1. Treatment Options for Severe Ankle Pain

2. Anatomy of the Ankle Hinge Joint Made up of 3 bones
Lower end of the tibia (shinbone),
Fibula (the small bone of the lower leg)
Talus, the bone that fits into the socket formed by the tibia and the fibula
Source
“Anatomy of the Ankle ”. DePuy Orthopaedics, Inc. 2 April,
Notes
The ankle joint is made up of three bones: the lower end of the tibia (shinbone), the fibula (the small bone of the lower leg) and the talus, the bone that fits into the socket formed by the tibia and the fibula.
The talus sits on top of the calcaneus (the heel bone). The talus moves mainly in one direction. It works like a hinge to allow your foot to move up (dorsiflexion) and down (plantarflexion).
There are ligaments on both sides of the ankle joint that hold the bones together. There are many tendons that cross the ankle to move the ankle and move the toes. Ligaments connect bones to bones while tendons connect muscles to bones.
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3. Ankle Joint Healthy ankle joint Arthritic ankle joint Source
“Symptoms of Arthritis ”. DePuy Orthopaedics, Inc. 2 April,
Notes
When all the articular cartilage is worn off the joint surface, like the x-ray on the right, there may be a squeaking sound when the ankle joint moves. Doctors refer to this sound as crepitance. Arthritis will eventually affect the motion of the ankle joint and it will become stiff and lose the ability to move. Certain motions can become painful, and it may become difficult to trust the ankle joint to hold your weight in certain positions. The body has a pain reflex to ensure that, when a joint is put into a position that causes pain, the muscles around the joint may stop working without warning. This reflex can lead to falls when arthritis affects the leg joints. When osteoarthritis has reached a very severe stage, the bone under the articular cartilage may become worn away. This can lead to increasing deformities around the ankle joint. In the final stages, the alignment of the joints can begin to form odd angles where they meet to form the joint.
Healthy ankle joint
Arthritic ankle joint
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4. Causes of Ankle Pain Osteoarthritis (wear and tear)
Common joint injuries
Fractures and sprains
Excessive stress causing damage to the cartilage.
Source
“Osteoarthritis of the Ankle ”. DePuy Orthopaedics, Inc. 2 April,
Notes
While ankle fractures and ankle sprains heal pretty well, they can lead to problems much later in life. This is due to the wear and tear that occurs for years after the injury. This condition is called osteoarthritis, or post-traumatic arthritis. The term "trauma" means injury, and the term post-traumatic arthritis is used to describe the condition of the arthritis after injury.
Injury to a joint, such as a bad sprain or fracture, can cause actual damage to the articular cartilage. The cartilage can be damaged by "bruising" when too much pressure is exerted on the cartilage surface of a joint. This damages the cartilage, although if you look at the surface it may not appear to be any different. An injury to a joint, even if it does not injure the articular cartilage directly, can alter how the joint works. This is true for a fracture where the bone fragments heal slightly different from the way they were before the break occurred. It is also true that when ligaments are damaged it leads to instability in the joint. When an injury results in a change in the way the joint moves, the injury may increase the forces on the articular cartilage.
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5. Symptoms of Ankle Pain Pain Swelling and Tightness
During activity
At rest or sleeping
Swelling and Tightness
Squeaking or grinding sound when ankle is moved.
Stiffness and decreased movement
Source
“Symptoms of Osteoarthritis ”. DePuy Orthopaedics, Inc. 2 April,
Notes
Pain is the main problem with degenerative arthritis of any joint. At first, this pain occurs only related to activity. Once the activity gets underway there is not usually much pain, but after resting for several minutes the pain and stiffness increase. Later, when the condition worsens, pain may be present even at rest. The pain may interfere with sleep. There may be a swelling around the joint and the joint may fill with fluid and feel tight, especially following increased activity. When all the articular cartilage is worn off the joint surface there may be a squeaking sound when the joint moves. Doctors refer to this sound as crepitans. Degenerative arthritis will eventually affect the motion of a joint and it will become stiff and lose the ability to move.
