Foot, Ankle, & Lower Leg REHABILITATION

Great Toe Sprain RICE: Rest, Ice, Compression, Elevation RICE: Rest, Ice, Compression, Elevation Eliminate forced flexion or extension through shoes or taping Eliminate forced flexion or extension through shoes or taping Stretch Great Toe, foot, and calf muscles Stretch Great Toe, foot, and calf muscles If worsens, Non-Weight bearing If worsens, Non-Weight bearing

In-Grown Toe Nail Soak in hot water for minutes Soak in hot water for minutes Lift edge of nail and put small piece of cotton under to elevate the nail Lift edge of nail and put small piece of cotton under to elevate the nail Apply antiseptic and cover with a sterile dressing Apply antiseptic and cover with a sterile dressing Or cut a “v” into middle of nail (grows and pulls toward center) Or cut a “v” into middle of nail (grows and pulls toward center) If pus present, refer to MD for antibiotics If pus present, refer to MD for antibiotics

Management of Ingrown Toe Nail

Ankle Sprains Rest, Ice, Compression, Elevation Rest, Ice, Compression, Elevation Apply horseshoe to medial malleolus Apply horseshoe to medial malleolus Decide if Xrays are needed to rule out Jones’ Fracture Decide if Xrays are needed to rule out Jones’ Fracture

Ankle Sprain Exercises Strengthen foot, ankle, and lower leg Strengthen foot, ankle, and lower leg Circles, ABC’s, Windshield Wipers, Towel Scrunches, Theraband, Calf Raises, Stretch Circles, ABC’s, Windshield Wipers, Towel Scrunches, Theraband, Calf Raises, Stretch Improve proprioception Improve proprioception Balancing exercises, Playing catch Balancing exercises, Playing catch Tape or ankle brace if needed! Tape or ankle brace if needed!

Jones’ Fracture Cast or Walking Boot, 4-6 weeks usually Cast or Walking Boot, 4-6 weeks usually After MD clearance, begin ankle strengthening program to safely return to sport After MD clearance, begin ankle strengthening program to safely return to sport Tape Tape

Achilles Tendinitis Rest Rest Stretching of calf and foot muscles Stretching of calf and foot muscles Look at foot alignment Look at foot alignment Recent change in running surface, distance, form, or intensity Recent change in running surface, distance, form, or intensity Excessive pounding (jumping) Excessive pounding (jumping) Decrease what is aggravating Achilles Decrease what is aggravating Achilles

Achilles Tendinitis Heat Heat Stretching Stretching Massage Massage Heel Lifts Heel Lifts Taping for Achilles Tendinitis Taping for Achilles Tendinitis Strengthen entire lower leg/foot/ankle Strengthen entire lower leg/foot/ankle Cross train Cross train

Achilles Rupture Surgical Repair Surgical Repair 4-6 month rehabilitation after surgery 4-6 month rehabilitation after surgery

Shin Splints Ice and Rest (reduce impact) Ice and Rest (reduce impact) Check foot alignment Check foot alignment What about wear and tear of shoes What about wear and tear of shoes Modify activity = cross train Modify activity = cross train Tape shins and/or arches Tape shins and/or arches STRETCH lower leg and foot STRETCH lower leg and foot Heat & Massage (to feet, shins, and calves) Heat & Massage (to feet, shins, and calves)

Shin Splints Strengthen lower leg, ankle, and foot muscles Strengthen lower leg, ankle, and foot muscles Especially dorsiflexion Especially dorsiflexion

Stress Fractures No activity (non-weight bearing in pool okay) No activity (non-weight bearing in pool okay) May or may not be on crutches May or may not be on crutches 4-6 weeks 4-6 weeks Females = think about eating disorder, or if they have lost their menstrual cycle (amenorrhea) Females = think about eating disorder, or if they have lost their menstrual cycle (amenorrhea)

Plantar Fasciitis Rest, Ice Rest, Ice Stretch foot and lower leg Stretch foot and lower leg Add tennis ball stretch Add tennis ball stretch Strengthen lower leg and foot Strengthen lower leg and foot Check foot alignment Check foot alignment Tape arches Tape arches Night Splint Night Splint

Foot, Ankle, & Lower Leg Exercises Alphabet Alphabet Seated Calf Raises, Standing Calf Raises Seated Calf Raises, Standing Calf Raises Toe Scrunches Toe Scrunches Toe Pick ups Toe Pick ups Single Leg Balancing (SLB) Single Leg Balancing (SLB) SLB eyes closed, Dyna disc, Bosu, play catch SLB eyes closed, Dyna disc, Bosu, play catch Cone Touches Cone Touches

Foot, Ankle, & Lower Leg Exercises Inversion, Eversion, Dorsiflexion with Theraband or Manual Resistance (hands) Inversion, Eversion, Dorsiflexion with Theraband or Manual Resistance (hands) Wall Squats Wall Squats Jumping Jumping Running Running Lateral Movements/Lateral Jumping Lateral Movements/Lateral Jumping Sport Specific Exercises Sport Specific Exercises

Assignment Groups of 2 Groups of 2 Given an injury with the athlete’s sport Given an injury with the athlete’s sport Using the IMPRESS model, break down the steps of the rehabilitation to create their own specific programs Using the IMPRESS model, break down the steps of the rehabilitation to create their own specific programs Under the IMPRESS model, follow the order of progression Under the IMPRESS model, follow the order of progression