BC Foot and Ankle Template

Physical Therapy - Postop Ankle Replacement Protocol

Week	Physical Therapy Guidelines	Goals
0-2	casted or walker boot NWB education on proper crutch/walker use hip and knee range AROM rest and elevation of limb to 14 cm above the heart	ADL’s with safe crutch/walker use Control swelling and pain
2	1^st postop visit at Foot & Ankle Clinic seen by physiotherapist in F&A Clinic and taught AROM of joints not fused remove boot 2x/day to do above exercises at home	increase ROM at ankle increase exercise tolerance maintain hip and knee ROM safe use of crutches/walker
2 - 10	walker boot NWB until week 4 -6 then possible WBAT in boot as per surgeon's instructions AROM at ankle (refer to exercise sheet given by therapist in Foot and Ankle Clinic) core exercises – recruit transversus abdominus hip AROM/strength - glut max - clam shell - abduction - SLR joint mobilizations elevate to control swelling increase ADL’s in standing scar massage may begin swimming if wound is healed and safe to get in and out of pool begin cycling on stationary bike in boot with no resistance	maintain ankle ROM maintain hip & knee ROM/ strength improve core strength safe use of crutches/walker increase mobility of scar
10 - 14	wean from walker boot & increase weight bearing to full scar massage heat joint mobilizations stationary bicycle gait training low level balance and proprioceptive exercises progressive strengthening of hip, knee and ankle continue core hip and knee strengthening	WBAT out of boot and into shoe increase core hip, knee and ankle strength safe gait with/without walking aid
14 - 16	begin unilateral stance exercises bilateral heel raises progressing to unilateral heel raises higher level balance/proprioceptive exercises return to normal activities i.e. golf & tennis	full weight bearing ambulation with no walking aid EXPECTED ANKLE ROM: DF: 10 Degrees PF: 35 Degrees

Pain and Swelling

This is a procedure which does cause a lot of swelling and pain. It is normal for the foot and ankle to be swollen 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

If the operation is on the right foot, the patient may return to driving if they can safely demonstrate an emergency stop to somebody else. Please note to ensure legality the patient should contact their local insurer.

Return to Work

Usually the patient can return to work at 4 months postop, however, the following should be taken into consideration:

type of work
the surgeon’s approval
any post-operative complications
no patient with a total ankle should be doing a job causing impact to the joint

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BC Foot & Ankle Clinic, St. Paul's Hospital, Third Floor, North Wing
1081 Burrard Street, Vancouver, BC V6Z 1Y6
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