How Is Physical Therapy Used After a Total Ankle Replacement?

A total ankle replacement surgery (also known as a total ankle arthroplasty ) can benefit people with chronic ankle pain or disability. Following this operation, physical therapy (PT) typically plays an important role in helping you recover the function in your leg.

While each person’s situation is unique, most post-operative therapy contains several specific interventions. This article will discuss the purpose of this surgery and explain the rehab protocol typically recommended following the procedure.

What Is a Total Ankle Replacement?

Your ankle joint is the section of your lower leg where the shinbone ( tibia ) meets the talus bone on the top of your foot.

Occasionally, the slippery surface (known as articular cartilage ) that coats the ends of these bones begins to thin or deteriorate. As this process becomes more advanced, it can lead to significant pain, disability, and difficulty walking.

In these situations, a total ankle replacement may be beneficial. Specifically, there are several conditions that may be helped by this procedure, including:

• Advanced osteoarthritis
• Rheumatoid arthritis
• Osteonecrosis
• Post-traumatic arthritis
• Joint damage from gout
• Septic arthritis

During an ankle replacement procedure, an orthopedic surgeon (a specialist in the joints and bones) removes the damaged ends of the tibia and talus bones and replaces them with an artificial metal covering. A polyethylene component is also secured in between these two structures to help the new joint endings move smoothly on one another.

Following the procedure, you are typically placed in a protective boot or splint and will be advised by your healthcare provider to stay off the surgical leg for 4 to 8 weeks to allow it to heal properly.

Total Ankle Replacement Physical Therapy

Outpatient physical therapy (PT) is typically initiated several weeks after your ankle operation.

PT can last for five months or more, depending on your circumstances. Your physical therapist will usually focus on a number of different areas in order to maximize your outcome.

The common focuses of PT treatment when you are recovering from this surgery, include the following:

Controlling Pain and Swelling

Post-operative pain and swelling are also normal occurrences after a total ankle replacement. It is not unusual for an ankle to be swollen even six to 12 months after the operation.

While your surgeon will normally prescribe medication to help manage your discomfort early on, physical therapy also plays an important role in addressing these symptoms.

Treatments like electrical stimulation (mild electrical pulses applied to muscles), icing, and vasopneumatic compression (an inflatable sleeve used to create pressure around the limb) are commonly utilized in the early days of physical therapy to reduce your pain or swelling. These modalities are typically used in conjunction with other therapy treatments such as stretching.

Restoring Range of Motion

Early on after your procedure, your ankle is typically very stiff. This is due to a number of factors including the inflammation and swelling that occur after surgery and the time spent immobilized in a boot afterward.

Your physical therapist will employ several tactics to help improve your range of motion or how far your ankle joint can rotate and flex.

In PT, your physical therapist may employ passive stretching of the ankle (stretching induced by an outside force such as the therapist or a resistance band) to help improve mobility.

Other manual techniques like soft tissue massage (hands-on massage of ankle muscles and ligaments) and joint mobilizations (gentle movements or pressures applied on the joint by the therapist) may also be beneficial.

In addition, your physical therapist will create a home exercise program that consists of self-stretching techniques and gentle active movements. This plan will help continue the progress in
between PT sessions by addressing your specific motion limitations.

Work on Gait Training and Balance

After multiple weeks of staying non-weight bearing on the affected ankle, your surgeon will clear you to begin walking on your leg again. When this occurs, your physical therapist will work with you to improve your overall gait (step) pattern and eliminate any limping. They will also help you transition from using crutches or a walker to walking independently once again.

What's more, after multiple weeks of reduced movement and lack of bearing any weight on the affected ankle, the muscles that surround the ankle have often atrophied or weakened, which can impact your balance.

When you are allowed to begin placing weight through the leg, your PT will typically initiate proprioceptive (sense of joint position) training aimed at improving your overall ankle stability. Your physical therapist will recommend strengthening exercises at the appropriate time.

After working on these techniques in physical therapy, balance exercises will be added to your home program and will be progressed as you improve from week to week.

Building Strength

The muscles in your leg, ankle, and foot are typically quite weak due to the arthroplasty surgery and the subsequent time spent in a splint or boot. These structures not only play an influential role in your balance but also affect your ability to stand, walk, and go up or down the stairs.

Because of this, regaining the strength and power in these muscles is a critical goal of rehab.

In the first few weeks of PT, your physical therapist will focus on gentle strengthening exercises, like isometrics, which lightly turn on the muscles but avoid irritating the surgical site.

As time goes on and weight-bearing is allowed, these gentle moves are typically replaced with more challenging ones, using resistance bands and standing exercises to accelerate your strength gains.

Ultimately, higher-level sport-specific exercises may be attempted, though caution must be taken to avoid any high-impact movements as these can affect the lifespan of your ankle replacement.

Summary

Total ankle replacement surgery is a major procedure and it will take some time to fully recover. Physical therapy can be critical to regaining movement in your ankle and restoring your full mobility. Your physical therapist will work with you to control pain and swelling, restore the ankle's range of motion, train on your walking gait and balance, and rebuild strength in the surgical leg.

A Word From Verywell

Recovering from a total ankle replacement is a challenging task and progress can seem slow at times. That said, in many individuals, this procedure can significantly improve your overall pain and function over time, so do your best to have patience with yourself during your recovery.

During the rehabilitation process, physical therapy plays a critical role in your ability to regain your independence. Because of this, it is important to keep open communication with your PT and to stay compliant with the program they design for you. Ultimately, this will help maximize your chances of a successful outcome after surgery.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Cleveland Clinic. Total ankle replacement.
2. Lawton CD, Butler BA, Dekker RG, Prescott A, Kadakia AR. Total ankle arthroplasty versus ankle arthrodesis—a comparison of outcomes over the last decade.J Orthop Surg Res. 2017;12(1):76. doi:10.1186/s13018-017-0576-1
3. Massachusetts General Hospital. Physical therapy guidelines for total ankle arthroplasty.
4. UW Health Orthopedics and Rehabilitation. Rehabilitation guidelines following total ankle arthroplasty.

By Tim Petrie, DPT, OCS
Petrie is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade.

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