Having a cast on your leg can turn simple daily tasks into bigger challenges. After your cast is removed, physical therapy can help restore your movement, strength and function. Because a variety of ankle injuries require casting, see a physical therapist for an exercise program customized to your specific diagnosis once your cast is removed.
Skin After Cast Removal
You might be surprised by your skin after cast removal. Dead skin hasn't been able to slough off, and new skin underneath might be tender. Although you might be tempted to scrub it off, damaging the new skin can lead to wounds and infection. Your physical therapist will teach you how to gently clean and care for your leg to protect the new skin with gentle soap and nonperfumed lotion or cocoa butter.
Physical Therapy Modalities
Physical therapy uses a variety of modalities, or physical agents, to aid in recovery of a broken ankle after cast removal. Thermal modalities include heat and cold in several different forms to speed up the healing process.
Heat modalities can be categorized as superficial or deep, depending on the target structures. Superficial heat, such as a hot pack or warm whirlpool, might be used to increase blood flow to your ankle prior to exercise or other functional activities in your PT sessions. These modalities heat tissues that are close to the surface of your skin. Superficial heat also helps decrease soreness, muscle tightness and stiffness.
Deep heat modalities include agents such as ultrasound (sound waves) and diathermy (high-frequency electrical current). These modalities heat deeper tissues in your ankle without overheating your skin. Deep heat modalities increase blood flow in your underlying muscles and ankle joint and help decrease pain.
In some cases, heat modalities can't be used. If you have an open wound, raw skin, metal screws or plates in your ankle, these modalities could be inadvisable.
Cold therapy, also called cryotherapy, is also commonly used in physical therapy and at home after injury. In fact, if you've ever applied ice to your ankle, you've experienced cryotherapy. In addition to cold packs, physical therapy professionals also use cold compression units, which help pump out swelling while cooling your ankle. Because cold decreases blood flow, it's often used at the end of PT sessions to decrease post-exercise pain and swelling.
Electrical stimulation is another modality commonly used in physical therapy. Different types of stimulation have different benefits. This modality can be used to help decrease pain and swelling, or to help contract ankle muscles that are weak.
Range-of-motion activities are key exercises for your ankle after the cast comes off. Movement helps decrease stiffness and also helps reduce swelling that might still occur.
Active range-of-motion exercises are typically initiated first. This means that you're actively moving your ankle within your pain tolerance. Exercises might include ankle circles, pointing your toes, pulling them toward the ceiling and writing the alphabet in the air. These exercises also help begin to strengthen your leg muscles as you move them against gravity.
You won't be able to get full active motion until your passive motion is restored. Passive range-of-motion exercises are often performed by the physical therapist (PT). Or the PT might teach you to perform them yourself by wrapping a towel around your foot and gently pulling until you feel a stretch in your ankle. These exercises decrease stiffness in your ankle and foot.
Joint Mobilization Techniques
Your PT professional might also use joint mobilization techniques to decrease stiffness in your ankle and foot. These techniques each help improve a specific movement that you might be having difficulty with. Joint mobilization is different from passive range of motion. Rather than moving your entire ankle, the therapist is stretching structures inside the joint itself.
Ankle Strengthening Exercises
Strengthening exercises typically start in a seated position after a leg cast is removed because your balance is not yet up to par. Early strengthening exercises might include marble pickup or towel curls for the muscles that curl and straighten your toes.
The four-way ankle exercise is commonly performed in physical therapy after leg injury. It uses a resistive band or tubing to strengthen your ankle in the four main ways it moves — dorsiflexion (pulling foot up toward the ceiling), plantarflexion (pointing toes down toward the ground), eversion (tilting the sole of your foot outward) and inversion (tilting the sole of your foot inward). As strength improves, heavier bands are used.
Although your cast has been removed, your ankle might still be healing. Your doctor might limit the amount of weight you can put on your leg, requiring you to continue using crutches. Standing exercises will begin once you're cleared to put full weight on your leg.
Ankle Balance Activities
Balance activities in physical therapy often begin with just standing on your injured leg. Initially you might practice shifting weight from the opposite side to the affected side, then progress up to standing on only the injured foot for specific amounts of time.
Higher-level balance activities might include toe raises, heel raises, walking on your toes or heels, tandem walking along a line and standing on one foot with your eyes closed.
Balance is also progressed by standing on an uneven surface, such as a balance board, foam, rocker board or pillow — first with your eyes open, then working up to eyes closed.
Back to Work and Play
Once your ankle is fully healed and your movement, strength and balance have been restored, physical therapy will focus on getting you back to your normal daily life. Depending on your diagnosis, this could be several months or more after your initial injury occurred.
Therapy sessions might include work-conditioning exercises or activities that simulate your job duties. These activities typically condition your whole body rather than focus on your ankle.
Return to sport is another important goal for physical therapy after ankle injury. Sports-specific activities such as running, jumping, step-ups and agility drills are included in these sessions.
- Physiotherapy Services: Advice: After the Removal of a Lower Leg Cast
- American Physical Therapy Association: Physical Therapist's Guide to Ankle Fracture
- American Academy of Physical Medicine and Rehabilitation: Therapeutic Modalities
- Wolters Kluwer: Foot and Ankle Mobilization
- Pine Plains Central School District: Ankle Strengthening Exercises