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Anke and Foot

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Ankle Sprains/Instability

Ankle sprains are a common injury. They usually occur when the foot is forcefully inverted or turned inward. Grade I (minor tear), Grade II (partial tear), or a Grade III (complete tear into two pieces) damage of the outer ligament complex (the anterior talofibular ligament and less often the calcaneofibular ligaments) is the result. Injuries to the inner aspect of the ankle are rare and often result in a fracture before ligamentous damage occurs.

Signs and symptoms of an ankle sprain include lateral ankle pain, swelling and a sense of instability. Stress X-rays may be helpful in ruling out fractures.

Treatment of an acute injury requires rest, ice, compression, elevation, and bracing of the injured ankle. Early rehabilitation assists in a rapid recovery. Surgery (reconstruction of the ligaments) is only necessary when the ankle is repeatedly sprained.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Isotonics
  • Ankle Active Range of Motion
  • Ankle Joint Mobilization
  • Ankle Passive Range of Motion
  • Ankle Resistive Range of Motion
  • Plyometrics
  • Physical Agents
  • Proprioception Exercises
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Improve ability to bear weight/stand on the leg(s)
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Additional Resources

Fractures (Broken Bones)

Fractures may involve the outside or inside of the leg. The signs and symptoms of fractures are pain, swelling and bony deformities. X-rays are essential and rapid “reduction” (setting the bones close together for healing) is necessary. In extreme cases, open surgery is necessary to reduce the fracture. Often pins, plates and screws are used to maintain the reduction.

Possible Treatments

  • Cryotherapy or Cold Therapy
  • Isometric Exercise
  • Physical Agents

Possible Treatment Goals

  • Improve Balance
  • Improve Function
  • Improve Muscle Strength and Power
  • Decrease Postoperative Complications
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Safety
  • Improve Wound Healing

Achilles Tendonitis and Rupture

The Achilles tendon attaches the calf muscle (called the gastrocnemius and soleus muscles) to the heel. Excessive stress or a tight or fatigued calf muscle can result in microtrauma, degeneration, and even inflammation of the tendon- a condition called Achilles Tendonitis/Tendinosis. Prolonged walking, overtraining (excessive running or jumping, or walking hills can cause this condition.

Recent research suggests that a gradual onset of pain and prolonged recovery might be due to a similar condition called Achilles tendinosis. Tendinosis is chronic degenerative condition and it differs from tendonitis in that there is no inflammation present. It is probably more common than tendinitis because often times tendon pain is not accompanied by the classic inflammatory signs of swelling, redness, and warmth.

Treatment usually consists of rest, non-steroidal anti-inflammatory drugs (NSAIDs), ice, stretching, strengthening and progressive return to function or sport. Achilles Tendon Rupture

Forceful contraction of the calf muscle may rupture (completely tear) the Achilles tendon. It occurs during jumping, running, and cutting and is often seen in basketball and baseball players. The patient often reports the sensation of having been hit or violently kicked in the lower calf. There is pain and a “divot” in the tendon above the heel.

Treatment- non-surgical rehabilitation and surgical repair are viable treatment options. Active people may experience more benefit from surgical repair. Rehabilitation may require six to twelve months of progressive care.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Isotonics
  • Ankle Active Range of Motion
  • Ankle Joint Mobilization
  • Ankle Passive Range of Motion
  • Ankle Resistive Range of Motion
  • Heat Pack
  • Plyometrics
  • Physical Agents
  • Proprioception Exercises
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Improve ability to bear weight/stand on the leg(s)
  • Improve Fitness
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Additional Resources

Plantar Fasciitis

Inflammation of the fascia on the bottom of the foot is the most common cause of heel pain.

There are many documented causes of plantar fasciitis. Poor flexibility of the calf muscles, no arch support, a sudden increase in one’s level of activity, poor footwear, being overweight, excessive pronation, or repetitive stress conditions (long distance running). Common causes of a bruised heel bone are poor cushioning of the heel due to fat pad atrophy (shrinkage in the size of the fat pad) poor footwear, excessive walking on hard surfaces, and being overweight.

Depending on which medical study you read, anywhere form 8-21% of the population suffers from plantar fasciitis. The pain is typically located at the front of the base of the calcaneus. Less often, the pain extends along the arch of the foot. The result is micro-tearing of the plantar fascia where it attaches to the base of the calcaneus. An ensuing inflammatory response occurs producing pain, swelling, warmth, loss of function (difficulty with any standing or walking), and less often, redness.

Plantar fasciitis is often worst in the morning when one takes his /her first steps out of bed. Theories propose that when we are sleeping, the inflamed fascia is shortening and perhaps attempting to heal. If the problem is chronic, a bone spur may be seen on x-ray.

Currently, we believe that a bone spur is not the cause of the pain but the result of the body’s attempt to heal the damaged plantar fascia.

