After ankle replacement surgery, most people get back to their regular activities in 6 months to a year. Before that, you'll work with a physical therapist or on your own to gain strength and range of motion in your new ankle. You'll feel a little better and a little stronger each day.
You can start physical therapy after your incisions heal and you're able to put weight on your new ankle. That's usually about 6 to 8 weeks after surgery.
"Whether a patient does it on their own or with a physical therapist depends on their comfort level and the guidance they need," says Judith Baumhauer, MD, MPH. She's a foot and ankle surgeon at the University of Rochester Medical Center.
A referral to physical therapy also depends on the doctor. "Some surgeons will give you exercises to do at home. I am a staunch believer in formal physical therapy," says Selene Parekh, MD. He's a foot and ankle surgeon at Duke Medicine Health System.
Around the time that you begin physical therapy, you also move from a boot to an ankle brace.
Therapy increases range of motion in the new joint, strengthens it, helps you manage pain and swelling, and shows you how to move properly.
"A lot of patients with arthritis have changed their gait for so long -- they walk with a limp or in some other incorrect way to try to minimize the pain and stress on the bad ankle -- that you've got to re-teach them to walk," Parekh says.
Physical therapy generally lasts from 6 weeks to 3 months. Your surgeon will follow up with you regularly to track your recovery and see how much more therapy you need.
"I check at 4-to-6-week intervals. More often than not, they need the full 3 months, sometimes more," Parekh says. "I'd say that 80% to 90% of patients are done with therapy by 3 months. At that point, they continue [the exercises] on their own."
Will It Hurt?
Physical therapy won't be comfortable -- at least not at first -- but the pain should be manageable.
"If you're having sharp, stabbing pain, tell your therapist, because you probably need to back off a little bit. If you're feeling dull pain, that's fine. You need to work through that," Parekh says. "As the weeks go on, the amount of pain you experience with therapy drops pretty quickly."
Though formal physical therapy will end after a few months, you'll continue your ankle exercises on your own.
"I tell patients to do them every day after they brush their teeth. It takes 10 minutes and will continue to strengthen the ankle," Baumhauer says.
Your doctor will probably suggest you keep doing your ankle exercises for the rest of your life, "but it's just like a New Year's resolution. We start off strong, then we taper off," Parekh says. "Most patients stop doing all their exercises by the 6-month mark, because they're feeling pretty good and the ankle's functioning the way they want."
Lifelong Healthy Joints
Besides ankle exercises, your doctor will recommend that you do regular low-impact exercise to stay in good health and keep to a healthy weight.
An ankle replacement usually lasts about 8 to 10 years. The more body weight that's on your joint, the more quickly it will wear out.
"If people become sedentary [inactive] and gain weight after ankle replacement, 10 pounds of weight gain is like 40 to 60 pounds of pressure on your ankle, because the ankle surface area is so small," Baumhauer says. "That's a huge load. You need to stay lean."
Certain types of exercise can also wear out your joints. Running, jumping, and contact sports such as football are off limits after ankle replacement. "You can't pound on your joints. There are lifestyle changes you must adopt," Parekh says.
But you can enjoy most physical activity, he says. "I'm fine if my patients are walking, swimming, biking, playing golf, light tennis, even light basketball."
Your doctor might want to see an annual X-ray of your new ankle for the life of the joint to see how well it's holding up.
People who have ankle replacement often tell their doctors they feel better than normal after recovery from surgery is over.
"You lose things that you are passionate about because of the pain," says Parekh. "Then you get motion back, and you get pain relief, and the majority of patients tell me that their quality of life has been restored and that they feel like they've gotten 10 to 20 years back on their life."