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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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  • American Academy of Orthopaedic Surgeons
  • Arthroscopy Association of North America
  • American Orthopaedic Association
  • South Carolina Orthopedic Association