Wellness & Lifestyles Australia

ANKLE ARTHROSCOPY REHABILITATION E-BOOK

prepared by

Wellness & Lifestyles Australia

2007,2008,2009

Table of Contents Page No. IMPORTANT NOTICE .................................................................................................................1 INTRODUCTION ......................................................................................................................2 ANKLE ANATOMY.....................................................................................................................3 ANKLE ARTHROSCOPY...............................................................................................................4

Indications for surgery.................................................................................................... 4 The procedure: ............................................................................................................ 4

AFTER YOUR ANKLE ARTHROSCOPY ..............................................................................................5 Advice and information:.................................................................................................. 5 Walking:..................................................................................................................... 5

REHABILITATION AFTER ANKLE ARTHROSCOPY .................................................................................6 SUMMARY ........................................................................................................................... 12 CONTACT US ....................................................................................................................... 13

MANUAL LAST MODIFIED 21/03/2011

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IMPORTANT NOTICE The information provided in this document can only assist you in the most general way. This document does not replace any statutory requirements under relevant State and Territory legislation. Wellness & Lifestyles Australia (W&L) accepts no liability arising from the use of, or reliance on, the material contained in this document, which is provided on the basis that the Office of W&L is not thereby engaged in rendering professional advice. Before relying on the material, users should carefully make their own assessment as to its accuracy, currency, completeness and relevance for their purposes, and should obtain any appropriate professional advice relevant to their particular circumstances. To the extent that the material in this document includes views or recommendations of third parties, such views or recommendations do not necessarily reflect the views of the Office of W&L or indicate its commitment to a particular course of action. Copyright Australia 2009 This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved.

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INTRODUCTION Welcome to the W&L series of e-Books. You have chosen the edition on ankle arthroscopy rehabilitation. This resource will be beneficial to: Anyone who is interested in the anatomy of the ankle Anyone who wants to know what an ankle arthroscopy involves Anyone who has had an ankle arthroscopy and needs a rehabilitation program This e-Book will cover information about the anatomy of the ankle and it will also provide a rehabilitation program for ankle arthroscopy surgery. The information provided is up to date and follows industry standard. W&L recommend that you continue to consult your doctor and physiotherapist so that your progress can be monitored and program tailored to your specific requirements.

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ANKLE ANATOMY The ankle is made up by the two bones in the lower leg (tibia and fibula), the heel bone (calcaneus) and the talus which is in the middle. Connecting these bones is a series of ligaments. There are also many nerves and muscle tendons which pass around the bones and through the canals they form.

Diagram taken from: LARS Ligaments.com & JK Orthomedic LTD (2004-2007), About Ankle Ligaments, viewed 16th March 2011

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ANKLE ARTHROSCOPY

Indications for surgery Ankle arthroscopies can be performed in order to examine and repair the ankle after a variety of injuries, such as ankle sprains. The main reason for an ankle arthroscopy after an ankle sprain is when there has been extensive damage and there may be bone fragments. Arthroscopy is also used if there have been recurrent sprains and there is painful scar tissue which needs removing.

The procedure: Arthroscopy involves keyhole surgery where a small incision is made and a tiny camera is guided into the ankle where the tissues and joint surfaces can be examined and specific surgical interventions can be performed. This can usually be done under a local anaesthetic as this procedure is not particularly invasive.

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AFTER YOUR ANKLE ARTHROSCOPY

Advice and information: Ask your doctor and surgeon about pain management plans. Once the anaesthetic wears off from the operation and as you are trying to use your ankle more you may experience an increase in pain. Pain will vary between people and between procedures. There will be a bandage wrapped around your ankle after surgery. Remove the bandage the morning after the surgery with your shower but keep the bandaids on, trying to keep them dry. Follow the RICE regime below to minimise pain, swelling and inflammation.

R Rest: Do not walk with weight through your ankle too much. Limit activity levels with consideration to the amount of swelling and pain. Use walking aids where required to assist with activities.

I Ice: Use ice packs or ice wrapped in moistened cloth on your injured ankle for 20 minuets every 2 hours. Continue until the ankle is no longer swollen by the end of the day.

C Compression: Keep two layers of tubigrip (like an open sock of bandage) around your ankle until your ankle no longer swells.

E Elevation: Keep the ankle resting on a chair or cushion so that it is above the level of the hip to reduce swelling pooling locally in the ankle.

