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The ankle consists of the tibia and fibula (lower leg) bones and a dome-shaped bone called the talus that sits below. There is another joint below the talus bone that also creates movement at the ankle. The foot has 26 different bones with over 100 muscles, tendons, and ligaments running over them to provide flexibility yet rigidity necessary for walking.
Ankle sprains can be the result of weaknesses and excessive force through the ankle joints. A high ankle sprain occurs when the talus bone is forced upward and irritates the joint between the lower leg bones. Outer and inner ankle sprains can occur during quick movements, such as sprinting during sports or stepping on an uneven surface resulting in "rolling" the ankle. Some other familiar sources of ankle and foot pain include Achilles tendonitis, plantar fasciitis, and bunions on the great toe.
The physical therapy exam for the ankle and foot begins with assessing the hip and knee for impairments. Assessing all of the joints involved in the ankle and foot is also critical to identify where the pain is originating from. Intrinsic foot strengthening, balance, and hip and knee strengthening are all critical components of the physical therapy plan of care.
Physical therapy is critical to reducing the likelihood of re-injury in the future. According to an article published in Physical Therapy in Sport, patients with chronic ankle instability had lower ankle and hip peak torque compared to those who did not, further supporting the importance of hip and knee strengthening in rehabilitation protocols. Another article from the Physical Therapy Journal found that home-based exercise programs had similar scores in range of motion, adherence, and motivation to the program compared to those who went through programs at a physical therapy clinic. A comprehensive physical therapy home exercise program can reduce pain and improve ankle mobility.
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