Treatment Philosophy: The philosophy is to reduce inflammation/ pain, address behavior modification (exercise/work activity and/or shoe wear), progress with pain free range of motion, progressive resistance exercise, and return to full functional activity.

Desired outcomes: Full return to previous level of function without pain, independence with an exercise program to maintain strength and flexibility and education/behavior modification to deal with future exacerbations.

Acute Phase:

R.I.C.E. Method
Gentle Range of motion 2-3 times per day
Gentle gastroc and soleus stretches holding 20-30 seconds
Modalities: Ultrasound, Iontophoresis, moist heat/ cold pack and transverse friction massage
Assessment of biomechanical factors and behavior modification (training, shoe wear, ect..)
Patient education- risk factors and home treatment

Goals:
1. Pain and inflammation decreased
2. Education/ Modification initiated
3. Restoration of ROM

Subacute:

Continue as above
Begin low level strengthening with isometrics and progress with isotonic strength with theraband (when painfree with isometrics)
Conditioning exercises: swimming, bicycling, aquatic therapy, walking
Begin weight bearing strengthening of gastrocsoleus with gradual progression to eccentric strength (discontinue if symptomatic)
General lower extremity strength (if needed)

Goals
1. Restored full ROM
2. Begin low level strength with progression per tolerance
3. Conditioning exercises initiated

Advanced:
Progress with isotonic strength and gradually increase eccentric strength per tolerance
Begin low level sport specific exercises and monitor signs and symptoms
Progress with sport specific activities with gradual return to sport
Review home exercise program, behavior modification, education

Goals
1. Strength grossly equal to uninvolved with manual muscle test
2. Able to return to previous activity without pain
3. Independent with home exercise program and corrected risk factors (when
possible)

Injury Classification (symptom related)
1. Pain only after activity
2. Pain initially with activity that decreases after warmup but reappears after activity
3. Pain during and after activity
4. Rupture