ankle and foot rehabilitation Flashcards
week 3
absolute contraindications to manipulation for ankle/foot
- decrease bone integrity
- fracture
- absence of working diagnosis
- ligament rupture
- severe pain levels orsignificant muscle gaurding
- empty end feel
- acute episode of rheumatoid arthritis
- central sensitzation
- overreliance on manual therapy for relief
- no consent
regional contraindications to mainpulation
- compromised transverse ligamnet (cervical spine)
- vertebral artery dysfunction (cervical spine)
- cauda equina syndrome (lumbar spine)
- post surgical care
relative contraindications to manipulation
- disc herniation
- pregnancy
- infammation
- decreased overall general health
- advanced diabetes
- adverse event with pervious manual therapy
- children or teenagers
- severely worsening condition
what are the 5 mobilization grades?
Grade I: small amplitude movement performed at hte beginning of the range
Grade II: large amplitude movement performed within the range but not to the limit ofthe range
Grade III: large amplitude movement performed up to the limit of the range
Grade IV: small amplitude movement performed at the limit of the range
Grade V: manipulation: high velocity thrust at the end ROM
3 things you want to look at in rehabilitation of lateral ankle sprain
- progressive weight bearing ASAP (crutch use)
- restore ankle dorsiflexion ROM
- strenthening (gastroc-soleus, fibularis longus)
if lateral ankle sprain is chronic need to evaluate:
- nerve integrity
- peroneals (deep, superficial) - fibular longus/brevis integrity
- distal tibiofibular mobility
rehabiliation needs for chronic ankle instability?
- restore ankle dorsiflexion ROM
- proprioception & balance
- motor control & correction of movement patterns
- hip abduction & ER strengthening
what do you do with medial ankle sprains first? high ankle sprains?
what are the grades?
need to refer to orthopedic specialist
Grade I: immobilization
Grade II & III: possible surgery
then follow rehabilitation progression pyramid
What are common tendinopathies?
- tibialis posterior
- achillies
- fibularii
what are other tissues to assess when also checking for tendinopathies? (secondary injuries)
- joint dysfunction
- stress fracture/fracture
- artiucalr cartilage
foot alignment:
rearfoot:
forefoot:
rearfoot:
- varus/inversion
- valgus/eversion
forefoot:
- varus/adduction
- valgus abduction
what are the 3 categories of foot alignment?
- neutral foot
- high arch (pes cavus)
- flat foot (pes planus)
high arch (pes cavus)
- under pronation
- decreased shock absorption at the foot and ankle
- associated with:
- forefoot valgus
- rearfoot varus
flat foot (pes planus)
- overpronation
- excessive shock absorption at the foot and ankle
- associated with:
- forefoot varus
- rearfoot valgus
when assessing arch height - clinical examination
- subtalar neutral
- OKC vs CLC (flexible vs fixed)
- rearfoot and forefoot alignment - navicular drop
- tibial torsion
- gait
classification: overpronation
cause: what are the 2 causes of overpronation observed in foot alignment?
- compensated subtalar varus
- compensated forefoot varus
classification: overpronation
what are the two foot alignments that could be noted with overpronation?
- rear-foot varus angle >4°
- forefoot inverted >5° relative to rear foot
classification: overpronation
compensated subtalar varus, rearfoot varus angle >4°
what gait dysfunction would be expected?
- excessive pronation early in the gait cycle
- lack appropriate supination later in the gait phase
classification: overpronation
compensated forefoot varus
forefoot inverted >5° relative to rear foot
what gait dysfunctions would be expected?
excessive pronation from foot flat through toe- off, limited supination needed for toe off
classification: over pronation
Compensated Subtalar Varus
Rear-foot varus angle >4°
Excessive pronation early in the gait cycle, lack appropriate supination later in the gait phase
potential pathology?
- retrocalcaneal bursitis, posterior tibialis tnedinosis, medial knee pain
classification: over pronation
Compensated forefoot varus
Forefoot inverted >5° relative to rear foot
Excessive pronation from foot flat through toe-off, limited supination needed for toe off
potential pathology?
- posterior tibialis tendinosis
- hallux abducio valgus
- plantar fasciitis/fasciopathy
- medial achilles tendinosis
- anterior knee pain
classification: underpronation
what are three potential causes?
- uncompensated forefoot varus
- compensated forefoot valgus
- equinus
Equinus is a condition where the ankle joint lacks flexibility and upward movement (dorsiflexion) is limited, often due to tightness in the Achilles tendon or calf muscles.
classification: under pronation
- alignment associated with uncompensated forefoot varus
- alignment associated with compensated forefoot valgus
- alignment associated with equinus
- forefoot inverted >8° relative to rear foot
- forefoot everted > 5° relative to rear foot
- PF of forefoot on rear foot
classification: underpronation
gait dysfunctions expected to see with uncompensated forefoot varus
limited pronation throughout gait
increased weight to lateral aspect of foot
classification: underpronation
gait dysfunctions expected to see with compensted forefoot valgus
same as uncompensated forefoot varus
(limited prontion throughout gait, increased weight to lateral aspect of foot)
classification: underpronation
gait dysfunction expected to see with equinus
limited pronation throughout gait
classification: underpronation
potential pathology associated with uncompensated forefoot varus
- diffuse dorsal ankle pain
- diffuse capsular pain
- plantar fasciitis
- metatarsalgia
classification: underpronation
potential pathologies associatedwith compensated forefoot valgus
- lateral ankle sprains
- plantar fasciitis
- fibularis tendinosis
classification: underpronation
potential pathologies associated with equinus
- plantar fasciitis
- achilles tendinosis
- diffuse metatarsalgia
- lateral knee pain
- LBP
