Ankle Surgery & Fractures
The ankle is one of the most commonly injured areas in the body, especially in terms of fractures and breaks and as such our physiotherapists see a lot of patients who have had an operation such as an athroscopy or have recently broken their ankle and require physiotherapy.
Due to its importance in terms of walking, balance and general mobility it is vital for patients to have access to good quality and intensive physiotherapy. Our home visit physiotherapy service is based in Lichfield and serves surrounding areas such as Sutton Coldfield, Tamworth, Rugeley, Walsall and Cannock. This page contains information about some common orthopaedic procedures, ankle arthroscopies, ankle fractures and how physiotherapy can help with recovery.
Ankle Fractures (Non-Operative)
Ankle fractures and breaks are extremely common and are usually the result of a fall, trip or some form of trauma such as a car accident or a sporting injury. Commonly one of the malleoli (the bumps on either side of the ankle) will be fractured, usually resulting in an extended period in a cast or possibly boot. In general it takes approximately 6-8 weeks for lower limb fractures to heal and for bone union to take place and for the period of time, patients will generally be non-weightbearing and using 2 elbow crutches to mobilise around. After 6 weeks or so the patient will usually attend a fracture clinic and may possibly have another x-ray to determine how healing has progressed, if all is well then the cast will be removed and the patient should be referred to physiotherapy and instructed to start weightbearing through the affected foot.
It is at this stage that it is vital that you get access to high quality physiotherapy and our home visit service really helps at this stage. After being in a cast for an extended period of time and without having any weight going through it the ankle will feel extremely stiff and may be swollen, range of motion will be reduced and there is likely to be a loss of muscle mass in the calf muscles. You are also likely to feel nervous about what to do next, how to get walking again and what exercises to do -all things that our physiotherapists can help you with. In the initial few weeks,hands on physiotherapy, joint mobilisations and soft tissue massage are extremely helpful to improve range of motion, reduce swelling and lower sensitivity. Your physiotherapist will also be able to help you with how to reduce reliance on 2 crutches and slowly reduce your need for support until you are walking properly again. Once out of this initial period and when you are walking normally again it is vital that you work on your balance and proprioception (spatial awareness) as this will have been compromised with 6 - 8 weeks of inactivity. At this point our physiotherapists will prescribe a comprehensive exercise program for you to follow and which will maximise your recovery. It is all too tempting to think that once you are off the crutches and walking again that there is no need to work on anymore rehab!
Ankle Fractures (Requiring Surgery)
Some fractures/breaks can be much more serious and will require surgery to pin and plate the bones back together, this is usually because the bones have moved away from their normal alignment and if left alone will not set back into a good position. A common orthopaedic procedure used is that of open reduction internal fixation (ORIF), this is where the surgeon will open up the ankle and will pin and plate the bones back into a good position. At this point the foot and ankle will be cast in a downward pointing position to maximise chances of a good bone union, later (possibly a few weeks later) the ankle will be re-cast into more of a normal foot position. Healing times from these type of operations are in general longer than that of a simple fracture and your surgeon will advise you of when you can start weight-bearing again through that ankle/foot.
Once your surgeon has given permission for you to start weight-bearing through the ankle, then it is time for physiotherapy. Again, our home visit physiotherapy service is ideal as it removes the difficulty of getting to a clinic and gives you access to rehab in your own home. In the initial few weeks manual therapy can help reduce swelling improve range of motion and make your ankle feel much better. Our physiotherapists will also work on reducing reliance on walking aids, assist with improving your gait and help you feel more confident about how to progress. Once past the initial stage and as both range of motion and walking improve our physiotherapists will design and prescribe a comprehensive rehabilitation program aimed at improving balance and strength of the ankle.
An arthroscopy is keyhole surgery of a joint (as opposed to open surgery), the technique is used to reduce trauma, chance of infection and improve recovery time. Ankle arthroscopies can be done for a number of reasons including - exploratory (simply to look and find out what is wrong), to clean up and repair and cartilage inside the joint and to repair ligaments. Usually this is day surgery and will not require an overnight stay in hospital and you should be able to walk with the aid of a crutch straight away (although you need to check with your surgeon regarding any restrictions). Physiotherapy is a key part of recovery in terms of promoting good range of motion and also strengthening and improving balance. Our home visit physiotherapy service can assist and speed up your recovery after any ankle operation, especially if the NHS is unable to provide sufficient support.
Sometimes, it can be necessary to fuse the ankle joint into place, this is often done after major trauma or if pain has become too difficult to deal with. Ankle fusion is usually offered as a last resort and will need a large amount of physiotherapy to recover from. After an ankle fusion our home visit physiotherapy service can help promote maximal recovery by first completing a thorough assessment of your current function and goals and then using a combination of hands on manual techniques to reduce pain and a tailored balance and exercise programme to assist you with strengthening and mobilising.
This is a major orthopaedic operation requiring the insertion of an artificial ankle joint to replace the original ankle joint. Physiotherapy is a key component of making a good recovery and it is essential that you have regular and speedy access to a physiotherapist. After an ankle replacement there is likely to be a large amount of swelling, pain and restriction of movement and you will likely be using crutches to walk with. Our physiotherapists can help with restoring range of motion, reducing pain, reducing reliance upon walking aids and can design a thorough rehabilitation and exercise program to meet your needs. If you have had your operation via the NHS we can supplement any NHS physiotherapy provision to ensure that you receive the optimal amount of physiotherapy.
Stem Cell Treatment
This a recent treatment option that is becoming more popular and involves the use of stem cells to stimulate the growth of cartilage in the joint. It is used to repair cartilage and to attempt to avoid a joint replacement and can be used in the knee, hip and ankle. It is done arthroscopically and is usually day surgery. Depending upon any restrictions put in place by your surgeon you should be able to weight-bear through the joint soon after the operation and will need access to physiotherapy. Our physiotherapy service has a large amount of experience of helping patients recover after stem cell treatments for ankle, knee and hip arthritis and we will be able to assist you in making the optimal recovery.
Due to the complexity of the ankle joint, the need to clearly determine any protocols from the surgeon and the lengthy assessment process; treatment sessions are 1 hour for all sessions including follow ups. It is our experience that this extended period of time allows for a much greater benefit and response to therapy and is especially beneficial for patients who are in significant pain and benefit from a slower and more progressive approach to rehab.