Rehab Protocols
Please note it takes up to one year for swelling to go away in the toe, foot, or ankle. This is to be expected.
Forefoot
| Bunion Correction(Scarf or Chevron) | |
| Day 0 to 2 weeks | Heel weight bearing in post op shoe |
| 2-6 weeks | Stable toe spacer WB in short boot or post op shoe |
| 6-12 weeks | Transition to shoe continue toe spacer in closed toe shoe until 3 months Its OK to ride a bike at 6 weeks, but no running for 12 weeks |
| 1st MTP Fusion | |
| Day 0 to 2 weeks | Heel WB on crutches |
| 2-6 weeks | WBAT in short boot |
| 6-8 weeks | WBAT in athletic shoes, no high impact exercise for 12 weeks |
| Hammertoe correction | |
| Day 0 to 14 | WB in post-op shoe |
| 2-6 weeks | WBAT in post-op shoe or short boot. Initiate passive PF stretching of involved MP joints, utilize dressing or Budin splint if toes are cocking. |
| 6 weeks | Pull pin, Transition to regular shoe as swelling allows |
| Plantar Plate Reconstruction | |
| Day 0 to 2 weeks | Heel WB in post-op shoe |
| 2-6 weeks | WBAT in post-op shoe or short boot. Initiate passive PF stretching of involved MP joints, utilize dressing or Budin splint if toes are cocking. |
| 6 weeks | Transition to regular shoe as swelling allows |
| Cheilectomy | |
| Day 0 to 14 | WBAT in post-op shoe |
| 2-4 weeks | Start PT |
| 4 weeks | Transition to regular shoe as swelling permits |
| Jones Fracture | |
| Day 0 to 14 | NWB splint |
| 2-4 weeks | PWB in CAM boot |
| 4-6 weeks | WBAT in a CAM boot |
Midfoot
| Lapiplasty/bunion correction | |
| Day 0 to 14 | CAM boot or splint NWB |
| 2-6 weeks | WBAT in a CAM boot |
| 6-10 weeks | Wean out of boot, WBAT, increase activity, possible PT |
| TMT/Midfoot fusion | |
| Day 0 to 14 | Splint, NWB |
| 2 - 6 weeks | Non-weight bearing cast |
| 6-10 weeks | Boot, progressive weight bearing |
| 10 – 12 weeks | Wean out of boot, WBAT, increase activity, possible PT |
| 12 weeks | No restrictions |
| Lisfranc ORIF | |
| Day 0 to 14 | Splint, NWB |
| 2 - 6 weeks | Non-weight bearing cast |
| 6-10 weeks | Boot, progressive weight bearing |
| 10 weeks – 12 weeks | Wean out of boot, WBAT, increase activity, possible PT, Poss arch support |
| 12 weeks | Begin running/jumping activities |
| 5-6 months | Consider hardware removal |
| Flatfoot Reconstruction (FDL Tx, MDCO, etc) | |
| Day 0 to 14 | Splint, NWB, Neutral flex, slight inversion |
| 2 - 6 weeks | Non-weight bearing cast |
| 6 – 12 weeks | Boot, progressive weight bearing, start PT |
| 10 to 12 weeks | Wean out of boot, WBAT, increase activity |
HINDFOOT
| ORIF calcaneus | |
| Day 0 to 14 | Splint, NWB |
| 2 - 6wks | NWB in cast or CAM boot |
| 6- 8 to 12 wks | Boot, ankle ROM, progressive weight bearing, start PT |
| 12 - 16 wks | Wean out of boot, WBAT, increase activity, no running/jumping |
| 16 weeks | Increase activity to tolerance |
| Subtalar fusion | |
| Day 0 to 14 | Splint, NWB |
| 2 - 6 wks | Non-weight bearing cast |
| 6 - 10 wks | Boot, ankle ROM, Progressive WB |
| 10 - 16 wks | Wean out of boot, WBAT, increase activity, possible PT, no running/jumping |
| 16 weeks | Increase activity to tolerance |
| Triple/double fusion | |
| Day 0 to 14 | Splint, NWB |
| 2 - 6 wks | Non-weight bearing cast |
| 6 - 10 wks | Boot, ankle ROM, NWB |
| 10 - 16 wks | Wean out of boot, WBAT, increase activity, possible PT, no running/jumping |
| 16 weeks | Increase activity to tolerance |
