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At one time an ankle damaged by a condition like osteoarthritis, rheumatoid arthritis, or arthritis, and which would not respond to non-surgical treatment, was bad news. Ankle replacement, was a thing of the future.
As recently as a few decades ago, doctors could only recommend yet more pain medication, comfortable shoes, reduced activity. In serious situations a process called fusion surgery was, and still is, used— a procedure in which screws, plates and bone grafts fuse ankle bones into one continuous structure.
But times have changed. Beginning in the 1990s, if surgery is called for, surgeons have been able to use technologies which replace the damaged ankle bones with a prosthetic, an artificial bone and ligament system of advanced metal alloys and plastics or ceramics. Since the 1990s, technology used in the procedure, known as ankle arthroplasty, has developed even further.
On this page, we describe:
- Who Undergoes Ankle Replacement Surgery?
- What might it look like?
- What is the timeline for recovery?
- Ankle replacement recovery FAQ
People recovered from ankle replacement and physical therapy. Photos via Hospital of Special Surgery backinthegame.com
Recovery Expertise
The ankle and foot are complicated, the foot alone containing fully 1/4 of all the bones in the entire body. So a sophisticated surgical team, along with an advanced physical therapy program are needed for success.
And success there has been at medical centers such as the respected Hospital for Special Surgery (HSS), where Park Sports is a chosen member of the HSS Rehabilitation Network. Some of the HSS patient success stories can be found on the hospital’s site, backinthegame.com, here.
Who Undergoes Ankle Replacement Surgery?
Ankle arthroplasty is most often used for people over the age of 50, who have struggled with arthritis-related conditions. But accidents, such as sports mishaps, and car accidents can unfortunately happen to anyone at any age.
Physical Therapy for Ankle Replacement Surgery: What might it look like?
We here at Park Sports Physical Therapy value the notion of individualized therapy. Not all plans for a given condition will look alike, and especially in a complicated part of the body like the ankle and foot.
Treatment plans will differ across individuals and as a result of conversations with different surgical teams. Your plan will differ from someone else’s, based on your needs and what your surgical team recommends.
Throughout the whole process, you will be working with a physical therapist anywhere from 2-4 times per week. Physical therapy goals in ankle replacement rehabilitation focus on:
- Flexibility
- Weight bearing
- Range of motion
- Endurance
- Balance
- Strengthening
Our unique rehab procedures might include the utilization of soft-tissue mobilization, kinesiology taping, manual therapy, among other unique techniques like yoga therapy, to encourage a holistic approach to treatment. You can expect to use tools like a stationary bike and specialized weights throughout the process, but the ways in which these are used will differ at different stages for different individuals.
An expertly customized treatment plan, available at places like Park Sports, is especially important after a procedure that is less common than many. Only about 4000-6000 ankle replacements were performed during 2014, the most recent data available, compared to 750,000 hip replacements. (In more recent years, according to the American Orthopaedic Foot & Ankle Society, the number of ankle replacements is “increasing dramatically.“).
What is the timeline for recovery from ankle replacement surgery?
Keeping individual variations in mind, here is a general guideline and timeframe –based on the clinical data— of what you might expect in physical therapy for ankle replacement surgery.
For the first six weeks following surgery, the ankle which was operated on will be placed in a plaster cast. Generally speaking, rehab cannot begin until about 14 days after surgery.
Ankle Replacement Physical Therapy: Weeks 1 – 6
During the initial 6 weeks, the therapist’s goals are to prevent weight-bearing movement on your ankle, to increase range of motion in the ankle, to learn how to do daily activities with a crutch/walker, and to maintain the strength of the knees, hips and core muscle.
Components of this plan might include ankle elevation, active ankle range-of-motion exercises, upper-body ergometer for cardiovascular rehab, edema massages, and lying-down leg strengthening exercises.
Ankle Replacement Physical Therapy: Weeks 6-10
Usually, about 6 weeks after surgery, the ankle can begin to handle weight-bearing exercises.
The objectives during this period of rehab are to reduce ankle swelling, to begin normalizing walking patterns, increase scar mobility, and progress weight-bearing as tolerated in a boot. More standing exercises and mobilization techniques will be included during this period of time, to help increase the ankle’s strength and mobility.
Ankle Replacement Physical Therapy: Weeks 10-14
Around 10 weeks after surgery, in conjunction with your surgeons and as tolerated, clients will begin to wean off the support boot and into an ankle brace. Likewise, exercises will become progressively more challenging and phasing into functionality (which might include exercises like squats, step-ups, balancing, and proprioception exercises.)
Ankle Replacement Physical Therapy: Weeks 14-16
Usually around 14 weeks after surgery, therapists begin to wean clients into normal shoes while continuing to increase weight-bearing exercise as tolerated. After 16 weeks, clients can usually return to sedentary jobs and start slowly easing themselves back into normal activities like walking and biking.
Your medical team will consult with you to determine how much impact the new ankle replacement can support at this point.
Ankle replacement recovery FAQ
When can I begin driving after ankle replacement physical therapy?
If the operation has been on your right foot, you must be able to demonstrate an emergency stop before you are legally allowed to drive.
When can I begin to walk without a brace after ankle replacement physical therapy?
You may wean off a brace somewhere between 10 and 14 weeks into physical therapy. The precise timing depends on your physical fitness, the consistency of your work with physical therapy exercises, and must be a decision made in consultation with your medical team.
Can my ankle replacement physical therapy be accelerated?
As in all physical therapy, the time to recovery is mainly driven by your commitment to follow through with your exercises at home, a commitment which will be supported fully by your Park Sports therapist.
