Physical Therapy Protocol

Calcaneus Fracture Open Reduction Internal Fixation (ORIF)

New Patient Visit/Pre-op Post-Op 2-6 Weeks 6-12 Weeks 12 Weeks 4-6 Months
Assessment
RN pre-screen for “red flag” NWB on surgical foot. 2- to 3-week MD visit: 6- to 7-week MD visit with X- 12-week visit, x ray. 4 months:
patient referral to PT pre-op. Sutures out, change to ray. - Progression of gait,
- No previous ortho surgery RN to mobilize pt to bedside removable posterior foot Typically start Progressive advanced balance and
- Bilateral surgery commode on POD 1 with the splint. NWB on surgical foot, WB per MD written orders. proprioception activities.
- Previous failure PNC's* in place. posterior splint.
- over 65 Leg elevated 8-10 inches NWB on surgical foot. -Gait training: Gradual No Dead Lift-/Clean and
- co-morbidities including UE from bed-level. - Measure range of motion. increase in weight bearing Jerk-type weight lifting after
injury/dysfunction Foot in bulky “Jones” splint - Patient teaching: Edema (in shoe) starting at 20 lbs, 6 months when cleared by
control. Desensitization increase 20 lbs every 2-3 MD.
- Pt. teaching: Scar
- POD 1: Bed exercises for techniques prn. Gentle scar mobilization. days over 1 month period to
PT pre-op visit FWB. Joint depression type
joints above surgical sites. massage. Sample exercises for home
- Assess current level of calc. fracture hold at 40 lbs exercise program:
function (ADLs/Mobility), Make sure to fully straighten - Edema management,
knees periodically. for 1 month before Progressive calf stretching.
ability to manage post-op - Measure range of motion. compression stocking. progressing.
Gentle A/AA/PROM toes, Progressive strengthening
restrictions, use of assistive using elastic band. Single
devices. intrinsics; stretch toes into - Continue toe/intrinsic
dorsiflexion at MTPs with - Continue/reinforce H.E.P. - If patient develops leg stance activities. Step-
- Screen PMH, condition of exercises. A/AA/PROM ankle, STJ, increased pain or swelling, ups, stairs. Foam standing/
UEs, and contralateral LE MTs stabilized.
toes. Mild overpressure/ back off to lesser weight and wobble board/Baps.
- Home environment: Add: A/AA/PROM ankle, gentle joint mobilization gradually build back up.
modifications needed? - POD 2-3 Ambulation with STJ with gentle (grade 1-2) OK.
PT. May be up in chair for 6 months:
Assistance available? SNF overpressure OK.
or HH needs. limited time at MD Over the counter orthotic - Ankle, subtalar stretching.
discretion. Keep foot - OK to use light weight (Spenco, Superfeet) may be
elevated while sitting. - Continue HEP with hip, resistance band, start belt- helpful.
- Teach post-op mobility type calf stretch. - Joint mobilization.
Limit time with extremity knee, UE exercises and
restrictions isometrics/general body
dependent. - OK to use resistance band - Advanced balance and gait
- Gait training: NWB on strengthening and - Home exercise program, for ankle, STJ exercises.
surgical foot unless conditioning. strengthening, conditioning training, maximize quality of
otherwise indicated. Must Family/caregiver training as uninvolved extremities. gait.
be able to transfer and walk needed. - Soft tissue/scar
- Patient will be NWB on mobilization.
maintaining precautions. affected foot until at least 12 - Higher impact activities
- Swimming OK but not
Examples of potential gait Sample exercises for home weeks post-op. walking in water. No OK.
devices: program: Sidelying leg lift, aggressive kicking. - Desensitization techniques.
Crutches, walker, affected leg, prone leg lift - Ankle, STJ, strength-
(hip extension), supine hip/ Sample exercises for home
wheelchair, knee scooter, program: Ankle pumps, - Gentle joint mobilization. endurance training.
“peg-leg” knee flexion/extension.
alphabets, figure 8’s,
Patient to obtain inversion/eversion. - When comfortably FWB - Functional assessment:
equipment and bring to *peripheral nerve catheter with good gait pattern wean* e.g., timed single leg stance
hospital. off assistive device (by balance and reach, heel
16-17 weeks). Shoe raise, squats, step ups.
Verbally review/educate: modification if needed.
-Pt and caregivers to
- General post-op exercise monitor resting foot posture - Assess shoes/orthotics.
program: ROM, strictly in neutral - Begin balance and
strengthening for UEs, proprioceptive training when
uninvolved leg; full WB.
Physical Therapy Protocol
Calcaneus Fracture Open Reduction Internal Fixation (ORIF)