Certain motions can become painful, and it may become difficult to trust the joint to hold your weight in certain positions.
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6. Preparing for Examination
Have the following information ready for your exam:
Chief complaint (Where it is hurting the most?)
Chronology of illness
What effect does the pain have on your life?
Family history
Arthritis Foundation. Primer on the Rheumatic Diseases. Atlanta, Georgia: Arthritis Foundation, 1997.

7. Diagnosing Ankle Pain Physical Examination Medical History Review
Range of Motion Test
Medical History Review
X-rays
Source
“Diagnosis of Osteoarthritis of the Ankle ”. DePuy Orthopaedics, Inc. 2 April,
Notes
Your orthopaedic surgeon will evaluate your ankle, determining the type of arthritis you have and other factors important in deciding whether or not an ankle arthroplasty can be expected to be successful. In the process of the examination, not only will the motion of your ankle be measured, but also fluid may be taken from the joint to determine if infection is present. X-rays will also be taken to assess the size and condition of your ankle.
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8. How Can My Life Change with Treatment?
A return to mobility
Regaining a sense of your former lifestyle.
A change in pain symptoms
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9. Non-Surgical Treatment Options for Ankle Pain: Over-the-Counter Medications
Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)
Usually first drug used to treat arthritis
Can reduce pain, swelling and redness
Relief can take several months
Examples:
ibuprofen (Advil®, Motrin®)
naproxen (Aleve®)
Aspirin
Reduce joint pain and inflammation
Form of NSAIDs.
Source
“Over-the-Counter Medicines can Reduce Joint Pain”. DePuy Orthopaedics, Inc. 2 April,
Notes
Over-the-counter (OTC) arthritis medicines can be a very important part of your comprehensive arthritis treatment plan. Over-the-counter arthritis medicines are used to reduce the swelling, redness, joint pain and inflammation. At this time, there is no known cure for arthritis.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs are usually the first drug to be used to treat arthritis. These drugs reduce inflammation, but are not steroids like cortisone, consequently the name nonsteriodal anti-inflammatory. NSAIDs can reduce joint pain, swelling, tenderness and redness.
NSAIDs may take several months for relief of symptoms to be noticed. Currently, the only NSAIDs that are over-the-counter are ibuprofen (Advil®, Motrin®, and others), naproxen (Aleve®), and aspirin.
Aspirin: Aspirin has been used since eighteenth century England to treat arthritis. It can reduce joint pain and inflammation in arthritis sufferers. Aspirin is a form of  NSAID.
Acetaminophen – Tylenol®, Datril® Extra Strength, Tempra®, and others: Acetaminophen is a painkiller and lowers fever. However, it is not an anti-inflammatory drug so it does not decrease or reduce inflammation of arthritis.
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10. Non-Surgical Treatment Options for Ankle Pain: Over-the-Counter Medications
Acetaminophen
Reduces pain
Lowers fever
Does not reduce inflammation of arthritis
Examples:
Tylenol®
Datril® Extra Strength
Tempra®
Source
“Over-the-Counter Medicines can Reduce Joint Pain”. DePuy Orthopaedics, Inc. 2 April,
Notes
Over-the-counter (OTC) arthritis medicines can be a very important part of your comprehensive arthritis treatment plan. Over-the-counter arthritis medicines are used to reduce the swelling, redness, joint pain and inflammation. At this time, there is no known cure for arthritis.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs are usually the first drug to be used to treat arthritis. These drugs reduce inflammation, but are not steroids like cortisone, consequently the name nonsteriodal anti-inflammatory. NSAIDs can reduce joint pain, swelling, tenderness and redness.
NSAIDs may take several months for relief of symptoms to be noticed. Currently, the only NSAIDs that are over-the-counter are ibuprofen (Advil®, Motrin®, and others), naproxen (Aleve®), and aspirin.
