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Ankle Rehabilitation Exercises 
31st-Oct-2010 11:41 pm
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This is here for my reference, and for your assistance should you find yourself in a similar condition.

I sprained my ankle back in June, and it hasn't healed right.

Went to the doctor, and got a flier on which the doctor suggested a subset of the exercises for me to perform.

He also suggested that I could ice the arch (where the pain was when I saw him), and use Advil or Aleve.



Flier Copyright 1981 U of M, last modification April 2005

(Any typographical errors are the fault of my typing skills)

Exercises are important after a sprain to assist with the removal of inflammatory products, to restore normal flexibility, to strengthen the muscles around the ankle joint and improve balance and position sense. Complete Rehabilitation is needed for prevention of recurrent sprains.

Motions of your ankle:
 dorsiflexion     = moving your foot up toward your leg.
 plantarflexion = pointing your foot down.
 eversion          = turning the sole of your foot outward.
 inversion         = turning the sole of your foot inward.

WHILE YOU ARE IMMOBILIZED IN A CAST, SPLINT OR TAPE, YOU SHOULD DO THE FOLLOWING EXERCISES:

1. Isometrics. Push your foot against resistance in each direction listed above, without letting your foot move. Resistance can be provided by your other foot, a wall, or other immovable object. He suggested that I do this one.

2. Move your toes up and down at least 10 times each hour during the day. Practice picking up small objects with your toes. He suggested that I do this one.

AS SOON AS THE SWELLING HAS STABILIZED (NO LONGER INCREASING) BEGIN WORKING ON THE FOLLOWING EXERCISES TWICE DAILY:

3. Place a towel on the floor. Sit in a chair with your foot on the towel. By curling your toes and arching your foot, drag the towel toward you. The towel will wrinkle. When this is easier, do the same activity with a book placed on the towel for added resistance. He suggested that I not do this one, since it is more geared toward flexibility which is not my problem.

4. Move your ankle in each direction, attempting to achieve the degree of motion present in your uninjured ankle. Move in circles as well. Repeat 10 times in each direction. Care should be taken not to strain too far in any direction that is painful. He suggested that I not do this one, since it is more geared toward flexibility which is not my problem.

5. Sit on a bench with your knee straight and your ankle over the edge. Print the alphabet with your foot. He suggested that I not do this one, since it is more geared toward flexibility which is not my problem. I remember this one from the last time I had a bad sprain -- nearly exactly 30 years ago.

6. Sit on the floor with your knee straight and a towel around the ball of your foot. Pull the towel toward you (foot will dorsiflex). You should feel a stretch in your calf muscles. Hold 15 seconds. Repeat 10 times. He suggested that I not do this one, since it is more geared toward flexibility which is not my problem.

7. To control swelling, lie down with your leg elevated higher than your head on pillows or propped against the wall, or sit with your foot propped up on pillows to raise it above hip level. Apply ice while your foot is elevated -- fill a baggie with ice, place it on your ankle with a damp cool cloth in between the ice and your skin. Apply ice for up to 20 minutes per hour. Do ankle pumping exercises by moving your forefoot toward you then away (as pressing on an accelerator). Repeat 30-50 times. He suggested that I not do this one, since it is more geared toward flexibility which is not my problem.

WHEN YOU ARE ABLE TO PUT WEIGHT ON YOUR INJURED ANKLE, BEGIN WORKING ON THE FOLLOWING EXERCISES DAILY.

8. Stand facing a wall about arms length away, with your feet slightly apart. Step forward with your uninjured foot. [K]eep your feet pointed straight ahead, don't turn them out. Lean toward the wall, keeping your body in a straight line and your knee straight. Feel the stretch in your calf. Hold 30 seconds. Repeat 3 - 5 times. He suggested that I do this one.

9. Stand on both feet. Rise up on the balls of your feet as far as possible. Lower slowly. Hold on for balance, if necessary. When you can do 30 repetitions with good control and balance, rise up on the injured foot alone. Do as many as you can on one foot, and the rest with two feet, keeping the total at 30. When you can do 30 on one foot, do a set of rises with your feet pointing inward, and a set with your feet pointing outward. When you have good flexibility, do this exercise standing with the ball of your foot on the edge of a stair or on a 2 X 4. He suggested that I do this one.

