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Ankle replacement is a surgical procedure which involves a diseased or damaged joint being replaced with special metal and plastic material to reduce pain and improve mobility of the ankle. The talocrural (ankle) joint is made up of the tibia (shin bone), fibula (small leg bone) and the talus (wedge shaped bone at the front of the foot). There are a number of reasons why you may need to have an ankle replacement including:
  • Osteoarthritis
  • Other types of arthritis including Rheumatoid arthritis
  • Serious trauma to the joint such as a fracture
  • Infection
  • Congenital deformities
However, the main reason for ankle replacement is osteoarthritis. Arthritis of the ankle is usually due to “wear and tear” of the joint over a long period of time although it can also be caused by an injury to the joint such as a fracture or due to the joint being unstable over many years. This can lead to a number of changes:
  • Reduced space between the surfaces of the joint
  • Osteophytes (bony outgrowths around the joint)
  • Joint surfaces become thickened
  • A loss of cartilage over the joint surfaces which normally allows smooth movement
  • Stiffness and pain when moving your ankle
  • Inflammation of soft tissue (synovitis) which may cause redness
  • Crepitus (clicking) during some movements
  • “Locking” of the joint due to loose cartilage
  • Swelling of the joint following weight bearing activities
  • Deformity of the ankle joint
Less frequently it may be caused by severe inflammation (rheumatoid arthritis) or gout. There are several options to consider before ankle replacement is decided including:
  • Conservative (non-surgical) treatment such as physiotherapy, local injections to help with pain and inflammation or orthotics (foot insoles)
  • Arthroscopic debridement (removing loose or additionally tissue that may be causing you pain or discomfort)
  • Ankle fusion (joining the joint surfaces together with metal pins to allow new healthy bone to grow across it)
If these techniques do not provide adequate pain relief or improved function it may be necessary to have ankle replacement surgery. This involves replacing the worn joint surfaces with a special metal and plastic material in order to resurface the joint and help regain pain free range of movement and improve mobility. Before and after surgery physiotherapy at is recommended to ensure that you give your ankle the best possible results of surgery.

Active stretch and strengthening exercises for the ankleAbove: Active stretch and strengthening exercises for the ankle

Physiotherapy prior to ankle replacement

Before your surgery, it is important that you maintain the strength in the muscles of your lower leg and foot and the movement at the joint. At, the experienced physiotherapists will create a personalised programme focussing on a variety of treatments:
  • Strengthening of the affected and non-affected lower limb
  • Range of movement activities
  • Balance exercises to maintain joint positioning (proprioception)
  • Advise on the most effective and painless walking pattern (gait education)
  • Non-weight bearing cardiovascular activity such as cycling and swimming
  • Specific exercises to maintain the strength of the Achilles tendon
  • Hydrotherapy
  • Cryotherapy (ice) treatment if swelling is present
  • Gentle mobilisation techniques to help with joint movement and pain reduction
  • Pain management advice

Taping the ankle to improve stability during rehabilitation exercisesAbove: Taping the ankle to improve stability during rehabilitation exercises

Symptoms following ankle replacement

During the first 24 hours after your surgery the focus will be on controlling your pain levels and you will be given analgesia by tablets or intravenously. Other symptoms of surgery may include:
  • Post-operative stiffness
  • Swelling
  • Temporary pins and needles or numbness around the foot and ankle area due to damage of the nerve during surgery
  • A scar from the incision
  • Temporary pain from the operation

Physiotherapy following ankle replacement

Your ankle will be placed in a light weight cast or splint which will be changed after two weeks. After 24 hours you will be able to begin physiotherapy at although walking for the first 4-6 weeks will be non-weight- bearing using two crutches.

Mobilisations and stretches applied to the connective tissues in the ankleAbove: Mobilisations and stretches applied to the connective tissues in the ankle

Weeks 1-6

During the first 4-6 weeks, physiotherapy at will focus on non-weight- bearing activities:
  • Pain control
  • Elevation to reduce swelling
  • Cryotherapy to reduce swelling
  • Scar mobilisations to ensure that it doesn’t become stiff
  • Simple strengthening exercises in sitting
  • Stretching and range of movement exercises in sitting
  • Activities for the unaffected lower limb
  • Non-weight-bearing cardiovascular exercises including cycling and swimming

Weeks 6-12

After 4-6 weeks your cast will be removed and you will no longer have to use your crutches. You will now be able to begin a more active rehabilitation with which will focus on the following treatments:
  • Gait re-education
  • Balance retraining and proprioception exercises
  • Progression of strengthening exercises to weight-bearing positions
  • Progression of stretching and range of movement exercises to weight-bearing positions
  • Continue with cardiovascular exercises
  • Exercises in more dynamic and functional positions
  • Gentle mobilisations on the ankle joint to improve movement
  • Upper limb stretching, strengthening and cardiovascular activity

Weeks 12 onwards

After 3 months you be able to return to driving and your physiotherapist will look to progress all your previous exercises and returning you to your level before the operation. Certain activities should be continued for the coming months although you should now be doing more functional activities such as walking and other activities of daily living which will gradually replace the specific exercises.


Ankle replacement is a surgical procedure which involves removing the damaged joint surfaces with metal and plastic artificial replacements. The procedure has a very good success rate and will reduce your previous pain and improve mobility of the ankle joint. It is usually performed on severely arthritic joints but occasionally is recommended for severe fractures, infection and deformities. For the recovery to be as successful as possible, it is important that you adhere to your personalised rehabilitation programme designed by as this will also minimise post-operative complications. To book a physiotherapy appointment, call on 0330 088 7800 today!

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