Key Points for Success:

Transcription

1 ANKLE & FOOT 1

2 2

3 All of the stretches described in this chapter are detailed to stretch the right side. Key Points for Success: Keep your movements slow and precise. Breathe in before you move and breathe out while you move. When working on individual toes, place them in a neutral position before you stretch them. A neutral position is as follows: The toenail should face straight ahead, not turned in or out. Each joint should be straight below/above the each other. Body Awareness: Alternately focus on the muscles moving the joint and the muscles being stretched. Check for tension during the movement. Never force your assist. Never strain with your movement. If your muscles are shaking, you are working too hard; breathe and relax. 3

4 Ankle Dorsal Flexion 1 3 Area Being Stretched: Back of Calf and Achilles Muscles Emphasized: Distal attachments of Gastrocnemius and Plantaris 1. Lie on your back with your strap wrapped around the ball of your R foot. Hold one strand in each hand. 2. Lock your R knee; keep your toes relaxed and extend through your heel. 3. Bring your R foot towards your head. 4. When you cannot move farther on your own, assist yourself gently with both of your hands. 5. Hold for 2 seconds. 6. Return to the starting position. REPEAT the above sequence turning your ankle #2 - slightly inward (leading with your big toe) and then #3 - slightly outward (leading with your little toe) as you move your foot towards your head. Precautions: If you have heel spurs or plantar fasciitis move gently and slowly, especially in the morning. Strap Use Tips: When you are leading with your big toe, use the inner strap to create the assist and your outer strap to help hold your position. When you are leading with your little toe, use the outer strap to create the assist and your inner strap to help hold your position. Keep your upper and lower body relaxed. Engage your abdominals, quadriceps and shins. Keep your knee locked throughout the movement. Keep your toes relaxed. Health Tips: This stretch is exceptionally beneficial in the treatment of plantar fasciitis and heel spurs. Advanced Movement: As your flexibility improves, add the movement of your toes into the stretch. Stretching the fascia: 1. Straighten your R leg and lift it up towards the ceiling. 2. When you feel a stretch behind the back of your knee, lower your leg a few degrees until you no longer feel the stretch. 3. Continue the stretch as above. 4

5 Ankle Dorsal Flexion 4 6 Area Being Stretched: Back of Calf, Achilles and Bottom of Foot Muscles Emphasized: 4 - Soleus, 5 - Tibialis Posterior, 6 - Flexor Digitorum Longus 1. Sit with your R leg in front of you and your L leg bent to your side. 2. Bend your R knee so that you can reach your R foot with your hands. 3. Wrap both hands around the sole of your foot. If you cannot reach with your hands use your strap to wrap around the sole of your foot. 4. Bend your ankle, lifting your foot up towards the ceiling. 5. When you cannot move farther on your own, assist yourself gently Repetitions: with both Two of your Sets hands. of Hold for 2 seconds. 7. Return to the starting position. REPEAT the above sequence turning your ankle #5 - slightly inward (leading with your big toe) and then #6 - slightly outward (leading with your little toe) as you move your foot towards the ceiling. Helpful Hints: Precautions: If you have heel spurs or plantar fasciitis move gently and slowly, especially in the morning. If you feel pressure or pain in the front of your ankle joint, double check the direction of your assistance. Advanced Movement: As your flexibility improves, add the movement of your toes into the stretch. Keep your upper and lower body relaxed. Engage your abdominals and shins. Health Tips: This stretch is exceptionally beneficial in the treatment of plantar fasciitis and heel spurs. Keep your heel on the floor throughout the movement. Keep your toes relaxed. Mr. Stretchy: Remember to keep the direction of your assistance upward, towards the ceiling, not directly toward you. 5

