You are here

Articular cartilage transplantation to 1st metatarsal joint (Big toe) post-operative physical therapy protocol

Download PDF

General Considerations

  • Non weight bearing status for 4 weeks post-operative.
  • Patients may need a posterior splint to remind them not to bear weight through foot with aide of crutches, or can use a post operative shoe which puts weight in heel of foot only.
  • Regular manual treatment should be conducted to decrease the incidence of fibrosis. No scar mobilization until 4 weeks post operative.
  • Light to no resistance stationary cycling is okay at 2 weeks post-operative with heel contact only.
  • Low impact activities for 4 months post-operative.

*Use of the continuous passive motion machine (CPM) for 6-8 hours a day for 4 weeks is imperative.

Week 1

  • Nurse visit day 2 to change dressing and review home program.
  • Icing and elevation every 2 hours for 15 minute sessions during wake hours.
  • CPM (continuous passive motion machine) at home for at least 6 hours every day.


  • Soft tissue treatments, effleurage for edema, gentle range of motion.


  • Extremity non weight bearing strengthening exercises (i.e. lying, seated, and standing straight leg raise exercises, isometrics, well-leg stationary cycling, upper body conditioning).
  • Ankle exercises, core strengthening.


  • Decrease pain, edema.
  • Gait non weight bearing x 4 weeks.
  • Range of motion full unless otherwise indicated by MD

Weeks 2 - 4

  • Nurse visit at 14 days for suture removal and check-up.


  • Soft tissue treatments, effleurage for edema, range of motion.
  • Manual resisted (Proprioceptive neuromuscular facilitation patterns) of ankle and hip.


  • Non weight bearing aerobic exercises (i.e. unilateral cycling, UBE, Schwinn Air-Dyne noninvolved limb and arms only).
  • AFTER 2 weeks, bilateral cycling with light to no resistance, slow cadence; heel contact only.


  • Decrease pain, edema. Gait non weight bearing x 4 weeks.

Weeks 4 - 6

  • M.D. visit at 4 weeks, will progress to partial weight bearing and discontinue use of splint. Progression to full weight bearing is dependent on demonstration of good gait mechanics.


  • Continue with soft tissue mobilizations, range of motion, and okay to add light joint mobilizations.


  • initiate resistance to 1st digit toe flexion/extension.
  • Incorporate functional exercises (i.e. squats, lunges, Shuttle/leg press, calf exercises, step-ups/lateral step-ups).
  • light to no resistance toe on peddle stationary cycling, slow cadence, pain-free.
  • Balance/proprioception exercises, seated calf raises.
  • Slow to rapid walking on treadmill (preferably a low-impact treadmill).
  • Pool/deep water workouts after incisions closed with the use of the splint.


  • Gait partial weight bearing to full weight bearing per quality.
  • Range of motion 80% of non-surgical limb.

Weeks 6 - 8

  • Increase the intensity of functional exercises (i.e. add stretch cord for resistance, increase weight with weightlifting machines).
  • Add standing calf raises.


  • Full range of motion.
  • Full weight bearing, good gait mechanics.

Weeks 8 - 12

  • Out door cycling, initiating with flat surfaces, slow cadence with slow progression to hills.
  • Sports test 1 at 12 weeks.
  • Low-impact activities until 16 weeks.
  • Patients should be pursuing a home program with emphasis on sport/activity-specific training.


  • Complete and pass Sports test 1.

*No cutting, running, jumping, or explosive type exercises for 5-6 months post operative.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.

Avoid joint replacement
You are told you have knee arthritis. The advice the doctor gives you is to go home, rest your knee, take anti-inflammatory drugs, lose some weight, wait until you are older and then get an artificial knee replacement. This advice is awful. Here's why.
Untethered Athlete
All athletes get injured. The best ones use the injury as an excuse to come back better than they were before they were hurt. Others may not be able to. This may, in part, be due to their inability to let go of the self-image they are attached to. Here are some tips for avoiding that trap.
The Great Stem Cell Divide
Stem cell therapies are sprouting like weeds. This is a good thing. The medical community is rushing into the biologic sciences, opening up the field of stimulating tissues to heal—rather than suppressing them with steroids, anti-inflammatories, or joint replacement surgeries. Here is my take on where the field is now and where it is going.
July 14th, 2015
In light of Wes Matthews and other NBA athletes suffering Achilles ruptures, Dr. Stone speaks to Mavs Moneyball, a...
April 27th, 2016
Dr Stone talking about Steph Curry's injury and the Warrior's season.
December 11th, 2014
"A few select orthopedic surgeons and researchers around the country are pioneering alternate cartilage...

Kevin R. Stone · Jonathan R. Pelsis · Scott T. Surrette · Ann W. Walgenbach · Thomas J. Turek 

Stone, K.R., Pelsis J.R., Adelson W.S., Walgenbach, A.W. 2010.

Stone, K.R., A.W. Walgenbach, A. Freyer, T.J. Turek, and D.P. Speer. 2006.