Chapter 12 Corrective Strategies for Foot and Ankle Impairments

Question 1

Corrective Exercise Strategies

Foot and Ankle
Impairments

Learning objectives

Answer 1

Upon completing this chapter, you will be able to:

• Understand basic functional anatomy for the foot and ankle complex.
• Understand the mechanisms for common foot and ankle injuries.
• Determine common risk factors that can lead to foot and ankle injury.
• Incorporate a systematic assessment and corrective exercise strategy for foot and ankle impairments.

Question 2

INTRODUCTION

Answer 2

he human body is susceptible to movement dysfunctions and neuromusculoskeletal imbalances. Some causes may include repetitive movements, overuse, sedentary living, and improper movement techniques. These dysfunctions, in turn, lead to many of the common injuries seen in an active population. The foot and ankle complex may greatly influence the entire human movement system (HMS). This the region represents the platform from which our base of support is derived and is the main contact point between the ground and the body. As such, it must withstand a high amount of contact force (ground reaction force) with each step taken because it is closest to the impact site (foot strike). As the body is an interconnected chain (kinetic chain), compensation or dysfunction in one region such as the foot and ankle may lead to dysfunctions in other areas of the body (

Question 3

Foot and Ankle Functional Anatomy

Answer 3

The foot and ankle is a complex structure with great potential for influence on the rest of the human movement system.

Question 4

Metatarsophalangeal (MTP) and tarsometatarsal joints.

Answer 4

The phalanges, metatarsals, and tarsals

Question 5

the “ankle” joint.

Answer 5

Talocrural joint (tibia, fibula, and talus)

Question 6

Proximal and distal tibiofibular joints

Answer 6

tibia and fibula bones

Question 7

Tibiofemoral,
patellofemoral, and iliofemoral joints

Answer 7

the tibia and fibula bones

Question 8

Key Muscles Associated with the Foot and Ankle Complex

Answer 8

‡ Flexor hallucis longus

‡ Gastrocnemius

‡ Soleus

‡ Peroneals

‡ Posterior tibialis

‡ Anterior tibialis

‡ Medial hamstrings

‡ Gluteus medius and Maximus

Question 9

Common Foot and Ankle Injuries and

Associated Movement Deficiencies

Answer 9

Plantar Fasciitis

Achilles’ Tendinopathy

Medial Tibial Stress Syndrome

Ankle Sprains and Chronic Ankle Instability

Question 10

Plantar fasciitis

Answer 10

Plantar Fasciitis The plantar fascia is a thick, fibrous band of tissue that runs from the calcaneus and fans out to insert on the metatarsal heads to support the longitudinal arch of the foot

Irritation and swelling of the thick the tissue on the bottom of the foot. The most common complaint is pain at the bottom of the heel.

Question 11

Achilles’ Tendinopathy

Answer 11

The gastrocnemius complex, which consists of the gastrocnemius and soleus muscles, share a common Achilles’ tendon that inserts on the base of the calcaneus. Tendonitis, or inflammation of this tendon, is a
common sports-related injury Figure 12. 5. Alternately, if inflammation is not present, but tendinopathy and tissue degeneration are present.

Signs and symptoms may include pain during physical activities or at rest, inflammation,
swelling, and thickening of the tendon. A tight Achilles’ tendon (lack of dorsiflexion)
( 9 ) and the increased rearfoot inversion has been associated with Achilles’ tendinopathy

Question 12

Tendinosis

Answer 12

Damage to the tendon at a cellular level, but does not present to inflammation.

Question 13

Tendinopathy

Answer 13

A combination of pain, swelling, and impaired performance commonly associated with the Achilles’ tendon.

Question 14

Medial Tibial Stress Syndrome

(shin splints)

Answer 14

Pain in the front of the tibia caused by an overload to the tibia and the associated musculature.

Question 15

Periosteum

Answer 15

A membrane that lines the outer surface of all bones.

Question 16

Ankle Sprains and Chronic Ankle Instability

Answer 16

Ankle sprain:

An injury to the ankle ligaments in which small tears occur in the ligaments.

Chronic ankle instability

Repetitive episodes of giving way at the ankle, coupled with feelings of instability.

Question 17

Foot and Ankle Dysfunction and the
Human Movement System Chain Reaction

Answer 17

See page 273

Question 18

FOOT AND ANKLE ASSESSMENT PROCESS

AND OBSERVATIONS

Answer 18

Assessment Observation

Static posture Feet excessively pronated
Overhead squat Feet turn out (externally rotate) or flatten (evert)
Single-leg squat Feet flatten

Question 19

STATIC POSTURE

Foot types

Normal arch Pes planus / Pes Cavus

Answer 19

As mentioned in chapter five, the first step in developing a corrective exercise
the strategy is a static postural assessment, which should be performed with the
individual barefoot and in shorts.

For a general identification, feet may be divided into three categories: normal arch, pes planus, and pes cavus.

Question 20

Foot types

Normal arch Pes planus / Pes Cavus

Answer 20

Pes planus - A flattened medial arch during weight-bearing.

Pes cavus - A high medial arch when weight-bearing.

Question 21

Hyperpronation

Answer 21

A condition associated with lower leg dysfunction and lower limb pathology. Increased hyperpronation may also cause increased anterior pelvic tilt (hip flexion) ( 32 ), potentially leading to the tightness of the hip flexor complex (iliopsoas, TFL). This malalignment may be minimized by rotating the individual’s feet out of hyper pronation into a more neutral alignment.

Question 22

TRANSITIONAL MOVEMENT ASSESSMENT

Answer 22

The second step in developing a corrective exercise strategy is a transitional movement assessment such as the overhead squat (chapter six). Health and fitness professionals should be assessing the feet to determine whether they turn out and/or flatten. This may mimic the observations from the static assessment or maybe more excessive. If the knees come together during the squat (knee valgus), the individual may have decreased calf flexibility, greater hip external range of motion, and decreased plantar flexion strength

Question 23

TRANSITIONAL MOVEMENT ASSESSMENT

(cont)

Answer 23

( 3 ). Based on the collective information obtained from the assessment, the health and fitness professional can begin to identify potential muscle imbalances and joint range of motion deficiencies to address. It is likely that poor performance on the transitional movement assessment is attributable to multiple factors, at multiple joints.
Several structures, as well as underlying mechanical malalignment, may need to
be addressed.

Question 24

SAMPLE CORRECTIVE EXERCISE PROGRAM FOR FOOT AND ANKLE IMPAIRMENT

Answer 24

Question 25

SUMMARY

Answer 25

The foot and ankle complex may greatly influence the entire human movement system. It must withstand a high amount of contact force through ground reactive forces, momentum, and gravity. As the body is an interconnected chain, compensation or dysfunction in one region such as the foot and ankle may lead to dysfunctions in other areas of the body. For this reason, it becomes a crucial region to assess. Symptoms that are being felt in other regions of the body could potentially be caused by dysfunction at the foot and ankle complex. If not assessed, the symptoms may be addressed, but the cause of those symptoms is not, with reoccurring injury being the result.