REHAB Foot, Ankle & Lower Leg

UNIT 6

FOOT, ANKLE, AND, LOWER LEG

Sports Medicine

Rehab. Ankle ROM

● Ankle pumps- ● elevated (above heart) have athlete plantar flex all the

way hold 3 sec, then dorsiflex all the way hold 3 sec● Perform for 1 min do 3 sets

● ABC’s- ● have athlete “write” with their big toe, the alphabet.● They should do capital letters and make them large to

work a greater ROM.● Perform for 1 min do 3 sets

● Both of these exercises are done to increase ROM and reduce swelling after acute injury.

Stretches

● All stretches should be held 20-30 seconds with NO bouncing

● Calf- (Gastrocnemius & Soleus)● Can be performed against wall, push up position

or standing (knee should be straight)● Against wall can add turn to isolate Medial or

Lateral head of the Gastrocnemius

Stretches

● Achilles- (Tendon of Soleus and Gastrocnemius)

● performed the same way as calf, but with knee bent● Push knee closer to wall

Stretches

Arch● Arch- need corner of wall or step● Athletes position will be similar to Achilles stretch● Athlete should push down so that they are trying

to flatten arch into corner or wall or step.● *This stretch may only be felt by someone with an

inflamed/tight arch

Stretches

● Tib Ant- (Tibialis Anterior)● Have Patient in “sit up” position● Hold their feet down to the floor or table● Have them “scoot” their butt away from their feet

Stretches

● Peronials- (Peroneus Longus, Brevis & Tertius)

● Should be performed with a shoe on.● Bare feet or sandals do not work● While athlete is standing have them purely invert

their ankle● They should lean the hips toward side being

stretched and lean their shoulders away from side being stretched

● *This stretch may only be felt by someone with an inflamed/tight Peroneus

● For greater stretch push butt posteriorly

Stretches

● Tibialis Posterior -(Tib Post)● Standing, with hand resting on table or wall● Feet staggered similar to Achilles stretch but

both feet are on the ground● Have athlete bend (flex) both knees as they

bring their weight forward (trying to keep back heel on ground)

● For greater stretch externally rotate foot● Should feel stretch on med/post side

Stretches

● Toe extensors- (Extensor Digitorum)● foot plantar flexed ● fully flex toes● Grab athletes distal foot over toes and slowly pull down into

plantar flexion● Great Toe Flexors- (Flexor Hallicus Longus- Flexor

tendon of Great toe)● Grab big toe and pull into extension● To get greater stretch dorsiflex ankle

● 3 times for 30 seconds

Stretches

● Great Toe Extensors- (Extensor Hallicus Longus- Extensor tendon of Great toe)

● Grab big toe and pull into flexion● To get greater stretch plantar flex ankle

Rehab Proprioception

● Proprioception-Body awareness, knowing where your body (limb) is in space.

● Dyna-disc● Blue disc designed to challenge athlete to maintain

balance● Can also use no equipment (basic), foam half rolls,

foam pads, pillows, or other soft/uneven surface● Perform 3x 30 sec ● How do you increase the resistance/challenge?

●play catch or close eyes● w/ Dyna disc, wobble board, Bosu ball

Rehab. Strengthening Ankle Program

● Eversion/Dorsiflexion- ● seated, knees straight,● feet shoulder width apart, ● band loop around foot of injured leg, ● band wrapped around uninjured foot, ● band held in hand● Muscles worked Peroneus Tertius ● Important for Lat. ankle sprains● ** Strengthening exercises are done for 3 sets of

10 reps**

Rehab. Ankle Program

● Plantar Flexion/Eversion● Seated, injured leg straight● Bend knee of uninjured leg● Heel of uninjured leg resting on the table● band loop around foot of injured leg, ● band wrapped around uninjured foot, ● band held in hand● Muscles worked Peroneus Longus and Brevis

Rehab. Ankle Program

● Dorsiflexion- ● seated, uninjured knee straight,● knee of injured foot bent, ● Heel of injured foot resting on table, ● band loop around foot of injured leg, ● band wrapped around uninjured foot, ● band held in hand● Muscles worked Tib. Ant., Peroneus tertius,

Extensor Digitorum

Rehab. Ankle Program

● Plantarflexion/Inversion● seated, injured knee straight, ● cross uninjured leg over injured leg (good over

bad), ● Heel of uninjured foot resting on table, ● loop around foot of injured leg (high on toe, ● band wrapped around uninjured foot, ● band held in hand

