Physiotherapy Protocol

HIGH TIBIAL OSTEOTOMY

Phase 1: (0 – 4 weeks)

Weight-bearing status:

• (0-2 weeks) PWB 25% with crutches and brace locked in extension.

Brace:

• Locked in extension (including sleeping) – remove for exercises

ROM:

• As tolerated – gentle passive ROM of 0-90 degrees flexion daily

Guidelines:

• Sitting: Heel slides. Hold for at least 3 sec at flexion, release and repeat
• Lying: Inner range quad sets. With rolled-up towel/pillow under knee, lift foot up off bed, hold and repeat
• Ankle pumps
• Straight leg lifts with brace on. Slow and controlled
• Plantarflexion/Dorsiflexion with theraband
• Standing: calf and hamstring stretching

Phase 2: (4 – 6 weeks)

Weight-bearing status:

• As tolerated with crutches – advance to full weight bearing

Brace:

• Unlocked for ambulation and removed for sleeping

ROM:

• Reduce passive ROM exercises if 90 degrees flexion is easily achieved

Guidelines:

• Lying: Straight leg lifts without brace (if active full extension is easily achieved)
• Stationary bike with low resistance (if ROM allows)
• Double leg calf raises

Phase 3: (6 – 12 weeks)

Weight- bearing status:

• No restrictions/FWB
• Normalised gait pattern

Brace:

• Discontinue use – per surgeon

ROM:

• Full and pain-free

Guidelines:

• Standing: Step ups and step downs – ensuring proper alignment, pelvic and gluteal control
• Proprioceptive exercises: progress from firm/stable surface to soft/unstable surface
• Hamstring curls: in standing, progressively add ankle weights
• Sitting: Leg press: Low resistance, 0-60 degrees
• Stationary bike: increase resistance as tolerated
• Lying: Bridging: Double leg to single leg

Phase 4: (3 – 9 months)

Weight- bearing status:

• Full

Brace:

• None

ROM:

• Full and pain-free

Guidelines:

• Progress closed chain exercises
• Increase walking distance and pace (varied surfaces, hills etc)
• Commence and progress swimming
• Re-train for sport specific demands
• Strides and deceleration exercises