Exercises after an ankle fusion

Search for exercises after an ankle fusion and you get lists. Almost none of them say where they came from, and the reason is that the research on ankle arthrodesis measures outcomes rather than testing programs. It records when people walked, when they went back to work, what they took up again, and what happened to the neighboring joints over the following decade. It does not contain a rehabilitation protocol that anyone has compared against another one.

That is not a reason to do nothing. It is a reason to be clear about which parts of this are evidence and which parts are your surgeon’s judgment about your fixation, your bone and your foot. The evidence is below. The judgment is theirs, and they are the only person who has seen the x-rays.

Sixty-one people with advanced ankle arthritis, all treated with an isolated ankle arthrodesis at one hospital, average age 63. The researchers recorded four time points afterwards. These are group averages with 95 percent confidence intervals, from a retrospective single-center study, which is the weakest of the designs represented on this page.1

Two things are worth pulling out of that list. Exercise came last, several weeks after work, and it came after union rather than alongside it. And the spread is wide: the interval on the exercise figure runs from a little over four months to nearly six, in a group all operated on by the same service. An individual number outside that range is not a failure.

The same study measured the remaining up-and-down movement through the rest of the foot afterwards at an average of 22.7 degrees.1 That movement is not the ankle. It is the joints below and in front of it doing the job, which is the whole subject of the next section.

A Dutch group put eight people with painless, successfully fused ankles through four tasks: walking at preferred speed, walking fast, standing up from a chair, and balancing on foam. It is a small study and it says small things carefully.3

Read that as a map of where the work went, not as a training plan. The one thing it does point at is balance. If the unaffected leg is carrying the balance load, then single-leg work on both sides is a more defensible use of time than chasing strength in a calf attached to a joint that no longer moves.

The closest published answer comes from 66 ankle fusions followed for a mean of nine years. Fusion was achieved in 91 percent after the first operation, six patients needed a second procedure to get there, and 91 percent said they were satisfied with the clinical result.4

Arthritis had clearly progressed in every neighboring joint. The authors then wrote the sentence that most summaries of this study drop: the functional and clinical importance of that progression remains unclear.4 Both halves are the finding. Something is visible on the films; what it costs the person is not established.

A nonunion is a fusion that did not set. It is the complication searched for more than any other, and there are two honest ways to count it, which give two different pictures.

That last figure is the uncomfortable one, and it is worth understanding rather than being alarmed by. When reviewers restricted themselves to studies that confirmed union on CT, the rate came out below the greater-than-90-percent figures reported earlier, and the authors say so directly: their stated purpose is to give surgeons better numbers for consent conversations.6 A CT sees gaps a plain x-ray does not. Some of what it finds is a fusion that is doing its job anyway.

The practical version: a nonunion usually means a second operation, roughly one in ten people in the pooled estimate, and the odds are worse for the larger fusions than for an isolated ankle.