Beginning Ankle Replacement Physical Therapy

My Two Week Follow-up

With Yolanda driving, we arrive at The Steadman Clinic for my follow up appointment two weeks after my ankle replacement surgery. I crutch, to coin a verb, down the hallway lined with photos, jerseys and thank you’s from many of the famous professional athletes The Steadman Clinic has fixed over the years. 

Football players, skiers and olympic athletes, former patients of The Steadman Clinic.

Injured skiers are there in spades. Football, basketball, hockey and soccer players from around the world have been returned to competitive form by the clinic. I’m just a peon in their long list of patients but feel I’ve gotten the same level of care as the most famous.

More of the famous athletes treated by The Steadman Clinic

After a couple minutes in the exam room, Terie, one of Dr. Clanton’s PA’s arrives to remove the splint. Scissors in hand she cuts through the layers of gauze and wrapping to reveal my 5-6” incision and its sutures. She washes and cleans my foot thoroughly then carefully cuts and removes the multiple stitches and applies steristrips to keep the incision closed.

Not too pretty. The ankle replacement incision with steristrips holding thing together,

All but the lowest stitch appear to have healed together. The healing of this one wound along with my scrunched and abraded little toe are to be the most difficult parts of the entire ordeal.

I’m put in a wheelchair and wheeled to radiology to have my ankle replacement x-rayed. When I return to the exam room, a smiling Dr. Clanton arrives to have a look at both the X-rays and my ankle. After manipulating my foot and ankle, about which I’m a bit squeamish, he pronounces that everything looks as it should and that I’m ready to begin physical therapy.

Protocols For Becoming Full Weight-bearing On My Ankle Replacement

Another assistant comes in with my new walking boot. He also has a pair pressure socks, not covered by medicare. I decide to pay the $35 but come to regret the purchase because the socks are so tight especially around my contused toes that I’m never able to use them. My feeling is that perhaps after the swelling goes down they might become more comfortable. It doesn’t happen.

Terie gives me several protocols to help me become first full weight-bearing and then to lose the walking boot and progress into shoes. Each protocol has a two week and a four week progression depending upon my recovery.

2 week crutch weaning protocol
4 week crutch weaning protocol

I’m hoping against hope that two weeks for each will do it and that I’ll be walking around like a semi-normal person much sooner than I ever could have expected.

Now able to put a little weight on my ankle through the protection of the boot, it’s much easier to hobble around. I still dread the flight of stairs I’ll need to climb when we get home. And not just that flight, but also the second flight up to the loft and my office. And then of course, there’s getting back down to the bedroom.

Home Again

 The drive goes quickly and I’m faced with the few exterior steps and then the interior flight. Applying the principles the physical therapist taught me at the hospital plus being very careful, it all goes surprisingly easy. I’m home for the first time in two weeks.

Dr. Clanton’s office recommended a physical therapist, Matt Pakorny, who used to work at the Howard Head Clinic in Vail but is now on his own at GTO Physical Therapy in Golden. I’ve already set up my first PT appointment for the following day.

Sleep that night is still fitful even in our own bed. Dr. Clanton insists I wear the boot in bed as it not only protects the ankle replacement but keeps the ankle at a 90 degree angle that will prove beneficial over the recovery. It’s a constant struggle to find a method for adjusting the five velcro straps and padded inserts that allows me to sleep with relative comfort.

One strap or another, usually among the bottom three, wakes me up by being too tight and restrictive. The forced angle of my foot and ankle in the boot becomes uncomfortable during the night causing pressure on the ball of my foot and behind the toes. Straps seem to cut into or aggravate where the incision isn’t healed making my foot throb a bit. Acetaminophin helps but is no solution.

I can’t sleep under tucked-in sheets and blankets because it’s too constrictive so I sleep on top covered by a single blanket. Inevitably, the blanket gets tangled around the boot. I toss and turn trying to get comfortable. I’m not allowed to sleep on my stomach so every night is a bit of a struggle. Still, there’s no pain to speak of, just discomfort.

Beginning Physical Therapy

The next day Yolanda drives me to my first PT appointment. I’ve never had PT before and conjure images of painful manipulation and forced stretching.

It turns out it’s anything but. Matt proves a sensitive and experience therapist. He massages my foot and applies pressure to various points. Matt gives me a series of easy exercises aimed at relieving the swelling and bring back first the flexibility and then the strength.

Images of the gentle exercises I'm to begin.

He explains better the full weight-bearing protocol for my ankle replacement helping me to understand what is meant by 20%, then 30%, then 40%, 50%, 70%, 80% and finally 100% weight-bearing. Each progression lasts two days depending upon whether or not it begins causing pain. If all goes well, two weeks later I can lose the crutches! I’m hopeful.

By Dennis Jones/Dreamcatcher Imaging