Ankle Range of Motion Exercises (Early Functional Rehab)

Stretches are generally held for 15 – 30 seconds for 10 repetitions each side
- Passive range of motion: assistance required by physician
- Non-weight bearing Achilles tendon stretch: the client can use a towel to pull their feet
towards themselves to get a good stretch in the Achilles and calf muscles
- Weight-bearing Achilles tendon stretch: the client can stand on a decline platform to
feel a stretch in their Achilles tendon. They can do this either in a single leg stance or
can do this with both feet placed on the floor. It will just depend on the severity of the
injury and the phase of rehabilitation that they are in
- Alphabet exercises: the client draw the letters of the alphabet with each ankle to
improve range of motion in all planes of movement
Ankle Isometric Strengthening Exercises (Early Functional Rehab)
Isometric contractions are held for 5 - 10 seconds for 5 – 10 repetitions each side
- Plantar flexion: the client is to push the foot down as if they are pointing their toes,
and hold this position
- Dorsiflexion: the client is to lift their toes towards their head, and hold this position
- Inversion: the client is to move their foot in a position towards the midline of their
body, and hold it their
- Eversion: the client is to move their foot away from their body, and hold this position
Ankle Isotonic Strengthening Exercises (Early Functional Rehab)
Isotonic exercises are those that require the muscle hold any amount of static/equal weight
throughout the full range of motion i.e. any form of weight training, whether it be free weights
or machines.
Isotonic contractions are performed for 2 – 3 sets of 10 repetitions.
- Plantar flexion exercise: the client performs the set number of repetitions without
holding the position
- Dorsiflexion: the client brings the toes upwards towards the head
- Inversion
- Eversion
- Toe towel curls: the client is asked to scrunch a towel with the toes of one foot until
the whole towel is scrunched. Perform the same exercise on the opposite side
- Marble pick-ups: the client is asked to pick up a certain number of marbles with their
toes. Perform this on both the affected and unaffected foot
- Toe raises: the client is asked to keep their heels on the ground throughout
repetitions and attempt to lift their toes up off the floor
- Heel walks: the client is asked to walk a certain distance while balancing on their
heels, making no contact on the ground with their toes
- Toe walks: the client is asked to walk a certain distance on their toes without touching
the floor with their heels
Balance/Proprioception Exercises for the Ankle (Intermediate Functional Rehab)
- Circular wobble board exercise: the client is asked to stand with either one or two feet
on the circular wobble board, and to create circular motions with the board for 5 – 10
repetitions. This can be progressed to a unilateral stance, having eyes closed, or by
attaching an ankle weight to the limb in stance for increased resistance.
- Walking on different surfaces: the client is asked to walk the length of the surface
(e.g. uneven foam pads, carpet, or a hard surface) in a heel-to-toe manner
- Single leg stance: the client is asked to stand on one limb at a time for a period of 15
– 30 seconds on each limb, with hands remaining on the hips if possible. You can
progress this by asking them to stand on a semi-bosu ball, or by closing their eyes
during sets.
- Trampoline single leg stance: the client is asked to stand on each limb unilaterally.
This can be advanced by asking the patient to close their eyes; asking them to
perform a dual task while balancing e.g. throwing a medicine ball back to the
physician; balance on the trampoline while the practitioner applies perturbations to
the trampoline, requiring greater stability
Return to Activity Exercises for the Ankle (Advanced Rehab Phase)
- Squatting on the wobble board: client is required to squat on the board while
maintaining their balance. This can be made harder by performing a unilateral stance
- Functional exercises on various surfaces: the client is asked to walking across
various surfaces with added resistance or with their eyes closed. The physician can
 impose time limits to make increase the difficulty of the task in order to mimic real-life
sporting/hobby situations
- Walk-jog: the client is asked to walk at 50% and jog at 50% in a straight direction,
forwards and backwards, as well as in a pattern e.g. a zigzag pattern
- Jog-run: client is asked to move at a speed that is a 50% jog and 50% run in a
straight direction, moving both forwards and backwards, as well as in a various
patterns
Peroneal Strengthening Exercises
- Theraband eversion: the client is asked to wrap a theraband around their foot so that
the band is trying to draw the foot in medially. The client is then to evert the foot
against the resistance of the band by everting the foot. This can done whilst the heel
is elevated on platform e.g. a foam pad that puts the foot into a plantarflexed position.
The same exercise can be done for the invertors of the foot, however the band will be
applying resistance from the opposite direction, and the foot will be moving towards
the midline of the body.
- Standing theraband eversion: the client is asked to hold a stretched theraband across
their body. To target the evertors of the right foot, the client is asked to hold the band
when the attachment is coming from the left side. With increased tension in the band,
it will try to pull the client inwards, therefore the right foot evertors will need to be
activated in order to maintain balance and keep the body in an upright position. To
make this exercise harder, the client can be asked to perform the same exercise,
however with their foot plantar flexed (targeting fibularis longus and brevis more). In
order to target fibularis brevis more, the client can be asked to stand in a position with
the foot dorsiflexed. The same exercise can be performed to strengthen the invertors
of the foot, however the band will be applying resistance from the opposite side i.e.
the band will be trying the pull the client into an everted position, requiring them to
invert the foot in order to maintain balance. To target the right foot invertors, the band
will be anchored at an attachment from the right side, as this will pull the patient into
an everted position, requiring contraction of the invertors for balance maintenance.
- Eversion isometric hold: the client is asked to evert their foot against a stationary
object such as a wall or bosu ball that is placed against a wall
Achilles Tendinopathy Exercises (Eccentric exercises are best)
- Static single leg stance on a step: the client is asked to stand on a step with their
heels hanging off the edge of the step, and are asked to lower their ankle and heel to
the point where they feel a stretch in the calf and Achilles
- Calf raises with eccentric stretching: the client is asked to perform calf raises on their
toes, and is then required to lower their heels back to the ground in a slow and
controlled manner. This can also be done on an elevated surface or step the increase
the eccentric stretch at the end of the movement
- Non-weight bearing Achilles tendon stretch: using a towel, the client can pull their foot
towards their body to get a stretch in the Achilles.
Plantar Fasciitis (Improving gastrocnemius and soleus length is best)
- Static single leg stance on a step
- Weight-bearing Achilles tendon stretch: the client is asked to stand on a decline
platform either in a single leg or double leg stance. The patient can also perform this
stretch on the seated calf raise machine for added weight to increase the stretch on
the calf and Achilles
- Standing Achilles wall stretch: the client is asked to dorsiflex their foot against the wall
until they can feel a stretch in their calf and Achilles
- Plantar fascia stretch: the client is asked to partial weight-bear on a solid object such
as a frozen water bottle or a golf/cricket ball to stretch out the fascia at the base of
their foot. Alternatively, the patient can sit and pull their toes in an extended position
in order to stretch the fascia