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Therapeutic Exercise AT 523 > Foot and Ankle > Flashcards

Foot and Ankle Flashcards

1
Q

Medial Longitudinal Arch

A

Extends from calcaneus to metatarsal heads 1-5
runs proximal to distal
Important in shock absorption

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2
Q

Transverse Arch

A 
in midfoot (cuboid, cuneiforms, base of metatarsals)
runs medial to lateral

Plantar fascia is stressed-no elastic recoil so it collapses as they start to push off

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3
Q

Ankle Dorsiflexors

A

Prime mover-anterior tibialis

Synergists-Extensor digitorum longus, extensor hallucis longus, peroneous tertius

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4
Q

Ankle Evertors

A 
Prime Mover=Peroneus Longus
Synergists= Peroneus Brevis
Perneus Tertius
EDL
Ant. Tib
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5
Q

Ankle PF

A 
Prime mover=gastroc
Synergists= soleus
Plantaros-weak
Tibilais post
FDL/FHL-weak
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6
Q

Ankle Invertors

A

Prime Mover=Tibialis Post

Synergist=FDL/FHL

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7
Q

Plantar Fascia

A

Dense, fibrous tissue located on plantar surface of foot
extends medial calcaneal tubercle and inserts via 5 bands onto each toe
Supports longitudinal arch and protects structures on plantar surface

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8
Q

Talocrural joint

A

primary motion: Dorsi/Plantarflexion

Need 10 degs. DF for normal gait

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9
Q

Subtalar joint

A

Primary motions: Pronation/Supination

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10
Q

Initial Contact

A

Ankle joint in neutral
STJ is slightly supinated
GRF posterior to ankle jt creating PF torque
Ant. Tib and EDL are on eccentrically

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11
Q

Loading Response

A

5* PF occurs
Eccentric Pretibial mm action–tibia is pulled forward
Knee flexes

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12
Q

Subtalar Jt Loading Response

A 
Calcaneus everts 5 degs (CCP)
Allows for SHOCK ABSORPTION
-calcaneal eversion
-talus horizontally adducts
-tibia IR
-knee flexes
-Femur IR

Pronation “unlocks” MTJ—shock absorption
Ant. tib and Post tib ecc. contract

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13
Q

Midstance

A

Ankle dorsiflexes 5
Gastroc and Soleus work ecc. to control forward tibial advancement
–body is able to progress forward over a stable foot & tibia
Gastroc fires to control knee extension (stabilizes knee)

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14
Q

Terminal Stance

A 
Ankle DF to 10
Peak DF torque
1st MTP extends to 30
Calf mm activity peaks 
---prevents fwd tibial advancement
---allows heel to rise
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15
Q

Terminal Stance STJ

A

STJ and MTJ go into supination towards end of TS
=make a rigid lever for push off

Causes:
calcaneal inversion
talar horizontal ABD
tibial ER
Knee ext
Femur ER
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16
Q

Terminal Stance 1st ray support

A

controlled by Peroneal longus
Stabilizes 1st ray as weight is transferred to forefoot
Also controls midtarsal supination by ecc eversion

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17
Q

Preswing

A 
knee rapidly flexing by momentum
Ankle to 15 PF
1st MTP 60-70 ext
Calf muscle activity ceases
pretibial activity now becomes concentric in prep to clear foot off ground
forefoot on ground for balance
STJ goes to neutral for all swing phases
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18
Q

Initial Swing

A

Ankle in 5 PF

Concentric contraction of ant tib, EHL, EDL

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19
Q

Midswing

A

Ankle is in neutral position

pretibial muscles active

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20
Q

Terminal swing

A

Ankle in neutral-prepping for heel strike at initial contact

Pretibial muscles are active

21
Q

AAROM-Dorsiflexion

A

Towel
Contralateral limb
Hand

22
Q

AAROM-PF

A

Gravity assisted
Contralateral Limb
Hand

23
Q

AAROM Inversion

A

Towel
Contralateral Limb
Hand
Gravity Assisted

24
Q

AAROM Eversion

A

Towel
Contralateral Limb
Hand
Gravity assisted

25
Q

AROM–DF,PF,Inn, Ev

A

Used to facilitate muscles after period of disuse/immobilization or injury
Can combine with hydrotherapy
Ankle pumps/Ankle ABCs