Aspirin: Aspirin has been used since eighteenth century England to treat arthritis. It can reduce joint pain and inflammation in arthritis sufferers. Aspirin is a form of  NSAID.
Acetaminophen – Tylenol®, Datril® Extra Strength, Tempra®, and others: Acetaminophen is a painkiller and lowers fever. However, it is not an anti-inflammatory drug so it does not decrease or reduce inflammation of arthritis.
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11. Non-Surgical Treatment Options for Ankle Pain: Prescription Medications
NSAIDS
Most popular type for osteoarthritis treatment
Includes ibuprofen (Motrin®), naproxen sodium (Anaprox®), oxaprozin (Daypro®), sulindac (Clinoril®) , etc.
Analgesics
Provide pain relief, but do not reduce inflammation
Includes Acetaminophen with codeine (Tylenol® with Codeine), Oxycodone (OxyContin®, Roxicodone®), Hydrocodone with acetaminophen (Vicodin®, Dolacet®), etc.
Source
“Prescription Medications to Reduce Arthritis”. DePuy Orthopaedics, Inc. 2 April,
Notes
NSAIDs are the most popular type of prescription drug for the treatment of osteoarthritis.   Some of the NSAIDs your doctor may prescribe may include one of the following:
Ibuprofen (Prescription: Motrin®; Non-prescription: Motrin IB, Advil®, Nuprin®)
Naproxen (Naprosyn®, Naprelan®)
Naproxen sodium (Prescription: Anaprox®; Non-prescription: Aleve®)
Oxaprozin (Daypro®)
Sulindac (Clinoril®)
Analgesics
Unlike NSAIDs, analgesics do not fight inflammation, but instead are used to provide arthritis pain relief. Acetaminophen is the most commonly used analgesic and is available without prescription. Other types of analgesics that require a prescription include:
Acetaminophen with codeine (Fioricet®, Phenaphen® with Codeine, Tylenol® with Codeine)
Oxycodone (OxyContin®, Roxicodone®)
Hydrocodone with acetaminophen (Vicodin®, Dolacet®)
Propoxyphene hydrochloride (PP-Cap®, Darvon®)
Tramadol (Ultram®)

12. Non-Surgical Treatment Options for Ankle Pain: Prescription Medications
Biological Response Modifiers
Treat rheumatoid arthritis; may postpone injury to the joints
Includes: Infliximab (Remicade®), Etanercept (Enbrel ®)
Glucocorticoids or Corticosteroids
Treat rheumatoid arthritis; fight inflammation
Includes: cortisone, hydrocortisone (Cortef®, Hydrocortone®), Prednisolone (Prelone®)
DMARDS
Treat rheumatoid arthritis; slow joint destruction
Includes: methotrexate, injectable gold, penicillamine (Depen®), Azathioprine (Imuran®), etc.
Source
“Prescription Medications to Reduce Arthritis”. DePuy Orthopaedics, Inc. 2 April,
Notes
Biological Response Modifiers
Once given as part of a second-line treatment strategy for rheumatoid arthritis, biological response modifiers are now being used earlier in treatment. These drugs may postpone structural injury in the joints of rheumatoid arthritis patients. Unlike traditional drugs, these biologic agents target the specific area of the immune system that is a factor in the progression of the disease.
Etanercept (Enbrel®)
Infliximab (Remicade®)
Glucocorticoids or Corticosteroids
For over 50 years, glucocorticoids have been used to treat rheumatoid arthritis and other types of arthritis.  Glucocorticoids are hormones that fight inflammation and are similar to the naturally occurring hormones in our body. These drugs are available in many forms including pills and injections. Because there are serious side effects to high dosages and long term usage, doctors are now using lower doses to treat inflammation and joint damage.
