Ankle Fusion (Tibiotalar Arthrodesis) — Complete Exercise Program

Toe Flexion & Extension

Keeps the toes moving and blood flowing while the ankle is protected.

What it helps: Keeps the toes moving and the blood flowing while the foot heals.

1. Curl your toes downward, then straighten and spread them upward.
2. Move only the toes — keep your ankle still in the boot or cast.

Tips:

• A gentle way to stay active in the first weeks.

Commonly done as 15-20 repetitions, a few times a day.

Quad Sets

Re-activates the thigh muscle and supports knee control.

What it helps: Wakes up the quadriceps — the big thigh muscles that support and control your knee. Getting them firing is the foundation of a strong, steady leg.

1. Sit or lie with your leg straight.
2. Tighten the muscle on top of your thigh, pressing the back of your knee down.
3. Hold briefly, then relax.

Commonly done as 2-3 sets of 10, a few times a day.

Glute Squeezes

Gently re-engages the buttock muscles.

What it helps: Wakes up the glutes — the big muscles that steady and support your hip. Getting them firing again is the first step toward a hip that feels stronger and carries you with less strain on the joint.

1. Lie or sit comfortably.
2. Squeeze your buttock muscles together.
3. Hold a few seconds, then relax.

Commonly done as 2-3 sets of 10, a few times a day.

Straight Leg Raises

Strengthens the thigh while protecting the joint.

What it helps: Builds quad and hip strength while the knee stays straight, so the muscle works hard without stressing the joint.

1. Lie down with one leg bent and the other straight.
2. Tighten your thigh and lift the straight leg a few inches.
3. Lower slowly.

Tips:

• Keep the knee straight as you lift.

Commonly done as 2-3 sets of 10, once or twice a day.

Seated Knee Extensions

Keeps the thigh strong while you stay off the foot.

What it helps: Keeps the thigh strong and the knee straightening well while you stay off your feet.

1. Sit tall in a chair with your back supported and your foot resting on a low stool.
2. Straighten your knee, lifting the lower leg until it is level with your thigh.
3. Hold for a moment, then lower it slowly back down to the stool.

Tips:

• Let your thigh do the work — the lift comes from straightening the knee.
• Your foot can stay relaxed. There is no need to hold it in any particular position.

Commonly done as 2-3 sets of 10, once or twice a day.

Hip Abduction

Strengthens the outer hip while you stay off the foot.

What it helps: Strengthens the outer-hip muscles that keep your hip level and steady — strength you can build without putting any weight through your healing foot.

1. Lie on your side with the surgical leg on top and both legs straight.
2. Rest your head on your lower arm and your upper hand on the floor in front of you.
3. Lift the top leg a comfortable distance, keeping it in line with your body.
4. Lower slowly.

Tips:

• Keep your toes pointing forward, not up toward the ceiling — that is what keeps the work in the outer hip.
• Don't let the leg drift forward as it rises.
• A moderate lift done well beats a high one done badly.

Commonly done as 2-3 sets of 10, daily.

Hip Extension

Strengthens the back of the hip and buttock without loading the ankle.

What it helps: Strengthens the glutes and the muscles behind the hip that power each step — built while staying off the foot.

1. Lie on your stomach, or stand holding a counter for support.
2. Keeping your leg straight, lift it gently backward.
3. Lower slowly.

Tips:

• Move from the hip and avoid arching your low back.

Commonly done as 2-3 sets of 10, daily.

Core Activation

Gentle core engagement to support posture and balance while you recover.

What it helps: Switches on the deep core muscles that stabilize your pelvis and spine, giving your hips a solid platform to move from.

1. Lie or sit comfortably.
2. Gently draw your belly button toward your spine.
3. Hold a few seconds while breathing normally, then relax.

Tips:

• Avoid holding your breath.

Commonly done as 2-3 sets of 10, daily.

Walking with Assistive Device & Boot

Short, protected walking in your boot or cast with crutches or a walker.

What it helps: Short, protected walking in your boot with crutches or a walker — safe, gradual time back on your feet.

1. Use your crutches, walker, or knee scooter as directed.
2. Bear weight only as your surgeon allows.
3. Take short, level walks.

Tips:

• Follow your weight-bearing instructions closely in the early weeks.

Commonly done throughout the day.

Toe Flexion & Extension

Keeps the toes moving and blood flowing while the ankle is protected.

What it helps: Keeps the toes moving and the blood flowing while the foot heals.

1. Curl your toes downward, then straighten and spread them upward.
2. Move only the toes — keep your ankle still in the boot or cast.

