| Sample rehabilitation program for return to running following uncomplicated tarsal navicular stress fracture limited to dorsal cortex and treated non-surgically |
| Phase 1: |
- Weeks 1 to 6 (may extend to week 8 if more severe injury or complicating factors): Strict non weight bearing in a short leg cast.
|
| Phase 2: |
- Weeks 7 and 8. Cast is removed and patient placed in a weight-bearing cast-boot. If navicular is non-tender and there is no pain while walking in boot, patient may perform stationary cycling for 30 minutes daily at low resistance, and normal ADLs are permitted while weight-bearing in boot.
|
- Weight-bearing in a boot should be delayed as necessary, up to week 12, if tenderness persists or there is pain with weight bearing. Patient is referred to a surgeon if tenderness or pain is present at week 12.
|
| Phase 3: |
- Weeks 9 and 10 in uncomplicated cases. Patient begins fast walking in boot on treadmill: 15 minutes daily during week 9; 20 minutes daily during week 10. Patient may perform 30 minutes of stationary cycling in addition to fast walking.
|
| Phase 4: |
- Weeks 11 and 12 in uncomplicated cases. Patient begins treadmill running out of the boot: 2 minute run alternating with 1 minute walk for a total of 21 minutes.
|
- Most patients require a supportive running shoe and a custom orthotic.
|
- Stationary cycling can be used to supplement aerobic training for a maximum total of 50 minutes of aerobic activity daily, and on non-running days.
|
- During week 11, run-walk cycles are done for 4 days. During week 12, run-walk cycles are done for 5 days, and the total time permitted is increased to 30 minutes. Total time permitted for all aerobic activity (run-walk cycles plus stationary cycling) is increased to 60 minutes daily during week 12.
|
| Phase 5*: |
| This phase averages 4 to 6 weeks and involves the following steps: |
- First week: Run 15 minutes, then walk 3 minutes. May perform this cycle twice for a total of 36 minutes up to 5 days per week. Cross training on stationary bicycle permitted, but total aerobic activity is not to exceed 70 minutes daily.
|
- Second week: Run 20 minutes, then walk 5 minutes. May perform this cycle twice for a total of 50 minutes daily, up to 5 days per week. Cross training on stationary bicycle permitted, but total aerobic activity is not to exceed 70 minutes daily.
|
- Third week: Continuous running for 30 minutes. Not to exceed 6 days per week. Limit total aerobic cross training to 70 minutes daily.
|
- Fourth to sixth weeks: Patient may add 10 minutes per week to total running time, but no more. If successful, patient can return to normal training starting with the seventh week of this phase.
|
