Phase 1 (0 – 2 weeks) Protection and mobility
Rest with leg elevation
Rehabilitation goals:
- Protection of the post-surgical compartment
- Minimize post-operative swelling
- Positioning of limb (elevated)
- Restore normal ankle and knee range of motion
- Non-antalgic gait
Precautions:
- Avoid any impact activity including running, jumping or hopping (6-8 weeks)
- Avoid any activity that will increase swelling
Rehabilitation:
- Lying: Ankle pumps – Active range of motion (AROM) of the ankle begins immediately to maintain tissue extensibility as they heal and present post-operative contractures. Progress: use of thera-band for controlled ankle dorsiflexion and plantarflexion
- Supine: straight leg raises: Eg: 4×15
- Elevation, gentle compression and icing as needed
- Gentle distal to proximal massage to assist venous return and swelling control
Phase 2: (2 – 4 weeks) Light strengthening
Rehabilitation goals
- Lower extremity circumference within 1 cm of uninvolved side
- Minimize muscle atrophy and flexibility deficits in involved compartment
- Full flexibility/mobility of gastrocnemius/ankle
- Incision well healed
- Single leg stance control
Precautions
- Avoid eccentric loading
- Avoid post-activity swelling by limiting prolonged weight-bearing activity as appropriate; if swelling occurs, manage with rest, ice, elevation and compression
Rehabilitation:
- Gentle scar massage
- Gentle Hamstring, Gastrocnemius and Soleus stretching
- Neural mobilisations in involved compartment
- Standing: Proprioceptive exercises. Progress to single leg standing from a level/firm to soft/unstable surface.
- Gait drills: begin with forwards, sideways and backwards walking
- May commence gentle stationary bike work (once wound has healed)
- May commence gentle swimming or water walking once wound has FULLY healed
Phase 3 (4 – 6 weeks) progression of strengthening
Rehabilitation goals:
- Prevent post-operative recurrence of symptoms with all activity
- Tolerate 10-15min of continuous aerobic exercise without the onset of symptoms/pain
- Normal 5/5 ankle strength and pain free
- Proper lower extremity control and alignment
- No pain with single leg functional movements
- No residual swelling 12-24 hours following all physical activity
- No pain 1-2 hours following activity (including impact exercises)
Precautions:
- Avoid friction over scar
- No running until 6-8 weeks post-operatively
- Avoid pain with exertional activity
Rehabilitation:
- Standing: Gently increase stretching and neural mobilisations
- Lower extremity myofascial stretching and foam rolling
- Progression of lower extremity closed-chain functional strengthening including mini lunges, step-backs and mini single squats
- Single leg calf raises: slow and controlled eg 4×10 (continuous)
- Progress gait drills
- Initiate plyometric exercises (focus on lower extremity control and alignment at hip, knee and ankle). Example: at 6 weeks begin with 2 feet to 2 feet (jumping), progressing from 1 foot to the other foot (leaping) and then 1 foot to the same foot (hopping). Focus on landing technique and deceleration mechanics
- May begin elliptical trainer as tolerated
- Light jogging may commence at 6-8 weeks. Starting on a level surface, gentle interval style. Avoid hills and speed work. Consider progression of multi-planar activity for sport specificity.
Phase 4: (8-12 weeks) Impact/Sport Training
Rehabilitation goals:
- Proper dynamic neuromuscular control and alignment with eccentric and concentric multi-plane activities including impact for return to work/sports
- Within 90% of pain free plantar flexion and dorsiflexion strength
Precautions:
- Avoid pain with any exertional activity
- Avoid post-activity swelling
Rehabilitation
- Progressive strengthening exercises using higher stability and neuromuscular control with increased loads and speeds, along with combined movement patterns; begin with low velocity, single plane activities and progress to multi-plane high velocity
- Begin with strides and slow jogging forward and backwards, side to side and diagonals.
- Integrate movements and positions into exercises that stimulate functional activities
- Initiate sport specific training