the physical therapist/athletic trainer .