Month: January 2025

Ankle Replacement Recovery Timeline

arthroscopy ankle surgery diagram

Many patients considering ankle replacement surgery share the same question: ‘When will I be back to normal?’ While everyone’s journey is unique, this comprehensive timeline outlines the typical recovery process, from your first moments after surgery through your return to daily activities. At TSAOG Orthopaedics & Spine, our specialists are here to help guide you through each phase of recovery with expertise and personalized care.

Immediate Post-Surgery (0-2 weeks)

During the initial recovery phase, some patients can be discharged home the same day, while others may require an overnight stay in the hospital under close medical supervision. The primary focus is on pain management through prescribed medications, which usually include a combination of opioids and anti-inflammatory drugs. Keeping the foot elevated above heart level is crucial during this period – patients should maintain this position whenever they are sitting or lying down. A splint or cast protects the surgical site and maintains proper ankle position. Nurses and physical therapists will demonstrate proper use of assistive devices like crutches or a walker, as putting any weight on the surgical foot is strictly prohibited. Ice therapy is administered several times daily, typically 20 minutes at a time, to help control swelling and discomfort.

Early Recovery (2-6 weeks)

Around the two-week mark, the surgical site is evaluated, and sutures are typically removed if healing progresses appropriately. The original surgical dressing is replaced with a removable boot, allowing for better wound care and the initiation of gentle movements. However, patients must remain completely non-weight-bearing during this phase. Physical therapy begins with very gentle range of motion exercises, focusing primarily on maintaining mobility in the toes and preventing stiffness in the ankle joint. Patients learn proper wound care techniques and monitor for potential complications such as unusual redness, increased pain, or drainage. The surgical site should be kept clean and dry, with dressing changes as directed by the healthcare team. Many patients continue to require pain medication during this phase, though usually at reduced doses.

Intermediate Phase (6-12 weeks)

This phase marks a significant transition in recovery as patients begin carefully progressing toward weight bearing. Under close supervision from their surgeon and physical therapist, patients start with toe-touch weight bearing and gradually advance to partial weight bearing using a specialized boot. Physical therapy becomes more intensive, incorporating exercises to improve ankle mobility and strengthen surrounding muscles. Balance exercises begin, initially while seated or holding onto support, then progressing to standing activities. Gait training ensures proper walking mechanics as weight bearing increases. The focus is on restoring normal movement patterns while protecting the newly implanted joint. Patients typically notice a significant reduction in pain during this period, though some discomfort during and after therapy sessions is normal.

Advanced Recovery (3-6 months)

As patients transition to full weight bearing, they begin wearing regular supportive shoes. Physical therapy continues to progress, incorporating more challenging exercises to build strength and improve function. Balance training becomes more advanced, often including single-leg stands and unstable surface work. Walking distance increases gradually, with many patients able to walk continuously for 15-30 minutes by the end of this phase. Daily activities become easier, though modifications may still be necessary for more demanding tasks. Some patients return to light work duties, depending on their occupation’s physical demands. Swimming and stationary cycling may be introduced as low-impact conditioning activities.

Full Recovery (6-12 months)

The final phase of recovery focuses on optimizing function and returning to desired activities. Most patients achieve their maximum range of motion during this period, though it may be less than the natural ankle. Strengthening exercises continue, with emphasis on the calf muscles and other supporting structures. Patients typically return to most daily activities without restriction, though high-impact activities remain prohibited to protect the prosthesis. Some patients may experience occasional swelling after increased activity, which usually responds well to rest and elevation. Regular follow-up appointments monitor the prosthesis position and function. Many patients report significant pain relief and improved mobility compared to their pre-surgical condition, though some movements may feel different with the artificial joint.

Long-term maintenance includes regular exercise to maintain strength and flexibility, wearing appropriate supportive footwear, and avoiding activities that could damage the prosthesis. While most patients achieve good to excellent outcomes, the artificial joint’s longevity depends partly on activity level and adherence to recommended restrictions. Regular check-ups help ensure continued proper function and early identification of any potential complications.
To support your recovery journey, we’ve compiled a list of helpful products available in our Amazon store:

Ankle Replacement with TSAOG

Though less common than other joint replacements, ankle replacement surgery can be life-changing for those suffering from chronic ankle pain and arthritis. While recovery requires dedication, you’ll have the support of TSAOG’s comprehensive care team throughout your journey. Our ankle replacement specialists – Dr. Justin Robbins, Dr. Randall C. Marx, and Dr. Kevin L. Kirk – work closely with our expert physical therapy team to ensure optimal outcomes for each patient. If you’ve tried conservative treatments without success and persistent ankle pain is limiting your daily activities, it’s time to explore your options. Schedule an appointment with a TSAOG ankle replacement specialist today!