26
Q

Syndesmosis Sprains

A

High Ankle Sprains

Avoid excess DF during acute and subacute phases

27
Q

Stretching Dorsiflexors

A

Standing

Kneeling-more aggressive, use later in rehab, restores end-range of DF ROM

28
Q

1st MTP extension

A

Must be able to achieve 65-70* for normal gait
Hard to achieve if Hallux Valgus is present
-shoes with a narrow toe box can cause this

29
Q

Foot & Ankle Strengthening

A

Lower leg musculature has more of an endurance fxn with ADLs

Sport Specific (SS) fxn require strength and power across endurance time frames

Rehab must include strengthening of weak muscles to balance asymmetries—progress to strength and power mimicing SS

30
Q

Isometrics DF

A

ant. tibialis & perneus tertius

31
Q

Isometrics PF

A

gastroc, soleus, post. tib, FDL FHL, plantaris

32
Q

Isometrics Invertors

A

post. tib, FDL, FHL

33
Q

Isometrics Evertors

A

Peroneus longus, brevis, tertius

34
Q

Towel Curls

A

Strengthens:
Foot intrinsics
Long toe flexors/extensors

Towel slides with weight

35
Q

Calf raises on leg press

A

strengthens gastroc and soleus

loads achilles tendon

36
Q

Soleus Strengthening

A

Soleus is the dominant decelerating force

–largest PF muscle

37
Q

Fxnal Ankle Instability

A

Following acute inversion ankle sprains
—chronic instability=20-30%
Increased risk of sprain reoccurance
—delayed proprioceptive response of peroneals

38
Q

Fxnal ankle instability rehab

A

Afferent neuromuscular pathways need retrained to eliminate the deficit and restore normal reflex joint stabilization

39
Q

standing postural control

A

subjects with pronated and supinated foot structures had poorer static postural control during SL stance than those with a neutral structure

40
Q

LE NMC Static

A 
Static standing:
EO/EC
Bipedal/SLS
Tandem
Surface
41
Q

LE NMC Dynamic

A 
Ambulation/running
Cutting/pivoting
Ball toss
Reaching Tasks
Box hop
Wobble Board/Tilt Board--incorporate UE

Progressions=direction, speed, bipedal/SLS, surface, predicted vs unpredicted

42
Q

Neuromuscular Re-ed

A

includes balance, coordination, stability
–this is key to dynamic stability to foot and ankle

Progressions:
DL to SL
EO to EC
Stable to Unstable
Static to dynamic-add pertubations
Must activate core
43
Q

Proprioception prgressions

A 
DLS with EO
DLS tandem
SL EO
SL EC
Foam
Seated T-ball: ABCs
44
Q

resisted band walking

A

forward, backward, side stepping, around cones, up and over cones

45
Q

Rehab-Inversion Ankle Sprain Acute

A 
Goals: decrease pt swelling, restore ROM
PRICE
PF/DF ROM
--avoid INV/EV
-Weight bearing as tolerated
46
Q

Rehab-Inversion Ankle Sprain fibroplastic repair

A 
Goals: increase ROM all planes, restore NMC and proprioception
PRICE PRN
ROM all planes
Strengthening ankle and foot
progress to full weight bearing 
proprioception progression
47
Q

Hip strengthen & ankle sprains

A

unilateral chronic ankle sprains had weaker hip abduction strength and less plantar-flexion ROM of involved sides

Delayed G med firing
Delayed G max firing after ankle sprains

48
Q

Rehab-Inversion Ankle Sprain maturation

A

Goals: no pain or swelling, full ROM and strength, restore proprioception
Progress ROM, strengthening and proprioception training
progress with walk-jog-running
protect with tape and/or brace
progress with fxnal activities

Therapeutic Exercise AT 523 (3 decks)

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