Table 3 Phases and progression of physical therapy treatment

Phase I

1. Decrease irritability

1. Mild to moderate pain

1. Address contributing factors (footwear, orthotics, taping, neurodynamic impairments)

2. Educate participant on condition and rehabilitation

2. Dorsiflexion ≥10 degrees (measured in prone with knee extended) [11], or symmetrical dorsiflexion to uninvolved side

2. Participant education

3. Improve dorsiflexion

3. Modalities

4. Stretching/self-mobilization

a. Home Program; <5 exercises [55]

b. Night splint (if symptoms persist for >6 months) [19]

5. Manual therapy

Phase II

1. Further reduction in pain

1. Minimal to no pain

1. Exercise*

2. Single leg heel raise ≥12 repetitions [56], or symmetrical performance to the uninvolved side

2. Manual therapy*

2. Restore muscle performance

3. Gait training

3. Minimize gait deviations

3. Walking items on FAAM ≤ “slight difficulty”

4. Enhance basic function(s)

Phase III

1. Enhance higher level function(s) including sport and recreational activities

Discharge when:

1. Progression of exercise

GROC ≥ “quite a bit better” and participant demonstrates understanding of independent condition management

2. Sport/recreation specific training

2. Education on independent condition management and prevention

2. Prevent recurrence

OR

Plateau evident in GROC or FAAM scores and participant demonstrates understanding of independent condition management