Possible Treatments

  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Isotonics
  • Ankle Active Range of Motion
  • Ankle Joint Mobilization
  • Ankle Passive Range of Motion
  • Ankle Resistive Range of Motion
  • Iontophoresis
  • Physical Agents
  • Proprioception Exercises
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Additional Resources

Stress Fractures

These fractures result from repetitive submaximal loads applied to the foot, ankle, leg; they are usually the result of overuse (in athletes, over-training). They are common in long distance runners and female athletes.

Common stress fracture sites include the lower leg (in runners), calcaneus, talus, metatarsals in distance runners, and the big toe.

Pain and point tenderness, often relieved by rest, is typical. X-rays do not always show the fracture. Bone scans and MRI may be useful.

Most heal with rest, immobilization and cross training. Avoid high-impact workouts, and wear good shoes.

Possible Treatments

  • Cryotherapy or Cold Therapy
  • Isometric Exercise
  • Physical Agents

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Safety
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Additional Resources

Tibialis Posterior Tendonitis

This often occurs in overweight, middle aged women and men as a result of degenerative changes in the tendon. The rupture may be partial or complete with pain below or behind the inside ankle bone (medial malleolus). A flattened arch is common. Anti-inflammatory treatment (physical therapy modalities), orthoses, and surgical debridement are common treatments.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Isometric Exercise
  • Physical Agents
  • Proprioception Exercises
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Improve ability to bear weight/stand on the leg(s)
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Additional Resources

  • Ankle Sprains/Instability

    Ankle sprains are a common injury. They usually occur when the foot is forcefully inverted or turned inward. Grade I (minor tear), Grade II (partial tear), or a Grade III (complete tear into two pieces) damage of the outer ligament complex (the anterior talofibular ligament and less often the calcaneofibular ligaments) is the result. Injuries to the inner aspect of the ankle are rare and often result in a fracture before ligamentous damage occurs.

    Signs and symptoms of an ankle sprain include lateral ankle pain, swelling and a sense of instability. Stress X-rays may be helpful in ruling out fractures.

    Treatment of an acute injury requires rest, ice, compression, elevation, and bracing of the injured ankle. Early rehabilitation assists in a rapid recovery. Surgery (reconstruction of the ligaments) is only necessary when the ankle is repeatedly sprained.

    Treatments

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Gait or Walking Training

    The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

    Isotonics
    Ankle Active Range of Motion
    Ankle Joint Mobilization
    Ankle Passive Range of Motion
    Ankle Resistive Range of Motion
    Plyometrics
    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Improve Balance
    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Improve Relaxation
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

    Resources

  • Fractures (Broken Bones)

    Fractures may involve the outside or inside of the leg. The signs and symptoms of fractures are pain, swelling and bony deformities. X-rays are essential and rapid “reduction” (setting the bones close together for healing) is necessary. In extreme cases, open surgery is necessary to reduce the fracture. Often pins, plates and screws are used to maintain the reduction.

    Treatments

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Improve Balance
    • Improve Function
    • Improve Muscle Strength and Power
    • Decrease Postoperative Complications
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Safety
    • Improve Wound Healing

  • Achilles Tendonitis and Rupture

    The Achilles tendon attaches the calf muscle (called the gastrocnemius and soleus muscles) to the heel. Excessive stress or a tight or fatigued calf muscle can result in microtrauma, degeneration, and even inflammation of the tendon- a condition called Achilles Tendonitis/Tendinosis. Prolonged walking, overtraining (excessive running or jumping, or walking hills can cause this condition.

    Recent research suggests that a gradual onset of pain and prolonged recovery might be due to a similar condition called Achilles tendinosis. Tendinosis is chronic degenerative condition and it differs from tendonitis in that there is no inflammation present. It is probably more common than tendinitis because often times tendon pain is not accompanied by the classic inflammatory signs of swelling, redness, and warmth.

    Treatment usually consists of rest, non-steroidal anti-inflammatory drugs (NSAIDs), ice, stretching, strengthening and progressive return to function or sport. Achilles Tendon Rupture

    Forceful contraction of the calf muscle may rupture (completely tear) the Achilles tendon. It occurs during jumping, running, and cutting and is often seen in basketball and baseball players. The patient often reports the sensation of having been hit or violently kicked in the lower calf. There is pain and a “divot” in the tendon above the heel.

    Treatment- non-surgical rehabilitation and surgical repair are viable treatment options. Active people may experience more benefit from surgical repair. Rehabilitation may require six to twelve months of progressive care.

    Treatments

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Gait or Walking Training

    The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

    Isotonics
    Ankle Active Range of Motion
    Ankle Joint Mobilization
    Ankle Passive Range of Motion
    Ankle Resistive Range of Motion
    Heat Pack

    Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

    Plyometrics
    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Improve Balance
    • Improve ability to bear weight/stand on the leg(s)
    • Improve Fitness
    • Improve Function
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

    Resources

  • Plantar Fasciitis

    Inflammation of the fascia on the bottom of the foot is the most common cause of heel pain.

