Total ankle replacements also known as total ankle arthroplasty (TAA) were introduced as a procedure to improve end-stage arthritis of the ankle joint in the 1970’s. While arthritis can be seen by many people as a normal condition associated with aging, chronic arthritis of the ankle joint can lead to:
- Loss of cartilage
- Increased pain
- Reduced movement and function
- Deformity of the joint
Total ankle replacement then is a surgical procedure that offers many benefits that address these issues including:
- Increased mobility and range of motion
- Improved gait
- Reduced Pain
- Lowered Swelling and edema of the joint
The main goal for patients who have undergone TAA is to improve ankle function and reduce pain in day to day activities. So it makes sense that candidates for the procedure are those who experience chronic ankle pain and have lost the ability to function in daily activities. Patients who receive TAA do so because conservative treatments with anti-inflammatory medication, bracing and activity modification can no longer manage their pain or debilitating symptoms.
Total Ankle Replacement Case Study
Patient is a 62 y/o female who had a left ankle replacement. She suffered from L > R chronic ankle pain due to Arthritis for many years and walking > 5 minutes became intolerable for 2-3 months prior to surgery. Following surgery, patient had a weight-bearing protocol and was given an ankle cast, walker and ankle brace. Subject complains of pain and swelling post procedure.
- Walking for up to 45 minutes without pain
- Ability to complete household tasks without pain
- Ability to walk with normal gait pattern
In order to achieve these goals, certain tools and rehabilitation modalities need to be utilized to control any post-surgical pain and swelling while helping to increase range of motion and functional movement.
Physical Therapy Modalities for Total Ankle Replacement Patients
Ultrasound Therapy: Therapeutic ultrasound machines are beneficial because they produce targeted therapy to the ankle area. Coupled with a small ultrasound soundhead applicator and using low-intensity continuous mode, ultrasound therapy passes through the injured area, vibrating molecules which in turn creates friction and heat that penetrates the deeper tissues. The ultrasound therapy treatment helps flush out the injured area and increases a new supply of nutrient and oxygen-rich blood which helps facilitate faster healing times. What’s more the deep heating effect of ultrasound therapy works to decrease pain which helps increase function as patients participate in therapeutic exercise.
Electrical Stimulation: Electrical stimulation is based on the Gate Theory, meaning when the body experiences another sensation other than pain, like an electrical impulse, the spinal column effectively “closes the gate” and won’t let the pain impulse pass to the brain. With electrical stimulation, the impulses are sensed by the central nervous system faster than pain impulses. Because of this, the electrical information “closes the gate” to pain sensations, blocking its way from making it to the brain. In addition, electrical stimulation devices stimulate the body’s release of endorphins which helps reduce the body’s perception of pain for up to 8 hours at a time. Not only that, but once pain is reduced muscles relax making it easier for patients to participate in therapeutic exercise.
Treatment tip: Therapeutic ultrasound and electrical stimulation are great to use for TAA patients, both alone or simultaneously. When pain is acute, these modalities can be used to reduce pain in order to prepare patients for physical activities like therapeutic exercise. Once pain has been controlled, therapeutic ultrasound and electrical stimulation can be used as needed at the end of treatment to reduce any triggered pain as a result of physical exercise. Additionally, electrical stimulation used in the form of transcutaneous electrical nerve stimulation portable device can be used by the patients at home as an alternative to oral pain medication.
Related Article: The Power of Using Ultrasound Therapy in Rehabilitation Combinations
We’ve discussed two physical therapy modalities to use in the treatment of post-TAA procedure pain. Now it’s time to discuss therapeutic exercise. Therapeutic exercise is an important part of TAA rehabilitation and returning to full function. Therapeutic exercise as it relates to TAA rehabilitation is comprised of the following elements:
Improving Range of Motion: Gentle range of motion exercises help take the ankle safely through movements in each direction.
Strengthening: Strengthening the buttocks, hips, thighs and calf are an integral part of regaining function in the lower leg. Strength training may consist of lower-body exercises using resistance bands, for example: banded squats.
Endurance: Endurance is essential for not only daily activities, but improves the patient’s ability to participate in necessary exercise programs. To help improve overall endurance, exercises using a stationary biking, underwater treadmill, or even a continuous passive motion machine may be used.
Balance: Once a patient is able to be weight-bearing, it is important to improve balance, which involves the stability and control of the ankle joint. To improve these skills, a physical therapist will have the patient practice activities like heel-toe walking, side stepping, single leg standing, or working with a balance pad or balance platform.
Exercise Progression: As a patient’s range of motion, strength, endurance and balance improves, the physical therapist will progress the patient towards activities that mimic day-to-day activities; going up and down steps, squatting, toe raises, and bending down.
In a Nutshell: Total Ankle Replacements (TAA) is a procedure primarily for patients with chronic arthritis.
- Physical Therapy helps return function in patients who have had TAA.
- Modalities like ultrasound therapy and electrical stimulation are good pain-relieving alternatives to oral pain medication for patients post-TAA procedures.
- With TAA procedures, there is weight-bearing and exercise progression protocols that must be monitored and any residual pain and swelling can be addressed as a part of physical therapy.
Total ankle replacements aren’t as prevalent as other joint replacement procedures, but as chronic arthritis numbers continue to rise, so will our patient’s needs for total ankle arthroplasty procedures. Physical therapy remains one of the most powerful ways to help reduce a post-TAA patient’s pain and swelling, while also improving their recovery outcomes.
Related Article: Therapeutic Ultrasound & TENS: Alternative Pain Relief From Opioids