Several Months ago I fractured my talus (ankle bone above heel). Last week I went waterskiing and I thought I was doing great. During my ski run I noticed that I was favoring my heel on the injured foot big time! I have tried a couple of things to rehabilitate my ankle: Flamingo Stands, toes raises, and balancing on the injured foot. I cannot do flamingo stands without holding onto something for balance. Do you have any tips for rehab for a talus fracture?
Answer:
I like to break the rehabilitation process into three distinct phases. Phase I includes ensuring return of normal Range of Motion (ROM), increasing proprioception, reducing inflammation, and decreasing pain. Phase II includes Phase I and beginning strengthening. In Phase III, the focus shifts to advanced strengthening. You should not progress to the next phase until the criteria have been met for the current stage of rehab. Ice is an athlete's friend. You should ice after your rehab session or after you water-ski. Ice should be used any other time as needed by the athlete, whether it is in the form of an ice pack, ice massage, or ice bath.
While toe raises are good, do not begin with those exercises. Begin Phase I of rehab by working to restore ROM and proprioception. Proprioception can be best understood as your body's awareness of the particular joint movement and position at all times in its local environment. Also, the ability to remain stabilized when changes or abnormal movements occur. Focus on exercises such as balancing on an Indo Board or wobble board. Balancing on one foot is another excellent way to regain proprioception. You will find it difficult at first, often needing to hold on to something for balance. As your proprioception increases, the task will become less challenging. To keep it challenging, try the exercises with your eyes closed. Your ankle is capable of four ranges of motion: Inversion (rolling the foot inward), Eversion (rolling the foot outward), Dorsi Flexion (toes up heel down), Plantar flexion (walking on toes) or any combination of these. Writing the alphabet with your ankle (keeping the lower leg still) and stretching with the aid of a theraband (rubber tubing that comes in different resistance strengths) are great methods of restoring your ROM. Be sure to include stretches of the lower leg and Achilles tendon.
Dr. Weyman's Tips:
Indo Board:
Place feet equally on an Indo Board. When on the board keep yourback straight and butt tucked in. Work on balancing, then going from side to side in controlled manner. Hold handle and simulate skiing for a variation. When comfortable begin shifting more weight from one foot to another putting more balance on injured ankle.
Theraband:
With uninjured foot anchored (in picture left), bring injured foot (right) out away from the left one. Begin with light resistance, moving to heavier resistance as strength increases. Work all four ranges of motion using uninjured foot as anchor.
Single Leg Balance Rows On Block:
Place your foot on a wooden block. Come down into a deep squat keeping the back straight. Looking at the horizon will aid in keeping the back straight. Pull dumbbell up towards chest keeping elbow in close to the body.
Once ROM and proprioception are restored, you can move to Phase II of the rehab process. Good beginning strengthening exercises include walking on your toes, walking on your heels, toe raises (with your feet straight, inverted, and everted), and theraband exercises. Due to the body's position when you hit the ramp, walking on the outer edges of your feet will build strength for that lateral weight bearing.
In Phase III, advanced strengthening, you want to begin incorporating more sports specific exercises. Add exercises that require more weight bearing. Try single leg bent-over rows while balancing on a wood block. Do toe raises off a step, dropping as far down as possible before raising up again. Increase your resistance on the theraband exercises. Do leg exercises while balancing on a trampoline. To prepare for landing after your jump, do depth jumps off a box that is 24 inches off the ground. Then advance to depth jumps from 36 inches off of the ground. Be sure you are landing on a semi-soft surface that is flat and even. For added difficulty, when jumping, land onto a trampoline. The trampoline's surface will help simulate the ever-changing water surface. This would be much better than leg hops for water-skiing. By following these guidelines you will rehab your ankle faster and make it stronger and decrease the chance of re-injury.
Article and photos courtesy of Dr. Terry Weyman - www.chiropractic-sports.com