Phase I (Weeks 0-2)
- Weightbearing: Non-weightbearing using crutches.
- Brace: Patient in plantarflexion splint.
- No Formal PT.
Phase II (Weeks 2-6)
- Weightbearing: As tolerated in CAM Walker Boot with Heel Wedges in place (first wedge removed at 4 weeks, second wedge removed at 6 weeks)– discontinue crutch use.
- Brace: CAM Walker Boot at all times except showering and when working with PT.
- Range of Motion – PROM/AROM/AAROM of the ankle from full plantarflexion to neutral (NO DORSIFLEXION PAST NEUTRAL), Inversion/Eversion, Toe Flexion/Extension.
- Therapeutic Exercises.- Seated heel raises.- Isometric dorsiflexion to neutral.- Resistance bands for plantarflexion/inversion/eversion.- Proprioception exercises – single leg stance with front support to avoid excessive dorsiflexion.- Soft tissue mobilization/scar massage/densensitization/edema control.
Phase III (Weeks 6-12)
- Weightbearing: Full weightbearing in sneaker.
- Range of Motion – PROM/AROM/AAROM of the ankle – progressive dorsiflexion – 10° intervals (10° of dorsiflexion by post-op week 8, 20° by week 10, 30° by week 12).
- Therapeutic Exercises.
- Standing heel raises.
- Single leg eccentric lowering.
- Step-ups, side steps.
- Proprioception exercises – balance board.
Phase IV (Months 3-6)
- Progress with strengthening, proprioception and gait training activities.
- Begin light jogging at 12-14 weeks.
- Running/cutting at 16 weeks.
- Return to sports at 5- 6 months.