Total Ankle Replacement: Phase 4: Decrease Scar Adhesions: Increase Flexibility

My rehabilitation from total ankle replacement (TAR) has been coming along well.  However, dorsiflexion (pulling the toes and forefoot toward the nose) is limited. 

Dorsiflexion (DF) is important to create a normal walking pattern.  DF is necessary to create heel strike at the beginning of the gait cycle.  DF is also very important for advanced recreational activities such as running (which after TAR I will not be able to do) and skiing (which I will be able to do).

Interestingly, I am able to do closed chain DF better than active DF.  This is because when I activate my muscles to do DF, it causes a sensation of a tight band across the front of my shin to occur.  This is where the incision is.

I have been working on scar massage but now I'm starting to work more aggressively on the scar.  I used a small square of Dycem that allowed me to apply more stretch to the scar.  This is because the Dycem decreased the sliding of my fingers on the skin.  Dycem is a sticky material, that you can often find in a therapy clinic.  I also began to use suction cups to pull the scar upward off of the tibia.  Below is a video of these more advanced scar massage techniques.

After manual scar massage, it  is also very important to use the tendons to encourage sliding and gliding. Tendon gliding for the foot requires bending through each of the toe joints and then through the ankle.  Below is a video of how to do tendon glides.

Things are coming week will be about exercises and gait....returning to normal!