Ankle


Frequently Asked Questions

Dad had a stroke two months ago and is slowly recovering. At 72, he's not as motivated as he once was. Mother wants to find every gizmo under the sun to help him. We now have a mini-whirlpool in the bath, a portable sauna in the kitchen, and a set of dumbells in the TV room. What he really needs is help getting his foot flat on the floor. Whenever his foot touches the floor, it starts to jerk and bounce. What can we do about that?

It sounds like your father may have a residual effect from the stroke called ankle clonus. Clonus is described in the medical literature as a series of involuntary muscular contractions. It is caused by a sudden stretching of the muscle. Clonus is a sign of certain neurological conditions like stroke or multiple sclerosis. It doesn't go away unless and until the brain recovers from the injury. In the case of a stroke causing the clonus, there's been bleeding into the brain resulting in a cerebrovascular accident (CVA), the medical term for stroke. There are different ways to treat this problem of increased muscle tone, spasticity, and ankle clonus. Sometimes medications (antispastic drugs) can help reduce the muscle reactivity. Surgery to control muscle tone has been tried but isn't always successful. Surgery can (and often does) cause additional problems, so other approaches are tried first. Physical therapy is a common way to guide a patient through the rehabilitative and recovery phase after a stroke. The therapist can test for problems like increased muscle tone that is impairing daily function and help the patient and family find ways to restore as normal of function as possible. It's likely your father had some physical therapy when he was first diagnosed -- maybe while in the hospital when the stroke first happened. But once the patient leaves the hospital setting, physical therapy may be discontinued. That doesn't mean further rehab services are of no help now. Quite the contrary. Studies show the brain and nervous system are very plastic (changeable and responsive) even in adults. Check with the therapist who initially evaluated and treated your father. Find out what kind of services he qualifies for. Some services are covered by insurance. There may be limits on the number of therapy sessions patients can receive depending on whether they have Medicare and/or secondary insurance. Payment out-of-pocket for services that aren't covered may be possible.

Nobuyuki Takeuchi, RPT, MS, et al. Development and Evaluation of a New Measure for Muscle Tone of Ankle Plantar Flexors: The Ankle Plantar Flexors Tone Scale. In Archives of Physical Medicine and Rehabilitation. December 2009. Vol. 90. No. 12. Pp. 2054-2061.

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