Ankle, Subtalar, TTC, and Triple Arthrodesis Procedures
Warren Latham MD, FRCSC
This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Specific changes in the program will be made by the physician as appropriate for the individual patient.
REMEMBER: It can take up to a year to make a full recovery, and it is not unusual to have intermittent pains and aches during that time!
All Surgeries Require a 2 week follow up at Scarborough Birchmount fracture Clinic
Pre-operative gait analysis required
Phase I: Date of Surgery – 6 weeks
Objective: Healing, protection of fusions
Immobilization: Splint; After 2 week follow-up visit IN FRACTURE CLINIC: nwb below knee cast
WB Status: Flatfoot WB for balance only
Phase II: Week 6-8
Objective: Healing, protection of fusions
Immobilization: Removable aircast (foam walker)
WB Status: Weight bearing (IN AIRCAST) *DEPENDENT ON POST OP XRAY EVALUATION
Therapy: May be initiated towards the end of this phase, 1-2 x per week with a focus on swelling reduction, pain control, and early return of AROM, home care/exercise instructions for motion, pain/swelling control
SUBTALAR FUSION: Ankle ROM starting 6 weeks post-operatively
Phase III: Week 8-16
Objective: Swelling reduction, increase in ROM, neuromuscular re-education, develop baseline of ankle control/strength
Immobilization: None
WB Status: WBAT, progressive reduction in crutch use, *NOTE – WB status and gait progression determined by physician
Therapy: 1-2 x per week based on patient’s initial presentation, frequency may be reduced as the patient exhibits good recovery and progress towards goals, instructions in home care and exercise to complement clinical care
Phase III: Week 8-16 (cont.)
Rehab Program
Strength: Techniques should begin with isometrics in four directions with progression to resistive band/isotonic strengthening for dorsiflexion and plantarflexion. Due to joint fusions, eversion and inversion strengthening should continue isometrically, bands should progress to heavy resistance as tolerated, swimming and biking allowed as tolerated
Proprioception : May begin with seated BAPS board and progress to standing balance assisted exercises as tolerated
PHASE IV: Week 16-24
Post operative gait analysis
Objective: Functional ROM, good strength, adequate proprioception for stable balance, normalize gait, tolerate full day of ADLs/work, return to reasonable recreational activities
WB status: Full, patient should exhibit normalized gait
Therapy: 1x every 2-4 weeks based on patient status and progression, to be discharged to an independent exercise program once goals are achieved, patient to be instructed in appropriate home exercise program
Rehab Program
Strength: Progression to body weight resistance exercises with goal of ability to perform a single leg heel raise
Proprioception: Patient should be instructed in proprioceptive drills that provide both visual and surface challenges to balance
Agility: cone/stick drills, leg press plyometrics, soft landing drills
Sports: Prior to return to any running or jumping activity the patient must display a normalized gait and have strength to perform repetitive single leg heel raises