| Achilles repair/ Insertional Achilles Reconstruction | |
| Day 0 to 14 | Plantarflexion splint, NWB, consider leaving stitches in 3-4 wks |
| 2 - 4 wks | WB in 2 heel lifts& initiate gentle ankle ROM |
| 4 - 8 wks | Boot with 2 heel lifts, progressive weight bearing; peel off layer every 2-3days with goal of being WBAT flat in boot at 6 wks post-op; maintain boot until 8 wks post-op; start PT protocol at 6 wks |
| 8 - 12 wks | Wean out of boot, WBAT |
| 12 - 16 wks | increase activity level; no running/jumping |
| 16 wks | Begin higher impact activity (running/jumping) |
ANKLE
| Arthroscopic debridement, synovectomy, &/or exostectomy | |
| Day 0 to 14 | NWB boot |
| 2 - 4 wks | WBAT in boot; ankle ROM exercises |
| 4 - 6 wks | Wean out of boot |
| 6 - 10 wks | Increase activity, PT for ankle ROM if needed, no running/jumping |
| 10 wks | Continue increasing activity to tolerance |
| OCD debridement/microfracture | |
| Day 0 to 4 weeks | Splint, NWB |
| 4 - 6 wks | WBAT in boot; NWB ankle ROM exercises out of boot |
| 6 - 8 wks | Wean out of boot, WB ankle ROM exercises |
| 8 - 12 wks | Increase activity, PT for ankle ROM if needed, no running/jumping |
| 12 weeks | Continue increasing activity to tolerance |
| Brostrom or Peroneal Repair/Reconstruction | |
| Day 0 to 14 | Splint, NWB |
| 2 - 4 wks | WBAT in boot (Gross) or cast (Scott) |
| 4 - 6 wks | WBAT in boot, ankle ROM |
| 6 - 12 wks | Wean out of boot, ASO ankle brace, PT for ankle ROM/strengthening, no running/jumping |
| 12 wks | Continue increasing activity to tolerance |
| Bridle procedure or Tibialis anterior repair/reconstruction | |
| Day 0 to 14 | Splint, NWB |
| 2 to 6 wks | WBAT in SLWC |
| 6 to 10 wks | Progressive WB in boot; ankle ROM exercises |
| 10 to 16 wks | Wean out of boot, ASO ankle brace if needed, PT for ankle ROM/ strengthening, no running/jumping |
| 16 wks | Continue increasing activity to tolerance |
| Ankle fusion | |
| Day 0 to 14 | Splint, NWB |
| 2 to 6 wks | NWB in SLC |
| 6 to 12 wks | Start progressive WB in boot if XR looks good |
| 12 to 16 wks | Wean out of boot if XR shows good fusion, ASO ankle brace if needed for additional support |
| 16 wks | Increase activity as tolerated |
| Total Ankle Replacement | |
| Day 0 to 14 | Splint, NWB |
| 2 to 6 wks | WB in CAM boot or cast |
| 6 to 8 wks | Start ankle ROM exercises, start PT, wean out of boot |
| 12 wks | Increase activity as tolerated |
| Total Talus Replacement | |
| Day 0 to 14 | Splint, NWB |
| 2 to 6 wks | NWB in boot, start ankle ROM exercises |
| 6 to 8 wks | WBAT in a boot, PT for ankle ROM |
| 8 to 12 wks | Wean out of boot |
| Ankle ORIF (protocol may vary based on type of ankle fx. Important to take into account type of fracture, quality of fixation, and degree of healing) | |
| Day 0 to 14 | Splint, NWB |
| 2 to 6 wks | NWB in SLC or CAM boot |
| 6 to 10 wks | Start progressive WB in boot if XR looks good |
| 10 to 14 wks | Wean out of boot, ASO brace if needed, PT for ankle ROM/strengthening if needed |
| 14 wks | Increase activity as tolerated |
| Frame | |
| Day 0 to 14d | TDWB for transfers |
| 2 to 6 wks | WBAT in frame |
| 6 to 12wks | WBAT |
Abbreviations:
NWB: non-weight bearing
WBAT: weight bearing as tolerated
WB: weight bearing
SLWC: Short leg walking cast
SLC: short leg cast
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