Tips:

• A gentle way to stay active in the first weeks.

Commonly done as 15-20 repetitions, a few times a day.

Seated Heel Slides

Encourages gentle ankle and knee motion while seated.

What it helps: A supported way to ease motion back into the knee and ankle while you stay comfortably seated.

1. Sit with your foot flat on the floor.
2. Slide your heel back toward the chair, bending the knee and ankle.
3. Slide it forward again.

Tips:

• Keep it slow and within comfort.

Commonly done as 2-3 sets of 10, daily.

Quad Sets

Re-activates the thigh muscle and supports knee control.

What it helps: Wakes up the quadriceps — the big thigh muscles that support and control your knee. Getting them firing is the foundation of a strong, steady leg.

1. Sit or lie with your leg straight.
2. Tighten the muscle on top of your thigh, pressing the back of your knee down.
3. Hold briefly, then relax.

Commonly done as 2-3 sets of 10, a few times a day.

Straight Leg Raises

Strengthens the thigh while protecting the joint.

What it helps: Builds quad and hip strength while the knee stays straight, so the muscle works hard without stressing the joint.

1. Lie down with one leg bent and the other straight.
2. Tighten your thigh and lift the straight leg a few inches.
3. Lower slowly.

Tips:

• Keep the knee straight as you lift.

Commonly done as 2-3 sets of 10, once or twice a day.

Standing Hip Abduction

Strengthens the muscles on the side of the hip.

What it helps: Strengthens the outer-hip muscles that hold you steady whenever you're on one leg — which is every step you take. Stronger here, steadier hip.

1. Stand holding a counter for support.
2. Lift your leg out to the side, keeping it straight.
3. Lower slowly.

Tips:

• Keep your toes pointing forward.

Commonly done as 2-3 sets of 10-15, 1-2x daily.

Standing Hip Extension

Strengthens the muscles behind the hip.

What it helps: Strengthens the muscles behind the hip that power you forward with each step and help you stand tall — the engine of a strong, even stride.

1. Stand holding a counter.
2. Move your leg straight back without arching your back.
3. Lower slowly.

Commonly done as 2-3 sets of 10-15, 1-2x daily.

Core Strengthening

Supports posture and overall stability.

What it helps: Builds the core that holds your trunk steady, supporting your posture, your back, and everything you do on your feet.

1. Lie on your back with your knees bent, feet flat and arms resting at your sides.
2. Gently tighten your stomach muscles, as though bracing.
3. Lift your hips until your body makes a straight line from shoulders to knees.
4. Hold for a few seconds, then lower slowly.

Tips:

• Push through your heels and let your shoulders stay resting on the floor.
• Breathe normally through the hold rather than holding your breath.
• The bridge shown here is one of several ways to work the core - your therapist may give you others.

Commonly done a few times a week.

Upper Body Conditioning

Keeps your arms and shoulders strong — helpful for crutches and staying active.

What it helps: Keeps your arms and shoulders strong — especially helpful for using crutches and staying active during recovery.

1. Sit tall in a chair without arms, both feet flat on the floor and your back supported.
2. Hold a light weight in each hand, arms relaxed at your sides, palms turned in toward your thighs.
3. Raise both arms out to the sides until they are level with your shoulders.
4. Lower them slowly back to your sides.

Tips:

• Stay seated and supported while you're non-weight-bearing.
• Light weights are plenty — a resistance band, or no weight at all, works just as well.
• The lift stops at shoulder height.

Commonly done a few times a week.

Walking Program

Short, frequent walks build endurance and confidence.

What it helps: Comfortable, frequent walking keeps the joints loose, builds your stamina, and rebuilds confidence on your feet. Little and often beats long and tiring.

1. Take short walks at a comfortable pace.
2. Increase your distance gradually as you feel able.

Tips:

• Use your assistive device as directed.

Commonly done throughout the day.

Heel Raises

Strengthens the calf and improves balance.

What it helps: Strengthens the calf and steadies your balance, rebuilding the push-off that drives walking.

1. Stand holding a counter.
2. Rise up onto your toes.
3. Lower slowly.

Commonly done as 2-3 sets of 10-15, once or twice a day.

Mini Squats

Builds leg strength through a comfortable range.

What it helps: Builds hip and leg strength through a comfortable range, so everyday moves — sitting, standing, bending — take less out of your joints.

1. Stand holding a counter.
2. Bend your knees a small amount, keeping them behind your toes.
3. Return to standing.

Tips:

• Keep the movement small — this is not a deep squat.
• If bending under your own weight is not available yet, standing up from a higher chair asks the same muscles with less load.

