Ankle – What you don’t know about post-operative rehabilitation

  On the postoperative day: the patient should rest mainly in bed while elevating the patient (under the surgical knee and under the calf with pillows), with dorsiflexion and plantarflexion of the affected toe from time to time. Remember to move only the toes and not the dorsiflexion and plantarflexion of the surgical ankle.  The first day after surgery: Start to move to the ground, still encourage the patient to do dorsiflexion and plantarflexion of the toes. The patient begins to walk on the ground with the aid of crutches, however, the ankle on the operated side cannot be placed on the ground because it is in a cast. The time spent walking on the ground is controlled, and it is generally recommended to walk on the ground 3-4 times a day for 5 minutes each time.  From the second to the sixth postoperative day, in addition to the activities performed on the second postoperative day, daily strengthening of the quadriceps contraction, relaxation contact and straight leg raising exercises are performed. Still no ankle activities were performed, toe activities were the main focus.  One week to two weeks after surgery: The contraction and relaxation exercises of the quadriceps muscle were the same as before, but the ankle joint could not be moved freely because it was in a cast and had to be fixed.  Three weeks to six weeks after surgery: continue to walk with the crutches, still in a cast.  At seven weeks postoperatively, the cast was removed daily and the ankle joint was moved up and down, with slow dorsiflexion 0° to 5° and plantarflexion 0° to 5° in the 90° position. The reciprocal movement from plantarflexion 5° to dorsiflexion 5° is one ankle flexion and extension activity, 50 consecutive activities each time, 3 times a day, 150 times in total.  Eight weeks postoperatively: the range of dorsiflexion and plantarflexion angles of the ankle increased from 5° dorsiflexion to 5° plantarflexion to 10° dorsiflexion to 10° plantarflexion. Weight bearing of the foot on the operated side can reach 50% of normal.  Nine to ten weeks postoperatively: The ankle joint begins to move within a completely normal range of motion in addition to full weight-bearing. There are three ways to practice ankle dorsiflexion and plantarflexion: (1) the patient himself performs ankle dorsiflexion and plantarflexion by pulling with both hands; (2) the doctor or the patient’s family helps the patient to perform passive dorsiflexion or plantarflexion exercises; (3) the patient helps himself to practice ankle dorsiflexion by squatting and plantarflexion by kneeling on the bed.  Three months after surgery: Gradually resume normal functional activities of the ankle joint or walking, however, individual patients may experience swelling of the ankle and back of the foot when they move a lot in the short term after surgery, but it will disappear after rest.  Six months after surgery: Generally, the condition of the ankle joint can basically return to normal after six months after surgery. At this time, the swelling of the ankle joint after activity or the swelling of the back of the foot will also slowly disappear.