Physiotherapy after ankle surgery: the road to a successful recovery

The ankle is a complex joint that experiences a lot of stress on a daily basis. The multiple movements and weight the ankle has to bear make it more susceptible to various types of injuries. Although many ankle injuries can be treated with physiotherapy, there are cases where surgery is necessary.

A common ankle injury that may require surgery is a bone fracture in the ankle. This is a fracture in one or more of the bones that make up the ankle: the tibia (tibia), fibula (fibula) and talus (ankle bone). Ankle fractures can range from simple stable fractures to complex unstable fractures in which the bones are displaced. In cases where the bones are out of place, surgery is necessary. A common surgical procedure for these fractures is open reduction and internal fixation (ORIF), in which the bones are moved into place and secured with metal plates, screws or pins to promote proper healing.

Another type of injury that may require surgery is torn ligaments. Ligaments are firm bands of connective tissue that connect bones and provide stability in the ankle. A severe sprain can lead to a partial or complete tear of one or more ligaments. Although mild to moderate sprains usually heal without surgery, surgery may be necessary for a complete tear or when conservative treatments have not brought sufficient recovery. Surgical reconstruction of ligaments may involve repairing the torn ligament or replacing it with a graft, which is a piece of tissue from elsewhere in the body or from a donor.

Osteoarthritis, or wear and tear of the cartilage in the ankle joint, is another condition that may require surgery in some cases. In severe cases of osteoarthritis, where conservative treatments such as physiotherapy, medication and injections are ineffective, surgery may be considered. This may be an ankle fusion or arthrodesis, in which the bones of the ankle are permanently fixed to reduce pain. Another option is an ankle prosthesis, in which the damaged joint is replaced with an artificial joint to restore movement and reduce pain.

Osteochondral lesions are lesions in which both the cartilage and underlying bone in the ankle joint are damaged. They can occur due to trauma such as an ankle sprain. When the lesion is large and does not heal with conservative treatment, surgery may be necessary. This also applies if loose cartilage or bone fragments are present in the joint or if pain and restrictions persist despite physiotherapy and other treatments. Surgical options for osteochondral lesions may include microfracturing. Here, small lesions are made in the bone surface, stimulating new cartilage growth. Other methods may include osteochondral grafting and cartilage repair techniques.

Tendon injuries, such as a torn Achilles or peroneal tendon, can cause severe pain and functional limitations. Although smaller tears often heal without surgery, surgery is often necessary in cases of a complete rupture of the Achilles tendon or persistent pain and loss of function after a partial tear of a tendon. In such cases, surgery may involve suturing the torn tendon or using a graft to strengthen the tendon and restore function.

The first phase after ankle surgery is all about rest and recovery. Immediately after surgery, your ankle is likely to be swollen and painful. It is essential to take this phase seriously. Your body really needs time to heal from the surgery. Our physiotherapists will advise you on using aids such as crutches to take the weight off your ankle and prevent you from doing too much too soon.

At this stage, it is important to keep the ankle elevated and use ice regularly to reduce swelling. Your physiotherapist will teach you how to do this properly. In addition, gentle mobilisation exercises can be introduced to promote blood circulation without interfering with healing.

After the first few weeks of rest, the focus will shift to regaining movement in the ankle. During this phase, you will begin gentle stretching and mobilisation to prevent stiffness and improve range of motion. Your physiotherapist will guide you in performing specific exercises designed to increase ankle flexibility without causing strain.

An example of an exercise in this phase is gently bending and stretching the toes and foot which will make the muscles and tendons in your foot and ankle active again.

As your ankle gets stronger and your range of motion increases, physiotherapy will focus on building strength. Stronger muscles support the ankle and help the recovery process. Your physiotherapist will guide you through exercises aimed at strengthening the muscles around the ankle, such as the calf muscles and the muscles in your foot.

An effective exercise at this stage is to do the calf raise. Stand upright and slowly lift your heels off the ground, balancing on your toes. This strengthens the calf muscles and helps with ankle stability. Other exercises can include various machines that you can also find in the gym and exercises like lunges and squats.

Once you have regained sufficient strength and range of motion, the focus shifts to restoring functionality and preparing you to return to daily activities and sports. This is an exciting phase as you begin to see how far you have come since surgery.

Your physiotherapist will introduce exercises and activities specific to your goals and lifestyle. For example, for someone who is a runner, this might mean gradually resuming running on a treadmill under supervision. For others, it may mean resuming your daily activities, such as walking without pain or climbing stairs with confidence.

An important aspect of physiotherapy after ankle surgery is learning how to prevent future injuries. Your physiotherapist will advise you on wearing appropriate footwear, performing regular exercises and strengthening the muscles around the ankle. Moreover, you can learn how to tape your ankle or use a brace during sports activities to provide extra support, should this still be necessary.

Recovering from ankle surgery is a long journey that requires time, patience and commitment. Physiotherapy plays a crucial role at every stage of this process, from reducing pain and swelling immediately after surgery to restoring strength, mobility and functionality. By following a clear transparent approach, we can help you make your recovery as smooth and effective as possible.

At Fysio Fitaal, we are ready to support you every step of this journey. Our experienced physiotherapists will work closely with you to develop a customised treatment plan tailored to your specific needs and goals. Together, we work towards a successful recovery and a strong, healthy future.