Post Operative Physiotherapy
Protocol for Total Ankle Replacement

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.

All Surgeries Require a 2 week follow up at Scarborough Birchmount fracture Clinic

Phase I: Date of Surgery – 6 weeks

Objective: Healing, protection of joint replacement

Immobilization: Cast, splint; After 2 week follow-up visit: removable boot

WB Status: Partial weight bearing

Phase II: Week 6-8

Objective: Healing, protection of joint replacement

Immobilization: Use of removable walker boot as needed

WB Status: Weight bearing

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

Phase III: Week 8-16

Objective: Swelling reduction, increase in ROM, neuromuscular re-education, develop baseline of ankle control/strength

Immobilization: Use of removable walker boot from 8-14 weeks

WB Status: WBAT, *NOTE – WB status and gait progression determined by physician based on radiographic evidence of implant incorporation

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:

ROM: AROM, PROM, patient directed stretching, joint mobilization, *NOTE – joint mobilization should focus on techniques for general talocrural distraction and facilitating dorsiflexion and plantarflexion. Techniques for inversion and eversion should be minimized and may be contraindicated if the patient has had ancillary procedures such as subtalar fusion or triple arthrodesis. The distal tibiofibular syndesmosis should not be mobilized. Soft tissue techniques may be used for swelling reduction and scar tissue mobilization. Goals for ROM are ≥ 10° of dorsiflexion and ≥ 40° of plantarflexion

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

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:

ROM : patient to achieve ≥ 10° of dorsiflexion and ≥ 40° of plantarflexion

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