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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
  • Endurance
  • Bike
  • 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
  • Rebounder
  • Fitter
  • Seated BAPS board, progress to standing
  • Mobilisations per therapist
  • Modalities PRN – Fluidotherapy, moist heat, ice

Review References

  • Brotzman, S.B. and Brasel, J. "Foot and Ankle Rehabilitation," Clinical Orthopedic Rehabilitation.  Mosby, 1996. pgs. 258-263.
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