Inpatient Physical Therapy

Prior to your scheduled ankle replacement surgery, you may have the opportunity to visit your physical therapist for a preoperative assessment. One purpose of this visit is to get a baseline of information that includes the location and severity of your pain, your functional abilities, and your strength and available motion of each ankle. A second purpose of the preoperative visit is to prepare you for your upcoming surgery. You'll begin to practice some of the exercises you'll use after surgery. You'll also be shown how to use either a walker or crutches. Whether the surgeon uses a cemented or noncemented prosthesis will make a difference in just how much weight you'll be able to apply through your foot while walking.

You will be seen by your inpatient physical therapist one day after surgery to begin very gentle exercises. You will be helped out of bed for a short outing using your crutches or walker. Again, the amount of weight you can put on the foot depends on whether your surgery was a cemented or noncemented procedure. Inpatient treatments are usually done two times per day for up to four days after surgery. By that time, you should be safe and ready to go home. You'll be on your way home once you can safely get in and out of bed, walk 75 feet, and go up and down stairs with your crutches or walker.

Your First Visit to Outpatient Physical Therapy

On your first outpatient visit, your physical therapist will want to gather more information about the history of your condition. You may be given a questionnaire that helps you explain the day-to-day problems you are having with your ankle now that you've had surgery. The information you give will help measure the success of your treatment. You may also be asked to rate your pain on a scale of one to ten. This will help your physical therapist gauge how much pain you have now and how your pain changes once you've had treatment. Your physical therapist will probably ask some more questions about your condition to begin zeroing in on what will be needed to best treat your condition. Here are some questions your physical therapist may ask you:

• How is your pain since having surgery?
• Where do you feel the pain now?
• What makes the pain better or worse?
• How do your symptoms affect your daily activities?
• Do you have pain above or below the new ankle joint?
• Do you have swelling?

Physical Therapy Evaluation

Once all this information has been gathered, your condition will be evaluated.

Posture:
Your physical therapist will begin by checking your overall posture, including your foot and leg alignment.

Observation:
Your therapist will note if there is any swelling in or around the ankle joint. If so, measurements will be taken to get an idea how much swelling is present. Volumetric testing is done by placing your foot and lower leg in a container of water and measuring how much water is displaced. The results of each ankle and leg are compared. Another way to measure swelling is to use a tape measure and compare several measurements around one ankle and then the other. These measurements can be rechecked later to get an idea if the swelling is going away.

Gait analysis:
Your therapist will check to make sure you are walking safely and with the right amount of weight on your foot. If you were issued a walking aid, your therapist will check to make sure it is fit for you and that you are using it safely.

Range of motion (ROM):
Next, your physical therapist will check the ROM in your ankle. This is a measurement of how far you can move your ankle in different directions. Ankle movements include bending the ankle up and down (dorsiflexion/plantarflexion), as well as in and out (inversion/eversion). Your therapist may also want to get an idea of how other joints around the ankle are moving, including the foot, the lower leg, knee, and possibly even your hip. Your ROM is written down to compare how much improvement you are making with the treatments.

Strength:
Your therapist will then test the strength of your muscles. You'll be asked to hold against resistance as your therapist tests the muscles around the ankle. Other areas that may be checked include the muscles of the knee and hip. These measurements are compared to your other leg. Weakness in key muscles of the leg or ankle will be addressed with a strengthening program. Trained muscles can help control your new ankle, which eases pain and keeps the joint healthy for as long as possible.

Manual examination:
You may be given a manual examination of the muscles and joints of the ankle. Your physical therapist will carefully move your ankle in different positions to make sure that the new joint and surrounding joints are moving smoothly. Your physical therapist will also look at the flexibility of the muscles and tendons around your ankle. This type of exam can help guide your therapist to know which type of treatment will help you the most.

Palpation:
The evaluation usually ends with palpation. Palpation is when your physical therapist feels the soft tissues around the joint. This is done to check the skin for changes in temperature, areas of soreness, and whether you have swelling. Palpation is also done to find out whether there are tender points or spasm in the muscles around the ankle. This can help your therapist get a good idea about which treatments will help you the most.