A patient is evaluated in physical therapy three days following a lateral ankle reconstruction. Which of the following weight bearing limitations would be MOST typical for this patient?

1.    Non-weight bearing with bilateral axillary crutches
2.    Partial weight bearing with a single axillary crutch
3.    Weight bearing as tolerated with bilateral axillary crutches
4.    Weight bearing as tolerated with a single axillary crutch

Transcript

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A patient is evaluated in physical therapy three days following a lateral ankle reconstruction. Which of the following weight bearing limitations would be MOST typical for this patient?

1.    Non-weight bearing with bilateral axillary crutches
2.    Partial weight bearing with a single axillary crutch
3.    Weight bearing as tolerated with bilateral axillary crutches
4.    Weight bearing as tolerated with a single axillary crutch

Lateral Ankle Reconstruction Surgery

Lateral ankle reconstruction surgery is commonly performed secondary to a complete tear of the anterior talofibular ligament or calcaneofibular ligament, or secondary to chronic ankle instability. Precautions following surgery include limitations on weight bearing status and restrictions on allowable range of motion.

Surgical Considerations

There are two methods for reconstructing the ankle, both of which use an open approach. The first method involves actual repair of the torn ligaments in which they are sutured back together. The second method involves the harvesting of an autograft (usually the fibularis brevis) to replace the torn ligaments. This second option is usually performed when the original ligaments cannot be repaired due to deterioration. The surgery may also include arthroscopy or subchondral drilling since a high percentage of unstable ankles have chondral lesions within the joint. 

Rehab Considerations

The patient will usually be in a protective cast for a short period of time (e.g., one week), then they are placed in a walking cast or boot for several weeks, followed by a brace. 

Initially the patient is non-weight bearing while in the protective cast, which is progressed to partial weight bearing and full weight bearing once in the walking boot. Early rehab focuses on increasing the patient’s range of motion while still protecting the repaired tissues. 

Let’s explore each of the options:

Option 1 – Non-weight bearing with bilateral axillary crutches

Protocols for this surgery vary, however, it is expected that the patient will be in a hard cast and non-weight bearing for at least a short period of time following the surgery. The patient would need to use bilateral axillary crutches in order to maintain their non-weight bearing status.

Option 2 – Partial weight bearing with a single axillary crutch

It is unlikely that the patient would be partial weight bearing three days following a lateral ankle reconstruction surgery. Additionally, the patient would need bilateral axillary crutches to effectively maintain a partial weight bearing status.

Option 3 – Weight bearing as tolerated with bilateral axillary crutches

Following lateral ankle reconstruction surgery, a patient will typically have some limitation to their weight bearing status. As a result, weight bearing as tolerated would be unlikely.

Option 4 – Weight bearing as tolerated with a single axillary crutch

Following lateral ankle reconstruction surgery, weight bearing status is often initially limited. As a result, weight bearing as tolerated would be unlikely.

The correct answer is Option 1.

Rule of Thumb

Post-operative protocols often vary significantly based on the surgeon and the nuances of each patient case. It’s therefore unnecessary to attempt to memorize specific parameters of a given protocol. However, therapists should have a basic understanding of the surgical procedure and possess awareness of common rehab considerations.

Let’s explore the all student data:

65% of students selected Option 1 - Non-weight bearing with bilateral axillary crutches - the correct response
3% of students selected Option 2 - Partial weight bearing with a single axillary crutch
29% of students selected Option 3 - Weight bearing as tolerated with bilateral axillary crutches
3% of students selected Option 4 - Weight bearing as tolerated with a single axillary crutch

System Classification
This question is a Musculoskeletal question which represents approximately 27% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Check out page 140 in PTEXAM: The Complete Study Guide.

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