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Ankle Reconstruction - Physical Therapy Protocol

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Preoperative Guidelines

  • Restore full AROM
  • Teach normal heel-toe gait
  • Strengthen involved extremity
  • Decrease edema if present
  • Educate Patient on post-op protocol, use of crutches (level and stairs)

Note: Exercise prescription is dependent upon the tissue healing process and individual functional readiness in all stages. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist

Phase I (Post-op Days 1 – 7)

  • Splint until edema is reduced
  • Crutches – NWB
  • 4-way SLR
  • AROM hip and knee
  • Ice and Elevation

Goal – Pain and Effusion controlled

Phase II (Weeks 2 – 6)

  • In SLWC x 4 weeks, then CAM walker x 4 weeks (locked)
  • Crutches – WBAT (D/C crutches when gait is WNL)
  • Progress to Single leg balance in SLWC when tolerated
  • Stationary bike in SLWC if tolerated
  • Continue hip/knee ex: add HS curls
  • Upper body exercises okay (seated or bench only – no pushups)
  • Continue ice and elevation

Goal – No increase in pain, Full WB by 4 weeks

Phase III (Weeks 7 – 8)

  • Continue CAM Walker (locked)
  • Begin Scar massage/mobilization with oil/cream
  • Ankle AROM – pumps, alphabet, rotations
  • Light Theraband ex all directions
  • Gastroc/Soleus Stretching
  • Sitting BAPS board
  • Total Gym Leg Press at low levels
  • Standing single leg balance/well-leg tubing if tolerated
  • Stationary bike
  • Pool therapy – chest or shoulder deep only
  • Ice as needed

Goals: Normal Gait, Full DF/PF ROM, no increase in edema or pain

Phase IV (Weeks 9– 12)

  • Air Stirrup Brace
  • Continue appropriate previous exercises and progress as tolerated
  • Theraband ex all directions with increased resistance as tolerated
  • Lower extremity closed chain strengthening – leg press, heel raises, step ups, mini squats, well-leg tubing/perturbations
  • Proprioception ex – Single leg BAPS, Ball Toss, Body Blade, Balance
  • Functional activities – Fitter, Slide board, cone/obstacle course
  • Treadmill – Walking progression program
  • Elliptical trainer or stairmaster

Goals: Normal gait, Symmetrical ROM, strength 5/5 PF and DF, 4+/5 INV/EVER,

Phase V (Months 3 – 6)

  • D/C Air Stirrup when cleared by Ortho – if no limp/pain/increased edema
  • Wear lace-up ankle brace for all sports until 6 months post-op
  • Continue progressive strengthening and proprioception exercises
  • Agility drills / plyometrics and progress as tolerated
  • Treadmill – Running progression program, progress to track (in brace)

Goals: Normal strength, Functional tests at least 90% of opposite leg to clear for sports and discharge (single leg hop and 12 meter hop for time, figure of 8 running at full speed)

No sports until goals are met


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