6 Ankle Dorsal Flexion 7 9 Area Being Stretched: Back of Calf, Achilles and Bottom of Foot Muscles Emphasized: 7 - Achilles, 8 - Tibialis Posterior, 9 - Flexor Digitorum Longus 1. Sit in a position which allows you to have your R hip and knee bent so your R foot resting in front of you flat on the floor and your heel as close to your buttocks as is comfortable. 2. Wrap both hands around the sole of your foot. If you cannot reach with your hands, use your strap to wrap around the sole of your foot. 3. Bend your ankle, lifting your foot up towards the ceiling. 4. When you cannot move farther on your own, assist yourself gently with both of your hands. 5. Hold for 2 seconds. 6. Return to the starting position. REPEAT the above sequence turning your ankle #8 - slightly inward (leading with your big toe) and then #9 - slightly outward (leading with your little toe) as you move your foot towards the ceiling. Advanced Movement: Precautions: If you have heel spurs or plantar fasciitis move gently and slowly, especially in the morning. Keep your upper and lower body relaxed. Engage your abdominals and shins. As your flexibility improves, add the movement of your toes into the stretch. Helpful Hints: If you feel pressure or pain in the front of your ankle joint, double check the direction of your assistance. Health Tips: This stretch is exceptionally beneficial in the treatment of plantar fasciitis and heel spurs. Keep your heel on the floor throughout the movement. Keep your toes relaxed. Mr. Stretchy: Remember to keep the direction of your assistance upward, towards the ceiling, not directly toward you. 6

7 Ankle Plantar Flexion 1 3 Area Being Stretched: Front of Shin Muscles Emphasized: Proximal attachments of Dorsal Flexors 1. Sit with your R ankle crossed over your L thigh. 2. Place your R hand on your R leg to help stabilize it. Place your L hand over the top of your R foot. 3. Bend your R ankle, bringing the sole of your foot towards you. 4. When you cannot move farther on your own, assist yourself gently with your L hand. 5. Hold for 2 seconds. 6. Return to the starting position. REPEAT the above sequence turning your ankle #2 - slightly inward (leading with your big toe) you move your foot towards floor and then #3 - slightly outward (leading with your little toe) as you move your foot towards the ceiling. Advanced Movement: Precautions: Overexertion can cause camping in the sole of your foot. Keep your upper and lower body relaxed. Engage your abdominals and calves. As your flexibility improves, add the movement of your toes into the stretch. Health Tips: After an ankle sprain or strain scar tissue develops in the ankle joint. This stretch is particularly beneficial for keeping the scar tissue as pliable as possible. Keep your toes relaxed. 7

8 Advanced Ankle Plantar Flexion 1 3 Area Being Stretched: Front of Shin and Top of Foot Muscles Emphasized: Distal attachments of Dorsal Flexors 1. Lie on your back with your strap wrapped around the sole of your R foot. Hold one strand in each hand. 2. Straighten your R leg and lift it up towards the ceiling. 3. When you feel a stretch behind the back of your knee, lower your leg a few degrees until you no longer feel the stretch. 4. Lock your R knee, keeping your toes relaxed. 5. Bend your R ankle upwards towards the ceiling. 6. There is no assist for this movement. 7. Hold for 2 seconds. 8. Return to the starting position. REPEAT the above sequence turning your ankle #2 - slightly inward (leading with your big toe) and then #3 - slightly outward (leading with your little toe) as you move your foot towards ceiling. Advanced Movement: Precautions: Overexertion can cause camping in the sole of your foot. Keep your upper and lower body relaxed. Engage your abdominals and calves. Keep your toes relaxed. As your flexibility improves, add the movement of your toes into the stretch. Health Tips: After an ankle sprain or strain scar tissue develops in the ankle joint. This stretch is particularly beneficial for keeping the scar tissue as pliable as possible. Mr. Stretchy: When an ankle strain/sprain is in the acute phase these movements may cause some anxiety. Move slowly and gently! 8

