Monday, 30 May 2016

Georgetown Ankle Ligament Reconstruction Protocol 2017

Dr. Christopher Lu MBchB FRCSC / Darryl Yardley M.Sc.PT
Ankle ligament reconstruction post-op protocol


PRE-OPERATIVE PHYSIOTHERAPY:


- Gait training, advice on edema control and pain management: rest, elevation, cold therapy
- Ankle strengthening; Proprioception
- Assess with AOFAS Ankle/Hindfoot Scale
- Learn how to use - crutches, knee scooter, cast protector, cast boot and cold therapy unit
- Please Call Restore Physiotherapy Georgetown - 905-702-1840 to book your pre-operative physiotherapy appointment.
- Post-operative physiotherapy can be completed either at Restore Physio Georgetown or a reputable physiotherapy clinic near your home.
- Post-operative in home physiotherapy is also available with: www.therapia.com


0 - 2 WEEKS:


- Non-weight wearing in below knee back slab or cast boot locked with fiberglass and integrated cold therapy
- Leg elevation and cold therapy for edema control
- Mobilize with crutches, knee scooter
- Keep cast boot and dry - use cast protector in shower
- Wound check at 2 weeks post-op
- Toe curls, toe spreads / extension
- Take aspirin 81 mg - once a day for DVT prophylaxis - if there are no contraindications / allergies
- Continue aspirin every day you are in the cast boot


2 - 6 WEEKS:

- Can now start weight bearing in cast boot locked with fiberglass and integrated cold therapy.
- Continue to mobilize with crutches. Can weight bear on heel.
- Limit ankle ROM to prevent wound break down.
- Keep cast clean and dry - use cast protector in shower
- Toe curls, toe spreads / extension
- Leg lifts and extension to keep quads strong.
- Take aspirin 81 mg - once a day for DVT prophylaxis - if there are no contraindications / allergies
- Continue aspirin every day you are in a cast.


6 - 12 WEEKS:


- Cast boot removed
- Cover wound with Band-aid advanced healing bandage - this can be left on for several days at a time and is waterproof.
- Start physiotherapy at 6 weeks post-op
- ROM (Range of motion) in unilateral planes focus on dorsiflexion and progress to active exercises in protected ranges, avoid inversion, ankle traction, and tibio-fibular mobilization.
- Proprioception exercises, intrinsic muscle strengthening, start isometric eversion.
- Soft tissue treatments (plantar fascia, gastroc/soleus, achilles) and regular mobilization of intermetatarsal and midtarsal joints.
- Passive and active range of motion exercises (restore full ROM / multi-planar motions)
- Open kinetic and closed kinetic chain strengthening.
- Gradually progress closed-chain and balance / proprioception.
- Cycling, aerobic machines as tolerated.
- Can transition to anke brace at 6 weeks post-op
- AVOID: ankle traction, forced plantarflexion and ankle inversion for 12 weeks


3 - 6 MONTHS:


- Progress back into athletics based upon functional status at discretion of Orthopaedic Surgeon.

- Assess with AOFAS Ankle/Hindfoot Scale  (Post-op - 3 months and 6 months)

Disclaimer:  This physiotherapy protocol is specifically designed for patients who have had their ankle instability surgery performed at Georgetown Hospital.


Tuesday, 9 February 2016

Recommended aids to help with post-op recovery

1) Breg Kodiak Cold Therapy + Ankle / Foot Attachment / Game Ready / Ossur



US Amazon Link:


2) Walking Aids - Crutches / Knee Scooter / iWalk 2.0


US Amazon Link:

Crutches
Knee Scooter
iWalk 2.0

Canada Amazon Link:

Crutches
Knee Scooter
iWalk 2.0

3) Shower Aids

US Amazon Link:

Cast Cover
Bath Stool

Canada Amazon Link:

Cast Cover
Bath Stool

4) Vitamin D drops - 2000 IU / day

Please start this now - in preparation for surgery.



US Amazon Link:

Vitamin D drops

Canada Amazon Link:

Vitamin D drops

5) Aspirin 81 mg / day

If you do not have a contraindication for taking aspirin.  I would recommend you take an Aspirin 81 mg / day for each day that you are in the cast.


US Amazon Link:


Canada Amazon Link:


6) Foam Bed Wedge to elevate feet



US Amazon Link:

Foam Bed Wedge

Canada Amazon Link:

Foam Bed Wedge

7) Advanced healing waterproof band-aids


 
US Amazon Link:

Advanced Healing Band-aids

Canada Amazon Link:

Advanced Healing Band-Aids


8) Diet.  Make sure you are eating a good well balanced diet with adequate amounts of protein and fruits + vegetables.  No junk food.  No fast food.  No sugar. No smoking.

9) ASO Ankle brace



US Amazon Link:

ASO Ankle Brace

Canada Amazon Link:

ASO Ankle Brace

10) Long Cast Boot


US Amazon Link:


Canada Amazon Link:


Sunday, 24 August 2014

The Brostrum Procedure

The Brostrum Procedure is the standard procedure used to correct ankle instability.

It has been performed for over 50 years.

Brostrum's original paper was written in 1966.

Below are some links about the procedure.

Recovery is generally 3 to 6 months.

Brostrum Procedure / Wikipedia

Brostrum Procedure / Wheeless

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC164377/pdf/attr_37_04_0458.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC164377/


Friday, 24 May 2013

PXB - Percutaneous X-ray Guided Internal Brace

Ankle instability treated using PXB technique - Percutaneous X-ray Guided Internal Brace.
1) Make an incision and percutaneous identify the fibula

2) Drill hole for 4.75 mm SwiveLock
3) Tap fibula
4) Insert 4.75 mm SwiveLock
5) Mark and drill talus
6) Tap talus
7) Insert 4.75 mm SwiveLock in talus and tension fiber tape appropriately
8) Post-op incisions



Pre and post-op stress X-rays:

Case 1:


Case 2:


Case 3:


Case 4:


Case 5:


Case 6:


Monday, 20 May 2013

Tracking Outcomes - AOFAS Ankle-Hindfoot Scale

In an effort to track outcomes for our patients we will be using the AOFAS Ankle/Hindfoot Scale.  I have attached the AOFAS Ankle/Hindfoot scoring sheet.  If you are a patient it would be appreciated if you could fill out this form on your first and subsequent visits.

AOFAS Ankle-Hindfoot Scale PDF

Georgetown Ankle Ligament Reconstruction Protocol 2017

Dr. Christopher Lu MBchB FRCSC / Darryl Yardley M.Sc.PT Ankle ligament reconstruction post-op protocol PRE-OPERATIVE PHYSIOTHERAPY: ...