Ankle

By Hossein Khorrami PhD.

khorrami4@yahoo.com http://www.scribd.com/khorrami4

Ankle bones
Lateral view

Ankle bones & ligaments

Medial view

Lateral ligaments

Foot ligaments, medial view

Ankle movements
Plantar flexion Dorsiflexion Eversion Inversion

Ankle tendons
Posterior tibial tendon, inversion Anterior tibial tendon, dorsiflexion Achilles tendon, plantar flexion Proneal tendon, eversion

Ankle ligaments
Deltoid ligament at the medial side
Is strong Rarely thorn

Lateral ligaments thorn mostly in plantar flexion & inversion

Ankle sprain
Mostly in athletes Deltoid ligament: surgery Lateral ligament
Pain at plantar flexion & inversion Cast for 3 weeks Then cold pack, US & isometric exercises After 4wks to prevent happening again:
Warm pack Wobble board Plyometric exercises(Jump training)

Plyometric Exercises
Platform Vertical Staircase Long

Lat. Ligaments sprain

RICE(Rest, Ice, Compression, Elevation) Cast immobilization, 3 wks Active ROM pain free Avoid full plantar flexion or inversion Isometric exercises for all muscles No stretching before 6wk

Ankle sprain Ex.

Alphabets exercises While seated on the edge of the heel Use greater toe as pen A-Z 3times/day

Ankle sprain Ex.

Sheet grab exercise Try to grab a sheet on the floor

Ankle sprain ex.

Windshield wiper Mimic windshield wiper movement Pivot outward & touch inside edge of the foot to the floor Pivot inward & touch outside edge of the foot to the floor 10-15 reps 2-3 set/day

Ankle sprain ex.

After completion of previous ex with little pain

Seated calf raise Lift heel while toes on the floor Return heel to the floor 10-15 reps 2-3 set/day

Ankle sprain ex.

Single leg stand Place a hand on a table Shift a part of weight to the affected foot for 15 sec Increase time to 45 sec Gradually increase the weight until full weight 10-15 reps 2-3 set/day

Ankle sprain ex.

Isometric eversion & inversion Push outward for 2-3 sec Push inward for 2-3 sec 10-15 reps 2-3 set/day

Ankle sprain ex.

After completion of previous ex with little pain

Strengthening eversion & inversion Use a theraband & fix it 2 sets of 10-15 reps 2-3 times/day

Ankle sprain ex.

After completion of previous ex with little pain

Gastrocnemius & soleus stretch Straight injured leg behind Heel firmly planted on the floor Lean forward against the wall Hold for 30 sec 10-15 reps 2-3 set/day

Ankle sprain ex.

After completion of previous ex with little pain

Soleus stretch Bend injured leg forward Bend knee of the back foot Lower the body toward the floor without letting back heel rise off the floor 10-15 reps 2-3 set/day

Ankle sprain ex
Single leg standing calf raise
Stand FWB on injured foot Hold for 30 sec 10-15 reps 2-3 set/day Raise heel of injured foot 2 sets of 10-15 reps 2-3 times/day

Ankle sprain ex
Single leg stand with a towel
Stand FWB on injured foot on a folded towel Hold for 30 sec 2 sets of 10-15 reps 2-3 times/day

Ankle sprain ex
Lateral step
Step over the folded towel & remain on one foot Reverse the step Speed up as far as possible, least pain 2 sets of 10-15 reps 2-3 times/day

Heel spurs
Bony growth(osteophytes) Pain mostly at morning

Heel spur, risk factors

Walking gait abnormalities Jogging on hard surfaces Inappropriate shoes Age Obesity DM Hypercalcemia Flat feet or high arches Hi heel shoes

Heel spur ex
Avoid hi heel shoes Ankle support Stretching calf muscles Grab sheet by toes, for small muscles Rolling a cold or frozen bottle of water