PHYSIOTHERAPY

When do I start Physiotherapy?

At your first follow-up appointment, you will be instructed to start gentle range of motion exercises. These are non-weight bearing exercises and should be done twice a day; 30 repetitions each time. If you have access to a stationary bicycle, you may start to GENTLY pedal. The stationary bicycle should be set at the lowest tension possible. Do not put weight on your operated foot. Keep your Walker Boot on while you pedal. When can I start "weight bearing" on my operated foot?

2 to 6 Weeks: Most will remain non-weight bearing until six weeks (Fusions/Osteotomies). Do not stand on your foot. Depending on the type of surgery, some patients will be allowed to start "weight bearing" at an earlier time (Hardware removal or arthroscopy).

2 Weeks: Go to the appointment you made through the doctor's office to go to the Foot & Ankle Clinic at St. Vincent's, Heather for your follow-up.

8 Weeks: Return to the Surgeon's office for an x-ray.

6-8 Weeks: You may be permitted to put some weight on your foot (approximately 50% of your normal weight). You will still need to wear the Walker Boot and use your crutches or walker. Your Surgeon will tell you when you may start weight bearing. The timing for this depends on how well your bones are healing and the extent of your surgery.

8-10 Weeks: You may increase the weight bearing on the foot to 100%, still having the support of the Walker Boot and crutches or walker. Decrease weight bearing if the foot becomes painful.

10 Weeks and Onward: The boot can be taken off. You can take your full weight on the foot while wearing a large, comfortable shoe.

12 Weeks: Checkup and x-ray at your family physician's office or at the Foot & Ankle Clinic. Thereafter, follow-up will be as required.

Postop Ankle Fusion Protocol

Postop Total Ankle Replacement Protocol

Physiotherapists: Jill / Sandra / Gillian 604-806-8115

Physical Therapy

Achilles Tendon Repair- Postoperative Protocol

Week

0-2

Physical Therapy Guidelines

in cast/splint NWB
education on proper crutch/walker use
AROM of hip and knee
rest and elevation of limb to 14 cm above heart

Goals

ADL’s with safe crutch use
Control swelling and pain

1^st post-op visit at Foot/Ankle (F/A) Clinic at 2 weeks post-op
NWB in walker boot with heel raise
seen by Physiotherapist in F/A clinic and taught AROM of ankle and toes
remove boot 2x/day to do above exercises at home
can do very gentle passive ROM
scar massage

increase ROM
increase exercise tolerance

maintain hip and knee ROM

safe use of crutches

6-10

WBAT in walker boot at 6 weeks post-op
Remove 1 wedge from boot and continue to remove 1 wedge each week
AROM at ankle (refer to exercise sheet given by therapist in F/A clinic)
core exercise-recruit transverses abdominus
hip AROM/strength:
- glut max

- clam shell

- abduction

- SLR

· joint mobilizations

· elevate to control swelling

· scar massage

· increase ADL’s in standing

· begin cycling on stationary bike in boot

maintain ankle ROM
maintain hip & knee ROM/strength

improve core strength

safe use of crutches

increase mobility of scar

WB in boot

Week

10-14

Physical Therapy Guidelines

begin weaning from walker boot at 10 wks over a 2 week period so boot is D/C by 12wks

gait training in a shoe

scar massage

heat

joint mobilizations

stationary bicycle

low level balance and proprioceptive exercises

progressive strengthening of hip, knee and ankle

light theraband exercise for DF/Inv/Ev

Goals

· 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 at 16 weeks
no eccentric drops until 16 weeks post-op
higher level balance/proprioceptive exercises
swimming

ambulation with no walking aid
minimum of 0 degrees DF
good balance in unilateral stance

16+

progress to sport or work specific activity
progress to dynamic drills: hopping, skipping, jumping
eccentric drops
running

higher level of balance/proprioception in unilateral stance
full strength

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 months post-op. Redness does not necessarily indicate infection. Significant drainage from the wound is usually a sign of infection.