● Very important for Shinsplints and flat feet injuries

● Works Tib Post, Flexor Digitorum and Flex. Hallicus

Rehab. Ankle Strengthening cont

● Lateral T-band walks● Circular band (tied)- is wrapped around both feet● Athlete is to keep feet in neutral (pointing straight

ahead) position● Athlete walks Laterally (Side shuffle) done slowly● Works Lateral Low leg (Peronials), and Lat hip

(Glut Med, Tensor)● Done for distance or reps (do till fatigued)

Rehab. Ankle

● Toe walks- on balls of feet, have athlete walk (works Plantar flexors)

● Heel walks- on heels, toes pointed to the sky (works Dorsi flexors)

● Can be done straight, backwards or laterally to work different muscles

● Great for Functional testing for return to play and shinsplints

● Done for distance or reps (do till fatigued)

With both the steps should be small (4 inches)

Rehab. Ankle

● Calf Raises- 3 way● Hip externally Rotated- (medial Gastroc., Tib Post)● Hip Neutral- (Gastroc, works most plantar flexors)● Hip internally rotated- (Lat. Gastroc. ,peronials)

● Should do 3 sets of 15 can do less depending on readiness

Foot Rehab.

● Towel Scrunches- ● Towel laid on floor at feet of athlete ● Athlete puts foot/feet on end of towel● Ath. Curls (flexes) toes to “scrunch” the towel up● Repeat till towel is all curled up then lay out again.● Repeat till FATIGUED then do 2 more● Ath. Should experience a BURN in shins or feet

● Marble pick ups- ● Athlete will pick up marbles with toes and drop them into

a container● Works on toes flexors and shin muscles

FOOT INJURIES

UNIT 6

FOOT, ANKLE, AND, LOWER LEG

Sports Medicine

FOOT INJURIES

Athletic Shoes

Sports Medicine

FOOT INJURIES

Arch Sprain/StrainDescription – Sprain or Strain of

supporting structures of the foot’s arch, usually the medial longitudinal arch.

Sports Medicine

FOOT INJURIES

Arch Sprain/StrainMOI

● Activity on hard playing surfaces● Sudden increase in weight bearing

exercises ● Non supportive or inappropriate shoe

wear● Overuse

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FOOT INJURIES

Arch SprainMOI

● Non supportive or inappropriate shoe wear

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FOOT INJURIES

Arch Sprain/StrainSigns/Symptoms ● Arch pain while weight bearing● Arch pain while running● Point tenderness on sole of foot● Swelling on sole of foot

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FOOT INJURIES

Arch Sprain/StrainAIM ● Cold modality (Ice massage)● Arch Insole Support ● Longitudinal arch tape

● Teardrop or simple arch

Sports Medicine

REHAB● Stretch (How?)● Strengthen (How?)● Tape

FOOT INJURIES

Heel BruiseDescription - Contusion to heel’s fat pad.

Sports Medicine

FOOT INJURIES

Heel BruiseMOI –● Repeated starting and stopping on

hard surfaces.● Wearing athletic shoes without proper

cushion and support● Landing hard on one’s heel.

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FOOT INJURIES

Heel BruiseSigns/Symptoms ● Point tenderness under calcaneus (fat

pad)● Swelling under calcaneus (fat pad)

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FOOT INJURIES

Heel BruiseAIM ● Cold modality● Doughnut pad● Heel cup

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FOOT INJURIES

Heel Spur

Description - Bony growth on calcaneal tuberosity.

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FOOT INJURIES

Heel Spur

MOI ● Lack of gastrocnemius / soleus

flexibility.● Running on hard surfaces.● Inappropriate shoe wear.● Lack of cushion in shoes. ● Worn out shoes.

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FOOT INJURIES

Heel Spur

Signs/Symptoms ● Point tenderness● Pain while weight bearing

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FOOT INJURIES

Heel Spur

AIM ● Work on flexibility● Doughnut pad● Stiff soled shoe● Heel cupREHAB● Stretch (How?)

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FOOT INJURIES

Plantar Fasciitis Description - Inflammation of plantar fascia

Sports Medicine

FOOT INJURIES

Plantar Fasciitis MOI

● Lack of Achilles flexibility● Chronic Overuse● Fallen arch (flat feet)

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FOOT INJURIES

Plantar Fasciitis Signs/Symptoms

● Point tenderness over calcaneal tuberosity.