ACL Tear Recovery Time: What To Expect

acl physical therapy

Reviewed By Jeffrey B. Shroff, M.D. | Sports Medicine Surgeon in San Antonio

An ACL injury can be devastating, particularly for athletes and active individuals. Whether surgery is required or not, understanding the recovery process can provide peace of mind and help you return to your daily routine. In this guide, we discuss the typical recovery timelines for ACL tears, both with and without surgery, and offer practical tips for a smooth recovery.

How Long is Recovery For an ACL Tear Without Surgery?

Not all ACL injuries require surgery. Non-surgical treatment may be recommended for those with partial tears or for individuals who do not engage in high-demand sports or activities. Here’s a general recovery timeline if surgery is not needed:

0-2 Weeks: Initial Healing

In the first couple of weeks, the focus is on reducing swelling and managing pain. Rest, ice, compression, and elevation (RICE) are essential during this time. You’ll likely need crutches to avoid putting weight on the injured knee. Your doctor may prescribe physical therapy to help maintain strength and range of motion.

2-6 Weeks: Range of Motion and Strengthening

As pain and swelling subside, the emphasis shifts to restoring the knee’s range of motion. Gentle exercises and physical therapy sessions will be crucial during this phase. You’ll slowly start bearing weight on the knee, but high-impact activities should be avoided.

6 Weeks-3 Months: Stability and Strength

During this period, you’ll focus on strengthening the muscles around the knee to support the joint. Physical therapy will include balance exercises, strength training, and possibly low-impact aerobic activities like swimming or cycling.

3-6 Months: Return to Daily Activities

Depending on your progress, you may gradually return to your regular activities. However, it’s still important to avoid pivoting or twisting movements that could re-injure the ACL. You may still experience occasional stiffness or discomfort.

6-12 Months: Return to Sport or High-Impact Activity

Many patients who haven’t had surgery can return to light sports or exercise routines by six months to a year. However, for athletes or those in high-demand physical roles, returning to full strength may take longer and require further physical therapy.

How Long is ACL Tear Surgery Recovery?

For more severe ACL tears, surgery is often necessary, followed by a structured recovery program. Surgery recovery typically takes longer than non-surgical methods but can lead to a more stable outcome for active individuals. Here’s a general breakdown of what to expect:

Week 1: Post-Surgery Care

In the first week after surgery, the focus is on managing pain and reducing swelling. You’ll likely wear a knee brace and use crutches to avoid weight-bearing. Icing, compression, and prescribed pain medications will be crucial for comfort. It’s also important to start light physical therapy exercises to maintain circulation and flexibility.

2-6 Weeks: Regaining Mobility

During this phase, physical therapy becomes more intensive. Your therapist will work with you to restore your range of motion and begin gentle strengthening exercises. Crutches may still be needed, but you’ll slowly start transitioning to partial weight-bearing on the knee.

6 Weeks-3 Months: Strengthening

Strengthening exercises become the core of your recovery plan. You’ll focus on regaining strength in the quadriceps, hamstrings, and other muscles around the knee. Balance exercises will help improve knee stability, and low-impact aerobic exercises, such as swimming or stationary cycling, will aid in rebuilding overall fitness.

3-6 Months: Sport specific rehab

Running and plyometric progressions typically begin at 3 months following surgery. The focus will be on proper body mechanics and technique to avoid reinjury and prevent injury on the opposite leg. Depending on your goals and activity you are returning to, sport specific rehab and training will be implemented during this time.

6-12 Months: Return to Sport

Complete recovery may take up to a year for athletes or individuals involved in high-impact activities. It’s essential not to rush this process, as returning to sports prematurely increases the risk of re-injury. A gradual return under the guidance of your doctor and therapist will be key to a successful recovery.

ACL Tear Recovery Tips For a Safe Healing Process

No matter the treatment route, following these recovery tips will help you heal safely and reduce the risk of complications:

  1. Use RICE (Rest, Ice, Compression, and Elevation): Especially in the early stages of recovery, the RICE method helps control pain and swelling. This can significantly improve overall comfort and healing speed.
  2. Follow Your Physical Therapy Plan: Consistency in attending physical therapy sessions is crucial to regain strength and mobility. It is also important to do exercises at home, as your therapist prescribes. Your therapist will adjust your plan based on your progress.
  3. Avoid High-Impact Activities: Jumping back into sports or intense physical activity too soon can lead to setbacks or reinjury. Stick to low-impact exercises until your doctor gives you the all-clear.
  4. Wear a Knee Brace or Use Crutches: Depending on the severity of your injury, a knee brace or crutches can support the joint as it heals, preventing further injury.
  5. Stay Patient: ACL recovery is a long process, and it’s important not to rush. Follow your healthcare team’s recommendations and get back to full strength.

