Lecture #19 (Ankle and Foot Rehab)

Question 1

True or false:

Minor deviations in the mechanics at the ankle can cause a major injury.

Answer 1

True

Question 2

When rehabbing the ankle, what are you really “rehabbing”?

Answer 2

It’s more the lower leg muscles than “foot” or “ankle” muscles

Question 3

Is there a low or high potential for compensation by the patient when a foot or ankle injury is involved?

Answer 3

High because of the pain and the injuries that occur

Question 4

What is the #1 muscle that causes ROM problems at the ankle joint?

Answer 4

Gastroc

Question 5

What 3 things are critical in order to have good ROM at the ankle?

Answer 5

1) heel cord flexibility
2) adequate subtalar motion
3) joint mobility (dorsiflexion, great toe movement, tarsal joint movements, etc)

Question 6

What movement is necessary to have good push off in the gait cycle and requires adequate structural and muscular support in order to do so?

Answer 6

Supination

Question 7

What is the foundation for all balance and proprioceptive activity in the body?

Answer 7

The foot (so if you have a problem here than nothing will work correctly)

Question 8

What are some chronic injuries that might been seen with the foot and ankle?

Answer 8

Shin splints (MTSS), posterior tibialis tendonitis, achilles tendonitis, plantar fascitis, heel spur, tarsal tunnel syndrome, metatarsal stress fractures (“March fractures”), ankle instablity, arthrogenic/neurogenic inhibition, bunion, accessory navicular, morton’s neuroma, metatarsalgia, sesmoiditis, etc.

Question 9

What are some acute injuries of the ankle and foot?

Answer 9

Inversion (lateral) ankle sprain, syndesmosis sprain, medial (deltoid) sprain, achilles rupture, fractures (jones, talar dome), avulsion fractures, turf toe, soccer toe, arch sprain

Question 10

What is the first step in treating plantar fascitis? How would you take care of this?

Answer 10

Reduce the pain and inflammation: relative rest, ionto/ultrasound/deep cross-friction massage, night splints, and STRETCHING!

Question 11

What is an important emphasis needed when treating someone for plantar fascitis?

Answer 11

Correct mechanics, foot posture, and correcting any training errors…so make sure that they have correct gait while running, wearing proper shoes, get orthotics if needed, etc.

Question 12

What is the most common foot ailment?

Answer 12

Plantar fasciitis

Question 13

Why is it important to stretch the gastroc before weight bearing for someone that has plantar fasciitis?

Answer 13

By stretching the foot, the gastroc will relax some which then means that the foot doesn’t have to work as hard to overcome the lack of dorsiflexion (due to gastroc tightness)

Question 14

If a patient with shin splints/MTSS is an excessive pronator, how could you help treat this biomechanical fault?

Answer 14

Medial wedge or a shoe with a wide, supportive heel counter and good medial arch support

Question 15

How should you rehab shin splints/MTSS?

Answer 15

Increase flexibility of the gastroc, posterior tibialis, and the flexor hallucis longus, and strengthen the anterior and posterior tib

Question 16

How should you rehab someone for achilles tendonitis?

Answer 16

Increase the flexibility of the gastroc and progressive eccentric strengthening

Question 17

What percentage of ankle sprains may end up as chronic?

Answer 17

20-40%

Question 18

How should you treat turf toe or soccer toe?

Answer 18

Rest and immobilize to help protect the structures and also control the pain and inflammation

Question 19

Why is using cryokinetics important for rehab after an ankle sprain?

Answer 19

They force the joint receptors that were injured to work…cryokinetics numb the cutaneous receptors that the body would have relied on anyways

Question 20

When working on ROM of the ankle following an ankle injury, what type of ROM should you be working to primariliy improve?

Answer 20

Active

Question 21

When strengthening the ankle muscles following an ankle injury, what muscle group should your primary focus be on?

Answer 21

Peroneals

Question 22

When a pt has a syndesmosis sprain, how do you initially treat it acutely after the injury? After treating it acutely, then how do you treat it?

Answer 22

Acutely treat with NWB until they are pain free (you can use an aircast or something similar to squeeze the mortise), and then after they are pain free treat it like a regular ankle sprain

Question 23

When an achilles tendon rupture, what does rehab consist of after 4 weeks post op?

Answer 23

• Gradual WB and decrease heel lift (6-8 weeks)
• Active ROM
• Control pain and swelling

Question 24

When an achilles tendon rupture, what does rehab consist of after 6 weeks post op?

Answer 24

• Moving towards FWB
• AROM and PROM
• Normalize gait
• Start strengthening

Question 25

When an achilles tendon rupture, what does rehab consist of after 10 weeks post op?

Answer 25

• Progress to full ROM
• More aggressive stregthening
• Start balance and proprioception exercise

Question 26

What benefits are deep tissue massage done by the clinician used to help?

Answer 26

Promote flexibility and ROM

Question 27

What benefits are joint mobs used to help?

Answer 27

Promote ROM, decrease pain and swelling, and retard adhesion formation

Question 28

True or false:

You should use ankle mobs with all ankle sprains.

Answer 28

False…do not mob with a syndesmosis sprain

Question 29

What types of strengthening exercises could be used to help rehab the foot and ankle?

Answer 29

Therabands, manual resistance, cuff weights, machines, body weight, balance exercises (also improve strength),

Question 30

What is often the last thing patients will get back in rehab?

Answer 30

Proprioception