    There are many documented causes of plantar fasciitis. Poor flexibility of the calf muscles, no arch support, a sudden increase in one’s level of activity, poor footwear, being overweight, excessive pronation, or repetitive stress conditions (long distance running). Common causes of a bruised heel bone are poor cushioning of the heel due to fat pad atrophy (shrinkage in the size of the fat pad) poor footwear, excessive walking on hard surfaces, and being overweight.

    Depending on which medical study you read, anywhere form 8-21% of the population suffers from plantar fasciitis. The pain is typically located at the front of the base of the calcaneus. Less often, the pain extends along the arch of the foot. The result is micro-tearing of the plantar fascia where it attaches to the base of the calcaneus. An ensuing inflammatory response occurs producing pain, swelling, warmth, loss of function (difficulty with any standing or walking), and less often, redness.

    Plantar fasciitis is often worst in the morning when one takes his /her first steps out of bed. Theories propose that when we are sleeping, the inflamed fascia is shortening and perhaps attempting to heal. If the problem is chronic, a bone spur may be seen on x-ray.

    Currently, we believe that a bone spur is not the cause of the pain but the result of the body’s attempt to heal the damaged plantar fascia.

    Treatments

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Gait or Walking Training

    The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

    Isotonics
    Ankle Active Range of Motion
    Ankle Joint Mobilization
    Ankle Passive Range of Motion
    Ankle Resistive Range of Motion
    Iontophoresis

    Medications are propelled through the skin by an electrical charge. This modality works on the physical concept that like charges repel each other, therefore, a positively charged medication will be repelled through the skin to the underlying tissues by the positively charged pad of an iontophoresis machine. Iontophoresis is usually prescribed for injuries such as shoulder or elbow bursitis.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Improve Balance
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Optimize Joint Alignment
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

    Resources

  • Stress Fractures

    These fractures result from repetitive submaximal loads applied to the foot, ankle, leg; they are usually the result of overuse (in athletes, over-training). They are common in long distance runners and female athletes.

    Common stress fracture sites include the lower leg (in runners), calcaneus, talus, metatarsals in distance runners, and the big toe.

    Pain and point tenderness, often relieved by rest, is typical. X-rays do not always show the fracture. Bone scans and MRI may be useful.

    Most heal with rest, immobilization and cross training. Avoid high-impact workouts, and wear good shoes.

    Treatments

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound

    Goals

    • Decrease Risk of Reoccurrence
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Safety
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

    Resources

  • Tibialis Posterior Tendonitis

    This often occurs in overweight, middle aged women and men as a result of degenerative changes in the tendon. The rupture may be partial or complete with pain below or behind the inside ankle bone (medial malleolus). A flattened arch is common. Anti-inflammatory treatment (physical therapy modalities), orthoses, and surgical debridement are common treatments.

    Treatments

    Aerobic/Endurance Exercise

    Stationary cycling is usually prescribed for improving the strength and/or range of motion of the hips, knees, ankles as well as cardio-vascular endurance.

    Cryotherapy or Cold Therapy

    Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Cold therapy may be administered by using a cold pack or an ice massage as seen in the above video.

    Electrotherapeutic Modalities

    Possible Treatments

    • Neuromuscular Electrical Stimulation
    • Transcutaneous Electrical Nerve Stimulation (TENS)
    • Iontophoresis
    Gait or Walking Training

    The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

    Isometric Exercise

    An isometric exercise is a muscle contraction without joint movement. Isometrics are usually prescribed for gentle nerve and muscle reeducation. They are typically used for strengthening with arthritis patients, post-surgical patients, or as an introductory muscle strengthening exercise. A usual progression is from isometrics to active and resistive exercises that involve joint movement.

    Physical Agents

    Possible Treatments

    • Cryotherapy or Cold Therapy
    • Heat Pack
    • Ultrasound
    Proprioception Exercises

    Proprioception is the body’s ability to sense where it is in space. For example, close your eyes and touch your nose. How were you able to move your finger to your nose without seeing it? Proprioception exercises are used to help retrain your sensory system after the nerves have been damaged during a musculoskeletal injury. Your body uses its sensory system in the joints and muscles to know how they are moving. Balance and coordination both depend on your body’s proprioceptive skills.

    Soft Tissue Mobilization

    Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

    Stretching/Flexibility Exercise

    Exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

    Goals

    • Improve Balance
    • Improve ability to bear weight/stand on the leg(s)
    • Decrease Risk of Reoccurrence
    • Improve Fitness
    • Improve Function
    • Improve Muscle Strength and Power
    • Increase Oxygen to Tissues
    • Improve Proprioception
    • Improve Range of Motion
    • Self-care of Symptoms
    • Improve Tolerance for Prolonged Activities

    Resources