foot and ankle rehab

joint type of the ankle

uni-axial hinge made of the tib/fib/talus prducing DF PF

DF glide and normal motion

talus is convex, tib concave

glide is posterior

normal 20

10 needed for normal gait

PF glide and normal motion

talus is convex, tib concave

talus glides anterior

normal 30-50

subtalar joint

INV EVR

talus and calc

midtarsal

talus and navicular

lateral b/w calc and cuboid

links the rear and mid-foot

tarsometatarsal joint

mid foot

distal row of tarsals and base of mets

metatarsophalangeal joint

forefoot

mets and phalanges

windlass mechanism

interphalangeal joints

stability by pressing into ground during balance and gait

flx and ext motion

extrinsic muscles

origin in leg and attach to foot

intrinsic muscles

originate and insert in the foot (4 layers of the foot)

pronation

DF, EVR, ABD

supination

PF, INV, ADD

abnormal pronation - 3 things

hypermobility

lacking stability and strength

excessive medial side stress (causing impinge on LATERAL side)

Abnormal supination - 3 things

rigid foot (decreased EVR)

needs mobility

Lateral side stress

plantar fasciitis treatment

educate on NSAIDs and modalities to tx p!

stretching before activity

intervention focused on load of posterior leg muscles and intrinsic toe flexors

achilles tendonitis tx

education (load manage, and decrease inflammation)

DONT STRETCH THE TENDON

increase load of PFs

specialize tx based on foot - planus need stability, cavus need mobility

achilles tendinopathy tx

education load management

LONG DURATION ISOs

eccentrics when acceptable

DO NOT STRETCH TENDON

achilles tendon rupture

commonly an eccentric

predisposition if tendon issues or using steroids/corticosteroids

surgery for achilles

good for young, active people.

decreased risk of rerupture, existing PF strength

non-operative achilles tendon

elderly, when achilles is not fully ruptured.

20deg PF for 4 weeks in cast to heel in a shortened position

immobility in neural then progress into DF

achilles tendon repair rehab

0-2weeks in boot (lifts taken out every 2 wks)

2-6 increasing amount of DF. WB week 4. goal is ROM! foot intrinsics and general strengthening of lower leg

6-12 shoe with a heel lift - stop lifts at wk 8 exercise in closed chain

12 - return focus is strength and normal motion until bilateral

inversion ankle sprain tx

education, decrease swelling, limit frontal plane at first because that was MOI

NMJ and strength

often lack DF

Brostrom Procedure

when conservative tx does not work to manage a lateral ankle instability

common to lose inversion ROM (about 15 - because tight laterally)

eversion strength will have a deficit (10% or more) and balance decreased

precautions of brostrom procedure

NWD for 2 weeks

no active or passive INV or EVR for 6 wks

no INV at end range PF for 12 wks

posterior tibialis dysfunction

cannot support the arch!!

educate on load management!

focus on eccentric control

consider an orthotic, arch support

MTSS

load management and activity modification, shoe modifications, educate on narrowing of p!

STRETCH

build tolerance

custom orthotics

Lis Franc rehab and MOI

midfoot - PF and rotation

0-6 weeks NWB, RANGE IS GOAL, open chain and low intensity intrinsic

6-8 WB, ROM, intrinsic and LE strength

9+ rehab increase as normal, running around wk12-16, x-rays to monitor

TibFib repair

0-4 pain control and NWB, full ROM at knee and ankle!

4-8 WB, out of boot 8wks, closed chain

8+ return to sport, screw removal?

predisposing factors to achilles tendon rupture

tendinosis, corticosteroids