9 Ankle Inversion Area Being Stretched: Outside of Calf Muscles Emphasized: Proximal attachments of Peroneals 1. Lie on your back with your strap wrapped around the sole of your R foot. Hold one strand in each hand. 2. Flex your R ankle to a 90 degree angle. 3. Straighten your R leg. 4. Lock your R knee; keep your toes relaxed and extend through your heel. 5. Turn your ankle inwards, towards your L foot. 6. Anchoring the strap with your R hand assist with your L hand. 7. Hold for 2 seconds. 8. Return to the starting position. Stretching the fascia: Keep your upper and lower body relaxed. Engage your abdominals, quadriceps and shins. Keep your knee locked throughout the movement. Keep your toes relaxed. 1. Straighten your R leg and lift it up towards the ceiling. 2. When you feel a stretch behind the back of your knee, lower your leg a few degrees until you no longer feel the stretch. 3. Continue the stretch as above. Health Tips: After an ankle sprain or strain scar tissue develops in the ankle joint. This stretch is particularly beneficial for keeping the scar tissue as pliable as possible. This stretch is exceptionally beneficial in the treatment of plantar fasciitis and heel spurs. 9

10 Ankle Eversion Area Being Stretched: Inside of Calf Muscles Emphasized: Proximal attachments of Tibialis Anterior and Extensor Hallucis Longus Stretching the fascia: Keep your upper and lower body relaxed. Engage your abdominals, quadriceps and shins. Keep your knee locked throughout the movement. Keep your toes relaxed. 1. Straighten your R leg and lift it up towards the ceiling. 2. When you feel a stretch behind the back of your knee, lower your leg a few degrees until you no longer feel the stretch. 3. Continue the stretch as above. Health Tips: This is a key component in the treatment of pain in the arch of the foot. 10

11 Foot Supination Area Being Stretched: Top of Foot Muscles Emphasized: Extensor Digitorum Longus and Intrinsic Foot Muscles 1. Cross your R ankle over your L thigh. 2. Place your L hand on the top of the heel of your R foot. 3. Wrap your R hand around your R foot by placing the webbing of your thumb over your arch and your fingers reaching over the top of your foot. 4. Use your L hand to hold your heel in place as you gently turn only your foot up and inward, towards your face. 5. When you cannot move farther on your own, assist yourself gently with your R hand. 6. Hold for 2 seconds. 7. Return to the starting position. REPEAT the above with 3 different hand placements. The first position is at the bottom of your foot. The next two positions move towards your ankle about half the width of your hand with each repetition. Health Tips: Keep your heel in place throughout the movement. Keep your toes and ankle relaxed. This stretch is very helpful to get your foot moving again after an ankle sprain. 11

12 Foot Pronation Area Being Stretched: Bottom of Foot Muscles Emphasized: Flexor Digitorum Longus, Tibialis Posterior and Intrinsic Foot Muscles 1. Cross your R ankle over your L thigh. 2. Place your R hand under the heel of your R foot. 3. Wrap your L hand around your R foot by placing the webbing of your thumb over your arch and your fingers reaching over the top of your foot. 4. Use your R hand to hold your heel in place as you gently turn only your foot down and outward, towards the floor. 5. When you cannot move farther on your own, assist yourself gently with your R hand. 6. Hold for 2 seconds. 7. Return to the starting position. REPEAT the above with 3 different hand placements. The first position is at the bottom of your foot. The next two positions move towards your ankle about half the width of your hand with each repetition. Keep your heel in place throughout the movement. Health Tips: This stretch is very helpful to get your foot moving again after an ankle sprain. Keep your toes and ankle relaxed. 12

13 Toe Rotation Area Being Stretched: Webbing of Toes Muscles Emphasized: Lumbricals and Interossei 1. Sit in a position that allows you to have your R hip and knee bent and your R foot resting in front of you. 2. Use your thumb and 1 st finger to hold your rotated toe at the base of the joint that is rotated. 3. Turn your toe in the opposite direction of its rotated position. 4. When you cannot move farther on your own, assist yourself gently with your finger and thumb. 5. Hold for 2 seconds. 6. Return to the starting position. Precautions: These tissues can be extremely sensitive. Work slowly and very gently! Keep your heel in place throughout the movement. Keep your foot and ankle relaxed. 13

