achilles tendon rupture accelerated rehab protocol achilles tendon rupture accelerated rehab protocol

Fibrin biopolymer sealant and aquatic exercise association for calcaneal tendon repair. <>/Metadata 358 0 R/ViewerPreferences 359 0 R>> There is increasing evidence, summarized in systematic reviews, that one can successfully use a non-operative treatment protocol to manage patients who suffer an acute rupture of the Achilles tendon. (open!andclosed!kinetic!chainas!well!as!functional activities)-!start!withTheraband!tubingexercises! Initiate balance exercises (double leg wide base narrow . 0 of the Achilles tear and repair. hb```>VNAd`0p`8pLYY[R'}500Tttt40( C1C(?4 Introduction. Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. The goal of surgery is to reapproximate the ruptured tendon ends in order to promote healing and restore overall strength. Impact control exercises beginning with two feet to two feet, progressing from one foot to the other, and then one foot to the same foot. %PDF-1.5 % Copyright 2014 Elsevier Ltd. All rights reserved. group 2-4 weeks Aircast walking boot with 2-cm heel lift* Protected weight-bearing with crutches Clipboard, Search History, and several other advanced features are temporarily unavailable. It is recommended that clinicians collaborate The Achilles tendon, which is about 12-15 cm long and comprises both the gastrocnemius and the soleus tendons, is the thickest, strongest and largest tendon in the human body. Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back of your lower leg. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. q{b7\68wbZaX?MN3 ,iFaI!_>bT=BL~>k9Z'V>Y'Zo5M:Bt>Oby^|pRh/0UhclP"t~** 0! Knee Surg Sports Traumatol Arthrosc. Review Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence . York (UK): Centre for Reviews and Dissemination (UK); 1995-. Cardiovascular: Upper body circuit training, Physical therapy appointments begin one to two visits per week. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. #WDA Five trials compared full to non weight bearing, all applying immobilization in equinus. Application of Doctor-Nurse-Patient Co-Decision-Making Nursing Intervention Based on Evidence-Based Problems in the Rehabilitation of Acute Ankle Lateral Collateral Ligament Injury. Disclaimer. x\n#}!{B^pq8h*S=rz YTWu]N]zGo?Sz$ByhTTu_[UtzrVZO7'. The tendons twist from proximal to distal as they insert into the calcaneous, creating a shearing force. Online Physical Therapy Protocol Quality, Variability, and Availability in Achilles Tendon Repair. Biomed Res Int. In an acute Achilles Tendon Rupture, there are two options: Surgical repair with accelerated rehab protocol. Good control and no pain with functional movements, including step-up/down, squats and lunges. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Knee Surg Sports Traumatol Arthrosc. 2016. Clinical, Ultrasonographic, and Elastographic Comparison. Procedure: Conservative Management of Tendo-Achilles Rupture - Accelerated 8-week protocol Indications for Procedure: Tendo-Achilles Rupture Expected Length of Stay: n/a Surgeons: All orthopaedic trauma surgeons Scope of Practice These guidelines are designed to guide physiotherapists when treating patients following conservative management . Ruptures of the tendo achillis. Five trials compared full to non weight bearing, all applying immobilization in equinus. Lantto et al. +2 b6b ] ]-oF%@ZUiV'US7\4yk@RAQA$EB-;D2yR"H#YH ~Z/K>S'E_ R>-C^^[i. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. 2 0 obj <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 5 0 R/Group<>/Tabs/S/StructParents 1>> endstream endobj 180 0 obj <>/Metadata 7 0 R/PageLayout/OneColumn/Pages 177 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 181 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 182 0 obj <>stream Stretching for patient-specific muscle imbalances. Orthop J Sports Med. 2021 May 21;36(4):e360407. 4d1olrz?+Vg.TxH38@ g%L !.XyR-Kd-+"v+l3,~l|LR {Z^R}TTKS`p*9szqAdJAs2QGE6pzHf)'a n7=pMi-Sn3r7$5B"yUMQy^&hkj)V&a55JZp5JSb^]"37H919=N]?&h6.M{Af[Uf`0R;DW x^Q^5fu;%)Ptu$DtqEHg Post-op weeks 3-4: boot at 10 degrees, sleep in boot, TTWB with crutches. 0_'|,t0:!: . ^Fz,l6N}{D6Y?TP),#uz/i3F~bHG(BQ" eCollection 2022. 1 0 obj Low level calf plyometric exercises (fast CRs, tip toe Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. 