Physical Therapy After Leaving the Hospital

Once your physical therapist has completed the examination, an intervention/treatment plan will be established. This plan will list the goals for getting you back to daily activities. It will include how much time and how many visits the therapist feels will be needed.

You should continue following the precautions taught in the hospital to protect your ankle replacement for approximately 6 weeks. The precautions may include:

• 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 hand down for any extended period of time elevating your leg when sitting or lying down.
• Avoid getting the ankle wet until the sutures are removed.

Your therapist may choose from one or more of the following interventions to facilitate your recuperative process.

Exercises

Exercises will be performed daily after you are discharged from the hospital. Exercises will be prescribed by the physical therapist for many different reasons.

• To decrease swelling
• To improve your flexibility
• To increase your strength
• To enhance your endurance
• To increase your balance and coordination
• To make the performance of your daily activities easier
• To improve your walking and stair climbing ability

Decreasing Swelling

To decrease swelling during the early out-patient period, ice may be used especially after exercises sessions for up to 3 months postoperatively.

Improving Flexibility

To improve your flexibility, your physical therapist may use graded exercises including such things as active movement and stretching. These exercises help restore ankle movement. Stretching of the muscles of the back of the lower leg may be done while sitting or while standing if weight bearing is allowed.

Strengthening and Stability Exercises

Strengthening and stability exercises will progress during this phase to regain strength in the muscles around the ankle, the rest of the operative leg, the trunk, non-operative leg, and arms. Strengthening exercises for the operative ankle may progress over time. Initially non-weight bearing exercises may be used, followed by resistance exercises. Resistance may be in the form of elastic bands or tubing. If weight bearing is limited, seated exercises may be performed using a rocker board or a balance board under the foot on the operative side. Strengthening exercises may then progress to weight bearing exercises.

If you have a pool available and are cleared by your surgeon for immersion in water, aquatic exercises may be incorporated into your overall program.

Exercises should never be overdone. If you find your ankle swelling late in the day, it may be a sign you are doing too much too quickly. Pain should also be avoided. A small amount of muscle discomfort with increasing exercise may occur, but it should be reasonable discomfort, not pain.

Endurance Exercises

Endurance exercises will also be progressed so the muscles may function effectively over longer periods of time. Initially a recumbent bicycle may be used to begin to increase your endurance. As full weight bearing is tolerated, you may progress to a treadmill, stepper, or outdoor walking for increasing periods of time.

Weight Bearing Exercises

Weight bearing exercises may increase during this time. You may be asked to shift weight from side to side and front to back, to maintain your balance as your therapist tries to gently disturb your balance, rise up on your toes, raise your toes up, roll to the outer borders of your feet, perform modified squats, walk for increasing distances, go up and down ramps and curbs, climb increasing number of stairs, perform side stepping maneuvers, balance on a rocker or balance board while standing, etc.

Maintaining Hip and Knee Motion and Strength

To maintain motion and strength in your hip and knee joints, you may continue the activities started in the hospital. Your therapist may apply gentle resistance for the muscles around the hip and knee being sure to avoid stress on the ankle.

Postural Exercises

Postural exercises will be incorporated into the program to keep your back and head well aligned and avoid unnecessary stresses on your back.

Balance and Coordination Exercises

Balance and coordination exercises may be incorporated at this time. As long as you are able to bear full weight on the ankle, you may be asked to balance on one leg with your eyes open and closed or walk on uneven or softer surfaces.

Walking and Stair Climbing

Non-weight bearing is usually maintained for 3-6 weeks. Weight bearing may then progress from partial to full weight bearing. Once you are able to bear full weight on your operated leg, your physical therapist will work with you to fine tune your gait. Retraining may be needed if you developed a limp, as a result of pain prior to the surgery, apprehension, or simply a habit developed over time. The goal is to develop a normal walking pattern where your steps are equal in width and length, and learn to appropriately shift your weight.

Functional Activities

Exercises may be included in your program simulating day-to-day activities like stair climbing and partial squatting. You will review all of your self-care and home management activities, as well as all activities related to your job and leisure life. This is to ensure you are able to do them safely and effectively maintaining any appropriate ankle precautions.

Heat and Cold Therapy

Ice may be used if there is pain or swelling. Heat may also be used for pain management and for relaxation. Special care must be taken to make sure your skin does not overheat and burn.

Other Activities

If the surgery was on the right side, you may be given permission by the surgeon to drive between four and six weeks following surgery. In any case you must be able to move the leg easily from the gas pedal to the brake.

Home Program

As your condition continually improves, you will be given advanced exercises to do at home, in a pool, or in a gym setting. You may be scheduled to recheck with your physical therapist at regular intervals to make sure you are doing these exercises routinely and safely. During these rechecks, you may be given additional exercises to work on over the next few weeks. Eventually, you will be progressed to a final home program. Once you have been released to full activity, you may be instructed to follow up with a few visits over the next few months to make sure that you reach your peak level of performance.

Last Updated: 10/16/2007