14 Toe Dorsal Flexion Area Being Stretched: Bottom of Toes and Foot Muscles Emphasized: Plantar Flexors of the Toes (Emphasis is on the toe being stretched) 1. Sit in a position that allows you to have your R hip and knee bent and your R foot resting in front of you. 2. Grab your big toe with either hand. Cover bottom of your toe completely, with your pressure distributed evenly over each joint. 3. Bend big toe, lifting up towards the ceiling. 4. When you cannot move farther on your own, assist yourself gently with your hand. 5. Hold for 2 seconds. 6. Return to the starting position. REPEAT the above sequence with each toe, one after the other, until you have stretched each toe 8-10 times. Advanced Movement: As your flexibility improves, practice this movement with your ankle bent up towards the ceiling also. Helpful Hints: Precautions: Sometimes the surrounding skin takes on the shape of the dysfunctional muscles. If this has happened, move very slowly and gently as the skin may break if stretched too far. All of your toes should face forward when resting flat on the floor with their nail beds facing the ceiling. If your toes have angled away from or rotated out of their neutral position, turn them into a neutral position before you stretch them. Keep your upper and lower body relaxed. Engage your abdominals. Mr. Stretchy: Treat your feet! Regular use of skin moisturizer will help make your skin supple so that it is less likely to tear. 14

15 Toe Plantar Flexion Area Being Stretched: Top of Toes and Foot Muscles Emphasized: Dorsal Flexors of the Toes Mr. Stretchy: (Emphasis is on the toe being stretched) 1. Sit in a position that allows you to have your R hip and knee bent and your R foot resting in front of you. 7. Grab your big toe with either hand. Grab your toe with either hand. Cover top of your toe completely, with your pressure distributed evenly over each joint. 2. Hold your bottom big toe joint (ball of your foot). 3. Bend your toe, down towards the floor while keeping pressure on the ball of your foot. 4. When you cannot move farther on your own, assist yourself gently with your hand. 5. Hold for 2 seconds. 6. Return to the starting position. REPEAT the above sequence with each toe, one after the other, until you have stretched each toe 8-10 times. Advanced Movement: As your flexibility improves, practice this movement with your ankle bent backwards towards you as well. Precautions: These tissues can be extremely sensitive and tight. Work slowly and very gently. Keep your upper and lower body relaxed. Helpful Hints: All of your toes should face forward when resting flat on the floor with their nail beds facing the ceiling. If your toes have angled away from or rotated out of their neutral position, turn them into a neutral position before you stretch them. Engage your abdominals. 15

16 Toe Ab/Adduction 1 3 Area Being Stretched: Webbing of Toes Muscles Emphasized: Interossei and Lumbricals 1. Sit in a position that allows you to have your R hip and knee bent and your R foot resting in front of you. 2. Grab your 2 nd and 3 rd toes with your hands. Cover the tops and bottoms of your toes completely, with your pressure distributed evenly over each joint. 3. Spread your toes away from each other. 4. When you cannot move farther on your own, assist yourself gently with your hands. 5. Hold for 2 seconds. 6. Return to the starting position. REPEAT the above sequence moving your toes away from each other at 45 degree angles #2 - upward and #3 - downward. Precautions: These tissues can be extremely sensitive and tight. Work slowly and very gently. Sometimes the surrounding skin takes on the shape of the dysfunctional muscles. If this has happened, move very slowly and gently as the skin may break if stretched too far. Helpful Hints: All of your toes should face forward when resting flat on the floor with their nail beds facing the ceiling. If your toes have angled away from or rotated out of their neutral position, turn them into a neutral position before you stretch them. Keep your upper and lower body relaxed. Engage your abdominals. 16