Consult the Experts in Orthopedics at TSAOG

If you recently experienced a knee injury, consult the experts at TSAOG Orthopaedics. With years of expertise in treating ACL injuries and other orthopedic concerns, TSAOG’s specialists are dedicated to helping you regain your mobility and strength safely.

Book an appointment with TSAOG Orthopaedics today to learn more about your treatment and recovery options.

What is Plantar Fasciitis?

foot diagram of plantar fasclitis

Reviewed by Cory J. Moczygemb, D.P.M | Podiatrist in San Antonio

That first step in the morning shouldn’t feel like walking on broken glass. Yet for millions of Americans suffering from plantar fasciitis, this stabbing heel pain is an unwelcome part of their daily routine. Whether you’re an active runner, a busy professional, or someone who spends long hours on your feet, understanding this common foot condition is the first step toward finding relief. At TSAOG Orthopaedics & Spine, our specialists are here to help!

Understanding Plantar Fasciitis

The plantar fascia is a thick, web-like ligament connecting your heel and the front of your foot. It functions as a shock absorber and supports the arch of your foot during weight-bearing activities.

Plantar fasciitis occurs when this ligament becomes inflamed, typically due to repetitive strain or excessive stress. This condition represents one of the most common causes of heel pain, affecting millions of Americans annually. The plantar fascia is designed to act like a bowstring, supporting the arch of the foot and absorbing the impact of walking, running, and jumping. If too much pressure damages or tears the tissues, inflammation and stiffness result. The condition typically develops gradually over time, though some cases may appear suddenly after intense activity.

Understanding the anatomy is crucial: the plantar fascia is not a muscle or tendon, but rather a thick band of connective tissue (fascia) that has limited blood supply, which can make healing a slower process. The condition can affect one or both feet and is particularly common in middle-aged individuals, though it can occur at any age. The structure of the plantar fascia is unique, consisting of three distinct segments – medial, central, and lateral components – with the central portion typically being the most affected in plantar fasciitis.

Plantar Fasciitis Symptoms

The hallmark symptom of plantar fasciitis is a sharp, stabbing pain in the heel, particularly noticeable with the first few steps in the morning or after prolonged periods of rest. This characteristic “first-step pain” occurs because the plantar fascia tightens overnight or during extended periods of inactivity. As you begin moving, the ligament gradually stretches, and the pain typically subsides, though it may return after long periods of standing or when rising from a seated position.

Many patients describe the sensation as feeling like they’re stepping on a knife or hot coal. The pain is usually localized to the heel area, specifically at the point where the plantar fascia attaches to the heel bone, though some people experience pain along the entire length of the fascia into the arch of the foot. Unlike some foot conditions, the pain often improves with initial activity but worsens as the day progresses, especially after prolonged weight-bearing activities.

Some people may also experience associated symptoms such as heel swelling, redness, or warmth. The pain pattern can be quite distinct: while it may temporarily improve with movement, extended periods of activity typically lead to increased discomfort, creating a challenging cycle for many sufferers who need to balance activity with rest.

Common Causes of Plantar Fasciitis

Plantar fasciitis develops from a combination of factors that put excessive stress on the plantar fascia.

  • Biomechanics: One primary risk factor is biomechanical issues in foot structure, such as either very high arches or flat feet, which can affect weight distribution across the foot.
  • Work: Occupational hazards play a significant role, particularly in professions that require long hours of standing or walking on hard surfaces, such as teachers, retail workers, and factory workers.
  • Age: Age is another crucial factor, with the condition being most common between the ages of 40 and 60, as the plantar fascia loses some of its natural elasticity over time.
  • Lifestyle Changes: Sudden lifestyle changes can also trigger the condition, such as beginning a new exercise routine, particularly high-impact activities like running or dancing, without gradual conditioning.
  • Weight: Obesity or rapid weight gain significantly increases the risk, as extra weight puts additional stress on the plantar fascia.
  • Pregnancy: Pregnant women often develop plantar fasciitis, especially in the late stages of pregnancy, due to both weight gain and hormonal changes that can affect ligament laxity.
  • Footwear: Poor footwear choices, particularly shoes with inadequate arch support or worn-out soles, can contribute to the development of the condition by failing to properly distribute pressure across the foot.

How is Plantar Fasciitis diagnosed?

