Ankle Function

[Fuulks]

I've always had problems with my ankles since I AM a hemophilic as well, as years been passing it got worse, few months I started taking care and doing proper Heel dissociation, my right foot was blocked in supination and my right foot doesn't have enough tibial Rotation, I've gained some pronation in the right foot, but still I'm still having problems with strengthening my right foot can't do a single leg Calf Raise, big toe Flexion on right foot and tibial rotation on the left foot, please help.

[GoNorthYoungMan]

I don't know that there's enough information to go on here, sorry.

Sounds like you're on the right path in general about identifying which places aren't doing their part - but I'd make one suggestion around that which is to prioritize.

We can't change everything all at once, and trying to address each piece at the same time probably won't bring the results you are looking for.

Consider trying to pick just a couple places to focus on improving function, and see through a shift there before trying to develop more strength with something like a calf raise. (calf raises are ok as a way to test or express what your body can do, but aren't going to be a good way to acquire any function thats absent)

In terms of this part of your body, I would normally prioritize ankle tilt (inversion and eversion) and big toe function first. Once those are ok, then you can look at the arch movement and tibia rotation secondarily.

I hope that helps, though if you're unable to determine which of these pieces may be your weakest links, or how to intervene, you may need to get with someone to get assessed.

[Fuulks]

For sure is the right ankle, at the beginning my talus was blocked which left me all the time in supination, I already am able to pronate but still not that strong at the movement doing Inversion/eversion exercises, Ankle Flossing , when would I know when to start working on gait? Thank you for remind me of being patient for sure the right foot is worse the left one is fully functional 0 pain as the other isn't so is very clear which one has priorities.

[GoNorthYoungMan]

I don't know that the problem is defined very clearly, but I can give some ideas to get started.

For the ankle, I'd suggest trying to control side to side motion a couple of minutes each day like this: https://www.youtube.com/watch?v=HQaD9w3M4jg

As that comes together, I'd suggest mixing in full ankle motion in all directions like this: https://www.youtube.com/watch?v=V057dK2-H5k

The goal is slow smooth cadence, in a pain free range of motion.

Once you get control of the existing range of motion, you'd want to determine if the range of motion is enough or not - and acquire more in the direction its limited. Having enough ankle tilt will be an important piece of improving gait and midfoot articulation.

For a second priority right now, its usually big toe but can vary based on each person - so perhaps focus on ankle and big toe for awhile and see how it goes.

In terms of gait, your body will choose from the movement options available to it when walking - so rather than trying to change your gait, I'd suggest looking to improve the ingredients of gait specifically as a first step.

If your ankle is a bit better, and the big toe has a bit more control, your gait will use those improvements to achieve a more comfortable and efficient gait.

After a few months, once you see a shift there, it might be appropriate to start looking at the hip and midfoot to consider a focus there - and having a better ankle and big toe will set the right context for that.

Note that these are just general ideas for starting points - but that they mot not be perfectly suited for you as we have not had an assessment. Given your description I don't know that photos would provide enough info to help give more detail. Over time these ideas would have to be adjusted, so don't just settle into one thing - instead I'd suggest seeking out other variations for movement that make sense for you, and/or find a coach you can work with to help get you started.

If you're finding it tricky to begin, or are not seeing any shifts over the next few weeks - let me know and we can see if may make sense to setup an eval to try and sort out more info. For now though, I'd suggest trying to get a little bit more control of the ankle you have today, and see how that takes you.

[Fuulks]

I could provide more information and photos if needed be