Progress can be challenging for individuals in post total ankle replacement surgery. How can physical therapy help in recovery and restoring leg function?

Total Ankle Replacement Post Surgery Physical Therapy

Total ankle replacement surgery is a major procedure that takes time to recover. A total ankle replacement surgery or arthroplasty can benefit individuals with chronic ankle pain or disability. This procedure can significantly improve an individual’s overall pain and function with time. Physical therapy is essential to regaining movement in the ankle and restoring full mobility. A physical therapist will work with the individual to control pain and swelling, restore the ankle’s range of motion, train on walking gait and balance, and rebuild strength in the leg. This will help maximize the chances of a successful outcome after surgery.

Total Ankle Replacement

The ankle joint is the section of the lower leg where the shinbone/tibia meets the talus bone on the top of the foot. What can happen is the slippery surface/articular cartilage that coats the ends of these bones begins to thin or deteriorate. As the deterioration progresses, it can lead to significant pain, disability, and difficulty walking. (Cleveland Clinic. 2021) This is where a specialist may recommend total ankle replacement for the best results. Various conditions can be helped by this procedure, including:

• Joint damage caused by gout
• Post-traumatic arthritis
• Rheumatoid arthritis
• Advanced osteoarthritis
• Osteonecrosis
• Septic arthritis (Cort D. Lawton et al., 2017)

During an ankle replacement procedure, an orthopedic surgeon removes the damaged ends of the tibia and talus bones and replaces them with an artificial covering. A polyethylene component is also secured between the two structures to support the smooth movement of the new joint endings. (Massachusetts General Hospital. N.D.) Following the procedure, individuals are typically placed in a protective boot or splint. The healthcare provider will recommend staying off the leg for 4 to 8 weeks to allow healing.

Physical Therapy

Outpatient physical therapy is usually initiated several weeks after the ankle operation. (UW Health Orthopedics and Rehabilitation. 2018) Physical therapy can last for five months or more, depending on the severity of the condition and injury. The physical therapist will focus on different areas to get the best results. (Cort D. Lawton et al., 2017)

Pain and Swelling Control

Post-operative pain and swelling are normal after a total ankle replacement. It is not unusual for an ankle to be swollen for even six to 12 months after the operation. (UW Health Orthopedics and Rehabilitation. 2018) The surgeon will normally prescribe medication to help manage discomfort early on, and physical therapy also plays an important role in addressing the symptoms. Treatments used can include:

• Electrical stimulation – mild electrical pulses applied to the muscles.
• Ice
• Vasopneumatic compression, where an inflatable sleeve is used to create pressure around the area, is commonly utilized at the beginning of physical therapy to reduce pain or swelling.
• Other modalities, such as stretching and targeted exercises, are combined with other treatments.

Range of Motion

• Early after the procedure, the ankle will be very stiff and tight. This is due to several factors, including the inflammation and swelling after surgery and the time spent immobilized in a boot.
• The physical therapist will employ various techniques to improve the ankle joint’s range of motion to rotate and flex.
• The physical therapist may employ passive stretching induced by an outside force such as the therapist or a resistance band) to help improve mobility.
• Manual techniques like soft tissue massage and joint mobilizations are also utilized. (Massachusetts General Hospital. N.D.)
• The therapist will develop a home rehabilitation program comprising self-stretching techniques and gentle movements.

Gait and Balance Training

• After weeks of staying off the affected ankle, the surgeon will clear the patient to begin walking training.
• The physical therapist will work to improve the overall gait pattern and reduce limping.
• They will also help transition from using crutches or a walker to walking independently. (UW Health Orthopedics and Rehabilitation. 2018)
• After multiple weeks of reduced movement and lack of bearing any weight on the ankle, the muscles that surround the ankle have often atrophied/weakened, which can impact balance.
• When the individual can begin placing weight on the leg, the therapist will apply proprioceptive/sense of body position training to improve overall stability. (UW Health Orthopedics and Rehabilitation. 2018)
• Balance exercises will be added to the home program and will progress from week to week.

Strength

The muscles in the leg, ankle, and foot become weak from the surgery and the time spent in a splint or boot. These structures have a significant role in balance, the ability to stand, walk, and go up or down the stairs.

• Regaining the strength and power of these muscles is a critical goal of rehabilitation.
• In the first weeks, the physical therapist will focus on gentle strengthening exercises.
• Isometrics lightly activate the muscles but avoid irritating the surgical site.
• As time passes and weight-bearing is allowed, these gentle moves are replaced with more challenging ones, like resistance bands and standing exercises, to accelerate strength gains.

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Treating Ankle Sprains with Chiropractic Care

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References

Cleveland Clinic. (2021). Total ankle replacement.

Lawton, C. D., Butler, B. A., Dekker, R. G., 2nd, Prescott, A., & Kadakia, A. R. (2017). Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. Journal of orthopaedic surgery and research, 12(1), 76. doi.org/10.1186/s13018-017-0576-1

Massachusetts General Hospital. (N.D.). Physical therapy guidelines for total ankle arthroplasty.

UW Health Orthopedics and Rehabilitation. (2018). Rehabilitation guidelines following total ankle arthroplasty.