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

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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.

Manual

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

Exercises

  • 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.

Goals

  • 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.

Manual

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

Exercises

  • 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.

Goals

  • 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.

Manual

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

Exercises

  • 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.

Goals

  • 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.

Goals

  • 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.

Goals

  • 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.

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

Stone K.R., A.W. Walgenbach, A. Freyer. 2008.