Table 1.

Plantar-Plate Postoperative Rehabilitation Protocol for Cases 1 and 2

	Phase 1: 0–2 wk	Phase 2: 2–4 wk	Phase 3: 4–8 wk	Phase 4: 8–12 wk	Phase 5: 12–16 wk	Phase 6: 16–24 wk
Special instructions	Bed rest.	Passive range-of-motion movements are gentle. Go slowly.	None	Discontinue walking boot. Use athletic shoe with carbon or steel insert to limit dorsiflexion.	Begin resisted plantar-flexion and dorsiflexion strengthening of metatarsophalangeal joint.	Full return to contact sports without restriction 2–6 mo after surgery.
	Immobilization in 5°–15° of plantar flexion for 7–10 d to encourage scarring and discourage damage to sutures and reconstructed soft tissue.
Passive range of motion	None	In extension to neutral only.	Increase range of motion.	None	More aggressive passive metatarsophalangeal-joint plantar flexion and dorsiflexion.	None
		Metatarsophalangeal and interphalangeal joints in flexion only.	Passive flexion and extension guided by tolerance to pain.
Active range of motion	None	No active movements.	Gentle active extension to neutral only.	Active flexion and extension without resistance.	None	None
			No active flexion until 8 wk.
Weight bearing	Non–weight bearing with crutches.	Non–weight bearing with crutches and walking boot for protection for 4 wk.	Partial weight bearing in walking boot.	Continue progression to full weight bearing.	Begin running by initiating a walk/jog program.	Continue running program.
			Begin with 25 lb (11.25 kg) and increase.
			25 lb/wk (11.25 kg/wk) to full weight bearing.		Case 1: 12 wk	Full running and agility program 18–19 wk after surgery.
			Discontinue crutches at 6–7 wk after surgery.		Case 2: 16 wk
Exercises	None	None	Weight shifts.	Single-legged balancing, core strengthening, stationary bicycling, and swimming without push off.	Continue previous exercises.	Continue previous exercises.
			Core and hip strengthening.		Increase proprioception exercises.	Begin gradual plyometrics.
			Single-legged balancing exercises in boot 6–7 wk after surgery.		Add unstable surfaces (eg, Airex balance pad, mini-trampoline).a
Avoid	None	None	All resistance at metatarsophalangeal and interphalangeal joints of great toe.	All eccentric contractions at metatarsophalangeal joint.	None	None
				Running.
			Active flexion of metatarsophalangeal and interphalangeal joints of great toe.	Extremes of great toe metatarsophalangeal-joint dorsiflexion.
Additional concerns and instructions	Edema control.	Edema control.	Soft tissue mobilization for foot and ankle edema control.	Continue soft tissue mobilization.	Continue soft tissue mobilization.	Wear shoe modified with carbon or steel insert for 6 mo after full return.

^aAirex AG, Sins, Switzerland.