Foot and Ankle Rehabilitation

Heather L. Smith

Rehabilitation of musculoskeletal injuries of the foot and ankle requires multiple intervention techniques to address impairments that may include strength deficits, decreased balance, and gait abnormalities. Foot and ankle injuries often present with multiple impairments that need to be addressed in order to ensure full recovery from injury and prevent recurrence. Basic rehabilitation techniques can be employed by the patient, as instructed per the physician, to provide improved function following injury.

ANKLE SPRAIN

One of the most common injuries of the foot and ankle is the ankle sprain. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, approximately 850,000 Americans sprain their ankles on an annual basis. The severity of ankle sprain is variable, with the more severe ankle sprains requiring longer periods of rest and immobilization.¹^,²^,³ Compression and elevation can be applied in the acute phase to decrease edema and ecchymosis. Gentle strengthening exercises such as ankle range of motion (ROM) in four directions (Figs. 76-1,76-2,76-3,76-4) and seated heel raises (Fig. 76-5) can be initiated in the first 1 to 2 weeks. Early movement has been advocated in the research to improve and restore motion and decrease joint edema.⁴^,⁵ Progressive weight-bearing exercises can be added beginning in weeks 2 to 4, depending on the severity of the sprain. As the patient’s ROM improves and pain decreases, single-limb balance and bilateral, progressing to unilateral, heel raises and lunges can be added (Figs. 76-6,76-7,76-8,76-9). Patients who sustain severe or syndesmotic (high) ankle sprains may present with residual strength and balance deficits, continued pain, and gait abnormalities, requiring assessment and treatment by a physical therapist.⁶^,⁷^,⁸

The importance of rehabilitation and exercise to the ankle sprain patient has been documented in the literature.⁹^,¹⁰^,¹¹ Ankle sprains can lead to persistent conditions such as chronic ankle instability if the joint is not returned to its premorbid status. Research demonstrates that patients with chronic ankle instability exhibit decreased dynamic stability, and in these cases, comprehensive rehabilitation programs have been shown to be effective in addressing and improving functional deficits.⁹^,¹²^,¹³

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