Chapter 12 Corrective Strategies for Foot and Ankle Impairments Flashcards
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.
Corrective Exercise Strategies
Foot and Ankle
Impairments
Learning objectives
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.
INTRODUCTION
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 (
Foot and Ankle Functional Anatomy
The foot and ankle is a complex structure with great potential for influence on the rest of the human movement system.
Metatarsophalangeal (MTP) and tarsometatarsal joints.
The phalanges, metatarsals, and tarsals
the “ankle” joint.
Talocrural joint (tibia, fibula, and talus)
Proximal and distal tibiofibular joints
tibia and fibula bones
Tibiofemoral,
patellofemoral, and iliofemoral joints
the tibia and fibula bones
Key Muscles Associated with the Foot and Ankle Complex
Flexor hallucis longus
Gastrocnemius
Soleus
Peroneals
Posterior tibialis
Anterior tibialis
Medial hamstrings
Gluteus medius and Maximus
Common Foot and Ankle Injuries and
Associated Movement Deficiencies
Plantar Fasciitis
Achilles’ Tendinopathy
Medial Tibial Stress Syndrome
Ankle Sprains and Chronic Ankle Instability
Plantar fasciitis
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.
Achilles’ Tendinopathy
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
Tendinosis
Damage to the tendon at a cellular level, but does not present to inflammation.
Tendinopathy
A combination of pain, swelling, and impaired performance commonly associated with the Achilles’ tendon.
Medial Tibial Stress Syndrome
(shin splints)
Pain in the front of the tibia caused by an overload to the tibia and the associated musculature.
Periosteum
A membrane that lines the outer surface of all bones.
Ankle Sprains and Chronic Ankle Instability
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.
Foot and Ankle Dysfunction and the
Human Movement System Chain Reaction
See page 273
FOOT AND ANKLE ASSESSMENT PROCESS
AND OBSERVATIONS
Assessment Observation
Static posture Feet excessively pronated
Overhead squat Feet turn out (externally rotate) or flatten (evert)
Single-leg squat Feet flatten
STATIC POSTURE
Foot types
Normal arch Pes planus / Pes Cavus
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.
Foot types
Normal arch Pes planus / Pes Cavus
Pes planus - A flattened medial arch during weight-bearing.
Pes cavus - A high medial arch when weight-bearing.
Hyperpronation
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.
TRANSITIONAL MOVEMENT ASSESSMENT
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
TRANSITIONAL MOVEMENT ASSESSMENT
(cont)
( 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.
SAMPLE CORRECTIVE EXERCISE PROGRAM FOR FOOT AND ANKLE IMPAIRMENT
SUMMARY
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.
