Clinical Consult

Does anyone out there have any literature/references/recommendations for patients returning to running after ankle surgical procedures--(most specifically brostrom-gould, peroneal tendon repair, osteophyte removal).  I'm searching for some resources to provide me with more guidance for these patients.  Not necessarily elite/competitive runners, but also those recreational runners (10k and less).. any insight would be greatly appreciated..

Thanks
AW

Comments

[Bob]

I think we have a pretty good post-op guideline, I only included the functional training/running progression portions.
References cited at the end.

PHASE III: ADVANCED STRENGTHENING & FUNCTIONAL PHASE:
Generally begins at 12 to 16 weeks post-operative and lasts 1-2 months (until 18 to 20 weeks post-op).
** Do not begin Functional Training until FAROM all directions

Endurance Training
Elliptical Machine progression -able to do 30-40 minute workout prior to beginning running.

Walk to Jogging/Running Program Progression 3x/wk.
2-3 minutes walk/2-3 minutes jog. Repeat 2-3x. gradual increase 2 minutes per week over next x 8 wks.

Gait / Functional Training: Treadmill walking x 4 directions 2-3 minutes ea direction progressing intensity gradually.

Carioca jog, shuffles, directional jogging, fitter, slide board

Proprioceptive/Balance Training:

Standing Wobble Board (BAPS w/ eyes open & closed),
One Legged Standing Exercises (2-3 exercises per day),
Stork Stand, Airplane, Rubber tubing kicks, Body Blade, Trampoline ball catch, plyoback, etc.

**BRACE: Patient is to wear ankle brace for 6 months when playing sports or on uneven terrain.

REFERENCES

1. Bahr R: Sports medicine (Clinical review: Recent advances), BMJ 323(7308), August 2001:328-331.

2. Eils E, Rosenbaum D: A multi-station proprioceptive exercise program in patients with ankle instability (Clinical Sciences: Clinical Investigations), Med Sci Sports Exerc, Vol 33 (12). December 2001:1991-1998.

3. Appling S, Kasser R: Current concepts of Orthopedic Physical Therapy (Foot and Ankle), HSC 11.2.12, 2001.

4. Brotzman B. Clinical Orthopaedic Rehabilitation. St Louis, MO. Mosby, Inc; 1996:246-281.

5. Ferkel R, Donatelli R, Hall W: Lateral Ligament Repair. Rehabilitation for the Postsurgical Orthopedic Patient,St. Louis, MO. Mosby, Inc, 2001:288-301.

6. Ferkel R, Donatelli R, Hall W: Open Reduction Internal Fixation of the Ankle. Rehabilitation for the Postsurgical Orthopedic Patient,St. Louis, MO. Mosby, Inc, 2001: 302-312.

7. Ferkel R, Cozen D: Ankle Arthroscopy. Rehabilitation for the Postsurgical Orthopedic Patient,St. Louis, MO. Mosby, Inc, 2001:314-322.

8. Melham T et al: Chronic ankle pain and fibrosis successfully treated with new noninvasive augmented soft tissue mobilization technique (ASTM), Med Sci Sports Exerc, Vol 30(6).June 1998.801-804.

9. Vandenborne K et al: Longitudinal study of skeletal muscle adaptations during immobilization and rehabilitation, Muscle & Nerve.21(8). August 1998.1006-1012.

[Matt Stehr]

Most of my experience with post-op ankles is with patients who have had a modified Brostrom, so I'll comment on that. In my experience, outcomes vary greatly based on how long the injury was present prior to the surgery and the extent of damage present. If there was an OCD present, patients will probably progress more slowly and are less likely to be able to return to their prior level of function. Our protocol calls for a gradual return to running starting at about week 12-14, but I think this is usually overly ambitious. Patients need to have 5/5 peroneal strength, adequate DF ROM, good SLS balance, and minimal pain. I agree with using the elliptical to get them into the motion without the impact initially. According to the research, most patients who undergo this procedure will have good outcomes and return to running. I can't find the study now, but I recall one study that showed that nearly everyone returned to running at 1-2 yrs post-op, but that's not really helpful in telling patients when they can start running again.

[Dr. K-Orthopedic Surgeon]

Here try mine:

Dr. K's Blog

[oakley]

I relate so much to this post. I've been reading you for years,