Talar Fracture Rehab Protocol

Phase I – Initial Stability (0 to 6 weeks)

• Patients will be Non-weight-bearing (NWB) in cast or splint or 6-10 weeks. Do not begin weight bearing until specifically instructed by surgeon.
• Ambulatory device training (walker or crutches) and transfers.
• General lower extremity strengthening – SLR, quad sets, etc.

Phase II – Early Range of Motion/Gait training (6-8 weeks)

• Patient is placed in a removable cast boot in orthopedics office (6 weeks).
• Begin NWB ankle ROM exercises – PF, DF, inversion, and eversion.
• Gradually increase weight-bearing (PWB) status so patient is full weight bearing WBAT) by the end of the 8^th week.
• Advance to cane.
• Advance with aggressive stretching program.
• Isometric exercises for PF, DF, inversion and eversion.
• Seated towel toe crunches and push aways (intrinsic foot musculature).
• Stationary bike for range of motion.
• Ice for swelling.  Minor swelling usually occurs as patient increases weight-bearing status. 

Phase IV – Return to Function (After 8 weeks)

• Theraband strengthening exercises - DF, PF, inversion, eversion. Advance to home exercise program.
• Mini squats, toe raises (bilateral and unilateral)
• Advance daily stretching
• Unilateral standing balance (eyes open, eyes closed)
• Strength program (2-3 sets of 10 repetitions)
• Total gym squats and toe raises
• Leg press
• Hamstring curls
• Leg extension
• Endurance
• Bike
• Treadmill walking (advance to lateral stepping, backwards walking)
• Proprioceptive Exercises – advance per tolerance and patients functional needs
• 4-way straight leg raises with tubing (a.k.a. "steamboats")
• Proprioceptive star – toe touch and lunges
• Rebounder
• Fitter
• Seated BAPS board, progress to standing
• Mobilisations per therapist
• Modalities PRN – Fluidotherapy, moist heat, ice

Review References

• Brotzman, S.B. and Brasel, J. "Foot and Ankle Rehabilitation," Clinical Orthopedic Rehabilitation.  Mosby, 1996. pgs. 258-263.