Ankle Home Exercise Program
Patient name: ___________________________
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Date Instructed |
Rechecked |
Performed Correctly |
Comments |
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Ankle ROM-PF; DF INV; ERV |
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Alphabet Exercise |
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Resisted dorsiflexion |
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Resisted plantar flexion |
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Resisted inversion |
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Resisted eversion |
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Gastroc stretch |
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Soleus stretch |
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Toe curls (towel) |
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Heel rises (standing plantar flexion) |
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Single leg balance |
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‡ roll plantar flexion/dorsiflexion |
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‡ roll inversion/eversion |
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C.C. Dorsiflexion |
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C.C. Plantar
flexion |
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________ =
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Signature