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Introduction: Water has been used therapeutically throughout human history. Today, water is commonly used as an aquatic therapy to assist in the rehabilitation of various conditions, including musculoskeletal, cardiopulmonary, neurological, and even integumentary complications. Water has essential properties that can influence physiological changes within the human body, making it an effective treatment tool for these conditions. The purpose of this case report is to highlight the initial response to the use of land-based therapy combined with aquatic therapy for treatment of a patient with a multitude of co-morbidities, most specifically a multi joint fused ankle. Case Description: A 62-year-old female with multiple co-morbidities presented to the clinic following an extensive right ankle surgery. The involved surgical procedure left the patient with high anxiety and less confident movement patterns. Intervention: To accommodate the patient’s weight bearing restrictions, as well as the patient’s additional co-morbidities, a therapy prescription utilizing an aquatic environment that limited all activities to not exceed 50% body weight was utilized. When the patient was able to walk with a normalized gait as well as bear more than 50% weight while performing her aquatic exercises with good mechanics she was transitioned to land-based therapy. Outcome Measures: Multiple outcome measures were utilized to assess patient progress including: Care Connection Index, Lower Extremity Functional Scale questionnaire, 30 second Sit to Stand Test, Timed Up and Go, Two Minute Walk Test, Stair Test, and a balance assessment. Discussion: Few studies have looked at combining aquatic therapy and land therapy in relation to functional outcomes. In addition to significant improvement physically, the patient also had positive outcomes mentally. Perhaps aquatic therapy for complex patients, such as the one in this case study, should be routinely offered.