12 weeks with supervision (double Progression of calf stretching past plantar grade. Discussion. Morimoto S, Iseki T, Nakayama H, Shimomura K, Nishikawa T, Nakamura N, Tachibana T. Regen Ther. Rehabilitation regimen for non-surgical treatment of Achilles tendon rupture: A systematic review and meta-analysis of randomised controlled trials. Closed chain weight bearing quads, hamstrings, glutes, calf strengthening with physio guidance. We mostly see ruptures of the Achilles tendon in high-impact sports predominantly in the male athlete. CAMBOOT with 10mm heel lift or VACOPED at (1) with flat sole for 4th week Continue hip and sharing sensitive information, make sure youre on a federal Splint/Boot: Locked 20-30 degree plantarflexion for two weeks Acute Achilles Tendon Rupture Repair Rehab The Achilles tendon is the biggest and strongest tendon in the human body and is formed by the tendons of the soleus and gastrocnemius muscles which both insert at the calcaneus. After the Achilles tendon rupture repaired , patients were randomly divided into 2 groups, and the rehabilitation protocol was traditional rehabilitation protocol and accelerated rehabilitation protocol under ultrasonic monitoring , respectively, to study the difference in efficacy between the groups. -, Injury. The length of the incision and the surgical approach will depend on location of the rupture. Unable to load your collection due to an error, Unable to load your delegates due to an error. management of Achilles tendon ruptures. =+Q%90Z6U='-rj\Ig pV.4FqW%W)53s^#D3 a`CN3=z[lmOgEA5CWwpLz9r4-+94Is9>}n-9k=n6R LAJxeF$ylM>MY@0vFEviCM ml@5s? Functional movements (squats, step backs, lunges). National Library of Medicine Plaster Cast or CAMBOOT with 30mm heel lift or VACOPED (3) plus wedge sole for 1st week. 2021 May 28;18:112-116. doi: 10.1016/j.reth.2021.05.002. Frankewycz B, Krutsch W, Weber J, Ernstberger A, Nerlich M, Pfeifer CG. ACHILLES-TENDON-RUPTURE-ACCELERATED-REHAB-PROTOCOL.pdf - Free download as PDF File (.pdf), Text File (.txt) or read online for free. 204 0 obj <>/Filter/FlateDecode/ID[<5F38DF44F3FF7641895593BD7106A5BB>]/Index[179 50]/Info 178 0 R/Length 115/Prev 119698/Root 180 0 R/Size 229/Type/XRef/W[1 3 1]>>stream One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. Pool exercises if the wound is completely healed. [PubMed: 25059505]. eCollection 2021. Study Selection Criteria Randomized . Plaster Cast or CAMBOOT with 20mm heel lift or VACOPED (2) plus wedge sole for 2nd week. Achilles Tendon Repair; ACL Reconstruction: Quadriceps Tendon Autograft; The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment. high load ankle, knee, hip Weight-bearing: Touchdown weight-bearing (TDWB) with crutches Accelerated rehabilitation following Achilles tendon repair after acute rupture development of an evidence-based treatment protocol, Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet], Centre for Reviews and Dissemination (UK). Before Consequently, physicians may have reservations about adopting functional rehabilitation. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. ,dDu=hQ*S:m6 _0}NTD4%Dw $k7pQ(@Wi:s.K^ 1 0 obj Wr5)Z nK!e*~[~[)$WoU]sMHUoUbmJ9yOJ}` Very gently at first and gradually build up . Cardiovascular upper extremity circuit training. The acute rupture of the Achilles tendon is a protracted injury. Braunstein M, Baumbach SF, Boecker W, Carmont MR, Polzer H. Knee Surg Sports Traumatol Arthrosc. No tackling, sudden unexpected change An Achilles tendon rupture is a full or partial tear of the Achilles tendon. `p19~%t?JGw]Sv+[ ]RDir)A) '$M*0 eC5 7<81$^;c! In addition, surgical repair involves, but is not limited to, an increased risk of infection, adhesions and disturbed skin sensibility with a pooled relative risk of 10.6 (95% CI; 4.8;23.3) as . Passive dorsiflexion both with knee in extension and flexed to 35 - 400 until gentle stretch on achilles. Would you like email updates of new search results? The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. sharing sensitive information, make sure youre on a federal Achilles tendinopathy can be described as an insertional or mid-portion, the difference . < endobj The American journal of sports medicine. scar mobilization and friction massage) to decrease fibrosis. Tripping, falling or twisting your ankle can also cause an Achilles tear. Frontal and transverse plane agility drills (progress from low velocity to high, then gradually add in sagittal plane drills). Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. Normalize gait on all surfaces without boot or heel lift. 2014 Nov;45(11):1782-90. doi: 10.1016/j.injury.2014.06.022. The site is secure. Using Long-Duration Static Stretch Training to Counteract Strength and Flexibility Deficits in Moderately Trained Participants. To correct these problems, a physical therapist may show you exercises or use hands-on techniques to ease the tension. Accessibility Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. An objective assessment of surgical and non-surgical treatment. Everything went well, had the staples removed yesterday. 