Walking: It is important to maintain a normal walking pattern and to try to keep it symmetrical. It is crucial that you maintain a heel-toe pattern while walking. In order to achieve this, place your heel down first as your foot strikes the ground, roll through the sole of your foot, then push off with your toes as the step is completed. You may need to use a walking aid which you will be instructed in using after your surgery, to manage this effectively. Do not spend prolonged periods on your feet when you ankle is still swollen. When your swelling and pain have reduced, you can challenge your walking by going in different directions (sideways and backwards) and in circles (both clockwise and anticlockwise).

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REHABILITATION AFTER ANKLE ARTHROSCOPY

You perform this program in consultation with a therapist so that they can prescribe the exercises appropriate to your needs. There are different stages of rehabilitation and the amount of exercise needs to be moderated as you improve. Perform the following with your foot elevated as high as comfortable and knee bent slightly. Ankle pumps draw your toes towards the ceiling and hold this position for 3 seconds. Point your toes down and hold for 3 seconds. Repeat each direction 10 times.

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Ankle twists turn your toes inwards and hold then turn them outwards and hold. Make sure that the movement is coming from your ankle and that you knee is stationary. Hold each position for 3 seconds and repeat 10 times each side.

Ankle circles draw circles with your foot, making sure that your ankle is moving. Do 10 circles clockwise and then 10 anticlockwise.

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Toe scrunching use your toes to pick up a tissue and then drop it again. Repeat 10 times.

Ankle stretch with exercise band in sitting with your knee bent about 45, use an exercise band to pull your foot towards your body. Hold for 10 seconds and repeat 5 times.

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Heel raises in sitting in sitting with your feet on the floor, raise the heel of your operated leg and lower slowly. Repeat 10 times. You can make this exercise harder by doing this with both feet in standing, and eventually, single legged, on your operated ankle. The reverse exercise raising the toes off of the floor can be graded in much the same manner: single leg sitting, double leg standing, single leg standing.

Ankle dorsiflexion draw your toes towards the ceiling and use an exercise band to help pull them up further. Hold for 30 seconds and repeat 3 times a day.

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Gastronemius muscle stretch stand with the foot of your injured leg slightly angled inward but your knee pointing straight ahead. Take a step forward with your good leg and keep the knee of your injured leg straight with your heel planted flat on the floor. You should feel a slight stretch in your calf with this exercise. Hold for 30 seconds and repeat 3 times a day.

Soleus muscle stretch stand in a lunge with your injured leg leading (with only a small amount of weight going through your injured leg). Do a small squat so that your knee goes over your toes. Make sure your heel stays planted. You can use a chair or wall to hold yourself steady and take some weight if desired. Do this exercise only to the point where you begin to feel an increase in pain. Hold for 30 seconds and repeat 3 times a day.

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The final part of your rehabilitation will be fine tuning the joint receptors in your ankle to know where it is and what it is doing in space. Your therapist will prescribe exercises such as the examples below. Steps up, down, forward, backward and sideways will also help to retrain your ankle. Balancing stand near a wall or between two chairs with a pillow or wobble board in between. Balance on your injured leg with your knee bent slightly. Hold your balance for as long as possible. Make this exercise harder by standing on your toes, closing your eyes, tilting your head back, drawing arches with your other leg or moving your arms (to throw or catch for example).

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SUMMARY In summary, ankle arthroscopies are a relatively non-invasive surgery which can be done to examine and clean up the ankle after a variety of injuries. After surgery there is a large focus on reducing pain and swelling by using the RICE protocol. Early rehabilitation will gently increase knee movement and strength of your ankle but it is important to be sensitive to pain and swelling. At all stages of recovery it is important to make sure that walking technique is symmetrical and walking aids can be used to facilitate this. Please use this resource as a guide to your rehabilitation in consultation with your surgeon and therapist. All the best for a speedy recovery, The W&L Team

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CONTACT US Wellness & Lifestyles Australia 2/59 Fullarton Road, Kent Town SA 5067 P: +61 08 8331 3000 F: +61 08 8331 3002 E: contact@wellnesslifestyles.com.au W: www.wellnesslifestyles.com.au www.wleducation.com.au W&L services include: Physiotherapy Aged Care Funding Instrument (ACFI) Consultancy Podiatry Speech Pathology Dietetics Diabetes Education Occupational Therapy Psychology Physiotherapy Aide Diversional Therapy Aromatherapy Natural Therapies Massage Exercise Physiology Educational Training Staff Wellness Program Locum Services Medicare Billing Aged Care Funding Instrument Documentation Online Training W&L products include: Posters E-books E-learning modules