Rehabilitation Protocol
Hi all
As requested. I have posted my rehab protocol, my PT says I am one week ahead of this schedule. Spent all day today out of brace walking in trainers, periods of rest, ice and elevation in between working and did 54 double leg toe raises.
Weeks 1-2
Immobilised in POP backslab set in plantar-flexion as determined by OS at time of surgery
Stay in POP full time
To mobilise NWB on crutches
No ankle movement
Routine care of adjacent joints etc taught to patient pre-discharge from hospital
Weeks 2-4
Out of POP and protective boot fitted (Donjoy, Aircast, Vaco-ped) fixed in plantar flexion
Mobilise PWB with crutches from week 2. Increase WB pain allowing
Patient to stay in brace at home at all times, including sleep.
Supervised exercise only!
No unsupervised exercise. Outpatient physiotherapy to include:
Active assisted PF, DF, INV, Eversion.
Swelling control
Soft tissue work and scar mobilisation
Gentle passive non weight bearing calf stretches
Adjust brace bringing ankle towards plantagrade in line with DF range achieved in each treatment session, allowing movement between plantar flexion and Doris flexion barrier, rather than fixing brace at one angle.
Weeks 4-6
Unsupervised ROM exercise permitted
Progress ROM exercise - active all directions. Can add theraband resistance at week 5
Continue soft tissue work
Can use exercise bike
Aims: neutral dorsiflexion (plantagrade) by week 6
Weeks 6-8
Can progress to FWB in brace without aids from week 6
Commence double leg heel raises
Aim: FWB independently by week 6
Weeks 8-12
Remove brace at week 8 if functional dorsiflexion has been achieved. Use heel lift in shoes or shoes with small heel until week 12.
Graded increase of weight bearing activity
Continue lengthening and strengthening work , exercise bike, gait re-education
Proprioceptive training
Weeks 12+
Begin single leg heel raises or progress from 50/50 double heel raises to increase load on affected side
Start jogging or trampoline and to treadmill vis a walk run programme
Eventually progress to 20 minute outdoor run before adding cutting and figure eight drills
Polo metrics eg double to single jumps/hops/lunges on toes, acceleration/deceleration work
Sport specific exercises as required
Full return to contact sport in 6 months.
Hope this is of interest and helps.
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Thanks for posting this, Roger. Do you know the author, or institution, behind this protocol? That information would be helpful to share with OSs and PTs, who may want to investigate further. It’s interesting that it starts out much faster than most protocols I’ve seen, but then it slows down and arrives at full return to sports at 6 months, which is quite common–home by another way. -David
I have been following the discussion regarding this rehab protocol and after seeing this post I realised it looked a bit familiar. So when comparing the protocol to my own I see I got the exact same protocol, word by word. I’m in week 13.5 now and I have not progressing as fast as Roger though. FWB at week 6 and 2-shoes at week 9. (Was set back a week because of a wound infection at week 7). I’m in London UK and my consultant is supposed to be one of the best in town for ATR so I guess I can assure that this protocol probably is a proven one. I can ask my consultant where it comes from if anyone is interested.
As a side note it says on my protocol that it’s for repairs with Achillon Device (google it) but my consultant told me to just ignore that since I had a ‘traditional’ repair (regular vertical incision along the tendon).
I am under Mr Mark Davies at the London Foot and Ankle clinic at St John and St ELizabeth Hospital London, I believe it is his protocol.
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Roger, that explains why I got the same protocol. I’m on the London Foot and Ankle clinic too but under another consultant. These guys are very skilled and that’s why I choose to let them repair me.
Thanks for the detail Roger. I am away for a week so I will try to get a closer look at it after that. I do note that you hope to be jogging at week 8 but it does not suggest it until week 12. Always good to set goals but there is still the need to be careful. I am sure you are doing that. It would be good to know how much weight is placed on the injured tendon during the two leg heel raises. Many other protocols will have most of the weight transfered to the good leg but this is not mentioned. Too much weight too early has been shown to cause damage or re-ruupture but what we understand now is the tendon likes to be loaded and needs that to align the collagen. I will be interested to follow your progress. Thanks again.