Cortisone
Hydrocortisone (Cortef®, Hydrocortone®)
Methylprednisolone (Medrol®)
Prednisolone (Prelone®)
Prednisone (Deltasone®, Orasone®, Prednicen-M®, Sterapred®)
Triamcinolone (Aristocort®)
DMARDs
Over time, DMARDs slow joint destruction in people with rheumatoid arthritis. The effects of DMARDs are generally slow and can take several months to make a difference. Experts are now prescribing DMARDs earlier in the treatment of rheumatoid arthritis and are often using a combination of two or three drugs.
Methotrexate is one of the most widely used DMARDs on the market and has been used for over twenty years. Approximately half of all people with rheumatoid arthritis are taking methotrexate®. Other DMARDs include:
Injectable gold
Penicillamine (Depen®)
Azathioprine (Imuran®)
Chloroquine
Hydroxychloroquine (Plaquenil®)
Sulfasalazine (Azulfidine®)  
Side Effects
Every drug has possible side effects. Be sure to talk with your doctor about possible side effects before taking a new medication. If you notice a side effect, contact your doctor immediately to discuss whether or not you should continue to take that medication. Your doctor may change your medication or reduce the amount of the drug you are taking. Only your doctor will be able to advise you on the best possible course of treatment.

13. Non-Surgical Treatment Options for Ankle Pain
Physical Therapy
Assistive devices
Orthosis, walking aids
Activity Modification
Avoid activities that put excessive stress on the ankle joint.
Source
“Treating Arthritis of the Ankle ”. DePuy Orthopaedics, Inc. 2 April,
Notes
Your First Visit to Physical Therapy
On your first visit, your physical therapist will want to gather some more information about the history of your ankle problem. You may be given a questionnaire that helps you tell about the day-to-day problems you are having with your ankle. The information you give will help measure the success of your treatment. You may also be asked to rate your pain on a scale of one to ten. This will help your physical therapist gauge how much pain you have now and how your pain changes once you've had treatment. Your physical therapist will probably ask some more questions about your ankle problem to begin zeroing in on the source and location of your pain and to know what will be needed to help relieve it.
Walking Aids: In cases of severe pain or joint wear and tear, you may need to use a cane or walker until your condition is stabilized. Using a walking aid can take some of the pressure off the ankle joint, protecting it from undue stress and strain.
Daily activities: Here are some helpful hints to use during the day to limit strain on your ankle.
Avoid standing for greater than 10 minutes; instead take frequent rests.
Use a heel or shoe cushion when standing or walking on hard surfaces.
Limit stair climbing; take the elevator, escalator, or ramp.
Avoid bending and squatting by storing items at waist level. Or use a reacher.
Park close to your destination.
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14. Surgical Options for Ankle Pain
Arthroscopic Debridement
Appx. 11,200 debridements a year.
Ankle Fusion surgery
12,000 fusions estimated for 2003.
Ankle Replacement surgery
Appx. 1,500 replacements a year.
Copyright 2002 by Solucient LLC
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15. Arthroscopic Debridement
Early stage of arthritis and ankle damage.
Small camera is inserted into the ankle through small incisions.
Remove debris
Cartilage surfaces smoothed.
Source
“Arthritis of the Foot and Ankle”. American Academy of Orthopaedic Surgeons. 2 April,
Notes
Arthroscopic debridement. Arthroscopic surgery may be helpful in the early stages of arthritis. A pencil-sized instrument (arthroscope) with a small lens, a miniature camera and a lighting system is inserted into a joint. This projects three-dimensional images of the joint on a television monitor, enabling the surgeon to look directly inside the joint and identify the trouble. Tiny probes, forceps, knives and shavers can then be used to clean the joint area by removing foreign tissue and bony outgrowths (spurs).
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16. Ankle Fusion Surgery End stage of arthritis and ankle pain
Traditional treatment historically
Fuse the bones of the joint to grow together.
Results in :
Strong joint
Eliminate pain
Immobile ankle (no range of motion).
