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Ankle Reconstruction - Postoperative Physiotherapy

Phase 1: recovery

0-2 weeks

GENERAL

  • Plaster backslab or CamBoot.
  • Non-weight-bearing.

PHYSIOTHERAPY

Goals:

  • Prevent complications e.g.: DVT.
  • Maintain movement and strength in unaffected joints.

Exercises:

  • Hip and knee range of motion exercises.
  • Quadriceps, hamstrings and gluteal strengthening.
  • Deep breathing exercises.

2-4 weeks

GENERAL

  • Transfer to camwalker boot or ankle brace (ASO or equivalent).
  • Commence weight bearing, PWB or WBAT depending on surgeon’s instructions.

PHYSIOTHERAPY

Goals:

  • Control pain.
  • Control swelling.
  • Regain active movements.

Exercises:

  • Free active plantarflexion, dorsiflexion, eversion.
  • NO active inversion until 6 weeks post op.
  • Towel stretch into dorsiflexion (gentle).
  • Swimming (no kicking), when wound healing appropriate.

4-6 weeks

GENERAL

  • Weight bearing as comfortable (WBAT).
  • Continue bracing (ASO or Boot) for majority of ‘up’ time.

PHYSIOTHERAPY

Goals:

  • Control swelling.
  • Avoid impingement (in any direction).
  • Avoid synovitis.
  • Commence strengthening.

Exercises:

  • Continue active ROM.
  • Commence PF, DF, EV Theraband strengthening.
  • Seated calf raises.
  • Static balance drills.
  • Swimming (no kicking).
  • Exercise / Stationary bike.

Phase 2: strengthening / neuromuscular training

6 weeks +

GENERAL

  • Normal gait.
  • Commence inversion movements.
  • Progress to general strength, proprioception, balance.
  • Ankle brace only for “high risk activities” or uneven surfaces.

PHYSIOTHERAPY

Goals:

  • Minimal swelling.
    • +4cm lunge or better (knee to wall).
  • Single leg balance 1 minute (eyes open).
  • Double leg calf raises 3 x 30.
  • Eversion strength 4/5.

Exercises:

  • Theraband strengthening all directions.
  • Double leg calf raises, progress to single leg calf raises.
  • Advanced balance / proprioception, i.e.: wobble board, foam etc.
  • Calf stretching.
  • Swimming with gentle kick.
  • Cycling as comfortable.

Phase 3: return to sport

PHYSIOTHERAPY

Goals:

  • Single leg balance, 1 minute, eyes open.
  • Single leg calf raises 3 x 30.
    • Single leg squat to 900.
  • Lunge +6cm.
  • Hopping on the spot.
  • Normal lower limb mechanics (including pelvis / hip / knee control).
  • Direction change tests within 10% of other side.
  • Wean off brace.

Exercises:

  • Single leg heel raises.
  • Calf stretching ++.
  • Theraband strengthening, focus on dorsiflexion and eversion.
  • Hop and land.
  • Ladder hopping.
  • Lateral hopping.
  • Running, cycling, swimming.

Phase 4: prevention of recurrence

PHYSIOTHERAPY

Goals:

  • Normal mechanics.
  • High-level balance.
  • Landing strategies.
  • Direction change strategies.

Exercises:

  • Advanced landing drills, +/- external factors i.e.: catching/marking.
  • “Feedforward” training.
  • Advanced balance integration i.e.: strength work on BOSU ball.
  • Plyometric training.

Produced with the help of Balwyn Sports & Physiotherapy Centre

These notes have been prepared by orthopaedic surgeons at OrthoSport Victoria. They are general overviews and information aimed for use by their specific patients and reflects their views, opinions and recommendations. This does not constitute medical advice. The contents are provided for information and education purposes only and not for the purpose of rendering medical advice. Please seek the advice of your specific surgeon or other health care provider with any questions regarding medical conditions and treatment.