2007 Nov 6;8:108. doi: 10.1186/1471-2474-8-108. 2021 Jun;24(6):536-543. doi: 10.1016/j.jsams.2020.12.005. Avoid forceful active and passive range of motion of the Achilles for 10 - 12 weeks. MRI studies may be indicated for surgical management of chronic injuries. It connects the muscles of your calf to your heel. Achilles Tendon Rupture - Non-operative treatment rehabilitation guidelines 0-2 WEEKS REST (PHASE 1) Goals Rest, recovery and mobilise non-weight bearing safely on crutches Immobilisation Plaster cast/Rigid boot with foot pointing downwards 20 (with 3 wedges inside - 22/16/10, more if needed) Design of a randomized controlled trial. 2011 Dec;17(4):211-7 Goals: Achilles Tendon Repair Rehabilitation Protocol, North Fork Orthopaedic and Sports Medicine, Lower Extremity Fracture Care Post-Op Instructions. 1 0 obj J Bone Joint Surg Am 2010; 92: 2767 - 75. It's important to get the right diagnosis so you can get the right treatment. Literature Search We searched the MEDLINE, Embase, CINAHL, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases. In chronic and neglected rupture, surgical treatment is preferred over non-surgical treatment . Achilles tendon is the biggest and strongest tendon in the body. A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Surgery is only the beginning of a long rehabilitation period. 228 0 obj <>stream TABLE E-1 Achilles Tendon Rupture Rehabilitation Protocol Time Frame Activity 0-2 weeks Posterior slab/splint; non-weight-bearing with crutches: immed. Knee Surg Sports Traumatol Arthrosc. s% i5iYd}mYSz;0Wj|*:2aO5ZmJeNWhqLx* EUgm"5l94`0;C1B]@-yH?0{2ER'fL-j6U,@tyS]?sZn|(E31-*=} Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. Shooting nb^t~luNS zRBR}mHbKz!MKCZ?/ibO'"qwDG&lQz=>4 QG`7]qvZ;{t;-rq@ .iij1QB\:Lw;hxAMOPNw(v9`K-{ig@@HymirxF> of direction, jumping (10% body hbbd```b``"Z@$"d8XDI90L~_DH`U&(H( X$D I]@k"_ 6' Moderate load plyometrics at training. 1 This is called "eccentric loading." If you have Achilles tendonitis, walking and running can be painful. 1,2 These reviews and other systematic reviews consistently show a slightly lower incidence of re-rupture with operative treatment, which is . Design Scoping review. Weak . The aim of this study was to define the most effective and safe post-operative rehabilitation protocol following minimal invasive repair. Achilles Rupture Non-operative Protocol Page 3 of 3 Last Updated September 3, 2020 REFERENCES: 1. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Frontal and sagittal plane stepping drills (side-step, crossover step, grapevine step). Epub 2010 Oct 29. Epub 2017 Jan 17. Objectives To (1) describe which resistance exercises are used in the first 8 weeks of treatment for acute Achilles tendon rupture and (2) assess the completeness of reporting of the exercise descriptions. postop. The Accelerated Rehabilitation Program lasts for 12 weeks and is supervised by your Physiotherapist. kicking small. ^C< ^/PgN`r3~LV*m{ (3Nl(+J?~I Return to the original sport at only 3 months after an Achilles tendon rupture by a combination of intra-tissue injection of freeze-dried platelet-derived factor concentrate and excessively early rehabilitation after operative treatment in a male basketball player: A case report. leg jumps, skipping). Disadvantages. Kangas J, Pajala A, Siira P, Hmlinen M, Leppilahti J. J Trauma. The best approach varies for each individual. 4 0 obj endobj Achilles Tendon Repair Rehabilitation Protocol Phase I (surgery to 2 weeks after): Splint/Boot: Locked 20-30 degree plantarflexion for two weeks Weight-bearing: Touchdown weight-bearing (TDWB) with crutches Cardiovascular: Upper body circuit training Patient Precautions: Keep elevated. II. Continue resisted inversion and eversion through range, Double leg stance out of boot; single leg stand in boot progressing to out of boot as balance improves. . 2018. r After the second postoperative week controlled ankle mobilization by free. Hydrotherapy MeSH SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. Pain-free isometric ankle inversion, eversion, DF and submaximal PF. 3. Continue active resisted theraband exercises; plantarflex through full range, dorsiflexion to a natural plantigrade position, push no further. 2014 2. Graduated!resistanceexercises! Acute Achilles tendon rupture: minimally invasive surgery versus non operative treatment, with immediate full weight bearing. An Achilles tendon repair surgery is a scheduled outpatient procedure done in an operating room located in a hospital or surgery center. 