Source
“Ankle Fusion Surgery: An Option for the Treatment of Degenerative Arthritis”. DePuy Orthopaedics, Inc. 2 April,
Notes
An ankle fusion surgery (or arthrodesis) is commonly suggested for a degenerative (worn out, painful) ankle joint. For many years, surgeons have considered an ankle fusion to be the permanent solution for advanced degenerative arthritis of the ankle joint. An ankle fusion is quite durable. After the ankle joint is successfully fused, patients can usually walk with a near normal gait (way of moving) and without the pain of arthritis.
In the majority of cases, surgeons consider the ankle fusion to be the most appropriate treatment for a degenerative ankle in a young patient. This is due to the high demands that an active adult will place on his or her ankle over time. Artificial ankle replacement may not be durable enough in a younger, high demand patient to withstand the stress. Surgeons have thought that the ankle fusion could permanently solve the problems faced by the patient with a degenerative ankle.
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17. Ankle Fusion Surgery Incision is made.
Fibula and tibia are held together until they heal and fuse into one with:
Pins
Plates
Screws
A bone graft is sometimes needed.
Source
“Ankle Fusion Surgery: An Option for the Treatment of Degenerative Arthritis”. DePuy Orthopaedics, Inc. 2 April,
Notes
The Surgery
To accomplish this the same instruments and guides utilized during ankle replacement surgery can be used during fusion surgery as well. The amount of bone that is removed during the ankle fusion should be the same, or less, than the amount of bone removed during the artificial ankle replacement. This guarantees that there will be enough bone to hold the artificial ankle joint firmly in place. Cuts to the bone are made at the right angles and depths to allow the artificial ankle to be inserted later.
In some cases, surgeons try to fuse the fibula to the tibia during the ankle fusion. This is routinely done during the ankle replacement surgery so that the bone that holds the socket is stable. Doing this during ankle fusion allows the fibula and tibia heal together before ankle replacement surgery is done.
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18. Ankle Fusion Surgery Benefits of ankle fusions
Durable and strong
Usually walk with a near normal gait
Removes pain of arthritis
Disadvantages of ankle fusion
Immobile joint; forcing remaining joints to move more.
Load transfer leading to arthritis
Uneven leg lengths, may cause limping
Source
Ankle Fusion Surgery: An Option for the Treatment of Degenerative Arthritis”. DePuy Orthopaedics, Inc. 2 April,
Notes
An ankle fusion surgery (or arthrodesis) is commonly suggested for a degenerative (worn out, painful) ankle joint. For many years, surgeons have considered an ankle fusion to be the permanent solution for advanced degenerative arthritis of the ankle joint. An ankle fusion is quite durable. After the ankle joint is successfully fused, patients can usually walk with a near normal gait (way of moving) and without the pain of arthritis.
In the majority of cases, surgeons consider the ankle fusion to be the most appropriate treatment for a degenerative ankle in a young patient. This is due to the high demands that an active adult will place on his or her ankle over time. Historically, artificial ankle replacement may not be durable enough in a younger, high demand patient to withstand the stress. Surgeons have thought that the ankle fusion could permanently solve the problems faced by the patient with a degenerative ankle.
However, over the years surgeons have found that by fusing the ankle, additional stress is placed on the other joints of the foot. With a fusion, the ankle joint no longer moves. Therefore, the remaining joints are forced to move more than usual during walking. The added stress can, in time, lead to arthritis of these joints. The result is a painful foot that may require additional surgical procedures to control these new problems. “
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19. Ankle Replacement surgery
End Stage of Arthritis and Ankle Pain
Replaces Diseased Bone
Results
Moveable Ankle Joint
Eliminates Pain
Source
“Ankle Joint Replacement: A Good Alternative to Ankle Fusion Surgery”. DePuy Orthopaedics, Inc. 2 April,
Notes
Fusion surgery is not the only option for relief of severe ankle joint pain. Ankle replacement, an alternative to fusion, is used in certain patients with rheumatoid arthritis, osteoarthritis or ankle trauma caused by an injury. The diseased or damaged parts of the ankle joint are removed and replaced with an Agility Ankle implant. The goal is to reduce pain while allowing movement within the ankle. Unlike ankle fusion, joint replacement closely matches the normal function of a healthy ankle as much as possible.
