A CHOP sports medicine physical therapist and a patient demonstrate the first phase in a home program to rehabilitate your foot or ankle following an injury.
Ankle Rehabilitation: Phase 1
Heather Stewart, PT, DPT, SCS: My name's Heather and I’m a physical therapist in CHOP's Sports Medicine. This home program is designed to help you get started to rehabilitate your foot or ankle following an injury. If you have been prescribed physical therapy by your physician, these exercises are not intended to replace formal physical therapy.
Emily: Hi, my name is Emily, and I’m at CHOP with my PT, Heather. I sprained my ankle at gymnastics, and these exercises are an important part of my recovery.
Heather Stewart, PT, DPT, SCS: Swelling can be a symptom when you have an ankle or foot injury. If you notice pain or swelling, treat the injured area immediately with ice. One good position is to lay on your back and prop your leg up with ice wrapped around your foot.
Emily: Make sure your foot is elevated above your heart so that your swelling can go down faster.
Heather Stewart, PT, DPT, SCS: It is best to ice the injury for 10 minutes several times a day until your swelling goes down. To regain your full range of motion, CHOP recommends ankle alphabets. Sit in a chair and straighten your knee. You are going to write out the alphabet in all capital letters and then repeat with all lowercase letters. Try to make the letters as big as possible. Do this at least twice a day.
It is common after an ankle or foot injury for your muscles to get tight, especially after being in a cast or boot. CHOP recommends four stretches to help regain your ankle flexibility and suggests that you perform these stretches at least once a day.
The first stretch is the hamstring stretch. Sit on the floor with your legs out nice and straight. Take a towel and loop it around your foot. Grasp both ends and sit up nice and tall, pull your toes back towards you and you should feel a stretch in the back of your legs.
Emily: When I do this stretch, I can feel it in my hamstrings.
Heather Stewart, PT, DPT, SCS: Hold this stretch for 30 seconds and repeat three times on your injured leg. The next stretch is a standing gastroc stretch, which stretches your calf muscle. Standing at a wall with your injured leg behind and your good leg in front, bend your front knee and keep your back knee straight. Now, lean forward keeping your feet flat.
Emily: I can feel this stretch throughout my calf muscle.
Heather Stewart, PT, DPT, SCS: Hold this position for 30 seconds and repeat three times. The next stretch is a soleus stretch. And for this one, you stand in the same position as the gastroc stretch. To do this, you need to bend your back knee while keeping your foot flat on the floor and begin to lean forward.
Emily: I can still feel this stretch in my calf muscle, but more towards my heel.
Heather Stewart, PT, DPT, SCS: Hold this position for 30 seconds and perform it three times on each side. The functional dorsiflexion on a step is the final stretch. This time, place your injured foot on a step, gently rock forward bringing your knee as far as you can over your toes.
Emily: It’s hard at first, but throughout the stretch try to keep your heel flat.
Heather Stewart, PT, DPT, SCS: Repeat this exercise 30 times once a day. To address the decreased strength in your ankle, here are some exercises you should do to start building back up your ankle strength. You will get the best results if you do these three sets of 10 repetitions for each of these exercises every day.
Emily: You can strengthen your ankle by using a resistance band like this one.
Heather Stewart, PT, DPT, SCS: The first strength exercise is called ankle 4 ways. We’re going to work four different directions and work four different muscle groups of your ankle. Start sitting with your legs out nice and straight. Take a resistance band and loop it around the ball of your foot. Keeping your knee nice and straight, you’re going to push your foot down into the resistance of the band and slowly come back up. We’re going to repeat this 10 times and do three sets.
Emily: With this exercise, I can start to feel the burn in the back of my calf muscle.
Heather Stewart, PT, DPT, SCS: For the next strength exercise, you’re going to want to find somebody to hold your band. Have them loop it around the top part of your foot. As you keep your leg nice and straight, pull your foot up towards you. We’re going to repeat this 10 times and do three sets.
The next exercise is going to work on the muscles of the outside of your ankle. For this one, you can also have somebody hold your band, or you can tie it around a table leg and sit on the floor. Keeping your knee nice and straight, you’re going to push the foot to the outside against the resistance of the band. For this exercise, make sure the motion’s not coming from your hip but instead coming from the ankle. We are going to repeat this 10 times and do three sets.
Emily: The muscles on the outside of my lower leg are starting to feel tired towards the end of this exercise.
Heather Stewart, PT, DPT, SCS: The last direction of the ankle 4 ways is going to work the muscles on the inside of your foot. Again, loop the band around your foot, keep your knee nice and straight and pull your foot in. For this exercise, make sure the movement is coming from your ankle while the rest of your leg stays nice and still. If any of these start to get easier, you may use a harder band that has more resistance, or you may increase your repetitions from 10 to 15.
This next exercise is called towel curls. In addition to not having your full range of motion or flexibility, some of your foot and ankle muscles actually get weaker after an injury. Start first by working on strengthening the muscles on the bottom of your foot. Sit in a chair and place a towel under your foot. Scrunch up the towel with your toes to pull the towel towards you, straightening as needed. Do three sets of 10 repetitions.
Emily: My toes are pretty tired. This is a lot harder than it looks.
Heather Stewart, PT, DPT, SCS: Clamshells is a final strengthening exercise that strengthens your hip muscles, which then help to protect your knees and ankles from future injuries. Take you band and tie it in a loop. You’re going to place this on both of your feet and station it above your knees. Now, roll on your side, bend your knees up and keep your feet together and your hips stacked. Now, you’re going to bring this top knee towards the ceiling up against the band.
Emily: You should feel the outside of your hip starting to get tired now, which is good cause that means you’re using the right muscle.
Heather Stewart, PT, DPT, SCS: You should do three sets of 10 repetitions. A big impairment following an ankle injury is decreased balance. This next exercise is designed to help you improve your balance. First, try to balance on your injured leg with your eyes open, and then as that gets easy, move onto balancing with your eye shut.
Emily: If you’re having a hard time balancing, try to stay near a table or counter so it can help you out.
Heather Stewart, PT, DPT, SCS: Try to work up to balancing for 30 seconds and repeat this three times, twice a day.
Emily: To make it more challenging, I like to have a catch with my friend while balancing at the same time.
Topics Covered: Sports Medicine Physical Therapy