3 0 obj It is important to evaluate whether early functional weight-bearing . Gentle calf stretching with a towel (not body weight). The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. 24 staples. Foot Ankle Spec. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. Keywords: The https:// ensures that you are connecting to the L6YZN Ko:7}BFk| V.&!Na 1"}2C1[irXd8`<9f4X|(iTerx_&>uQMAv/>My]Zg}?;fl|Hpt. Conclusion: Early functional rehabilitation protocol for Achilles tendon rupture improved patient satisfaction, compared with standard immobilisation regimens, with reductions in minor complications and no difference in re-rupture rates. weight) Goals: Protection of repair and achieve active dorsiflexion (DF) to neutral. Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. ACHILLES TENDON RUPTURE ACCELERATED REHAB PROTOCOL - Fowler Kennedy Sport Medicine. 2021 Apr 7;9:654084. doi: 10.3389/fcell.2021.654084. Epub 2020 Dec 17. Results: Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. 4 0 obj Copyright 2014 Elsevier Ltd. All rights reserved. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. The .gov means its official. Sport/work-specific balance and proprioceptive drills. Open chain strength exercises for quads, hamstrings, glutes hip flexors. building to Front Cell Dev Biol. Begin physio guided active range of motion ankle exercises from week 3-4. An official website of the United States government. Arch Orthop Trauma Surg. surgeon and physio. endobj %PDF-1.5 bearing Non-Operative Treatment of Achilles Tendon Rupture Post-Operative Protocol Accelerated Rehabilitation Program: Weeks 1-2: Short leg fiberglass cast with ankle in plantarflexion of ~20 degrees Non-weight bearing with crutches for ambulation assistance Weeks 2-6: Transition to CAM walking boot with 6 heel lifts -, Unfallchirurg. Good control and no pain with sport/work-specific movements, including the impact. CAMBOOT with no heel lift or VACOPED at (0) with flat sole. (50% BW) by but an accelerated rehabilitation program should be accompanied by good results. Mosconi M, Pasta G, Annunziata S, Guerrieri V, Ghiara M, Perelli S, Torriani C, Grassi FA, Jannelli E. Diagnostics (Basel). Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol. Ankle strengthening with resistance bands. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. J Bone Joint Surg Am. Please enable it to take advantage of the complete set of features! Detailed Description: Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. Effect of Transdermal Fentanyl Patch Combined with Enhanced Recovery after Surgery on the Curative Effect and Analgesic Effect of Liver Cancer. **No hopping, J Bone Joint Surg Am. The Achilles tendon gives your leg strength to walk, run and jump. It arises near the middle of the calf and rotates approximately 90 degrees laterally during its course to insert on the posterior aspect of the calcaneal tuberosity [ 1, 2 ]. <>/Metadata 1559 0 R/ViewerPreferences 1560 0 R>> This was the standard procedure (long back of the leg incision vs newer technique with a shorter cut and a heel incision). <> Please enable it to take advantage of the complete set of features! <> Multiple surgical and nonsurgical approaches to treatment exist, 28 and the superiority of one over the other remains controversial and depends on patient factors and preferences. Keywords: % Brumann M, Baumbach SF, Mutschler W, Polzer H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-development of an evidence-based treatment protocol. 5 0 obj We performed a systematic literature search in Medline, Embase and Cochrane library. Emerg Med Int. Independent gait. 8]z].U3wKI2 J Sci Med Sport. . 3 0 obj IRh3J@+ZR*RNE+Ni$Gg3) x):+!#$SEL*u:Jd4r Strengthening (can be performed eCollection 2021 Dec. Hidd SMCM, Tim CR, Dutra EF Jr, Maia Filho ALM, Assis L, Ferreira RS Jr, Barraviera B, Silva JF, Amaral MM. 2022 Jul 29;12(8):1824. doi: 10.3390/diagnostics12081824. Unauthorized use of these marks is strictly prohibited. The use of early functional rehabilitation in the treatment of nonoperative Achilles tendon ruptures has been shown to provide patients with outcomes similar to operative treatments. in surgical group, after injury in nonop. basketball, tennis shots from standing start, contralateral Methods: Tendon is a specialized tissue mainly composed of collagen extracellular matrix (ECM), transmitting forces from muscle to bone [1].Tendon injury accounts for a large proportion of musculoskeletal system disorders and poses a substantial burden on human health [2].Therapeutic interventions including surgery, drug, physical therapy and rehabilitation are used for tendon repair [3]. Everything went well, had the staples removed yesterday. A LOCATION OF STONY BROOK ORTHOPAEDIC ASSOCIATES. