This page is awaiting validation. It does not replace a consultation or a programme adapted to your situation.
Before choosing an exercise
Do not start this module with a suspected fracture or rupture, an unusually hot red foot, a concerning wound or significant unexplained pain. After surgery, immobilisation or confirmed rupture, your team’s instructions take priority. Ask which movements and loads are allowed.
Recent forefoot pain, a stiff big toe or a sensitive tendon attachment can also change the choice. One exercise may help in one situation and be unsuitable in another. Drawings explain movement; they do not prescribe a compulsory range.
Chapter sources [1] [2] [3] [4]
Understand the picture
Four exercises with different aims
Mobility
Regain permitted, comfortable movement.
Strength and balance
Build push-off and loading control gradually.
Sole of the foot
Stretch suitable tissue gently without forcing the toes.
How should you use the four cards?
Seated mobility practises simple ankle movement. Heel raises train calf push-off. Supported balance addresses loading control. The seated sole stretch mainly suits assessed plantar fascia pain when the toes can move comfortably.
You do not need every exercise. Select appropriate ones with your professional and use a manageable order. Add them to your exercise sheet and export a PDF. Precautions and sources accompany the selection; a printout is not a personal prescription.
Chapter sources [5] [6] [7] [8]
Your exercise sheet
Select the movements you would like to discuss with your physiotherapist. Your sheet includes the illustrations, steps and precautions from this page.
Exercises selected: 0
Choose at least one exercise to prepare your sheet.
1: Starting position. 2: Movement or hold. The drawing is simplified; follow the written instructions and limits.
Seated ankle movement
- Starting position
- Sit on a stable chair. Support your leg and leave the foot free without pulling on injured tissue. The movement must be permitted.
- Movement
- Gently bring the forefoot towards you, then point it away. Keep the knee quiet and stay within a comfortable range. Return slowly.
- Starting amount
- Start with 10 movements in each direction. One short daily session is a cautious starting point to adapt; the North Bristol leaflet describes 10 repetitions and allows more frequent sessions depending on the situation. If the response stays stable, add a short session as advised.
- Take care
- Do not force the foot towards you after Achilles rupture or surgery. Improve smooth movement first, then permitted range. Do not add resistance without advice.
- When to stop
- Stop for sharp pain, numbness or a lasting symptom increase. Sudden loss of function needs prompt advice.
Source for this exercise [5]
1: Starting position. 2: Movement or hold. The drawing is simplified; follow the written instructions and limits.
Two-legged heel raises on level ground
- Starting position
- Stand on level ground with feet comfortably apart, holding a stable counter. Full weight-bearing must be permitted and reasonably comfortable.
- Movement
- Raise both heels slowly, spreading pressure through the forefeet. Lower with control to the floor. Avoid letting the ankles roll sideways.
- Starting amount
- Suggested start: 1 set of 10 repetitions once daily if tolerated. This cautiously adapts the Berkshire leaflet, which gives 10 to 20 repetitions twice daily after sprain. A tendon programme needs its own prescribed dose.
- Take care
- Start flat, without a step or hanging heel. After several well-tolerated sessions, gradually build to 15 then 20 repetitions before discussing extra resistance. Big-toe or forefoot pain may require another version.
- When to stop
- Stop for sharp pain, loss of push-off or new swelling. Reduce the dose if walking or next-morning steps become clearly harder.
Source for this exercise [6] [10]
1: Starting position. 2: Movement or hold. The drawing is simplified; follow the written instructions and limits.
Single-leg balance with support
- Starting position
- Face a stable counter with hands or fingertips supported. Clear the floor. Loading the affected leg must be allowed and safe.
- Movement
- Lift the other foot slightly. Keep your pelvis as steady as possible and the supporting knee soft. Look ahead, then lower the foot slowly.
- Starting amount
- Hold for 5 to 10 seconds, 3 times on each side if both sides may be trained. NHS guidance suggests balance work at least twice weekly. Rest between attempts.
- Take care
- Keep support within reach. First progress towards the upper hold time before slightly reducing hand assistance. Do not close your eyes or move to an unstable surface without advice.
- When to stop
- Stop if the ankle gives way, balance is uncontrolled or sharp pain appears. Ask for an adaptation if you fear falling.
Source for this exercise [7]
1: Starting position. 2: Movement or hold. The drawing is simplified; follow the written instructions and limits.
Gentle seated plantar fascia stretch
- Starting position
- Sit and place the affected ankle on the opposite thigh if comfortable. This exercise is for assessed plantar fascia pain without toe movement restrictions.
- Movement
- Gently draw the toes towards the shin until you feel moderate tension under the foot. Release slowly. You may feel the tightened band with your other hand without strong massage.
- Starting amount
- Hold for about 10 seconds, release and repeat 10 times, twice daily if comfortable. This dose comes from IQWiG patient information. Reduce repetitions initially if needed with your clinician.
- Take care
- Do not pull harder to seek more pain. First work towards the suggested dose with comfortable technique. A stiff big toe, wound or reduced sensation needs adaptation.
