Peroneal Tendon Repairs – Dr. Strasser Protocol
Rehabilitation Protocol
This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Specific changes in the program will be made by the physician as appropriate for the individual patient.
REMEMBER: It can take up to a year to make a full recovery, and it is not unusual to have intermittent pains and aches during that time as well as swelling and numbness!
Special Considerations:
Time frames for each phase will depend on:
• Specific surgical procedures performed (i.e. presence of a retinacular repair)
• Unforeseen Post-operative Complications (eg: Infection, CRPS)
• Surgeon Preference
Big Picture –
0-2 weeks: immobilization in a postoperative splint
2-6 weeks: During this time, I will typically immobilize the ankle in a boot or cast. If I am able to start some motion, I will not allow active eversion. The patient can plantar and dorsiflex, and begin some gentle inversion.
6-12 weeks postop:
PT typically begins during this time. I will start with plantar and dorsiflexion and then begin active inversion. Active eversion can begin after 8 weeks. (no specific activity restrictions after 8 weeks)
Once range of motion begins to improve, I will also start to begin some light strengthening exercises against resistance.
Progressive WB can begin at this time as well (sometimes I will allow this after 2 to 4 weeks but most of the time it begins at 6 weeks after surgery.
The patient can usually wean out of the boot between 10-12 weeks (into a lace up ankle brace)
12-24 weeks:
During this time, physical therapy will continue. The goals will be restoring range of motion, normalized gait as well as strength and endurance. Sport or Activity related exercises can begin at this time as well. Gait can still take some work in order to minimize your limp.
6-9 months:
Continue to work on regaining your range of motion (mostly side to side) and strength of your ankle. Some intermittent swelling is normal. Some stiffness is normal. You should notice your endurance and stability improving
Phase I: Weeks 0-2
Goals
- Rest
- Control swelling and pain
- Activities of daily living
Guidelines
- Toe touch weight bearing in cast splint
- Sutures removed at 14 days
- Education: surgery, healing time, anatomy, phases of rehabilitation
- Encourage activities of daily living
- Rest and elevation to control swelling
- Control pain
- Hip and knee active range of motion
Phase II: Week 2-6
Goals
- Gradual progression to full weight bearing in cast or boot with no swelling (clarify exact time to WB with your physician)
Guidelines
- Shower without boot
- Elevation to control swelling as start to weight bearing
- Massage for swelling
- Gentle active range of motion: ankle and foot: plantar flexion and dorsiflexion only (2x/day @ 30 repetition) – no inversion or eversion; no ankle strengthening against resistance until week 6.
- Progress to stationary bicycle in boot
- Core exercises: abdominal recruitment, bridging, ball reach, arm pulleys /theraband in proprioceptive neuromuscular facilitation patterns
- Hip: active range of motion
– strength: clam, sidelift, gluteus maximus, straight leg raise
- Knee: active range of motion
– strength: straight leg raise, theraband press
- Stretch gluteus maximus, gluteus medius, piriformis, rectus abdominis, hamstrings
Phase III: Week 6-10
Goals
- Full weight bearing without boot with no swelling
- Full plantar flexion and dorsi flexion
Guidelines
- Wean from walker boot by approximately week 8
- Use an ankle brace during daytime
- Control swelling with elevation and modalities as required
- Stationary bike
- Active range of motion ankle and foot in all directions: gentle inversion & eversion (begin resistance training with plantar flexion and dorsiflexion; begin inversion and eversion strengthening at week 8)
- Passive Mobilization of foot and ankle in directions that do not directly stress repair (i.e. inversion or eversion – ok to begin after week 8)
- Muscle stimulation to intrinsics, invertors and evertors as necessary – eccentric, concentric and isotonic strengthening to peroneals, calf and tibialis muscles
- Continue with: core exercises, hip and knee strengthening
- Gait retraining – correct knee hyperextension and hip rotation that may occur due to wearing boot
Phase IV: Week 11-12
Goals
- Full active range of motion ankle and foot
- Normal gait pattern
- Achieve equal side to side strength
Guidelines
- Add: core exercises – strengthening in standing
- Hip: strengthening single leg with resistance
- Knee: leg press
- Ankle: – toe raises through range
-inversion/eversion against resistance through range
- Manual mobilization
- Start proprioception and balance
Phase V: Week 13-16
Goals
- Full functional range of motion all movements in weight bearing
- Good balance on surgical side on even surface
- Near full strength lower extremity
Guidelines
- Emphasize
- Proprioception:
– single leg, even surface
– single leg, even surface, resistance to arms or non weight bearing leg
– double leg stance on wobble board, Sissel, Fitter
– single leg stance on wobble board or Sissel
- Strength: toe raises, lunges, squats, hopping (14+ weeks), running (14+ weeks), bench jumps (14+ weeks)
- Manual mobilization to attain normal glides and full physiological range of motion
Phase VI: Week 16+
Goals
- Full function
- Good endurance
Guidelines
- Continue building endurance, strength and proprioception
- Plyometric training