Total Ankle Replacement

One Patients Story to Treatment and Recovery

““I found it improved the range of motion I have in my ankle and it improved the duration of walking I could do. The way the AlterG Treadmill off-loads weight, it helped me get that balance and rhythm back without a lot of pain.””

Lynn McNamee, Patient, Foot surgery and Rheumatoid Arthritis, Barr & Associates Physical Therapy

One Patients Story in Recovering from a Total Ankle Replacement

Robinson Wills, DPT

Introduction

Subject is a 62 y/o female who is s/p L ankle replacement 01-28-2013 with the STAR ankle system. She was suffering from L > R chronic ankle pain for many years and walking > 5 minutes became intolerable for 2-3 months prior to surgery. Following surgery she was compliant with weight bearing protocol coupled with wearing an ankle cast, cam walker, and lace-up ankle brace. The subject is able to manage her pain with medication, rest, and assistive devices/braces. She was seeing a physical therapist at Kaiser 1x/wk starting at post-op week 7 and discharged at week 18.

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Goals

  • Subject able to walk x 45 minutes with regular footwear in the community.
  • Subject able to complete all house chores without any L ankle pain.
  • Pt. able to demonstrate a normal gait pattern.
  • History / Progression

  • AlterG therapy started postoperative week 11, when the patient was cleared for WBAT with cam walker. L ankle AROM: DF = -3; PF = 30; Inv = 30; Ev =15 degrees. R ankle AROM: DF = 8; PF = 45; Inv = 50; Ev = 15 degrees.
  • Week 12 – Subject begins to ambulate WBAT with regular shoe in community. Subject capable of completing 37 repetitions of bilateral heel raises. TUG test average after 3 trials = 19.3 seconds.
  • Week 13 – Subject has completely weaned herself from the cam walker. SLB with LLE timed at 5 seconds. She c/o soreness later in the week from doing AlterG assisted squats two days prior.
  • Week 14 – Occasional verbal cues needed for proper mechanics and decreased compensation during squats and heel raises.
  • Week 15 – This week pt. is able to go from a prolonged sit to a stand, and walk without stiffness or pain in L ankle. Pt. planned on completing house chores and grocery shopping over the weekend, so we provided additional resting periods. The extra resting periods allow less muscle soreness post activity.
  • Week 16 – Subject notes feeling in her L ankle has been returning coupled with 2/10 pain. She was able to ambulate 30-40 minutes at the grocery store and cooking at home. She continues to have muscle soreness in the LLE following AlterG sessions.
  • Week 17 – 1/10 pain in L ankle due to walking 60 minutes over the weekend. Reassessment: SLB with LLE timed at 15 seconds; TUG test average after 3 trials = 7 seconds; completed 60 repetitions of bilateral heel raises. L ankle AROM: DF = 6; PF = 42; Inv = 30; Ev = 15 degrees.

  • To view the progression table, please click here.

    Results

    Patient began her AlterG intervention with manageable pain, which allowed her to progress somewhat comfortably. We initially had to deal with her increased apprehension and anxiousness regarding weight bearing through the L ankle while wearing a regular shoe. We were able to accomplish this by starting with a 30% assist and slow speed while maintaining tolerable pain. Once her pain irritability was established we were able to challenge her appropriately and progress weekly. The patient noted that the greatest improvement was her functional mobility. After her sessions in the AlterG, she would notice less stiffness when initiating walking following prolonged sitting, improved ability to ascend/descend stairs with alternating steps, and decreased effort necessary to take a step. She never suffered any serious setbacks in her rehab. Her biggest complaint was mostly muscle soreness from both LE’s due to a lack of activity prior and post operation. Our progression of her rehab was based on pain levels and her gait mechanics. She would present with notable foot abduction and decreased stance phase with L LE when fatigue began to occur.

    The patient’s primary disabling factors were poor weight bearing duration and an antalgic gait pattern. These factors were mostly due to very poor dorsiflexion AROM and plantar flexion strength in the L ankle. I believe the AlterG provided an environment where the clinician was able to manipulate, and the patient was able to progress, dorsiflexion incrementally with each step. The weight bearing assist reduced her pain and created the opportunity to do functional tasks, such as heel raises and squats. Due to high pain levels, these two exercises would not have been possible at full weight bearing so early in her rehab.

    During the patient’s follow-up visit with her surgeon, the doctor was amazed how much dorsiflexion she had gained with her L ankle in such a short period of time. I believe the AlterG’s ability to allow people to return sooner to specific functional activities improved her prognosis to PLOF, when compared to conventional physical therapy and therapeutic exercise.

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