- When to stop
- Stop for sharp joint pain, burning or tingling. If first steps become persistently more painful, pause and seek advice.
Source for this exercise [8] [11]
Understanding the suggested doses
The numbers are starting points from patient information and guidance, not a proven ideal dose for every diagnosis. Each card explains the context. A lower start may be needed with limited capacity or professional advice.
Achilles rehabilitation then needs a specific load and progression, often over months. Ten easy two-legged raises do not constitute a complete tendon programme. At the heel attachment, the early range should particularly avoid excessive compression.
What sensations are acceptable?
Moderate stretching tension or controlled muscle effort may be expected. Sharp pain, electric sensations, numbness or a tearing feeling is different. Stop and seek advice; sudden loss of push-off needs prompt assessment.
No pain score authorises every exercise. Compare walking, swelling and next-morning steps. If limping increases or symptoms remain clearly worse, reduce or pause the relevant exercise and have the programme adjusted.
How can you progress gradually?
Begin with stable technique and a tolerated dose. Increase one factor: a few repetitions, useful range or resistance selected with your physiotherapist. Allow time to observe recovery before changing again.
For balance, first improve control with support within reach. Closing your eyes, standing on an unstable surface or removing support is not compulsory. Moving strengthening to one leg can be substantially harder and should be prepared.
Why count the whole day?
Exercises add to walking, stairs, work and sport. After an unusually long standing day, the normal session may become too much. Adjusting a session is part of load management rather than failure.
As agreed with your clinician, you might keep only permitted mobility after an exceptional day and resume strengthening when reactions return to baseline. However, precise bone pain or a warning sign needs advice, not simply a lighter session.
Precautions for different painful areas
For Achilles attachment pain, initially remain on level ground as advised; do not lower the heel below a step. Hallux rigidus or forefoot pain may make heel raises unsuitable. Toe stretching must not force a painful joint.
With diabetes, reduced sensation, circulation problems or fall risk, ask for individual selection. Inspect skin and use stable support. A recent injury protected by a cast or boot should only be exercised within the team’s protocol.
Chapter sources [10] [11] [12] [3]
In everyday life
Observe before increasing
During
Keep movement controlled without sharp pain.
After
Check walking and any swelling.
Next day
Compare first steps before increasing the dose.
Setting up a safe space
Choose clear, non-slip flooring and a stable chair or counter. Keep support within reach for standing exercises. Shoes or bare feet depend on instructions and comfort; a prescribed brace is not automatically removed.
Breathe normally and rest if movement quality declines. You need not reproduce the drawing’s proportions exactly. If setup requires help, have the position checked before exercising alone. Safety matters more than added difficulty.
Chapter sources [7]
Making a realistic routine
Link selected exercises to an easy reminder, such as breakfast or a short permitted walk. A simple note can record exercise, dose and response. Constantly monitoring every foot sensation is unnecessary.
Do not automatically double the next session after missing one. Return to the planned dose or ask how to adjust. A realistic plan considers time, fatigue and other treatments. Explain difficulties so the programme can be changed.
When is review needed?
Ask for review if exercise choice is unclear, the dose remains difficult or daily function is not improving. Movement, resistance and frequency may be modified, or another cause of limitation considered.
Stop and seek prompt help for a new snap with function loss, inability to bear weight, an unusually hot swollen foot or loss of sensation. Calf pain and swelling with breathlessness or chest pain means calling 112.
Your questions
Must I do all four exercises every day?
No. Selection and frequency depend on your situation. The cards offer starting doses; your programme may use only some of them.
Can I increase because exercise does not hurt?
The response afterwards and the next day matters too. Restrictions and abilities also guide progression, especially after rupture or fracture.
Does the PDF replace a prescription?
No. It gathers selected exercises and precautions to help you find them again. It does not confirm suitability for your situation.
Chapter sources [13]
Sources and references
- [1] Achilles Tendon Rupture (Tear) - OrthoInfo - AAOS
- [2] Broken ankle - NHS
- [3] Recommendations | Diabetic foot problems: prevention and management | Guidance | NICE
- [4] DVT (deep vein thrombosis) - NHS
- [5] North Bristol NHS — Ankle injuries: movement exercises
- [6] Berkshire Healthcare NHS — Ankle sprains: heel raises
- [7] NHS — Balance exercises
- [8] IQWiG — oefeningen bij plantaire hielpijn
- [9] Haute Autorité de Santé - Entorse du ligament collatéral latéral (ligament latéral externe) de cheville : diagnostic, rééducation et reprise de l’activité physique et de la pratique sportive
- [10] Dutch multidisciplinary guideline on Achilles tendinopathy
- [11] AOPT/JOSPT — Heel Pain / Plantar Fasciitis: Revision 2023
- [12] Hallux Rigidus (Stiff Big Toe) - OrthoInfo - AAOS
- [13] Kiné Diddeleng — informations pratiques confirmées
Text updated on
Medical review: awaiting Hasib Selimovic.