Driving

The patient may return to driving if they can safely demonstrate an emergency stop to someone 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 post-op, however, the following should be taken into consideration:

type of work

the surgeon’s approval

any post-operative complications

Lateral Ligament Reconstruction- Postoperative Protocol

Week

0-2

Physical Therapy Guidelines

in walker boot NWB
education on proper crutch/walker use
AROM of hip and knee
rest and elevation of limb to 14 cm above heart

Goals

ADL’s with safe crutch/walker use
Control swelling and pain

2-6

1^st post-op visit at Foot/Ankle (F/A) Clinic at 2 weeks post-op
seen by Physiotherapist in F/A clinic and taught AROM of ankle and toes: AVOID VARUS/INVERSION STRETCH
remove boot 2x/day to do above exercises at home
WBAT in walker boot
Scar massage

increase ROM avoiding a varus /inversion stretch
increase exercise tolerance
maintain hip and knee ROM
safe use of crutches/walker

6-10

WBAT in walker boot at 6 weeks post-op
may come out of boot in Physiotherapy
AROM at ankle avoiding varus/inversion stretch (refer to exercise sheet given by therapist in F/A clinic)
core exercise-recruit transversus abdominus
hip AROM/strength:
- glut max

- clam shell

- abduction

- SLR

· joint mobilizations

· elevate to control swelling

· scar massage

· increase ADL’s in standing

· begin cycling on stationary bike

maintain ankle ROM avoiding inversion/varus stretch
maintain hip & knee ROM/strength
improve core strength
safe use of crutches/walker
increase mobility of scar

Week

10-14

Physical Therapy Guidelines

wean from walker boot
may start inversion ROM exercises
scar massage
heat
joint mobilizations
stationary bicycle
may start swimming if safe to get in/out of pool (flutter kick only)
gait training in a shoe
low level balance and proprioceptive exercises
progressive strengthening of hip, knee and ankle
continue core, hip and knee strengthening

Goals

· 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
will require some form of support (ie. ankle brace) x 4 months

ambulation with no walking aid
return to normal activities eg.. golf & tennis

Pain and Swelling

This is a proceedure 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

The patient may return to driving if they can safely demonstrate an emergency stop to someone 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 post-op, however, the following should be taken into consideration:

type of work
the surgeon’s approval
any post-operative complications

Ankle Fusion - Postoperative Protocol

Week

0-2

Physical Therapy Guidelines

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 heart.

Goals

ADL’s with safe crutch/walker use
Control swelling and

pain

2-6

1^st postop visit at Foot & Ankle Clinic at 2 weeks post-op
seen by Physiotherapist in F&A Clinic and taught AROM of joints not fused
remove boot 2x/day to do above exercises at home
continue non weight bearing on fusion side

protect fusion site
increase ROM at non-fused joints
increase exercise tolerance
maintain hip and knee ROM
safe use of crutches/walker

6-10

· walker boot NWB until week 6-8 then possible WBAT in boot as per surgeon’s instructions

· AROM at ankle of non-fused joints

(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 to unfused joints
elevate to control swelling
increase ADL’s in standing
scar massage
begin cycling on stationary bike in boot with no resistance at 6 weeks

· protect fusion site

· maintain ankle ROM of non-fused joints

· maintain hip & knee ROM/strength

· improve core strength

· safe use of crutches/walker

· increase mobility of scar

Week

10-14

Physical Therapy Guidelines

wean from walker boot & increase weight bearing to full

scar massage
heat
joint mobilizations to unfused joints
stationary bicycle
gait training

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

low level balance and proprioceptive exercises
progressive strengthening of hip, knee and ankle
continue core hip and knee strengthening

Goals

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
may require rocker sole shoe at this point

full weight bearing
ambulation with no walking aid

16+

return to normal activities ie golf & tennis

full strength

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. Swelling will be less in an arthroscopic fusion compared to an open fusion.

Driving

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

Total Ankle Replacement- Postoperative Protocol

Week

0-2

Physical Therapy Guidelines

casted or walker boot NWB
education on proper crutch/walker use
hip and knee range AROM
rest and elevation 14 cm above heart.

Goals

ADL’s with safe crutch/walker use
control swelling and pain

2-6

1^st postop visit at Foot & Ankle Clinic at 2 weeks post-op
seen by physiotherapist in F&A Clinic and taught AROM of ankle
remove boot 2x/day to do above exercises at home

● Increase ROM

● Safe use of crutches/

walker

● maintain hip/knee

ROM

6-10

· 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 at week 6

· maintain ankle ROM

· maintain hip & knee ROM/strength

· improve core strength

· safe use of crutches/walker

· increase mobility of scar

Week

10-14

Physical Therapy Guidelines

wean from walker boot & increase weightbearing 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

Goals

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

full weight bearing
ambulation with no walking aid

EXPECTED ANKLE ROM:

DF: 10 degrees

PF: 35 degrees

16+

return to normal activities i.e. golf & tennis

full strength

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 postoperative complications
no patient with a total ankle should be doing a job causing impact to the joint.

Continue on to other Postoperative pages: General Information, Scar Tissue and Pain Management.