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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