17 Big Toe Adduction 1 3 Area Being Stretched: Inside of Big Toe Muscles Emphasized: 1 - Adductor Hallucis, 2 - Flexor Hallucus Brevis, 3 - Extensor Hallucis Brevis 1. Sit in a position that allows you to have your R hip and knee bent and your R foot resting in front of you. 2. Place the webbing of your L hand directly over the base of your big toe. Hold your 2 nd toe back with the middle finger of your R hand. Place the thumb and pointer finger of your R hand against your big toe. 3. Spread your big toe away from your 2 nd toe. 4. When you cannot move farther on your own, assist yourself gently with your R fingers. 5. Hold for 2 seconds. 6. Return to the starting position. Alternate Position: Rest your R ankle over your L knee and proceed as above. REPEAT the above sequence moving your big toe away from your 2 nd toe at 45 degree angles #2 - upward and #3 - downward. Precautions: These tissues can be extremely sensitive and tight. Work slowly and very gently. Sometimes the surrounding skin takes on the shape of the dysfunctional muscles. If this has happened, move very slowly and gently as the skin may break if stretched too far. Helpful Hints: All of your toes should face forward when resting flat on the floor with their nail beds facing the ceiling. If your toes have angled away from or rotated out of their neutral position, turn them into a neutral position before you stretch them. Keep your upper and lower body relaxed. Engage your abdominals. Health Tips: This series of stretches is the key to treating bunions. 17

18 Little Toe Abduction 1 3 Area Being Stretched: Inside of Little Toe Muscles Emphasized: Flexor Digitorum Brevis, Interossei Mr. Stretchy: and Lumbricals 1. Sit in a position that allows you to have your R hip and knee bent and your R foot resting in front of you. 2. Place the thumb and 2 nd finger of your R hand against bottom joint of your little toe. 3. Place the 2 nd and 3 rd fingers of your R hand on the 4 th toe of your R foot to hold it in place. Use your R thumb to assist your little toe. 4. Spread your little toe away from your 4th toe. 5. When you cannot move farther on your own, assist yourself gently with your R fingers. 6. Hold for 2 seconds. 7. Return to the starting position. REPEAT the above sequence moving your little toe away from your 4 th toe at 45 degree angles #2 - upward and #3 - downward. Precautions: These tissues can be extremely sensitive & tight. Work slowly and very gently. Sometimes the surrounding skin takes on the shape of the dysfunctional muscles. If this has happened, move very slowly and gently as the skin may break if stretched too far. Helpful Hints: All of your toes should face forward when resting flat on the floor with their nail beds facing the ceiling. If your toes have angled away from or rotated out of their neutral position, turn them into a neutral position before you stretch them. Keep your upper and lower body relaxed. Engage your abdominals. 18

19 Key for Protocols of the Ankle and Foot - Name of Stretch Muscles Stretched Ankle Dorsal Flexion 1-9 Proximal Plantar Flexors Ankle Plantar Flexion 1-3 Proximal Dorsal Flexors Advanced Ankle Plantar Flexion 1-3 Distal Dorsal Flexors Ankle Inversion 1 Proximal Evertors Ankle Eversion 1 Proximal Invertors Foot Supination 1 Lumbricals Foot Pronation 1 Lumbricals Toe Rotation 1 Lumbricals Toe Dorsal Flexion 1 Toe Plantar Flexors Toe Plantar Flexion 1 Toe Dorsal Flexors Toe Add/Abduction 1-3 Lumbricals Big Toe 1-3 Lumbricals Little Toe 1-3 Lumbricals 19

