General Considerations:

•    Time frames mentioned in this article should be considered approximate with actual
     progression based upon clinical presentation. Careful observation and ongoing
     assessments will dictate progress. - No passive inversion or forceful eversion for 6
     weeks.
•    Avoid plantar flexion greater than resting position for 4 weeks.
•    Carefully monitor the incisions and surrounding structures for mobility and signs of
     scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization) to
     decrease fibrosis.
•    No running, jumping, or ballistic activities for 3 months.
•    Aerobic and general conditioning throughout rehabilitation process.
•    M.D. appointments at day 1, day 8-10, 1 month, 2 months, 4 months, 6 months, and
     1 year post-operatively.


0 – 3 Weeks:

•    90° immobilizer for 3 weeks. - Nonweightbearing for 3 weeks--no push off or
     toe-touch walking.
•    Progress from posterior splint to pneumatic walker once most of swelling is gone.
•    Pain and edema control / modalities as needed (i.e. cryotherapy, electrical stim, soft
     tissue treatments).
•    Toe curls, toe spreads / extension, gentle foot movements in boot, hip and knee
      strengthening exercises.
•    Well-leg cycling (bilateral once in walker with light resistance), weight training, and
     swimming in posterior splint after 10-12 days post-op.

3 – 6 Weeks:

•    Progress to full weight bearing in walking boot. Walking boot weight bearing for 3-6
     weeks post-op. Aircast splint for day-to-day activities for 6-12 weeks post-op. -
     Immobilizer for sleeping for 4weeks, then Aircast splint for 4-6 weeks.
•    Isometrics in multiple planes and progress to active exercises in protected ranges.
•    Proprioception exercises, intrinsic muscle strengthening, manual resisted exercises.
•    Soft tissue treatments daily and regular mobilization of intermetatarsal and midtarsal
     joints. Cautious with talocrural and subtalar mobilization.
•    Cycling, aerobic machines in splint as tolerated, and pool workouts in splint.

6 – 12 Weeks:

•    Gradually increase intensity of exercises focusing on closed-chain and balance /
     proprioception. - Passive and active range of motion exercises into inversion and
     eversion cautiously.

3 – 6 Months:

•    Progress back into athletics based upon functional status. - Wear a lace-up ankle
     support for athletics.