One must consider all the major muscles associated with the foot, ankle and lower leg. A program of three stages might include the following.

Stage One – Early rehabilitation (all exercises must be pain free before beginning stage two).

  1. Writing the alphabet with toes pointed. Three times.
  2. Picking up objects one at a time with the toes, such as ten marbles, and placing them in a container.
  3. Gripping and spreading the toes ten times.
  4. Ankle circumduction. Ten circles in one direction and then the other.
  5. Flatfooted Achilles’ tendon stretching. With the foot flat on the floor, the Achilles tendon is stretched first with the foot straight ahead, then with the foot turned in, and finally turned out. Each stretch is held for 20 to 30 seconds and repeated two to three times.
  6. Toe raises. Standing flat on the floor, rise on the toes as far as possible, with the toes pointed straight ahead, pointed in, and then pointed out.
  7. Walking on toes and heels. Walk ten paces forward on toes and then ten paces back on the heels.

Stage Two – Intermediate rehabilitation.

  1. Towel gather. Gather a towel spread forward with the toes. Heal planted.
  2. Towel scoop. Scoop a towel spread to either side of the foot with the toes. Heal planted.
  3. Achilles tendon stretch and toe raise. Stand on a raised area such as a step with heels over the edge. Raise the heels as far as possible and then return to stretch. Perform this with toes pointed straight ahead, pointed in, and then pointed out.
  4. Resistance. Exercise anterior, lateral, and medial leg muscles against resistance, such as surgical tubing or an inner tube strip. The rubber is attached around a stationary table or chair leg. Put the tubing around the foot and pull the forefoot into dorsiflexion and eversion. Reverse the position and exercise the foot in plantar flexion and inversion.

Stage Three – Advanced rehabilitation.

  1. Rope Jumping. Five to ten minutes daily.
  2. Heel-toe and then on-toe running. Start with heel-toe jogging until a mile distance can be performed easily. Jogging is then shifted to jogging 50 yards and on-toe running 50 yards, graduating to all on-toe running for one mile.
  3. Zigzag running. Run in a zigzag pattern graduating from slow to full speed without favoring the leg.
  4. Backward running. A final exercise for returning full ankle and lower leg function is running backwards in an on-toe manner.
Dr. Kenneth Simpson photo