20 Complete Ankle and Foot Protocol - Expect the entire protocol for the ankle and foot to take minutes per foot depending on your condition. Stretch - Page Ankle Dorsal Flexion 1-3 A4 Ankle Dorsal Flexion 4-9 A5-A6 Ankle Plantar Flexion 1-3 A7 Advanced Ankle Plantar Flexion 1-3 A8 Ankle Inversion 1 A9 Ankle Eversion 1 A10 Foot Supination 1 A11 Foot Pronation 1 A12 Toe Rotation 1 A13 Toe Dorsal Flexion 1 A14 Toe Plantar Flexion 1 A15 Toe Add/Abduction 1-3 A16 Big Toe 1-3 A17 Little Toe 1-3 A18 20

21 Sprains and Strains The timing below considers 1 side. Primary Purpose - If the injury occurred within the last 48 hours, the primary purpose is to reduce inflammation, stop muscle spasm and restore stability. If the condition is chronic, the primary purpose is to restore flexibility and strength. If the arch has deteriorated, you can restore it through diligent strengthening of the muscles that support the arch. Common Challenges - Joint deterioration, ligament instability and scar tissue are common challenges in resolving chronic ankle sprains and strains. Long Term Goals - Restore stability to the ankle, especially in the lateral compartment. Realign scarred tissue. Strengthen the muscles of the arch. Restore balance through proprioceptive exercises. Stretch Page Ankle Dorsal Flexion A4-6 Ankle Plantar Flexion 1-3 A7 Advanced Ankle Plantar Flexion 1-3 A8 Ankle Inversion 1 A9 Ankle Eversion 1 A10 Foot Supination 1 A11 Foot Pronation 1 A12 Toe Rotation (as needed) 1 A13 Tor Dorsal Flexion 1 A14 Toe Ab/Adduction 1 A16 Toe Plantar Flexion 1 A15 21

22 Hallux Vargus aka Bunions Treat a bunion of the little toe, a tailor s bunion, in the same manner. Primary Purpose - Return proper alignment to the joints of the big toe and create an environment in which the body can reabsorb the calcium it has laid down in order to protect the joint. Common Challenges - Weakness in the adductor hallucis (muscle on the inside of the big toe) and great sensitivity of the affected joint are the biggest challenges. Severe tension in the muscles on the back of the calf (plantar flexors) can also be a major stumbling block as they keep the your weight on the balls of your feet, which in turn places more pressure on the bunion. Long Term Goals - Create strength in the weak tissues of the big toe and the arch. Stretch all the muscles on the back of the calf and strengthen all the muscles on the front of the shin. Stretch Page Ankle Dorsal Flexion A4-6 Ankle Plantar Flexion 1-3 A7 Big Toe Adduction 1-3 A17 Ankle Inversion 1 A9 Ankle Eversion 1 A10 Big Toe Adduction 1-3 A17 Foot Supination 1 A11 Foot Pronation 1 A12 Toe Rotation (as needed) 1 A13 Tor Dorsal Flexion 1 A14 Toe Plantar Flexion 1 A15 22

23 Heel Spur - The timing below considers 1 side. Primary Purpose - Create a healthy environment that allows the body to reabsorb the calcium that has created the spur. Common Challenges - Inflammation in the tissues that attach at the site of the spur creates a very painful situation that will require a gentle touch. Long Term Goals - Open up all the tissue of the foot and ankle to allow for proper circulation, which in turn will eliminate inflammation. Once the inflammation has been reduced create strength throughout the ankle and foot. Stretch Page Ankle Dorsal Flexion 1-9 A4-6 Ankle Inversion 1 A9 Ankle Eversion 1 A10 Ankle Plantar Flexion 1-3 A7 Advanced Ankle Plantar Flexion 1-3 A8 Foot Supination 1 A11 Foot Pronation 1 A12 23

