Ankle/Foot Flashcards
Ottawa Ankle Rules
- pain on palpation: distal 6cm fibula; posterior, midline
- pain on palp: distal 6cm tibia; post, midline
- pain on palp: base 5th MT
- pain on palp navicular tubercle (medial)
- unable to WB immediately after
- over age 18, under age 55
Ottawa Foot Rules
- pain in midfoot (and 1+ following)
- unable to WB immediately and in ED for 4 steps
- bone tenderness at navicular or base of 5th MT
Lateral Ankle Sprain
- acute
- chronic ankle instability
Components to Chronic Ankle Instability
- mechanical (lax ligaments)
- neuromuscular (decr proprioception)
Treatment of Acute Lateral Ankle Sprain
- ice
- K-tape
- joint mobes (grade I/II and distraction)
- AROM: pain free (ankle pumps)
- Modalities
- gait in water
- aerobic exercise
- strengthening
Talar Position after sprain
- inversion/plantarflexion stress
- tear of ATFL
- talus glides ant
- ant impingement
Manual Therapy Techniques for Lateral Ankle Sprain–Acute Phase
- TC joint manip
- AP TC mob
- mobilization with movement (MWM)
Strengthening After Lateral Ankle Sprain–Acute Phase
- isometrics (submax)
- proximal hip
- opposite extremity
- UE
High Correlation between:
-hip weakness and lateral ankle sprains
Lateral Ankle Sprain Subacute Phase
- minimize pain/swelling
- ROM (& check arthrokinematics)
- Strength
- Aerobic Conditioning
Cuboid can
- sublux plantarly
- treat with cuboid whip then cuboid pad under
- peroneus longus attached to it
Problems with balance with chronic ankle sprain
- proprioceptive deficits
- decrease stability when landing from a jump
- reduced postural control
Bracing?
- brace/tape while rehabing, not forever
- 3-6 months
Prevention:
- strengthening
- balance training
Best Functional Tests to Return to Sport
- Figure 8 Single Leg Hopping
- Lateral Hopping Test
-no more than 10% difference between limbs
Surgical Treatment of Ankle Instability
-Brostrom Procedure
Brostrom Procedure
- surgical reattachment of ATFL and calcaneofibular ligament
- reinforce with peroneus brevis
- -then do PT
Plantar Fascia (Aponeurosis)
-main stabilizer of medial longitudinal arch
Plantar Fasciopathy
- heel pain–medial tubercle
- Heel spur not cause of pain
Management of Plantar Fasciopathy
- massage
- stretching
- tape/orthoses
- night splints
- manual therapy/exercise
Management of Plantar Fasciopathy
- massage
- stretching
- tape/orthoses
- night splints
- manual therapy/exercise
- strengthening
- rest
- Lateral glides of subtalar joint
- eccentric calf program
–check arthrokinematics
May be a relationship between plantar fasciitis and:
-posterior chain tightness (hamstrings, gastroc-soleus)
2 Achilles Tendinopathy Factors
- Intrinsic Factors
- Extrinsic Factors
Intrinsic Factors of Achilles Tendinopathy
- extreme foot types (planus, cavus)
- decreased ankle flexibility
- growth spurt in young athletes (sever’s disease)
Extrinsic Factors of Achilles Tendinopathy
- training too much too soon
- shoewear, cleats
- heel height change
- playing surface
Achilles Tendinopathy Management Framework
-EdUReP
- Educate
- Unload
- Reload
- Prevent
EdUReP:
Unload
- Heel lift (1/2 inch)
- active rest with alternative exercises
- immobilization=last resort
EdUReP:
Education
- not inflammation, no direct association with pain
- kennedy stages
EdUReP:
Reload
- Eccentric Program
- 12 weeks
- Slow
- Progress: load and speed
EdUReP:
Prevent Recurrence
- hip strength
- lumbar spine
- normal foot mechanics
Chronic Management of Achilles Tendinopathy
- soft tissue mobilization (ART)
- Cross friction massage
- dry needling
- orthotics
TENEX
- TENEX Health TX
- Invasive: Ultrasonic energy to break down and remove diseased tissue
EdUReP:
Education
- not inflammation, no direct association with pain
- ice won’t help
- not as worried about pain, more about function
- kennedy stages
