Post-op Protocol - Leg Fasciotomy

Lower Leg Fasciotomies

“As tolerated” should be understood to include with safety for the reconstruction/repair; pain, limp, swelling, or other undesirable factors are indicators that you are doing too much too soon. If any of these should occur, decrease activity level, ice and elevate the leg.  Ice should be applied to the leg six to eight times per day and when swelling or pain is present.  Return to sport based on provider team (physician, physician assistant, athletic trainer, therapist) input and appropriate testing. All times and exercises are to serve as guidelines. Progression through the protocol should be based upon criteria as opposed to dates listed and will vary depending on each individual patient. Progress should be agreed upon by the patient and his/her team of providers.

Phase 1: (Weeks 0-2)

Brace:
  • None
Crutches/Function:
  • Ambulation: weight-bearing as tolerated with crutches, progress to full  
Range of Motion (ROM):
  • Gentle ROM in all directions, progress to full
Therapeutic Exercises: 
  • Ankle TheraBand as tolerated, towel curls 
  • General hip and knee strengthening in non-weight bearing 
Manual Therapy:
  • Scar and soft tissue massage  
Proprioception:  
  • BAPS board, weight shifting 
Cardio:
  • Stationary bike, UBE (arm bike), swimming
Modalities:
  • HVPC (high volt pulsed current) for effusion (swelling) reduction as needed  
  • Cryotherapy six to eight times per day for 15 to 20 minutes each  
Progression to Phase II:  
  • Full and painless motion 
  • Ambulation without limp 
  • Strong and painless manual muscle testing in all planes except plantar flexion  
  • Minimal effusion

Phase II: (Weeks 2-6)

Crutches/Function:  
  • Full weight bearing without crutches  
Therapeutic Exercises:  
  • Initiate closed chain strengthening for ankle and entire lower extremity as tolerated  
  • Core strengthening 
Manual:  
  • Scar and soft tissue massage 
Proprioception:  
  • SLS (single limb stance), BAPS, unstable surfaces  
  • Joint repositioning  
Cardio: 
  • UBE, stationary bike, elliptical  
Modalities:  
  • HVPC for effusion reduction as needed  
  • Cryotherapy six to eight times per day for 15 to 20 minutes each 
Progression to Phase III:  
  • No effusion  
  • No pain  
  • Strong and painless manual muscle testing in plantar flexion  
  • 100% single limb stance of contralateral side 

Phase III: Week 6-12

Therapeutic Exercises:  
  • Progress strengthening in all planes  
Proprioception:  
  • SLS, BAPS, unstable surfaces  
  • Joint repositioning  
  • Perturbation training (balance against resistance)  
Cardio:  
  • UBE, stationary bike, elliptical, initiate treadmill running  
Plyometrics: 
  • Double-leg plyometrics progressing to single leg as tolerated  
Modalities: 
  • Cryotherapy after activity for 15 to 20 minutes  
Progression to Phase IV: 
  • No effusion  
  • No pain  
  • 80% single leg hop of contralateral side 

Phase IV: Month 3- Return to Sport

Recommend pursuing Transitional Therapy for return to sport activities during this phase  

Transitional Therapy – a strength and conditioning program that is led by medical professionals with a sports medicine background with the goal of transitioning from therapy back to sport  

Contact CCMC Sports Medicine for details in addition to ongoing strength, balance, and cardio conditioning, initiate agility drills and sport-specific plyometric activities as tolerated such as: 

  • Soccer/Football: Two-foot ankle hop, double-leg hop, front barrier hop, lateral barrier hop, single-leg hop, power skip, backward skip, double-arm alternate-leg bound, and cycled split squat jump  
  • Basketball/Volleyball: Two-foot ankle hop, double-leg hop, squat jump, double-leg vertical jump, single-leg hop, single leg vertical jump, power skip, backward skip, double-arm alternate-leg bound, alternate leg push off box drill, and side to-side push off box drill  
  • Baseball/Softball/Overhead throwing sports: Two-foot ankle hop, double-leg hop, front barrier hop, lateral barrier hop, single leg hop, power skip, backward skip, double arm alternate-leg bound, cycled split squat jump, and return to throwing program