Patient Info

Rehabilitation Guides

Achilles Tendon Rehabilitation

W0 – W2
  • Vacoped boot/ Cam Walker with 2cm heel lift
  • NWB with Crutches
  • Anticoagulation
W2 – W4
  • Review by Dr Dares and removal of sutures if operatively treated
  • Continue Vacoped boot with 2cm heel lift
  • Protected WB with Crutches; Can give away crutches when safe
  • Active plantar flexion and dorsiflexion to neutral
  • Inversion / eversion below neutral
  • Modalities to control swelling
  • Incision mobilisation modalities
  • Knee/ Hip exercises with no ankle involvement e.g. leg lifts from sitting, prone or side-lying position
  • NWB fitness / cardio exercises e.g. Bicycling with one leg, deep water hydro (within motion and weight-bearing limitations)
W4 – W6
  • Continue Vacoped boot with 2cm heel lift WBAT
  • Continue W2-W4 protocol
W6 – W8
  • Remove heel lift
  • WBAT
  • Dorsiflexion stretching, slowly
  • Graduated resistance exercises (open and closed kinetic chain as well as functional activities)
  • Proprioception and gait retraining
  • Modalities including ice, heat and ultrasound as indicated
  • Incision Mobilisation
  • Fitness / cardiovascular as tolerate e.g. stationary bicycling, walking on treadmill, stairmaster
  • Hydrotherapy
W8-W12
  • Wean off boot (may need crutches during period of weaning)
  • Continue to progress ROM, strength and proprioception
> 12 Weeks
  • Review by Dr Dares for final check
  • Continue to progress ROM, strength and proprioception
  • Retrain strength, power and endurance
  • Increase dynamic weight-bearing exercise including plyometric training
  • Sport-specific retraining

Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation Kevin Willits, Annunziato Amendola, Dianne Bryant, Nicholas G. Mohtadi, J. Robert Giffin, Peter Fowler, Crystal O. Kean and Alexandra Kirkley J Bone Joint Surg Am. 2010;92:2767-2775, published Oct 29, 2010;.2106/JBJS.I.01401 pg1

Ankle Fracture Fixation Rehabilitation

W0 – W2
  • CAM walker and Nonweightbearing
W2 – W4
  • Clinic Review by Dr Dares, Removal of sutures and XRay (prior)
  • Continue CAM walker
  • Weightbearing as tolerated if XRay good
  • Stationary bike
  • Active ROM exercises
W4 – W6
  • If able to Dorsiflex post neutral and full weightbearing commence resistive exercises
  • OK for deep water running hydrotherapy
W6 – W12
  • See Dr Dares with XRay
  • Wean off CAM walker (week 6 – week 7)
  • Ankle Brace as tolerated
  • Exercise bike, elliptical/ cross trainer, stairmaster
> 12 Weeks
  • Final Review by Dr Dares with XRay
  • Sports Specific Exercises
  • Straight inline running

Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation Kevin Willits, Annunziato Amendola, Dianne Bryant, Nicholas G. Mohtadi, J. Robert Giffin, Peter Fowler, Crystal O. Kean and Alexandra Kirkley J Bone Joint Surg Am. 2010;92:2767-2775, published Oct 29, 2010;.2106/JBJS.I.01401 pg1

Ankle Reconstruction Rehabilitation

W0 – W2
  • Non-weight bearing in a boot
  • Hip / Knee / Toe Exercises & Straight leg raises
W2 – W6
  • Clinic Review by Dr Dares and ROS
  • Weight bearing as tolerated
  • Start Active Range of motion
  • No inversion or passive or active assist plantarflexion
  • Boot can be removed for showering but keep boot on at night
W6 – W8
  • Clinic Review by Dr Dares
  • Wean boot ; Aircast A60 Ankle Immobiliser
  • ROM X’s – NO inversion/NO passive or active assisted plantarflexion
  • Calf stretching
  • Hydrotherapy
  • Upper ergometer
  • Bilateral stance proprioception
  • Theraband mm strengthening (except inversion)
W8 – W10
  • Start active inversion
  • Unilateral stance proprioception
  • Bilateral heel raises
W10 – W12
  • Start stairmaster / elliptical / treadmill / bilateral jumps progressing to unilateral
> 12 Weeks
  • Final Review by Dr Dares
  • Running
  • Sports Specific Exercises
Consideration of Discharge from physiotherapy when following milestones are met:
  1. Independently mobile unaided
  2. Good proprioceptive control on single leg stand on operated limb
  3. Return to normal functional level
  4. Return to sports if set as patient goal
  5. Grade 5 eversion power

Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation Kevin Willits, Annunziato Amendola, Dianne Bryant, Nicholas G. Mohtadi, J. Robert Giffin, Peter Fowler, Crystal O. Kean and Alexandra Kirkley J Bone Joint Surg Am. 2010;92:2767-2775, published Oct 29, 2010;.2106/JBJS.I.01401 pg1

Syndesmosis Fixation Surgery Rehabilitation

W0 – W2
  • CAM walker and Partial Weightbearing
W2 – W4
  • Clinic Review by Dr Dares, Removal of sutures and XRay (prior)
  • Continue CAM walker
  • Weightbearing as tolerated if XRay good
  • Stationary bike
  • Active ROM exercises
W4 – W8
  • If able to Dorsiflex post neutral and full weightbearing commence resistive exercises
  • OK for deep water running hydrotherapy
W8 – W10
  • Wean off CAM walker
  • Ankle Brace
W10 – W12
  • Straight inline running
> 12 Weeks
  • Final Review by Dr Dares with XRay
  • Sports Specific Exercises

* With thanks to Dr Steven Martin MD

Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation Kevin Willits, Annunziato Amendola, Dianne Bryant, Nicholas G. Mohtadi, J. Robert Giffin, Peter Fowler, Crystal O. Kean and Alexandra Kirkley J Bone Joint Surg Am. 2010;92:2767-2775, published Oct 29, 2010;.2106/JBJS.I.01401 pg1

At Wollongong Foot and Ankle Centre we treat patients with all foot and ankle conditions, come and experience our comprehensive service