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20. When is Ankle Replacement Surgery Right for You?
Significant pain, even when sleeping.
Loss of function despite non-surgical treatments.
Pain is no longer manageable.
Mobility similar to normal ankle is desired.
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21. Total Ankle Replacement Components
Tibial component
made of medical grade plastic with a metal base plate tray.
Talar Component
made of metal
replaces the top of the talus.
Source
“Ankle Replacement Surgery ”. DePuy Orthopaedics, Inc. 2 April,
Notes
Each artificial ankle prosthesis is made up of two parts:
The tibial component is the metal portion of the artificial joint that replaces the socket of the ankle (the top portion).
The talus component replaces the top of the talus. The talus is the first bone of the foot and sits in the mortise of the ankle.
The talus component is made of metal. The tibial component is usually made up of two parts, a metal tray that is attached directly to the bone and a plastic cup that provides the bearing surface. The plastic used is very tough and very slick.
Talar
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22. Benefits to Patient from Surgery
Return to Mobility
Restore their lifestyle
Freedom
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23. Surgical Procedure Incision is made
All arthritic portions of the ankle joint are removed.
Tibia (shinbone) and fibula are shaped for the implant.
Source
“Ankle Replacement Surgery ”. DePuy Orthopaedics, Inc. 2 April,
Notes
Your surgeon will assess the surfaces of your ankle joint. He or she will remove all arthritic portions of the ankle joint bones, preparing the bones for the ankle implant.
The tibia and the fibula will be shaped so that the tibial component will fit in place.
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24. Surgical Procedure
After the top of the talus is cut the talar component is inserted and tested.
The ankle joint is closed.
Your leg will be wrapped in a bandage and placed in a splint as it heals.
Source
“Ankle Replacement Surgery ”. DePuy Orthopaedics, Inc. 2 April,
Notes
The top of the talus is then cut so the talar component can be inserted. Your surgeon will test the ankle replacement joint to ensure the pieces fit properly and the desired range of motion is achieved.
When the surgeon is satisfied your ankle is properly fixed and moving correctly, he or she will sew back the ankle joint capsule followed by suturing the skin.
Your leg will be wrapped in a bandage and placed in a splint to protect your new ankle joint as it heals.
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25. X-Rays Before-After Total Ankle Replacement
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26. Preparing for Joint Replacement Surgery
Ease anxiety by mentally preparing with:
Breathing exercises
Meditation
Talking with family and friends
Learn more about ankle replacement surgery
Brochures
Handouts
Websites
Videos
Source
“Preparing Your Mind Before Joint Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April,
Notes
Mentally Preparing for Joint Replacement Surgery
Several kinds of relaxation techniques may be helpful for joint replacement surgery patients. These include:
Breathing exercises—Using awareness and conscious control over breathing to bring about relaxation.
Meditation—Relaxing the body and calming the mind by focusing on a repeated word or sound.
Another helpful tool is simply learning more about what to expect before and after joint replacement surgery. This type of patient is always looking for information on the Web, in books and magazines, and on television, they really want to know all the nitty-gritty details about their upcoming surgery. This type of patient feels reassured by focusing much of their energy into gathering information. Whichever type of patient you tend to be, your best pre-op prep plan should consist of both relaxation techniques and patient education. This well-rounded strategy will help you deal with the anxiety related to joint replacement surgery and the recovery process.
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27. The Night Before Surgery
Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.)
Do not consume any food or liquid after midnight.
Make sure you have everything you’ll need at the hospital.
Ask any questions you may have before surgery.
Source
“The Night Before Joint Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April,
Notes
Be sure to take all of your normal medications unless the doctor has instructed you not to take certain medications.
Medications such as "blood thinners" (coumadin, aspirin, ibuprofen and the other anti- inflammatory medications) may cause a greater blood loss. Your doctor has probably already had you stop taking these medications. Ask to make sure!
