Suggested Home Maintenance for the Postsurgical Patient 29-1

Maxey: Rehabilitation for the Postsurgical Orthopedic

Chapter 29: Open Reduction and Internal Fixation of the Ankle

Suggested Home Maintenance for the Postsurgical Patient

Weeks 6 to 8

Goals for the Period:

Minimize pain and swelling, improve ROM, initiate AROM and therapeutic exercises, improve gait, and maintain cardiovascular fitness

1. AROM of the ankle (plantar flexion, dorsiflexion, inversion, and eversion)

2. Stretching exercises for the gastrocnemius and soleus muscle groups in a non–weight-

bearing position (use of a towel or strap to stretch these muscles is recommended)

3. Seated heel and toe raises

4. Ice, elevation, and compression

5. Lower extremity conditioning using the stationary bicycle and/or pool

Exercise progression: Begin all exercises with 2 sets of 10 repetitions. If no adverse effects are noted to previous intensity level, progression can proceed to 3 sets of 10 repetitions, followed by

3 sets of 12 to 15 repetitions, and finally 3 sets of 20 repetitions. Once a patient is able to perform 3 sets of 20 repetitions of an exercise, the intensity of the exercise must be increased in some form (i.e., more resistance, longer duration, etc.) and the patient should start back with 2 sets of 10 repetitions and follow the same progression.

Weeks 9 to 12

Normalize ROM and gait, increase strength of the intrinsic and extrinsic foot and ankle musculature, and improve cardiovascular condition

1. Standing heel raises

2. Resistive exercises using elastic bands or tubing for all ankle movements

3. Step-ups and step-downs

4. Single-leg standing progressed to standing on a pillow with eyes open and then with eyes

closed (for balance and proprioception)

5. Walking program, including hills as appropriate

6. Lower extremity conditioning using a stationary bicycle, stair-climbing machine,

treadmill, pool, leg press, and toe raises

7. Weight-bearing stretching exercises to the posterior calf muscles

Weeks 13 to 18

Maintain normal ROM, gait, and strength; increase coordination for higher level activities; improve balance and proprioception; and transition to sporting activities

1. Strengthening exercises with increasing resistance

2. Pool activities such as jumping, running, and cutting drills

3. Agility drills such as side shuffles, backward walking, and carioca

4. Lower extremity conditioning continued from phase II

Week 19 and Beyond

Return to previous level of function (sport- and activity-specific exercises) without restrictions

1. Maximal strengthening of lower extremity muscles

2. Land-based functional activities, such as running, jumping, and cutting

3. Sports simulated activities