Commonly done as 2-3 sets of 10, once or twice a day.

Sit-to-Stand

Builds the strength and confidence to rise from a chair.

What it helps: Trains the exact strength you use to rise from a chair, a toilet, or a car. Stronger here means more independence and less of a struggle on tough days.

1. Sit at the edge of a sturdy chair.
2. Lean slightly forward and stand up.
3. Lower yourself back down with control.

Tips:

• Use your arms for support as needed.

Commonly done as 2-3 sets of 8-10, once or twice a day.

Step-Ups

Builds strength for stairs and daily activity.

What it helps: Builds the leg and hip strength — and the control — for stairs, curbs, and everyday activity.

1. Step up onto a low step with your operative leg.
2. Step back down with control.

Tips:

• Hold a rail for balance.
• Going up stairs one foot at a time, holding the rail, is this exercise at this stage. If that is how you manage stairs at home, you are already doing it.

Commonly done as 2-3 sets of 10, once or twice a day.

Stationary Bike

Builds motion and endurance with low impact.

What it helps: Keeps the joints moving and nourished while you build endurance — all with no pounding. One of the gentlest ways to stay active when a joint is sore.

1. Set the seat so pedaling is comfortable.
2. Pedal at an easy pace.
3. Increase your time gradually.

Commonly done as directed.

Balance Training

Ongoing balance work for steady movement.

What it helps: Sharpens your steadiness and reactions so you move with confidence and lower your risk of a fall — protecting the progress you've made.

1. Stand with your feet hip-width apart on a soft surface such as a balance pad, with something solid within reach.
2. Let your arms come out to the sides and settle over your midline - weight even, hips level.
3. Hold steady for up to a minute, then step off and rest.
4. As it gets easier, bring your feet closer together or close your eyes briefly.

Tips:

• A firm cushion or a folded towel works if you do not have a pad.
• Stand near a counter or a wall so there is always something to reach for.
• Some wobble is the exercise working, not a sign you are doing it wrong.

Commonly done a few times a week.

Resistance Band Hip Strengthening

Builds hip and glute strength in every direction with a band.

What it helps: Strengthens the hip in every direction with a band, building the all-around support that keeps the joint stable as you move.

1. Loop a band around your legs (above the knees or ankles).
2. Perform side steps, hip abductions, or extensions against the band.
3. Control the movement out and back.

Tips:

• Keep your core braced and trunk steady.
• Increase band resistance gradually.

Commonly done as 2 sets of 10–15, 3–4 times a week.

Core Stabilization

Trains your deep core to hold a steady, protected spine.

What it helps: Strengthens the core that holds your pelvis and spine steady, so your hips move from a strong, controlled base.

1. Brace your core gently to keep your spine neutral.
2. Add a small challenge — a marching foot, an arm reach, or a dead-bug motion — without letting your back move.
3. Return and repeat.

Tips:

• The goal is a still spine, not a hard crunch.
• Stop if your back starts to move or ache.

Commonly done as 2 sets of 8–10, daily.

Progressive Walking Program

Keep building your walking distance and pace.

What it helps: Keep building your walking distance and pace — steady gains in endurance and confidence on your feet.

1. Walk on level ground at a comfortable pace, landing on the heel and rolling through the foot.
2. Add a few minutes to the walk before you add speed or hills.
3. Go a little further each week rather than a lot further in one day.

Tips:

• Turning back while you still feel good is how the distance builds.
• Supportive shoes make more difference than the route does.
• The three figures here are the same walk with a longer stride, not a faster one - an even stride matters more than pace.

Commonly done daily.

Cycling

Low-impact endurance and motion.

What it helps: Low-impact endurance that keeps the joints moving smoothly while you build fitness — easy on the body, good for the long run.

1. Set the saddle so your knee stays slightly bent at the bottom of the pedal stroke.
2. Begin with light resistance on flat ground, pedalling smooth, full circles.
3. Build the time you ride before you build the resistance or the hills.

Tips:

• Many people start on a stationary bike and move outdoors, as drawn here, once balance and confidence are back. The pedalling is the same either way.
• A saddle set too low is the usual reason a hip or knee feels cramped while riding.
• Your surgeon can say when getting onto a road bike is reasonable for you.

Commonly done as able.

Elliptical Trainer

Low-impact cardio that is easy on the joints.

What it helps: Low-impact cardio that builds endurance and keeps the legs moving while staying easy on the joints.

