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Total ankle prosthesis star
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Total ankle prosthesis star - November 12, 2003 11:41:00 AM
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Pt John W
Posts: 5
Joined: June 20, 2003
Status: offline
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Total ankle prosthesis
My patient have a uncemented total ankle prosthesis STAR operated in 030513 then plastic 4 weeks.
Preoperatively: arthrosis, pain, rom 5 degree df and 30 degree pf.
Now: rom -5 degree df and 30 pf. Numnes around the forefoot , some parts hypersensitive. Compact swollen. He won less pain in the ankle.
He has difficult to walking because limited rom.
He has trained extensivle with r.o.m training, streching, muscular training , all whith poor result.I just now started whith manual therapy (thanks [URL=http://www.PTupdate.com)]www.PTupdate.com)[/URL] to increase ankle df, but the ankle is very stiff and i can hardly feel any motion in the ankle. The x-rays are good ,acording to the surgeon
In the operative report, they mention thight relaions in the ankle. The pat will do a emg test for the ankle nerves.
Any thoughts to increase df.
Best regards
John W
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Re: Total ankle prosthesis star - November 12, 2003 7:40:00 PM
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Sam B
Posts: 73
Joined: August 6, 2003
Status: offline
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Some ideas,
Check soft tissue mobility/ guarding in the posterior leg. These don't attach directly to the talus, but restrict DF of the foot, if the calcaneus can't tilt.
Sometimes, the syndesmosis is very tight due to difficulty weightbearing, and you have to encourage loading, to allow this to spread , just a little. ( talus is wider anteriorly, so should open the mortise a little with DF)
Check soft tissue anteriorly; tib ant and peroneals often restrict PF immensely.
Determine if the ankle is tight with the knee flexed and extended, to assess gastroc involvement versus ankle.
Don't forget all the tissue in the distal posterior leg, achilles tendon, retinacular slips, posterior tibial tendon/ FDL/ FHL sheaths etc
Check motion at talo-navic, calcaneocub joints. Remember, dorsiflexion motion needs abduction of the forefoot, and hindfoot eversion, due to the oblique axis of the ankle. Check subtalar joint.
Check the prox and distal tib-fib joints, check for tibial rotation loss at the knee, preventing late stance phase tibial rotation on talus.
If there is beaucoup pain with walking, due to -5 degrees DF, you way want to look at a small wedge/ heel lift to decrease pain/posterior leg muscle guarding, or a shoe with a rocker bottom ( convex, or ciurved up near toes), to allow push off at late stance phase.
I may have got the date wrong, but seems like the surgery was in March, so this is chronic stiffness? If I am wrong, and this is still acute post-op, my plan suggested will be totally different, and more related to inhibition of pain through more subtle methods.
Cheers,
Sam
[This message has been edited by Sam B (edited November 13, 2003).]
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Re: Total ankle prosthesis star - November 14, 2003 9:10:00 AM
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coloradojulie
Posts: 413
Joined: November 10, 2002
From: colorado usa
Status: offline
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I recently worked with a fellow who had an ankle replacement and he had a large problem with tissue impingement anteriorly especially with dorsi flexion. Scar tissue was a large concern. You may want to find out what the motion allowances are in the orthoses so you have a baseline normal.
My guy had to have a revision because the orthoses was not placed well. I don't think this surgery has all the kinks worked out of it yet.
Dorsiflexion with distraction may help reduce impingement, and scar work would be great to focus on.
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