24 Plantar Fasciitis - Follow the same protocol as with a heel spur to eliminate plantar fasciitis. Primary Purpose - Eliminate inflammation of the plantar fascia (sole of the foot). Common Challenges - Inflammation in the plantar fascia has led to severe muscle spasms, especially in the intrinsic muscles of the foot. The dorsal flexors are often very tight, placing too much pressure on the foot. Long Term Goals - Open up all the muscles of the foot and ankle to allow for proper circulation, which in turn will eliminate inflammation. Once the inflammation has been reduced create strength throughout the ankle and foot. This combination of stretching and strengthening will stop the cycle of muscle spasm, which will allow for the inflammation to go away. Fallen Arch Even though a fallen arch may require stretching the problem is more related to a lack of strength than a lack of flexibility. Follow the protocol for a raised arch for stretching and begin a rigorous strengthening routine immediately. If strengthening is done no less than every other day you can expect to see the positive results within 6 months. Here are some other issues to look for when considering the condition of the arch. Are your hips strong and flexible? Are your knees strong and flexible? Weakness in the stabilizers of the hip can be especially problematic as you go down the kinetic chain to the feet. The same can be said about the feet. If they are unstable, problems can occur up the kinetic chain into your knees, hips and on up the spine to your head! 24

25 Raised Arch - The timing below considers 1 side. Primary Purpose - Stretch the muscles of the arch. Common Challenges - Chronically tight plantar flexors, especially gastrocnemius may make progress slow. Long Term Goals - Stretch all of the muscles of the arch, including all of the muscle on the back of the calf. Stretch Page Ankle Dorsal Flexion 1-9 A4-6 Ankle Plantar Flexion 1-3 A7 Advanced Ankle Plantar Flexion 1-3 A8 Ankle Inversion 1 A9 Ankle Eversion 1 A10 Foot Supination 1 A11 Foot Pronation 1 A12 25

26 Achilles Tendonitis/Tendonosis - The timing below considers 1 side. If the ankle is stuck in a downward position, begin with movements of dorsal flexion. If the opposite is the case, begin with movements of plantar flexion. Primary Purpose - Restore appropriate circulation to the affected area. Common Challenges - A very sensitive stretch reflex and weakness due to prolonged lengthening of the muscles around the joint are common stumbling blocks to relieving this condition. Long Term Goals - Release the contracted muscles and strengthen the lengthened muscles. Stretch Page Ankle Dorsal Flexion 1-9 A4-6 Ankle Inversion 1 A9 Ankle Eversion 1 A10 Ankle Plantar Flexion 1-3 A7 Advanced Ankle Plantar Flexion 1-3 A8 26

27 Edema - The timing below considers 1 side. Primary Purpose - Restore circulation to the tissues of the foot and ankle. Common Challenges - Chronically tight plantar flexors (the muscles on the back of your calf); especially gastrocnemius may make progress slow. The soleus often requires much strengthening to get the circulation pumping strongly through your ankle and foot again. Long Term Goals - Stretch all of the muscles of the foot and ankle. Follow this work up with strengthening of the back of the calf for long lasting results. Stretch Page Ankle Dorsal Flexion 1-9 A4-6 Ankle Plantar Flexion 1-3 A7 Advanced Ankle Plantar Flexion 1-3 A8 Ankle Inversion 1 A9 Ankle Eversion 1 A10 27

28 Hammer Toes - The timing below considers 1 side. Primary Purpose - Create balance between the front and back of the ankle, foot and toes. Common Challenges - Weakened muscles in the front of the foot, combined with overly tight muscles in the bottom of the foot can make complete resolution of this condition difficult. Long Term Goals - Restore flexibility to the entire foot and ankle. Create the needed strength in your foot and toes to counter the demand placed upon them that created this problem in the first place. Stretch Page Ankle Dorsal Flexion 1-9 A4-6 Ankle Plantar Flexion 1-3 A7 Advanced Ankle Plantar Flexion 1-3 A8 Toe Plantar Flexion 1 A15 Ankle Inversion 1 A9 Ankle Eversion 1 A10 Advanced Ankle Plantar Flexion 1-3 A8 Foot Supination 1 A11 Foot Pronation 1 A12 Toe Rotation (as needed) 1 A13 Tor Dorsal Flexion 1 A14 Toe Plantar Flexion 1 A15 28

29 29