Talar Fracture Rehab Protocol
Phase I Initial Stability (0 to 6 weeks)
- Patients will be Non-weight-bearing (NWB) in cast or splint or 6-10 weeks. Do not begin weight bearing until specifically instructed by surgeon.
- Ambulatory device training (walker or crutches) and transfers.
- General lower extremity strengthening SLR, quad sets, etc.
Phase II Early Range of Motion/Gait training (6-8 weeks)
- Patient is placed in a removable cast boot in orthopedics office (6 weeks).
- Begin NWB ankle ROM exercises PF, DF, inversion, and eversion.
- Gradually increase weight-bearing (PWB) status so patient is full weight bearing WBAT) by the end of the 8th week.
- Advance to cane.
- Advance with aggressive stretching program.
- Isometric exercises for PF, DF, inversion and eversion.
- Seated towel toe crunches and push aways (intrinsic foot musculature).
- Stationary bike for range of motion.
- Ice for swelling. Minor swelling usually occurs as patient increases weight-bearing status.
Phase IV Return to Function (After 8 weeks)
- Theraband strengthening exercises - DF, PF, inversion, eversion. Advance to home exercise program.
- Mini squats, toe raises (bilateral and unilateral)
- Advance daily stretching
- Unilateral standing balance (eyes open, eyes closed)
- Strength program (2-3 sets of 10 repetitions)
- Total gym squats and toe raises
- Leg press
- Hamstring curls
- Leg extension
- Treadmill walking (advance to lateral stepping, backwards walking)
- Proprioceptive Exercises advance per tolerance and patients functional needs
- 4-way straight leg raises with tubing (a.k.a. "steamboats")
- Proprioceptive star toe touch and lunges
- Seated BAPS board, progress to standing
- Mobilisations per therapist
- Modalities PRN Fluidotherapy, moist heat, ice
- Brotzman, S.B. and Brasel, J. "Foot and Ankle Rehabilitation," Clinical Orthopedic Rehabilitation. Mosby, 1996. pgs. 258-263.