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0 should be applied. Westin et al. bearing transitioning towards full weightbearing. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 594.96 842.04] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Clipboard, Search History, and several other advanced features are temporarily unavailable. /n%^xij_2]!J] n >!UGld Sometimes healthcare providers misdiagnose Achilles tendon injuries as a sprained ankle. Active ROM between 15 degrees of dorsiflexion and 50 degrees of plantarflexion. National Library of Medicine ^sR**aX^IZ9(cxq+{R r? Detractors of conservative treatment argue that this option leads to a greater risk of a re-rupture when compared to surgical treatment. VQ4 L}3Sz~zzDM>{z?NO?UI(/oO=:0QI]WrDctQa4TxR6=&eA>F2z>'%62p2{c86Y82b%q}`D U4x$!fGjGg$grJ,l6hqs&Sn5?1qX:{6G|8(?Mu83V\kZO._C9=7R4z-XW3"tcFWPoJ^&K.HfZ5E.LJSe=jC7S'r++@7Tka'k{e1u_X\W{Rv3x:gj. 24 staples. 8600 Rockville Pike Begin standing calf stretch at 5 weeks (knee flexed and extended) Continue eversion, inversion and plantar flexion isometrics with resistance bands. 3,10,13,25 Historically, surgical repair of Achilles tendon rupture was thought to decrease the risk of re-rupture substantially. 2014. The acute rupture of the Achilles tendon is a protracted injury. The https:// ensures that you are connecting to the This combination was most beneficial. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. 2,3 Controversy still surrounds what the optimal treatment for achilles tendon ruptures is. knee strengthening as Purpose: stream 1.Introduction. <>/F 4/A<>/StructParent 0>> movements (not past plantar grade). Operative versus non-operative treatment of acute Achilles tendon ruptures: a multi-center randomized trial using accelerated functional rehabilitation. 2022 Oct 14;19(20):13254. doi: 10.3390/ijerph192013254. Multi-plane proprioceptive exercises single-leg stance. HHS Vulnerability Disclosure, Help Slowly wean from boot. Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated with sporting events. 2003 Jun;54(6):1171-80; discussion 1180-1. doi: 10.1097/01.TA.0000047945.20863.A2. stream Physiotherapy Tailored and monitored by physio, Achilles Tendon Rupture Non-operative treatment rehabilitation guidelines, Achilles Tendon Rupture Operative treatment rehabilitation guidelines, Achilles Tendon Rupture Rehabilitation Videos, Big Toe (Hallux) 1st MTP Joint Fusion Surgery, General Information about Foot and Ankle Arthroscopy, General Information Injuries and Fractures, National Guidance Documents for Foot Surgery, Rest, recovery and mobilise non-weight bearing safely on crutches, Plaster cast/Rigid boot with foot pointing downwards 20 (with 3 wedges inside - 22/16/10, more if needed), Can carefully shower with waterproof cover over plaster cast/boot, Confidently weight bearing as pain allows using the crutches, Begin early, supervised, gentle ankle plantarflexion exercises, Maintain core, upper limb, hip, and knee strength, Rigid walking boot with foot pointing downwards with wedges inside boot, Can shower out of boot as long as very careful not to stand/stumble on foot, otherwise leave boot on with waterproof covering, Can weight-bear with crutches as discomfort allows in boot, Maintain spinal/hip/knee/toe range of movement, Can remove boot for exercises to gently actively plantarflex foot from position in boot to full range plantarflexion, Can dorsiflex back to position in the boot but not beyond, Progress to fully weight bearing but maintain use of crutches for balance if needed, Active ankle movement through available range of plantarflexion from position foot held in boot, Regain full inversion and eversion in available plantarflexion range, Aim for ankle plantigrade/foot flat by6-8 weeks in boot, Rigid walking boot with wedges being removed weekly to plantigrade position, Can remove one wedge per week until foot flat in the boot, Can perform active resisted plantarflexion, eversion and inversion with theraband, Can actively dorsiflex foot ONLY to position allowed by wedges in boot, No knee hyperextension to compensate for lack of ankle dorsiflexion, Aim to remove boot by weaning out by 12 weeks, Increase ankle and lower limb muscle strength, Boot with ankle plantigrade/ foot flat on the ground, Shower carefully so as not to stumble/forcefully dorsiflex ankle.