1. Step on with your feet flat on the pedals and take hold of the moving handles.
2. Start with low resistance and let your legs trace smooth ovals, keeping your heels down.
3. Stay upright rather than leaning your weight onto the handles.
4. Build the time first and the resistance later.

Tips:

• Your feet never leave the pedals, which is what makes this gentler on the joints than a treadmill.
• The moving handles bring the arms in. The fixed centre bars are there instead if you would rather steady yourself.
• Ten easy minutes is a reasonable place to start.

Commonly done as able.

Swimming

Low-impact, full-body conditioning.

What it helps: Full-body conditioning with the water carrying your weight, so your muscles work hard with almost no load on the joints.

1. Wait until any wound is fully healed and you have been cleared to swim.
2. Start with a few easy lengths, resting between them.
3. Build the distance gradually across sessions rather than within one.

Tips:

• The picture shows front crawl. Which stroke suits you depends on which joint was operated on, and your care team can say which to begin with.
• The water carries most of your weight, so a session can feel easier than it was - judge it by how you feel the next day.
• Walking in chest-deep water is a gentler place to start than swimming lengths.

Commonly done as able.

Single-Leg Balance

Improves balance and stability.

What it helps: Trains your hip and leg to stay steady when all your weight is on one side — which is most of walking. Better balance means a surer, more confident step.

1. Stand near a counter for safety.
2. Lift one foot and balance on the other leg.
3. Hold as able.

Tips:

• Holding the counter with one or both hands still counts. Letting go comes later, if it comes at all.

Commonly done daily.

Lateral Step-Ups

Strengthens the leg and ankle with controlled side-to-side stepping.

What it helps: Strengthens the leg and ankle with controlled side-to-side stepping, building stability in every direction.

1. Stand beside a low step or block, feet level with it.
2. Step up sideways onto the step, leading with the leg nearest it.
3. Lower slowly back down under control.
4. Keep the knee tracking straight over the middle of the foot.

Tips:

• Start with a low step and add height only as it gets easy.
• Coming down slowly is where most of the work is — don't drop onto the floor.
• A wall or counter within reach is fine while you build confidence.

Commonly done as 2-3 sets of 8-12, daily.

Functional Strength Training

Task-based strengthening that rebuilds the movements of daily life and activity.

What it helps: Trains the real movements of daily life — lifting, carrying, squatting — with good mechanics, so everyday tasks feel easier.

1. Work through functional movements — squats, step-ups, lunges, and balance — as cleared.
2. Add resistance gradually.

Tips:

• Quality of movement first, then load.

Commonly done several times a week.

Balance Training

Ongoing balance work for steady movement.

What it helps: Sharpens your steadiness and reactions so you move with confidence and lower your risk of a fall — protecting the progress you've made.

1. Stand with your feet hip-width apart on a soft surface such as a balance pad, with something solid within reach.
2. Let your arms come out to the sides and settle over your midline - weight even, hips level.
3. Hold steady for up to a minute, then step off and rest.
4. As it gets easier, bring your feet closer together or close your eyes briefly.

Tips:

• A firm cushion or a folded towel works if you do not have a pad.
• Stand near a counter or a wall so there is always something to reach for.
• Some wobble is the exercise working, not a sign you are doing it wrong.

Commonly done a few times a week.

Balance & Proprioception Drills

Sharpens balance and joint awareness.

What it helps: Sharpens your sense of where your joints are in space — the control that keeps you steady and prevents missteps.

1. Step onto a wobble board with your feet either side of the centre, near a counter you can reach.
2. Bring the board level and hold it there - the work is in the small corrections.
3. Then tip it slowly side to side, and forward and back, under control.
4. Step off and rest before repeating.

Tips:

• A wobble board tips under you; a balance pad only gives. That is what makes this the harder of the two, and it is worth being steady on the pad first.
• Keep something solid within reach the whole time.
• Small, slow corrections teach more than big ones.

Commonly done a few times a week.

Walking Program

Short, frequent walks build endurance and confidence.

What it helps: Comfortable, frequent walking keeps the joints loose, builds your stamina, and rebuilds confidence on your feet. Little and often beats long and tiring.

1. Take short walks at a comfortable pace.
2. Increase your distance gradually as you feel able.

Tips:

• Use your assistive device as directed.

Commonly done throughout the day.

Cycling

Low-impact endurance and motion.

What it helps: Low-impact endurance that keeps the joints moving smoothly while you build fitness — easy on the body, good for the long run.

