After successful ankle arthrodesis, can intensive physical therapy restore any ankle dorsiflexion or plantarflexion?

Ankle Arthrodesis and Range of Motion Recovery

No, that is not true—ankle arthrodesis (fusion) is designed to permanently eliminate ankle joint motion, and physical therapy cannot restore dorsiflexion or plantarflexion at the fused ankle joint itself. The entire purpose of the surgery is to create a solid bony union that abolishes movement at the tibiotalar joint 1, 2.

Understanding What Ankle Fusion Actually Does

Ankle arthrodesis fundamentally eliminates ankle joint range of motion in all three planes:

• The fused ankle shows substantially reduced ROM in the sagittal plane (dorsiflexion/plantarflexion), frontal plane (inversion/eversion), and horizontal plane (internal/external rotation) compared to the normal ankle 2
• Research demonstrates that ankle fusion reduces ROM more dramatically than even total ankle replacement prostheses across all movement planes 2
• At an average of 7.3 years post-fusion, patients demonstrate virtually no subtalar motion, though they retain approximately 13 degrees of motion at Chopart's joint (midfoot) 1

What Physical Therapy Actually Accomplishes After Fusion

Physical therapy after ankle arthrodesis focuses on compensatory motion in adjacent joints, not restoring motion at the fused ankle:

• The hindfoot and forefoot develop compensatory mechanisms to restore a more functional gait pattern after fusion of a joint 3
• Patients can achieve near-normal gait with shoes through these compensatory strategies, despite the complete absence of ankle motion 1
• The midfoot (Chopart's joint) provides the primary compensatory motion, averaging 13 degrees of movement 1

Functional Outcomes You Can Expect

Despite permanent loss of ankle motion, most patients achieve satisfactory functional outcomes:

• 83% of patients report satisfaction with ankle fusion at an average 7.5-year follow-up 1
• Patients improve from their pre-operative activity levels, though they do not return to pre-injury sporting capacity 4
• Average Tegner activity scores improve from 1.15 pre-operatively to 2.67 post-fusion, though this remains below the pre-injury level of 3.82 4
• Post-fusion FADI scores average 76.5%, representing significant functional improvement over pre-operative scores of 47.41% 4

Critical Surgical Positioning Factors

The fusion position is permanent and critically determines your long-term function:

• Neutral position in both varus-valgus angulation and dorsiflexion-plantarflexion alignment is the optimum position for both men and women 1
• Varus or valgus angulation of the hindfoot is associated with greater symptoms in the subtalar area and midfoot 1
• Improper alignment cannot be corrected with physical therapy and may require revision surgery 1

Common Pitfall to Avoid

The most dangerous misconception is expecting physical therapy to restore ankle joint motion after fusion. This misunderstanding can lead to:

• Unrealistic expectations and disappointment with surgical outcomes
• Wasted time and resources pursuing impossible rehabilitation goals
• Failure to focus on the actual goals of post-fusion rehabilitation: compensatory motion in adjacent joints, gait optimization, and strengthening surrounding musculature 1, 4, 3

What Your Provider Likely Meant

Your provider may have been referring to:

• Motion at adjacent joints (subtalar, midfoot) that compensates for the fused ankle 1, 3
• Overall functional improvement and gait normalization through compensatory mechanisms 1
• Improved lower leg function scores, which do improve significantly post-fusion 4

However, if they specifically stated you could regain ankle dorsiflexion or plantarflexion at the fused joint itself, this represents a fundamental misunderstanding of what ankle arthrodesis achieves.