Parameters to Assess Return to Sports after Foot & Ankle Injuries and Surgery: Amol Saxena, DPM & Marc Guillet, PT, ATC
Basic guidelines to return an athlete to running sports, includes assessment of pain level, range-of-motion and strength. Simplistically, the patient must have no pain with daily activities. Some initial onset of activity stiffness or soreness may be present for long periods post-injury, and this is not uncommon to persist for up to a year according to our clinical experience. However, the soreness or stiffness should get better with activity. There can be mild pain with palpation to either the Achilles tendon or the insertion. Ankle range-of-motion should be within 5° of the contra-lateral (opposite) limb’s ankle but adequate to perform the necessary activities. The circumference of the affected limb should be within a ¼” or 5 mm of the non-injured side. Strength assessment includes pain-free hopping and 20 single leg heel raises. Generally, 45 seconds of consistent activity repeated five times, is a good guideline for allowing a patient to return to sport.
Our typical regimen is to have the patient progress to being able to perform five sets of single-leg heel raises of 25 repetitions each as a barometer. We have found this parameter, along with having the range-of-motion within 5°, and calf circumference within 5mm to be statistically significant in getting people back successfully, at least when we evaluated 200 Achilles surgeries. Patients should be able to walk briskly for 40 minutes before trying to run. Standard Vertical Leap Testing, Single Leg Three Hop Test and a 20 Yard Lateral Shuttle Test should be assessed in the athletic population, especially those involved in lateral motion sports (see www.agilePT.com). Return to sport is not allowed unless all limitations are within 90% of the non-affected extremity.
A typical return to running program would be as follows: have the patient alternate walking and jogging for two minutes each, completing four cycles (16 minutes of total activity). Have them take a rest day and then re-assess two days later. If they felt challenged, have them repeat this every-other day for a week. If this was far too easy, then have the patient alternate three minutes jogging with one minute walking, again for four cycles. Again have the patient re-assess and repeat this every-other day for a week. Then the patient can begin with the following running schedule outlined in Table 1.
Return to Running After Injury Plan - Spreadsheet
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Sample Rehabilitation Protocol - Spreadsheet
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