MR: Pain in the Top of the Foot and Tightness in the Right Thigh In Office Visit (3-20-18, 3-22-18, 4-10-18, 4-24-18, 5-8-18)

Evaluation Summary
- Subjective Report: pain in both ankles that varies in different regions. The pain is worst in the left foot on the top and lateral aspect of the ankle. There are also some symptoms in the right ankle that just started a couple weeks ago. Pain seems to occur on the left with tapping toes on the ground and going down stairs
- Objective findings
  - Excessive ankle mobility with no limitations in range of motion similar to the hip
  - Manual strength testing reproduced no pain or significant weakness
  - Heelraise at the wall: only able to do 5-6 reps on one leg with significant fatigue but no pain
  - Double leg heelraise 10x with no problems
  - Gait: Improved since previous assessment with reduced lateral shift of trunk when stepping onto R leg
  - Squat: significant collapse of the arch of the foot with pronation, similar to walking down stairs
    - Immediate reduction in pain when focused on maintaining outward position of knee to reduce collapse of the foot
  - Mild to moderate swelling lateral ankle more so on the left compared to the right
Updated program (5-8-18)
- 109) Band Around Knees bridge Progression VIDEO
  - 8-20 reps
- Heelraise holds on the floor or off edge of step for time just keeping heels off the ground
  - You did: 1:10 last session
- 109) Band Around Knees bridge Progression VIDEO
  - 8-20 reps
- At table height, leaning over table and keeping heels off the ground doing a small pumping motion in a painfree range or just holding heels off ground for time
  - you did :44sec here
- 109) Band Around Knees bridge Progression VIDEO
  - 8-20 reps
- 170.5) 1/2 kneel Clamshell or Foot on Stool VIDEO
  - red band
Updated program (4-24-18)
- Focus on knee position with daily activities…KNEES OUT
- During the day
  - 123) Seated Heelraise VIDEO
    - 5-10x at a time
    - Stay in a range that is not painful…so you do not need to go down all the way
  - 120) Tibialis Posterior Seated Sweep VIDEO
    - Do this lightly and focus on not going too far into the motion
- Strength movements: Can be done 1x/day or every other day if too difficult and giving you muscle soreness
  - Heel raise Progression (Get progressively harder…start at the top and work for 8-20 reps, if you get 20 reps, progress to the next movement below)
    - 124) Double Leg Heel Raise VIDEO
    - 125) Double Concentric/Single Leg Eccentric VIDEO
    - 126) Single Leg Concentric/Eccentric VIDEO
      - FOCUS ON WORKING TOWARDS 8-15 REPS
  - 150) Squat with Forward Reach Band Around Knees VIDEO
    - 8-20 reps
      - Progress to the step down below
      - 148) Step Down Progression VIDEO
  - 109) Band Around Knees bridge Progression VIDEO
    - 8-20 reps
  - 186) Sagittal Plane Stability VIDEO
    - you did 35sec…work up to 60-90sec
  - 141) Band Horizontal Abduction VIDEO
    - red band 8-20 reps
  - NEW:
    - Single leg holds off the edge of the step with heel off edge of step just hold on one leg without letting heel drop down
      - 30 sec to 2 min
    - On 2 feet small pumps keeping heels off ground for time
      - 30sec-2 min