1. Set the saddle so your knee stays slightly bent at the bottom of the pedal stroke.
2. Begin with light resistance on flat ground, pedalling smooth, full circles.
3. Build the time you ride before you build the resistance or the hills.

Tips:

• Many people start on a stationary bike and move outdoors, as drawn here, once balance and confidence are back. The pedalling is the same either way.
• A saddle set too low is the usual reason a hip or knee feels cramped while riding.
• Your surgeon can say when getting onto a road bike is reasonable for you.

Commonly done as able.

Swimming

Low-impact, full-body conditioning.

What it helps: Full-body conditioning with the water carrying your weight, so your muscles work hard with almost no load on the joints.

1. Wait until any wound is fully healed and you have been cleared to swim.
2. Start with a few easy lengths, resting between them.
3. Build the distance gradually across sessions rather than within one.

Tips:

• The picture shows front crawl. Which stroke suits you depends on which joint was operated on, and your care team can say which to begin with.
• The water carries most of your weight, so a session can feel easier than it was - judge it by how you feel the next day.
• Walking in chest-deep water is a gentler place to start than swimming lengths.

Commonly done as able.

Strength Training

Maintains and builds long-term strength.

What it helps: Builds and maintains long-term strength to keep you active, resilient, and independent.

1. Work the major muscle groups two or three times a week, leaving a day between sessions.
2. Use a weight you can lift with good form for the whole set - the last repetition should feel hard, not impossible.
3. Lower slowly. The controlled way down is where much of the benefit sits.
4. Add a little weight only once the current one feels comfortable.

Tips:

• The dumbbell squat shown is one example. Which exercises suit you depends on the joint you are recovering from, and your program will say.
• Breathe out on the effort rather than holding your breath.
• Muscle soreness a day or two later is expected. Pain in the joint itself while you lift is a sign to lighten the weight.

Commonly done a few times a week.

Balance Exercises

General balance work to steady your gait.

What it helps: Steadies your gait and sharpens your balance, helping you move with confidence.

1. Practice standing balance near support.
2. Progress as you feel steady.

Commonly done daily.

Flexibility Exercises

Maintains a comfortable range of motion.

What it helps: Keeps your joints and muscles moving through a comfortable range, so you stay supple and move with ease.

1. Sit tall on a chair and slide one leg forward, heel on the floor and toes up.
2. Hinge forward from the hips and reach gently toward that foot until you feel a stretch behind the thigh.
3. Hold for around 30 seconds, breathing normally, then ease back.
4. Repeat on the other side.

Tips:

• A stretch should feel like a long pull, never a pinch - and never bounce into it.
• Muscles stretch more easily when they are warm, so after a walk is a good time.
• The seated hamstring stretch drawn here is one example; your program may include stretches for other areas too.

Commonly done most days.

Core Strengthening

Supports posture and overall stability.

What it helps: Builds the core that holds your trunk steady, supporting your posture, your back, and everything you do on your feet.

1. Lie on your back with your knees bent, feet flat and arms resting at your sides.
2. Gently tighten your stomach muscles, as though bracing.
3. Lift your hips until your body makes a straight line from shoulders to knees.
4. Hold for a few seconds, then lower slowly.

Tips:

• Push through your heels and let your shoulders stay resting on the floor.
• Breathe normally through the hold rather than holding your breath.
• The bridge shown here is one of several ways to work the core - your therapist may give you others.

Commonly done a few times a week.

Hiking

Walking on trails and varied terrain as endurance and confidence return.

What it helps: Walking varied terrain builds endurance, balance, and confidence as you return to the outdoors.

1. Start with short, flat trails.
2. Keep a steady, comfortable pace and turn back while you still feel good.
3. Build distance and add gentle inclines as comfort allows.

Tips:

• Supportive footwear and trekking poles can help early on.

Commonly done as cleared.

Low-Impact Recreational Activities

Enjoyable activities that protect your joint.

What it helps: Getting back to the activities you enjoy in ways that are kind to your joints — the whole point of building this strength.

1. Choose activities that keep you moving without jarring the joint - walking, cycling and golf are three common ones.
2. Start with a short session and add time before you add intensity.
3. Spread them across the week rather than doing everything in one day.
4. Keep the effort at a level where you could still hold a conversation.

Tips:

• The picture shows three examples, not a list to work through - the best activity is the one you will keep doing.
• A little stiffness the next day is usual; a flare that lingers means the session was too long, not that the activity was wrong.
• Your surgeon or therapist can say when each activity is a reasonable one to add.

Commonly done as you like.