10. Using rubber tubing to provide resistance for moving your foot in, out and up. Sit in a chair with [a] loop of tubing around the ball of your foot and the other end wrapped around a table leg. Work up to 30 repetitions in each direction. Gradually increase the resistance by tightening the tubing. He suggested that I not do this one, since it is more geared toward flexibility which is not my problem.

11. Balance - stand on your injured foot, hold other foot off the floor. Try to balance for 2-3 minutes. When able to do this, add arm, leg and body movements while still balancing on one foot. Then balance while standing on a pillow. He suggested that I do this one. And indeed it is similar to something my chiropractor suggested, which involved not only arm movements, but small (up to 5 lb.) weights being held.

12. On your hand and knees with your feet pointed behind you, sit back toward your heels until you feel a stretch across the top of your foot, but no pain. You may put a cushion or pillow on your lower legs to control how far back you go.

GETTING BACK INTO ACTION:

When you have good range of motion and good strength in your ankle, and can walk on it without pain, you may begin jogging on a controlled surface (track). Alternate 50 yards of jogging with 50 yards of walking. Gradually increase your speed and distance.

When you are able to run at full speed in a straight line, begin jogging in figure-of-eights, gradually reducing the size of the circles.

Next practice cuts from side to side. Gradually change running surface, continuing to be cautious of rough pavement[,] gravel and holes.

You will need to tape or splint your ankle for sports for 6 months to one year after the ankle injury.




He further suggested that I could purchase Spenco Arch Supports, the brand his patients have had the best luck with. (I couldn't find them, and bought another brand, which it took me too long to figure out was worse than nothing.) It has been suggested that REI will sell these.

On a different note, I'm counting chickens. One chicken, two chickens, three chickens, four. I need to stop doing that.
Comments 
1st-Nov-2010 06:11 am (UTC)
He also suggested that I could ice the arch (where the pain was when I saw him), and use Advil or Aleve.

Urm? What kind of pain in the arch of the foot? Burning? Needles in the foot? Is it worse after you've been on your feet a while, or first thing in the morning?

I feel a bit confused, because arch pain (on the plantar/bottom side of the foot), IIRC, is generally considered plantar faciitis, and the exercises suggested for that are the ones he's suggested for you :) Good arch support is very important (ie, good insoles) - I found Keen shoe footbeds worked very well for me (along with daily stretches, and a nighttime splint for a couple of months).
2nd-Nov-2010 06:15 pm (UTC)
Much worse later in the day. Now some mornings are ok, and some I limp.

I don't know how to describe it. Not really burning or needles. More "this muscle has been beat to crap and your foot won't hold weight". Or maybe "there's a foreign object in your shoe and it's making a hole in your foot". Shortly before we left for Australia, I could FEEL (as well as see) the arch collapsing.

Bought the supports (which spouse said looked like orthotics) just before leaving for Oz and when I wore them, I was limping quite badly by about noon. (My pet theory based on analysis of the pain is that it would have been a fine support for someone who's foot is shaped differently than mine -- it was like it wanted to put my arch somewhere other than where it was, or give it a different shape. Perhaps it even bruised the arch.) When I got up to facilitate at 4 or 5 I was still limping, but by 6am I was walking fine. The days I did not wear them (or shoes because I didn't go out) I could make it to 1:30 pm or so before I was limping badly. That's why I called them "worse than nothing". (My feet _are_ odd. I have that extra bone, and while I'm a pretty solid size 36, for Birkenstocks, which have a bit of a shape to them, I need to buy 35s or they won't fit my toes/arch.)

My arch is now feeling (not quite right, but) much better, but my heel has a "You're the wicked stepsister who sliced off her heel to fit in that shoe" feel to it when I walk/put weight on it. That's getting better too, but slowly, slowly.

I think if I did all the stretches, exercises, etc. that have been prescribed for me over the years (feet, ankles, back, median (?) nerve, arm...), I'd spend at least 4 hours a day doing them. Need to find that "enough, but not prohibitive" space.
3rd-Nov-2010 12:19 am (UTC)
Good luck with rehab. I've sprained both ankles badly at least once and it took longer to heal each time. I wish you and your ankle well.
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