An ankle cast is often applied after a fracture or major surgery. Once your cast has been removed, your muscles will have atrophied from lack of use and will need to be strengthened. Your physical therapy will start with strengthening your ankle muscles and progress to ambulation, stair negotiation and the restoration of balance. Complying with your doctor's limitations while the cast in is place will allow your body to heal and facilitate the best recovery.
Ankle Strengthening
Your therapist will use a band or a weighted cuff to provide resistance to your ankle muscles while you perform a variety of exercises. Ankle circles clockwise and counterclockwise help to target the stabilizer muscles and provide mild strengthening to all your ankle muscles. Bending your ankle up and down and side to side will improve the strength of your large muscle groups. You can advance your exercises in PT by standing on the affected leg and completing ankle lifts on an inclined plane.
Functional Tasks
Once you are allowed full weight bearing on your foot, which often comes at the time your cast is removed, you will be able to begin functional activities to prepare for your routine home activities and restore your independence. Walking with a walker or crutches at first, your PT may advise you to walk with a cane or without any device, depending on the progress that you've made in PT. As your ankle heals further, you will be able to tolerate walking for longer distances without severe pain and may begin to climb stairs.
Balance
Most people with a severe ankle injury suffer from impaired proprioception of the ankle, which is the body's awareness of the location of the ankle. Proprioception in the ankle is a vital component of balance, and when it is impaired you will have a greater risk of falling or reinjury to the ankle. Your PT will target this impairment by challenging your balance with a series of tasks such as standing on one foot, keeping your balance with your eyes closed or standing on a soft, unstable surface such as a thick foam pad.
Modalities
Modalities are often used in physical therapy sessions to control pain and encourage tissue healing. Iontophoresis or phonophoresis use medication activated by ultrasound or electrical stimulation to penetrate the muscle fibers and reduce pain. Ultrasound and electrical stimulation themselves can encourage tissue regeneration and reduce pain. Massage can help to break apart scar tissue, reduce muscle tension and alleviate pain. Heat or infrared light treatment can provide mild pain relief as well.
