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What are ankle pumps?

Ankle pumps are a simple exercise that may be performed after any hip, knee, or ankle surgery. They are also recommended for anyone who may be sitting for long periods of time or less mobile than usual.

To perform ankle pumps the client is most often laying sitting with the legs propped up on a cushion or in a bed. The client will flex and extend the ankle which creates a pumping action. 

Ankle pumps to reduce swelling are best when performed while the leg is elevated above the client’s heart.

Watch the video below to see how ankle pumps may be performed following a total knee replacement video. 

Ankle Pumps

What is the benefit of ankle pumps after total knee replacement surgery?

During the first week following a total knee replacement, many patients are less active than normal and spend a lot more time sitting or laying. This may increase the chances of developing excessive lower leg or foot edema

Performing ankle pumps is beneficial any time you are less mobile than normal and will help both the venous system and lymphatic system return fluid from the lower extremity back into your body’s natural circulatory system. 

Sometimes patients feel dizzy or lightheaded the first couple of days after knee replacement surgery. Ankle pumps are safe to perform and may help to reduce blood pooling in the lower leg.

How do ankle pumps help to reduce swelling?

Ankle pumping exercises after total knee replacement surgery utilize a calf muscle pump function to move blood back toward the heart by a muscle contraction pumping action. These muscle contractions squeeze blood vessels and lymphatic vessels helping the blood and other fluids move through a series of venous valves. Source Link

Ankle pumping exercises are also often used to reduce lower extremity edema, reduce the chances of deep vein thrombosis (DVT), and deconditioning associated with prolonged episodes of immobility.

How many ankle pumps should you do a day?

While there is no exact number, ankle pumps are the kind of exercise I typically recommend a patient perform every hour that the patient has been sitting or laying without getting up and standing or walking.

The muscles of the lower leg are relatively high endurance muscles and should not experience and soreness or fatigue doing ankle pump exercises 30 times an hour every hour.

How often should you do ankle pumps after knee surgery?

Ankle pumps should be performed every hour you have spent without standing or walking. If you are drinking adequate levels of water you will likely need to use the bathroom every 2 to 3 hours. This and other episodes of standing/walking would qualify as an alternative to ankle pumps for that hour.

When performing ankle pumps one study suggested that 30 repetitions in a minute were better than 3 repetitions in a minute. Source Link

When can you stop doing ankle pumps?

If you are walking more and finding yourself spending more time on your feet during the day, walking and standing accomplish more than ankle pumps and you may start to reduce your frequency of performing ankle pumps.

If you purchase or own a pedometer, this can be a great way to track steps during the day. 

30-Ankle Pumps per Hour x12 Hours 360 Ankle Pumps a Day
Walking 50-feet = 30 steps 12 Laps of 50 feet a day = 360 steps

Should ankle pumps be painful or cause cramping?

No, ankle pumps should never be painful or cause cramping. If you find that pointing your toe while you extend your ankle becomes painful, please call your surgeon’s office or physical therapist. You may be experiencing possible signs of a blood clot. 

If you experience cramping while pointing your toe and extending your ankle, you may be dehydrated or your electrolytes may be out of balance.

In both cases, it is recommended you seek a professional assessment.

Tips #1: Elevate the Heel

To avoid rubbing your heel on the bed or couch surface I recommend placing a small pillow or towel roll under your calf muscle. 

Tip #1: ankle pumps with pillow under calf

Tip #2: Elevate the leg During Ankle Pumps

Tip 2 Elevate During Ankle Pumps To improve the effectiveness of ankle pumps in reducing edema, I recommend elevating the lower end of the leg to above the level of your heart. In the image below you can see how we are using a physioball in the clinic. At home, you may choose to use a stack of pillows.

Tip #3: Compression Wrap with Elevation and Ankle Pumps

My favorite of the three tips is to add a log ACE Wrap compression bandage to the elevation and ankle pump exercise.  This is really helpful for anyone who has significant lymphedema or pre-existing edema issues.

Tip 3 Compression Wrap with Elevation and Ankle Pumps