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Posterior Ankle Arthroscopy (Os Trigonum Resection)

John G. Kennedy, MD, FRCS, Lower Limb, Foot and Ankle, Cartilage Restoration, Orthopedic Surgeon, West Palm Beach, New York / Foot & Ankle / Post-op Protocols / Patient Surgery Binder / Posterior Ankle Arthroscopy (Os Trigonum Resection)

This protocol provides you with general guidelines for initial stage and progression of rehabilitation. Please note this protocol is a guideline. Specific changes will be made by the physician as appropriate for the individual patient.

Phase I: Weeks 0-2

General

  • Weightbearing (WB) as tolerated with or without crutches
  • Elevate and Ice to control swelling
  • Sutures dissolved/removed at 10-14 days

Exercises

  • Active range of motion as tolerated in all planes
  • Wiggle toes

Phase II: Weeks 2-4

General

  • WB as tolerated

Exercises

  • Start physical therapy

Goals

  • Full range of motion
  • Normal gait

Phase III: Weeks 4+

General

  • Full strength and endurance
  • Good proprioception
  • Return to work or activity

General

  • Full activity as tolerated

Exercises

  • Proprioception retraining
  • Dynamic training: hopping, skipping, running
  • Progress to plyometrics
  • Work or sports specific training

Return to full unrestricted activity or sports when cleared by a physician

General Post-Operative Care

Dressings

  • Maintain primary dressings until the two week mark post-surgery, unless otherwise instructed by your provider.
  • Have a water proof cover available to protect your dressing or splint while in the shower.

Infection

  • Observe for any signs of infection including redness, warmth, dehiscence or opening of the incision, or drainage at the incision site. Notify your provider right away if you experience any of these symptoms.

Pain Management

  • Talk to your doctor about your pain medication regimen before and after surgery. Usually, prescription pain medications can be taken every 4-6 hours. OTC Tylenol can be taken for breakthrough pain, the maximum dose for Tylenol is 3,000 mg per day for adults.
  • OTC stool softeners may be taken concurrently with your prescription pain medication to reduce the risk for opioid induced constipation.
  • Pain medications commonly have a side effect of drowsiness. Refrain from any activities that require strict attention after taking these medications (ie operating heavy machinery, driving, etc).

Swelling

  • Icing and elevating the affected extremity above the level of the heart can help alleviate swelling. Icing can be done 2-3 times a day or as needed.
  • Avoid applying the ice directly on your skin for a prolonged period of time as this may cause blisters.

Range of Motion (ROM)

  • Once your splint is removed, Range of motion exercises are encouraged to reduce stiffness.
  • In the ankle, ankle pumps (dorsiflexion and plantar flexion exercises) for 5-10 minutes about three times is encouraged.
  • In the toe, flexion exercises of the joint are encouraged.

Deep Vein Thrombosis (DVT)

  • Talk to your provider about Prophylaxis treatment for Deep vein thrombosis (DVT) needed for your surgery.
  • Antiplatelet and anticoagulant medications can increase your risk for bleeding and bruising.
  • If you experience any severe calf pain, leg swelling, along with chest pain and shortness of breath, call 911 or go to the nearest hospital as this can be a sign of a life threatening condition.