Total Ankle Arthroplasty

DR STRASSER TOTAL ANKLE REPLACEMENT POST-OP PROTOCOL

PHYSICAL THERAPY GUIDELINE:

Below is meant to be a tool to guide rehab related expectations.  Please keep in mind the surgery may involve additional procedures which may delay certain steps in the rehab (such as time to weight-bearing).  

Weeks 0-3:

•      Wound check between 2-3 weeks post-operative

•      change to a cast; patient is NWB

•      gait re-education with correct use of crutches/walker

•      AROM of hip and knee

•      rest and elevation of limb at least 6 inches above heart 22 out of 24 hours/day

Goals:  

•      ADLs with safe and independent use of crutches/walker

•      control pain and swelling

Weeks 3-6:

•      sutures removed

•      start Active Assisted ROM of ankle

•      boot on at all times except removal for exercises 2-3 X day and for hygiene;

            boot kept on at night

•      OK to weight-bear while standing (axial loading)

•      NWB quad strengthening

Goals:

•      increase ROM

•      safe and independent use of crutches/walker

Weeks 6-10:

•      wean from boot to be WBAT in shoe at 6 weeks post-op as long as wound is completely

healed

•      practice standing, weight shifting, and small periods of walking out of the boot.

Gradually increase time and distance out of boot with goal of being completely out of

boot by 8 weeks post–op.

•      continue AROM of ankle and elevating to control swelling

•      core exercises with Transversus Abdominal recuitment

•      hip strengthening with special focus on gluteus medius strength

•      begin joint mobilizations and scar massage

•      begin cycling on stationary bike

•      may begin swimming if wound is healed and safe to get in/out of pool

•      increase ADL’s in standing (as long as patient is not in an extended NWB period)

Goals:

•      maintain ankle ROM

•      maintain hip/knee ROM and strength

•      improve core strength

•      safe use of crutches/walker

•      increase mobility of scar WBAT out of boot and into shoe

Weeks 10-14:

•      continue scar massage and joint mobs

•      use heat as needed

•      continue stationary bike

•      gait training and low level balance/proprioception exercises

•      progressive strengthening of hip, knee, and ankle

•      continue core strengtheing

Goals:

•      increase core, hip, knee, and ankle strength

•      work to restore optimal gait and ensure patient is safe with/without walking aid

Weeks 14-16:

•      begin unilateral stance exercises

•      progress to higher level balance/proprioception exercises

•      begin bilateral heel raises progressing to unilateral

Goals:

•      ambulation without walking aid

•       EXPECTED ANKLE ROM:  DF= 10 degrees and PF= 35 degrees

Weeks 16+

•      return to normal activities (ie. Golf, tennis) with goal of full strength/optimal function

ADDITIONAL NOTES:

Pain and Swelling

This is a procedure that causes a lot of pain and swelling.  It is normal for the ankle to stay swollen for up to 6-12 months post-op.  Redness does not necessarily indicate infection.  Significant drainage from the wound is usually a sign of infection.  

Driving

The patient may drive if the surgery is on the LEFT foot as pain and swelling allows, and if the car is an automatic.  If the surgery is on the RIGHT foot the patient may return to driving if they are full weight-bearing and can safely demonstrate and emergency stop on the break.  THE PATIENT CANNOT DRIVE WHILE THEIR FOOT IS IN A WALKER BOOT.  The patient should contact their insurance company before driving a car.

Return to Work

Return to work at a fully sedentary job no earlier than 3-4 weeks post-op.

Return to work at a job requiring significant amounts of standing or walking no earlier than 4 months post-op.

Return to work for jobs with physical requirements between the above extremes is individualized (if uncertain please contact the surgeon).

IMPORTANT:

No patient with a total ankle should be doing a job, sport, or any activity involving impact to the joint