Base of the 5th Metatarsal Fracture

  1. You should remain immobilized in a walking boot/post-op shoe until 4 weeks from the initial injury.
  2. You are allowed to fully weight bear as tolerated in the walking boot/post-op shoe. I would like you to discontinue use of crutches or any other assistive walking devices as quickly as possible.
  3. You may remove the walking boot/post-op shoe whenever seated or lying down, in a safe environment. The walking boot is in place to protect rather than immobilize the fracture.
  4. At 4 weeks post-injury, you may gradually transition from the walking boot/post-op shoe back into stiff-soled, supportive shoes.
  5. I would like you to remain in the supportive shoes for a total of 2 weeks before gradually returning to all types of shoe wear.
  6. While in the walking boot/post-op shoe, I would like you to come out of the walking boot/post-op shoe twice daily to work on the following exercises. You should perform the following exercises once in the morning and once in the evening:
    • You should perform 3 sets of 15 reps of dorsiflexion (up) and eversion (out), but avoid plantarflexion (down) and inversion (in).
    • Stretch the Achilles by placing a towel across the ball of your foot and pulling up. Hold each stretch for a five-count and do five repetitions.
  7. There are no limitations to your activities, as long as they are performed in the walking boot/post-op shoe.
  8. Outside of the walking boot/post-op shoe, you should limit yourself to cycling on a stationary bicycle.
  9. I would like to see you back in 4 weeks for a follow-up appointment. We will obtain new x-rays upon return.
  10. Foot fractures typically take 10-12 weeks to fully heal.

Ankle Sprain Injury

  1. It takes 10-12 weeks to see biological healing of the ligaments.
  2. You should remain immobilized in a walking boot or ankle brace for the first 3 weeks. This should be worn whenever weight bearing.
  3. At 3 weeks post-injury, you may transition from the walking boot back into regular shoes with the assistance of an ankle brace. You should continue to wear the ankle brace for an additional 3 weeks. If you were initially immobilized in an ankle brace, you should remain in the ankle brace until 6 weeks post-injury.
  4. I would like you to come out of the walking boot or ankle brace twice daily to work on the following exercises. You should perform the following exercises once in the morning and once in the evening:
    • You should perform 3 sets of 15 reps of dorsiflexion (up) and eversion (out), but avoid plantarflexion (down) and inversion (in).
    • Stretch the Achilles by placing a towel across the ball of your foot and pulling up. Hold each stretch for a five-count and do five repetitions.
  5. At 6 weeks post-injury, you may discontinue use of the ankle brace with daily use but should continue to use it whenever engaged in higher impact and higher demand activities for the next 3 months.
  6. Physical therapy may begin at 6 weeks post-injury, or earlier if desired. For most patients, physical therapy is not necessary.
  7. I would like to see you back in 4 weeks for a follow-up appointment.

Non-operative Treatment of an Ankle Fracture

  1. You will remain immobilized in the walking boot until 4 weeks post-injury.
  2. You are allowed to fully weight bear as tolerated in the walking boot. I would like you to discontinue use of the crutches or any other assistive walking devices as quickly as possible.
  3. You may remove the walking boot whenever seated or lying down, in a safe controlled environment. The walking boot is in place to protect rather than immobilize the fracture.
  4. I would like you to come out of the boot/brace to work on the following exercises, twice daily:
    • Write the alphabet with your foot. Do two repetitions.
    • Stretch the Achilles by placing a towel across the ball of your foot and pulling up. Hold the stretch for a five-count and do 5 repetitions.
  5. At 4 weeks post-injury, you will gradually transition to regular shoes. An ankle brace should be used to facilitate the process.
  6. Once you have returned to regular shoes, you may gradually ramp up your activities in a step-wise manner as tolerated.
    • I would like you to first become comfortable with activities of daily living before reintroducing straight-line, low-impact activities (walking, bicycling, using an elliptical trainer, weight training).
    • Once you are comfortable at this level, you may reintroduce higher-impact, straight-line activities (jogging, running).
    • The final step will be the addition of activities involving lateral movement and uneven ground.
  7. I would like to see you back in 4 weeks for a follow-up appointment. We will obtain new x-rays upon return.
  8. Ankle fractures typically take 10-12 weeks to fully heal.

Morton’s Neuroma Excision: 1st Post-op

  1. You may shower tonight, letting soapy water run over your incisions(s) and patting them dry with a towel. You should avoid submerging the leg (bath, pool, hot tub, etc.) for at least one week.
  2. You may begin to transition out of the post-op shoe as swelling and sensitivity allow. Once you have fully transitioned out of the post-op shoe, you may begin to reintroduce activities in a step-wise fashion.
  3. Using your thumb, begin massaging around the incision to desensitize the area and break up any scar adhesions.
  4. In 2 weeks, you may begin applying a scar cream (vitamin E based, such as Mederma) or silicone sheets.
  5. I would like to see you back in 4 weeks for your next follow-up appointment.

Ludloff Bunion Correction: 1st Post-op

  1. You may shower tonight, letting soapy water run over your incision(s) and patting them dry with a towel. You should avoid submerging the leg (bath, pool, hot tub, etc.) for at least one week.
  2. You will be heel-weight bearing for the next 4 weeks.
  3. I have showed you in clinic today how to perform a bunion wrap to fine-tune the position of the toe. You should continue to perform this wrap daily. If you notice any drifting of the great toe towards the second toe, you may use tape as added fine-tuning. The bunion wrap should ALWAYS be in place unless you are showering.
  4. You will continue to ice and elevate the leg as much as possible. Elevating the leg above the level of the heart will reduce the amount of time required to bring down the swelling.
  5. I would like to see you back in 4 weeks for your next follow-up appointment. We will obtain new x-rays at that time. If there is appropriate evidence of healing, we will likely transition you to full-foot weightbearing in a flat post-op shoe.