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
Patient may return to sport/work if they have met the above criteria
Precautions: to reduce the risk of re-injury when returning to sport or high demand activities as appropriate; if collision/contact sport, may consider protective padding over area of scar tissue