| Phase 1 | Protection (0-6 weeks) 0-2 weeks Non-Weight Bearing (NWB) in POP |
| Phase 2 | 2-4 weeks Partial Weight Bearing (PWB) in Aircast boot up to 50% BW |
| Phase 3 | 4–6 weeks gradual return to Full weight bearing (FWB) in Aircast boot |
| Phase 4 | Early Mobilisation (6-12 weeks) A60/Airsport plus brace |
| Phase 5 | Return to sport (12-20 weeks) (elite RTS week 12) |
| Appointments planned | 2 weeks post op follow up appt with consultant |
| Rehab goals | • Control pain and swelling • Achieve good wound healing • ADLS with Safe crutch gait • Maintain Hip and Knee ROM • Improve hip, knee, arm core strength |
| Precautions | • Immobilise in plaster 2 weeks • Strict elevation for 1 week 45 mins every hour • Non weight-bearing (NWB) for 6 weeks • Watch for signs of infection |
| Suggested Manual Therapy/Exercise |
Wiggle toes, Straight leg raise (SLR), Isometric quads, isometric glut squeezes UL seated exercises |
| CV Exercise | Seated arm bike |
| Progression Criteria | No wound infections |
| Appointments planned | 6 weeks follow up appt with consultant |
| Rehab goals |
• Control pain and swelling |
| Precautions | • After 2 weeks move to Air cast Boot • Strict elevation for 30 mins every hour • PWB for 2-4 weeks post op • Watch for signs of infection • AVOID INVERSION and PLANTARFLEXION |
| Suggested Manual Therapy/Exercise |
• Soft tissue massage, scar massage, • Begin gentle active ROM – GENTLE DF, GENTLE EVERSION and toe flex/ext • Wearing air cast boot double leg (DL) seated leg extension, hamstring curl, single leg wearing air cast boot to begin with early proprioception training • HIP – AROM, SLR, side lying series • Knee – AROM, Theraband or Leg extension • Core – transverse recruitment, seated arm pulleys or theraband using diagonal patterns • UL seated exercises |
| CV Exercise | • Non-impact CV work • Seated arm ergo |
| Progression Criteria | No wound infections |
| Appointments planned | 6 weeks follow up appt with consultant |
| Rehab goals | • Begin to FWB in Air cast Boot • Strict elevation for 30 mins every hour • FWB till 6 weeks post op in boot • Watch for signs of infection |
| Precautions | Watch for signs of infection |
| Suggested Manual Therapy/Exercise |
• Continuation of weeks 2-4 manual therapy and exercises • Seated calf raise gently • Can begin to gently plantaflex ankle but wait till 6 weeks to invert and increase plantarflexion • Standing bilateral calf raises with support • Gait Education, retraining • balance proprioception drills with Air cast boot • HIP – AROM, SLR, side lying series • Knee – AROM, Theraband or Leg extension, Hamstring curl DL progression to SL • Mini squats • Core – transverse recruitment, seated arm pulleys or theraband using diagonal patterns • Gentle Stretching gastroc and soleus • UL seated exercises |
| CV Exercise | • Bike with air cast boot • Non impact CV work • Start Alter G / hydro week 5 |
| Progression Criteria | No wound infections |
| Appointments | Physiotherapy 1-2 x week |
| Rehab goals | • Reduce swelling • Increase ankle ROM in all planes gentle progression of PF/inversion • Improving Knee to Wall (KTW) • Weight-bearing without Air cast boot as tolerated • Boot can be removed and apply A60 brace if necessary for patient. If using A60/ airsport plus brace, perform all exercise out of the brace and wean use of brace every week • Improving single leg standing • Increase mobility of scar • Maintain hip/knee ROM, strength and flexibility |
| Precautions | • WB as tolerated • Control swelling |
| Suggested Manual Therapy/Exercise |
• Continuation of manual therapy as week 2 • Gait training and weight shifts • Mobilisation of t/c joint • Ankle AROM/PROM • Begin Inversion • Advanced intrinsic foot strengthening • Calf stretching • Four-way ankle isometrics • Seated calf raises • Bilateral calf raises isometric with support (put as much as weight as tolerated in to affected leg (AL) 20% AL to 80% UAL) • Seated tilt/ biomechanical ankle platform system (BAPS) board • Start gentle Single Leg press DL progress to SL as tolerated • linear progressing to lateral and rotational functional movements • balance and proprioception • Continue Hip/ Knee/ Core strengthening |
| CV Exercise | • Stationary bike in boot • Swimming • Alter G |
| Progression Criteria | • Able to FWB as tolerated by week 10 • Active ROM between 5 degrees of DF and 20 degrees of PF |
| Appointments | Physiotherapy 1-2 x week |
| Rehab goals | • Reduce swelling • WBAT in shoe • Improving KTW (90% of unaffected leg) • Normalise gait • Retrain ankle proprioception • Improve ankle strength • Improving Single leg press (90% of BW) |
| Precautions | Avoid exercises that create movement compensations |
| Suggested Manual Therapy/Exercise |
• Continuation of manual therapy as week 2 • AROM and PROM ankle • Gait training • Calf stretching • Four-way ankle strengthening with resistance band • Seated single leg calf raises with resistance • Bilateral calf raise isometric holds with single affected leg eccentric lowering • Leg press strengthening • Progress Balance and proprioception exercises, • Start basic Plyometric exercises • Functional movements (squats, steps) • Core and lower extremity strengthening |
| CV Exercise | • Stationary bike • Swimming |
| Progression Criteria | • Able to FWB in shoe • Able to bilateral calf raise |
| Appointments | Physiotherapy 1-2 week |
| Rehab goals | • Normal gait pattern • Improving KTW • Aim to restore full range of ankle inversion • Single leg stance with good control for >10 Able to complete single leg heel raise • Hop tests – Vertical and horizontal – 90% of unaffected leg • Sports – Y-Balance Anterior Reach within 4-6cm. |
| Precautions | Return to sport 3-4 month post passing sport specific test above |
| Suggested Manual Therapy/Exercise |
• Continuation of manual therapy as week 2 • Calf stretching • Balance and proprioception exercises on unstable surfaces • Higher level core and lower extremity strengthening exercises • Higher level functional movements, lunges, walking on upslopes • Seated single leg calf raises with weight • Single leg extension and hamstring curl with weight • Single leg calf raise • Single leg press 100% BW • Progressing plyometric exercises – skip, A,B,C’s, heel kicks, caricoca, high skip, fast feet, progression to hurdle drills, DL jumps to SL jumps, jumps to box, deceleration jumps single leg and explosion • Walking over hurdles/ ladders • Advance linear progressing to lateral and rotational functional movements build up slowly • Sport specific drills on field/ court/ playing area |
| CV Exercise | • Stationary bike progress • Running • Sport Specific |
| Progression Criteria | • Able to FWB in shoe • Able to single leg calf raise • Complete FAOS score |
Allow 1-2 Days of Rest between Running Progression Workouts, Reduce Volume/Intensity if Pain/Effusion Present
Goals of rehab
Control pain and swelling, improving ROM, increasing muscle strength and control, patient specific goals.
Use of modalities for pain and swelling- Ice machine , muscle stim and blood flow restriction. To improve muscle activation, hypertrophy to recover faster.
ICE MACHINE options.
MUSCLE STIM options.
Occlusion Therapy - (An example of a program -30, 15, 15, 15, 15 reps max 8 Mins of work or to failure start whilst doing seated calf raise progress to single leg calf raise, start at 60% of Limb occlusion pressure and build up to 80% over 2 weeks).
