MidFoot ORIF Rehab Protocol

Patient Overview:

• Initial Weight-Bearing Status: Non-weight-bearing (NWB) for 6 weeks.
• Immobilization Progression: Splint (0–2 weeks), Boot (2–6 weeks).
• Weight-Bearing Progression: Progressive weight-bearing (PWB) beginning at 6 weeks post-op.
• Goals: Protect the surgical repair, reduce swelling, restore mobility, regain strength, and return to function.

Goals:

• Protect the surgical site
• Manage pain and swelling
• Prevent stiffness in non-immobilized joints

Key Points:

• Immobilization: Splint for 2 weeks, NWB.
• Edema Control: Elevate the foot above heart level for 23 hours/day during the first week. Use ice or cryotherapy as appropriate.
• Exercise: 
  • Toe wiggling and gentle isometric contractions to prevent stiffness and improve circulation.
  • Begin gentle ROM exercises for non-affected joints (e.g., ankle pumps, knee ROM, and hip strengthening exercises).
• Precautions: Strict NWB on the affected foot.

Goals:

• Continue protection of the repair
• Prevent muscle atrophy and stiffness
• Begin preparing for progressive weight-bearing

Key Points:

• Immobilization: Transition to a CAM boot at 2 weeks, remaining NWB.
• Therapeutic Interventions: 
  • Continue edema control with elevation and compression wraps (as needed).
  • Gentle ROM for toes, ankle, and adjacent joints (e.g., dorsiflexion, plantarflexion, inversion, and eversion).
  • Begin low-intensity isometric strengthening for the ankle and foot (e.g., dorsiflexors, plantarflexors, inverters, and everters).
  • Core and upper-body strengthening exercises to maintain overall conditioning.

Goals:

• Gradual transition from NWB to full weight-bearing (FWB)
• Begin low-impact mobility and strength exercises

Key Points:

• Weight-Bearing Progression: 
  • Begin partial weight-bearing (PWB) in the CAM boot with crutches or walker support.
  • Progress to full weight-bearing as tolerated by Week 8.
• Therapeutic Interventions: 
  • Gentle ROM and mobility exercises for the midfoot and ankle (e.g., ankle circles, midfoot mobilizations).
  • Continue strengthening exercises for the foot and ankle, including: 
    • Theraband resistance for ankle dorsiflexion, plantarflexion, inversion, and eversion.
    • Intrinsic foot strengthening (e.g., towel scrunches and marble pickups).
  • Begin balance exercises (e.g., double-leg stance on a stable surface).

Goals:

• Restore strength and stability
• Normalize gait pattern
• Improve balance and proprioception

Key Points:

• Footwear: Transition out of the boot into supportive athletic shoes.
• Therapeutic Interventions: 
  • Strengthening: Progress calf raises (double leg to single leg), incorporate foot intrinsic exercises, and add functional exercises like step-ups.
  • Balance and Proprioception: Initiate single-leg balance training and progress to unstable surfaces.
  • Gait Training: Focus on proper gait mechanics and midfoot push-off.
  • Begin low-impact cardiovascular conditioning (e.g., cycling, elliptical).

Goals:

• Full strength and stability
• Return to high-impact activities (if appropriate)

Key Points:

• Strength Progression: Include functional strengthening (e.g., squats, lunges) and introduce light plyometrics if cleared.
• Balance and Agility: Progress to advanced balance drills (e.g., BOSU ball exercises, cone drills).
• Activity-Specific Training: Begin low-impact sports drills and progress to higher impact as tolerated.

• Progression should be guided by patient tolerance and absence of pain or swelling.
• Communicate with the surgeon regarding any setbacks or concerns (e.g., midfoot pain or difficulty transitioning to weight-bearing).
• Adjust the protocol for patients returning to specific sports or high-impact activities.

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