Post-surgical ankle stiffness is a nearly universal consequence of immobilization and the body’s natural healing response. Following a procedure, the joint capsule and surrounding soft tissues often become tight due to scar tissue formation, sometimes called arthrofibrosis. Immobilization also causes the muscles and tendons around the ankle to shorten, significantly restricting the joint’s normal range of motion. Restoring movement requires a deliberate, structured, and progressive rehabilitation program aimed at safely lengthening these tissues and mobilizing the joint surfaces.
Preparing the Ankle for Movement
Mobilization must only begin after receiving explicit clearance from the operating surgeon or physical therapist, as starting too soon can jeopardize the surgical repair. The rehabilitation plan must respect the specific weight-bearing and movement restrictions placed on the ankle, which vary significantly based on the procedure performed. Before attempting any physical activity, managing residual pain and inflammation is necessary.
Applying a cold compress or ice pack for 15 to 20 minutes, three to four times a day, helps control swelling and reduce pain perception. Elevation of the limb above the level of the heart aids in lymphatic drainage, further minimizing inflammation that can limit movement. Conversely, applying gentle heat before exercise can increase tissue elasticity, making muscles more pliable for stretching. All exercises should be performed without causing a sharp increase in pain; a tolerable, dull stretch sensation is the desired threshold.
Low-Impact Range of Motion Exercises
Initial exercises focus on gentle, non-weight-bearing movements to restore basic joint mobility and encourage circulation without stressing the surgical site.
Ankle pumps are a foundational exercise, performed by gently pointing the foot down (plantarflexion) and then pulling the toes toward the body (dorsiflexion). This movement helps maintain the length of the calf muscles and is often recommended for 30 repetitions, multiple times per day, to promote blood flow and reduce the risk of blood clots.
Ankle circles help restore movement in all directions of the joint, addressing stiffness in the ligaments and capsule. While sitting or lying down, rotate the foot slowly in a circular motion, tracing the largest circle possible without causing pain. Perform the circles in both clockwise and counter-clockwise directions, typically completing ten repetitions in each direction. This exercise helps to restore the gliding motion between the joint surfaces restricted during immobilization.
The ankle alphabet requires the patient to use their foot to “write” the letters of the alphabet in the air using their big toe. This activity encourages the ankle to move through its full available range of motion in various complex angles, engaging muscles and tendons. It is often recommended to trace the alphabet twice to ensure comprehensive joint mobilization.
For a passive stretch, the seated towel stretch targets the calf and Achilles tendon. Sit with the leg extended and loop a towel or strap around the ball of the foot. Gently pull the towel toward the body until a light stretch is felt along the back of the ankle and calf. Hold this position for about 30 seconds and repeat several times to sustain the lengthening of the posterior structures.
Progression to Strength and Flexibility
Once the ankle can move through a basic, pain-free range of motion, rehabilitation shifts to rebuilding the strength and stability lost during recovery. Resistance band work is typically the next step, using an elastic band looped around the foot to provide external resistance for all four ankle movements.
To strengthen the muscles that turn the foot outward (eversion), secure the band around a stable object and push the foot away from the midline of the body against the band’s tension. Similarly, inversion strength is developed by resisting the band’s pull while turning the foot inward, toward the opposite leg. Plantarflexion and dorsiflexion are also progressed by pushing the foot down and pulling it up against the band’s resistance, often performed for sets of ten to fifteen repetitions. This controlled resistance training is crucial for reactivating the stabilizing muscles around the joint that support dynamic movement.
As the ankle tolerates more load, weight-bearing exercises are introduced, starting with heel raises. Begin by performing these while seated, lifting the heels off the ground to strengthen the calf muscles without full body weight. Progress to standing heel raises, using a countertop for balance, which recruits the gastrocnemius and soleus muscles more intensely.
Balance training follows, starting with simple single-leg stands on a firm surface, eventually progressing to standing on an uneven surface like a folded towel. Deeper stretching, such as the standing wall stretch, is used to increase final flexibility. Stand facing a wall, place the affected foot back, keep the heel on the floor, and lean forward with the knee straight to stretch the calf, holding for 30 seconds.
When to Consult a Specialist
While some stiffness is expected, certain signs indicate that recovery may be complicated and requires professional intervention. If there is no noticeable improvement in ankle mobility or pain after four to six weeks of consistent, guided home exercises, consult a physical therapist or surgeon. Lack of progress may suggest excessive scar tissue formation or an underlying structural issue that manual therapy techniques could address.
Immediate medical attention is necessary if concerning symptoms arise:
- Signs of infection, such as a fever over 101 degrees Fahrenheit, increased redness, warmth, or discharge from the surgical incision site.
- A sudden, sharp increase in pain that is not relieved by rest, elevation, or prescribed medication.
- Persistent or new-onset numbness, tingling, or a grinding sensation in the joint, which may indicate nerve involvement or hardware irritation.
- Severe calf pain, especially when accompanied by swelling, redness, or warmth, as this could signal a deep vein thrombosis.
- Ankle instability, or the feeling that the joint is giving way during weight-bearing, which warrants consultation to prevent further injury.