● Increase AM (morning) tenderness when walking.

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FOOT INJURIES

Plantar Fasciitis AIM

● Achilles/Calf flexibility● Arch ROM/stretching ● Cold applicationsREHAB● Stretch (How?)● Strengthen (How?)

Sports Medicine

FOOT INJURIES

Jones FractureDescription - Fracture to base of the fifth

metatarsal (styloid process).

Sports Medicine

FOOT INJURIES

Jones FractureMOI

Traumatic inversion/plantar flexion of the foot.

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FOOT INJURIES

Jones FractureSigns/Symptoms ● Point tender over base of 5th (styloid

process)● Painful passive inversion and active

eversion of foot.

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FOOT INJURIES

Jones FractureAIM ● RICE● Refer to physician● Cast● Sometimes surgery

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FOOT INJURIES

Turf ToeDescription - Sprain of

metatarsophalangeal joint of great toe.

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FOOT INJURIES

Turf ToeMOI ● Forced hyperextension

of great toe, usually associated with push off or landing.

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FOOT INJURIES

Turf ToeMOI ● Non-supportive soled shoes.

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FOOT INJURIES

Turf ToeSigns/Symptoms ● Painful hyperextension.● Decrease metatarsophalangeal

joint flexion.

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FOOT INJURIES

Turf ToeAIM ● RICE● Tape to prevent hyperextension.● Stiff soled shoe or insert.REHAB● Strengthen (How?)● Stretch (How?)● Tape (How?)● Work on ROM (How?)

Sports Medicine

FOOT INJURIES

Ingrown ToenailDescription - Nail grows into lateral nail

fold.

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FOOT INJURIES

Ingrown ToenailMOI ● Lateral pressure from poorly fitting

shoes

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FOOT INJURIES

Ingrown ToenailMOI ● Improper toe nail trimming● Trauma, such as repeated pressure

from the foot sliding against the end of shoe.

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FOOT INJURIES

Ingrown ToenailMOI ● Trauma, such as repeated

pressure from the foot sliding against the end of shoe.

Sports Medicine

FOOT INJURIES

Ingrown ToenailSigns / Symptoms ● Lateral nail fold

becomes inflamed, painful, and swollen.

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FOOT INJURIES

Ingrown ToenailAIM ● Hot water soaks followed by (fb)

insertion of cotton under nail edge to keep nail out of skin.

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FOOT INJURIES

Ingrown ToenailAIM ● Trim nail to

prevent nail penetration into skin.

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FOOT INJURIES

Plantar WartsDescription - Wart that appears on pressure bearing surfaces of the sole of the foot. Warts originate from a virus.

Sports Medicine

FOOT INJURIES

Plantar Warts

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FOOT INJURIES

Plantar WartsMOI

● Cause by virus ● Fallen metatarsal arch

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FOOT INJURIES

Plantar Warts

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FOOT INJURIES

Plantar WartsMOI ● Fallen metatarsal arch

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FOOT INJURIES

Plantar WartsSigns/Symptoms ● Excessive callus

formation having associated “black seeds” within callus.

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FOOT INJURIES

Plantar WartsSigns/Symptoms ● Point tender as if

stepping on a piece of glass

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FOOT INJURIES

Plantar WartsAIM ● Doughnut pad application● Over the counter salicylic acid ● Refer to physician

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FOOT INJURIES

Athlete’s Foot (Tinea Pedis)Description ● Fungal infection appearing

between toes and on the ball of the foot.

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FOOT INJURIES

Athlete’s Foot (Tinea Pedis)MOI ● Dark, warm, and moist

environment found in shoes contribute to athlete’s foot formation.

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FOOT INJURIES

Athlete’s Foot (Tinea Pedis)Signs/Symptoms ● Rash with

extreme itching

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FOOT INJURIES

Athlete’s Foot (Tinea Pedis)Signs/Symptoms ● Inflammation and other associated

signs of infection

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FOOT INJURIES

Athlete’s Foot (Tinea Pedis)Signs/Symptoms ● Red, white, or gray

scaling of affected area.

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FOOT INJURIES

Athlete’s Foot (Tinea Pedis)AIM ● Good foot hygiene● Topical creams orSprays

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FOOT INJURIES

Athlete’s Foot (Tinea Pedis)AIM ● Elimination of dark,

warm, and moist environment

Sports Medicine