The diagnosis of plantar fasciitis typically begins with a comprehensive physical examination and detailed medical history. Healthcare providers usually start by asking about the pattern of pain, including when it’s most severe and what activities aggravate or relieve it.

During the physical examination, the doctor will touch and move the foot to identify specific areas of tenderness. The doctor may ask the patient to flex their foot to assess pain patterns and range of motion. They often perform specific tests, such as the windlass test, where the big toe is pulled back to see if it reproduces the pain.

While imaging tests aren’t always necessary for diagnosis, they may be ordered to rule out other conditions or confirm the diagnosis in unclear cases. X-rays might be taken to check for heel spurs or rule out stress fractures, while ultrasound can reveal the thickness of the plantar fascia and confirm inflammation. In some cases, MRI scans might be requested, particularly if standard treatments aren’t providing relief or if the doctor suspects another condition might be causing the symptoms.

The diagnostic process also typically includes a gait analysis to observe how the patient walks and distributes weight across their feet, as certain walking patterns can contribute to the condition.

Plantar Fasciitis Treatment Options

Like many other orthopedic issues, treatment for plantar fasciitis typically follows a progressive approach. Providers start with conservative methods before considering more intensive interventions. Each treatment option targets different aspects of the condition, from relieving immediate pain to addressing underlying biomechanical issues.

Stretching Exercises

Targeted stretching serves as the cornerstone of plantar fasciitis treatment. Key exercises include calf stretches against a wall, towel stretches performed first thing in the morning, and specific plantar fascia stretches that focus on lengthening the tissue. These stretches are most effective when performed multiple times throughout the day, particularly before taking the first steps in the morning and after prolonged periods of rest. The goal is to increase flexibility in both the plantar fascia and the Achilles tendon, which can help reduce stress on the heel.

Strength Training

Building intrinsic foot strength helps support the arch and reduce strain on the plantar fascia. Exercises such as toe curls, marble pickups, and arch raises target the small muscles of the foot that provide dynamic support during walking and standing. Additionally, strengthening the calf muscles through exercises like heel raises can improve overall foot mechanics and reduce stress on the plantar fascia. A physical therapist can prescribe conditioning exercises.

EPAT (Extracorporeal Pulse Activation Technology)

This non-invasive treatment uses pressure waves to stimulate blood flow and promote healing in the affected tissue. EPAT sessions typically last about 10 minutes and are performed weekly for several weeks. The treatment works by triggering the body’s natural healing response and can be particularly effective for chronic cases that haven’t responded to stretching and strengthening.

Surgery

Typically reserved for severe cases that haven’t responded to conservative treatments after 6-12 months, surgical intervention involves releasing part of the plantar fascia from its attachment to the heel bone (partial plantar fasciotomy). This is typically performed as a last resort due to the potential complications and extended recovery time. Surgery may be recommended when chronic heel pain significantly impacts daily activities and quality of life, but only after other treatment options have been exhausted.

Plantar Fasciitis FAQs

Should you walk with plantar fasciitis?

While complete rest isn’t usually necessary, it’s important to modify your activity level. Light walking can help maintain mobility, but avoid long distances or activities that cause significant pain. Listen to your body and take breaks when needed.

Can plantar fasciitis be healed?

Yes, plantar fasciitis can heal with proper treatment. Most cases improve within several months of consistent conservative treatment, though some chronic cases may take longer. The key is early intervention and following a comprehensive treatment plan.

What makes plantar fasciitis flare up?

Common triggers include sudden increases in activity, wearing unsupportive shoes, prolonged standing, weight gain, and changes in exercise routine. Additionally, skipping stretching routines or returning to high-impact activities too quickly can cause flare-ups.

Will plantar fasciitis go away by itself?

While plantar fasciitis might eventually improve on its own, without proper treatment, it can become chronic and take much longer to resolve. Active treatment typically leads to faster recovery and better outcomes.

What is commonly mistaken for plantar fasciitis?

Several conditions can mimic plantar fasciitis, including heel spurs, tarsal tunnel syndrome, stress fractures, and Achilles tendonitis. This is why proper medical diagnosis is important to ensure appropriate treatment.

Get Treatment for Plantar Fasciitis from TSAOG

Don’t let plantar fasciitis hold you back from living your best life. Since 1947, TSAOG Orthopaedics & Spine has been providing expert care to the San Antonio and South Texas community. Our team of over 42 orthopedic specialists, including dedicated foot and ankle specialists Dr. Kirk, Dr. Marx, and Dr. Robbins, along with our skilled podiatrists Dr. Moczygemba, Dr. Rustein, and Dr. Hughes, are here to help you find relief. Schedule an appointment today with one of our specialists and take the first step toward healing.