Physical Therapy in the Hospital

The instructions you will be given following your ankle replacement surgery will depend on the type of ankle implant used. The components of the in-patient physical therapy program are detailed below.

Examination

The physical therapist may see you in the hospital on the day following the surgery. Your ankle will be immobilized in a compression dressing and splint. During the first visit your physical therapist will perform a thorough examination, which may include gathering information about the history of your condition. Quick screening examinations of your heart rate, blood pressure, breathing rate, skin integrity, range of motion of other joints of the body, functional strength of other areas of the body, and your overall ability to move may be done during this phase.

When the dressing is removed and the splint has been changed, your physical therapist may assess the following:

• How your operated ankle is moving
• The presence of pain
• The allowable range of motion in your new ankle
• How you are able to move while in bed
• Your safety when getting up and sitting on the edge of the bed and sitting in a chair
• How well you remember and are practicing ankle precautions and breathing techniques
• Whether you can begin to walk using a walker or crutches and whether you are able to maintain walking while non-weight bearing on the operative side

Interventions/Treatment Plan

Initially the compression dressing/immobilizer will help to control fluid build-up (edema). Ice may be used to help reduce the pain and the swelling. Ice makes the blood vessels become more narrow, called vasoconstriction, which helps control inflammation. The foot will be elevated higher than the heart any time you are in bed. The immobilizer will be used to maintain neutral position of the ankle for approximately 3 weeks.

Precautions

Your therapist will discuss ankle precautions with you to follow after your surgery.

• Avoid weight bearing on the foot
  • When standing or walking, keep the foot off the ground at all times
  • When sitting, elevate the foot
• Avoid letting your leg hang down for any extended period of time
  • When sitting, keep leg elevated on a chair
  • When in bed, elevate the ankle higher than the heart.
• Avoid getting the ankle wet
  • Until the sutures are removed, keep the wound area dry
  • Whether you shower or take a bath, cover the ankle area with a plastic garbage bag secured so no water can enter the area
  • If you take a bath, keep the leg out of the bathtub

Exercises

Exercises should be done only at the direction of your surgeon and physical therapist. Exercises may be used to help control pain and help with movement in the ankle, as well as in the hip and knee on that side. Some of the following exercises may be incorporated in your treatment plan:

Gentle bending and straightening of your hip and knee – These movements help the circulation of your leg.

Gentle isometric contractions of the muscles around the ankle – These exercises make the muscles contract without moving the ankle joint. They help the circulation around the ankle, may help to prevent edema, and may help to keep the muscles around the ankle strong for when weight may eventually be borne on the ankle.

Gentle resistance movements of your hip and knee -These exercises may be performed to strengthen the muscles around your hip and knee to make walking easier.

Arm exercises – These exercises may also be included in your postoperative physical therapy program to assure you have adequate strength in your arms for moving around in bed, for standing up from a chair, and for walking when using a walker or crutches.

Breathing exercises - These are incorporated into your post-operative program to help prevent pneumonia from developing. Deep breathing is the simplest form of breathing exercise. In addition, you may be given an incentive spirometer, a device requiring you to take in as deep a breath as you possibly can, hold it for a few seconds, and then blow it out. An indicator on the incentive spirometer will enable you to track your deep breathing progress as you attempt to take in deeper and deeper breaths each time you use the device.

Trunk strengthening exercises - Exercises to keep your trunk muscles strong may help to avoid back problems that may arise from initial uneven weight bearing. Your therapist will instruct you in the type and number of exercises, the amount each exercise is to be done, and how often they should be done.

Position Changes

You will be given instructions and assistance on how to move and change positions in bed, as well as, getting to the seated position using all appropriate precautions. Your physical therapist will also assist you to the standing position and teach you how to transfer safely from the bed to a chair and toilet. Proper body mechanics will be stressed during all activities.

Walking and Stairs

You will be non-weight bearing on the operative side in the hospital. Your physical therapist will provide detailed instructions on achieving non-weight bearing walking and how to use a walker or crutches.

Instructions will be given to you in the hospital for stair climbing with crutches. If there is no handrail, the general rule for ascending stairs is to place the crutches on the same level as the non-operative foot, then push down strongly on the hands as the body is lifted up to the next step on the non-operative foot. The crutches are then brought up to this new step. For descending stairs, the crutches are placed down one step, then press down strongly on the hands as the body is lowered to the next step on the non-operative foot.

If there is a handrail, the general rule is to use one crutch and the handrail. The second crutch is held in the same hand as the crutch hand. Your physical therapist will show you how to carry the second crutch so it is parallel to the ground. The principles of ascent and descent are the same as above.

Other Interventions

Your physical therapist will indicate activities you should avoid, which put additional strain on the surgical area. During your activities, pain acts as your guide. If you feel pain with any activity, stop and consult with your physical therapist to determine if it is straining or irritating the ankle.

While you are in the hospital, your physical therapist may see you for therapy up to two times each day. You will progress from doing activities bedside to doing them in the therapy department. You may expect to stay in the hospital several days after the surgery.

Last Updated: 10/16/2007