You can eat about anything you wish the night before surgery. You can eat solid food until midnight. After midnight, you should not eat or drink anything unless your doctor has told you otherwise. This means nothing - not coffee, not water, not ice chips.
Make sure you have everything you'll need at the hospital, that all of your questions are answered and that you have your advanced directives available if you wish.
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28. After Surgery Foot is elevated and immobilized in a splint.
Basic gentle range-of-motion exercises are started.
The dressing is normally removed two days after surgery.
If necessary, physical therapy will be prescribed by your doctor.
Source
“Ankle Replacement Surgery ”. DePuy Orthopaedics, Inc. 2 April,
Notes
After the Surgery and in the Hospital
On the day after surgery, you will probably be allowed to get out of bed, sit in a chair, or if indicated by your surgeon, begin physical therapy. Generally, physical therapy begins quite soon after ankle replacement surgery.
Your foot and lower leg will be elevated and immobilized in a splint, so you will not be able to move your ankle. Frequently, blood will be visible on the dressing and should not be cause for alarm. This is common and usually stops after a few hours. The first day after surgery, you will probably be allowed to get out of bed, sit in a chair and, on occasion, start physical therapy. The dressing is normally removed two days after surgery and movement of your ankle is started in physical therapy.
You will begin gentle range-of-motion exercises. A physical therapist at the hospital will also show you safe ways to get in and out of a chair or a car, maneuver steps, and use a walker or crutches.
You can expect to use a walker or crutches for the first six weeks. During this time, you will not be able to put weight on your ankle. Your surgeon will provide specific instructions.
It is also normal to have a mild fever for a few days after surgery. You can help get rid of the fever by taking deep breaths and getting moving. The fever will usually go away before or just after you leave the hospital.
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29. Hospital Discharge Hospital stay
Three to five days
Dependent on healing.
May need some assistance for several weeks after surgery.
Post-operative care period lasts for approximately six weeks.
Follow surgeon’s directions precisely.
Source
“Following Ankle Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April,
Notes
Healing After Surgery
Your foot and lower leg will be elevated and immobilized in a splint, so you will not be able to move your ankle. Frequently, blood will be visible on the dressing and should not be cause for alarm. This is common and usually stops after a few hours. The first day after surgery, you will probably be allowed to get out of bed, sit in a chair and, on occasion, start physical therapy. The dressing is normally removed two days after surgery and movement of your ankle is started in physical therapy.
Progress
You will not be able to put weight on your ankle for the first six weeks, during which time you will be using crutches or a walker. Instructions on how to take the splint off twice a day to perform range of motion exercises will be given prior to your discharge. The sutures will be removed about two weeks after surgery.
At Home
You may need help with your daily activities, so it is a good idea to have family and friends prepared to help you. It is normal to feel frustrated, but these frustrations will soon pass.
Special Instructions
You will normally be seen six weeks and three months after surgery. A six-month exam is also usually scheduled for new x-rays and an assessment of your progress.
Note for the future: You should always tell your dentist or physician that you have an artificial joint. If you are having dental work performed, notify your dentist or physician so he/she can prescribe antibiotics for the day before and the day of your dental care. Antibiotics must be used before and after any medical or dental procedure. This precaution must be taken for the rest of your life.
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30. A Caregiver’s Role Provide support and show patience
Help with needs that the patient can not do, like:
Meal preparation
Grocery shopping
Laundry
Driving to medical appointments
Source
“Caregiver’s Roles and Responsibilities”. DePuy Orthopaedics, Inc. 2 April,
Notes
This volunteer must be resilient, as duties for this position as the caregiver to a joint replacement patient include (but are not limited to):
Helping patient stand, sit, lie down, and move from room to room and place to place;
Providing help with bathing/grooming, dressing, feeding, and using the bathroom;
Doing (or arranging for) the shopping, cleaning, cooking, laundry and errand-running;
Keeping track of medical appointments and providing transportation to and from the hospital, the surgeon’s office, the physical therapist’s, and to any other appointments;
Picking up prescriptions or manage delivery of prescriptions;
Administering medications, changing dressings, keeping track of assistive devices (cane, walker, crutches, etc);
Communicating with the healthcare team about any changes or concerns;
Managing finances, including paying regular household bills and handling the patient’s insurance paperwork.
