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ankle arthrodesis
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ankle arthrodesis - August 3, 2000 11:55:00 AM
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ruralPT
Posts: 31
Joined: August 2, 2000
From: Concordia, KS USA
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Can anyone enlighten me on how much range of motion is expected after an ankle fusion? I received a patient who had an ankle fusion on 5-19-00. He just got out of a cast and is in a cam walker for 3 weeks. The Dr. sent orders for ROM.
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Re: ankle arthrodesis - August 4, 2000 2:44:00 AM
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Dana D
Posts: 142
Joined: September 18, 1999
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What bones do they fuse in an ankle arthodesis? Did the doctor specify PROM or AROM?
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Re: ankle arthrodesis - August 4, 2000 3:28:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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Rural PT:
What bones did they fuse?? ROM prognosis would be dependent upon that.
mcap
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Re: ankle arthrodesis - August 4, 2000 5:38:00 AM
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ruralPT
Posts: 31
Joined: August 2, 2000
From: Concordia, KS USA
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Well, I guess I should have elaborated. This is the first referral I have received from this doctor. The orders said s/p ankle fusion, needs ROM. It seems that I cannot call and talk to the Dr. or nurse, I must FAX my question to the facility and someone will get back with me. Well, I did that on Monday. I have called the clinic many times and the secretary tells me that I may fax the question again, but they just probably have not gotten to it. In the meantime.....
So, I guess I don't have more to add. I will add anymore info. if I ever hear back from the DR. Oh, the patient doesn't know what bones were fused either. He fell off a ladder in 1963. States he didn't break it, but has had pain since then and the Dr. said the only thing they could do now was fuse the joint.
Thanks!
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Re: ankle arthrodesis - August 4, 2000 10:34:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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Rural PT:
Without knwong what bones were fused I don't know how much range to expect. But you might as well proceed with your range of motion interventions and perhaps you will get an answer from the doc as you are working.
It never ceases to amaze me that a doctor can send a post-operative case to PT and then won't take a phone call. Even if they are not conciensious, it is still their liability!!
Take care,
mcap
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Re: ankle arthrodesis - August 4, 2000 1:25:00 PM
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nicaragua
Posts: 28
Joined: July 10, 2000
From: Australia
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Dear rural PT
Do you have access to his x-rays? If you do you should be able to determine which joint was fused. Generally, the joint that is fused is the talocrural joint. So the management for this type of patients is to mobilise every joint in the foot that was not fused and is hypomobile. You do this by passive-active ROM or mobilisations. That is the treatment. [QUOTE]Originally posted by mcap:
Rural PT:
Without knwong what bones were fused I don't know how much range to expect. But you might as well proceed with your range of motion interventions and perhaps you will get an answer from the doc as you are working.
It never ceases to amaze me that a doctor can send a post-operative case to PT and then won't take a phone call. Even if they are not conciensious, it is still their liability!!
Take care,
mcap[/QUOTE]
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Re: ankle arthrodesis - August 16, 2000 6:04:00 AM
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ruralPT
Posts: 31
Joined: August 2, 2000
From: Concordia, KS USA
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FINALLY!!!!! After many long hours of faxing and calling and cursing! It seems that a triple arthrodesis was performed. The reply from the DR. (I didn't actually speak to the Dr. of course) was that he wanted him to be able to get "some" dorsiflexion back. The patient has -20 degrees df at this time. He is still in a cam walker until next week and then is supposed to go to a regular shoe, but does not see the Dr. again until the end of September. The pt. is on his feet all day at work and the past two visits he has been having increased pain over bilateral malleoli, even with light palpation. His swelling is located primarily in these areas. We are doing a warm wpl. with AROM followed by sitting prostrech ex and towel gathering. Any suggestions!!!
Thanks
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Re: ankle arthrodesis - August 16, 2000 7:55:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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Rural PT:
If he needs to stand on his feet for prolonged periods he will need at least some dorsiflexion, 10 should be fine.
For suggestions, reduce the effusion and then push dorsiflexion. I find that having patients perform AROM every hour (when effusion is gone go to PROM) is a good way of getting the range back. I encourage them to be diligent but not to push hard. When they tolerate weighted dorsi flexion (calf stretch), it is often the best way to go.
Down the road.....Mulligan's mob with movement for dorsiflexion is an option. If the range doesn't come back, dynamic splinting is a consideration.
These are all just basic ideas...without supporting research. Maybe someone can give you additional tricks.
Good luck,
Marc
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