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31. Recovery in the First Week
Use a walker or crutches
No weight on your ankle until instructed by your doctor.
Range-of-motion exercises at least two to three times a day.
Special precautions during bathing.
Source
“Following Ankle Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April,
Notes
Progress
You will not be able to put weight on your ankle for the first six weeks, during which time you will be using crutches or a walker. Instructions on how to take the splint off twice a day to perform range of motion exercises will be given prior to your discharge. The sutures will be removed about two weeks after surgery.
Resuming Activities
You can walk as much as you like using crutches or a walker, but you'll need to remain non-weight bearing on the affected side for about six weeks. Your surgeon will provide specific instructions.
Do the exercises prescribed by your doctor/physical therapist at least two to three times a day.
For bathing, sit in the bathtub and wash. Be certain that you keep your ankle dry until the sutures have been removed, then resume normal bathing. On occasion, you may use plastic to cover your ankle so you can shower while the sutures are still in place.
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32. Recovery in the First Month
“Post-operative” visit
X-rays
Examination
2 Weeks: Sutures Removed
Source
“Following Ankle Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April,
Notes
Medication/Pain Control
It is normal for you to have some discomfort, but it would be unusual for you to use pain medication more than five to seven days after surgery. You will receive a prescription for pain medication before you leave the hospital. If a refill is needed, please call your surgeon's nurse at least three days before you run out of pills.
Special Instructions
You will normally be seen six weeks and three months after surgery. A six-month exam is also usually scheduled for new x-rays and an assessment of your progress.
Your sutures will be removed two weeks after surgery.
Note for the future: You should always tell your dentist or physician that you have an artificial joint. If you are having dental work performed, notify your dentist or physician so he/she can prescribe antibiotics for the day before and the day of your dental care. Antibiotics must be used before and after any medical or dental procedure. This precaution must be taken for the rest of your life.
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33. Recovery After Six Weeks
6 weeks (with Doctors Instruction)
Gradually put weight on the leg
Use of a cane or walker.
Begin Driving
6 to 8 weeks - automatic shift
12 weeks – manual shift
12 weeks - low-impact activities, such as walking.
Up to 1 year - may require the use of an ankle support
Source
“Following Ankle Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April,
Notes
Progress
You will not be able to put weight on your ankle for the first six weeks, during which time you will be using crutches or a walker. Instructions on how to take the splint off twice a day to perform range of motion exercises will be given prior to your discharge. The sutures will be removed about two weeks after surgery.
Resuming Activities
You can walk as much as you like using crutches or a walker, but you'll need to remain non-weight bearing on the affected side for about six weeks. Your surgeon will provide specific instructions.
When you rest, be sure to elevate your ankle, preferably above the level of your heart.
Do the exercises prescribed by your doctor/physical therapist at least two to three times a day.
At night, rest on your back with a pillow or two under your splinted ankle.
For bathing, sit in the bathtub and wash. Be certain that you keep your ankle dry until the sutures have been removed, then resume normal bathing. On occasion, you may use plastic to cover your ankle so you can shower while the sutures are still in place.
You may return to work when authorized by your surgeon. Contact Your Family Doctor If: You develop a cold, fever, sore throat, pulmonary (breathing) problems, cardiovascular (heart or circulation) problems or other general physical difficulties that cause you concern.
You may begin driving an automatic shift in six to eight weeks- 12 weeks for a manual. By 12 weeks, you can begin low-impact activities, such as walking. You may have to use an ankle support for up to one year.
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34. Questions?

35. Thank-you