lecture 7: therapeutic exercise for the ankle and foot Flashcards
what are the primary motions of the talocrural joint
DF and PF
during OKC supination and pronation what is the motions of the foot
sup: calcaneus PF , add and inversion
pro: calcaneus DF , ADB and eversion
during CKC supination and pronation what is the motions of the foot
SUP: calcaneal inversion , talus abd and DF
pro: calcaneal eversion , talus add and PF
what is included int he bifurcate ligament and when is it injured
calcaneonavicular ligament
calcaneocubdoid ligament
what 4 ligaments are included in the deltoid ligament
posterior tibiotalar
tibiocalcaneal
tibionavicular
anterior tibiotalar
what are the primary plantar flexors
Gastrocnemius
Soleus
Plantaris
what are the secondary plantar flexors
Posterior Tibialis, FDL, FHL
Peroneal longus and brevis
what is the primary and secondary DF
Anterior Tibialis (primary)
EHL
EDL
Peroneal tertius
what does the tibial nerve break off into
medial calcaneal nerves
inferior calcaneal nerves
lateral plantar nerve
medial plantar never
what mms are responsible for eversion of the foot
Peroneal longus
Peroneal brevis
Peroneal tertius
what mms are responsible for inversion of the foot
tib ant and post
what are included int he foot intrinsic dorsaly
EDB
EHB
what is the function fo the foot intriniscis
toe motion and arch stability
what are the 4 layers of the foot intrinsics plantarlly
Layer 1 (superficial): Abductor Hallucis, FDB,
Abductor DM
Layer 2: Quadratus Plantae, Lumbricals
ayer 3: FHB, Adductor Hallucis, FDMB
Layer 4: Plantar Interossei, Dorsal Interossei
in CKC tibial IR and ER is associated w what at the foot
IR= pro
ER= sup
as the heel strikes the ground there is slight ___ and as at the foot lowers to the ground there is __- to absorb some of the impact of the ground)
sup
pro
as the foot is fixed on the ground and the tibia comes up over the foot what happens at the ankle
DF
tibia IR , reinforces pronation of the foot
what happens at the tibia and hind foot during instance thru terminal stance
tibia ER
initiating supination of hind foot , locking transverse tarsal joint (foot is in closed packed position)
what is claw toe
MTP hyperextension and IR flexed
what is hammer toe
MTP hyperextension
PIP flex
DIP hyperextension
what is the MOI for a lateral ankle sprain
inversion and PF
if you are examining an ankle after an inversion and PF MOIn and there is a slight stretching and microscopic tearing of the ligament fibers , they have some mild tenderness and swelling around the ankle what grade would u suspect and what lig is prob injured
grade 1 sprain (mild)
anterior talofibular ligament
what is a grade 2 sprain (moderate) of a lateral ankle
partial tearing of anterior talofibular lig and some tearing of the calcaneofibualr lig
mod tenderness and swelling
recover in 2-3 weeks
what is a grade 3 lateral ankle sprain (severe)
complete tear for the ATFL , CF and PTFL
sig tenderness and swelling around the ankle
takes 3-12 weeks to recover
if a pateint comes in and their MOI is forced eversion and DF of the ankle wha kind of sprain are u thinking
syndesmotic ankle sprain (high ankle sprain)
what is the most common ligament that is invovled in the syndesmotic ankle sprain
anterior interior tibiofibular ligament
what are teh S/S for a syndesmotic ankle sprain
less swelling , inability to bear weight , inability to fully PF and ecchymosis
what is the MOI of a medial ankle sprain
eversion
what are the validated outcome measures used for a ankle sprain
PROMIS
FAAM
LEFS
what do u assess and document for a ankle sprain
ankle swelling
ROM (DF using weight bearing lunge test(
talar translation
talar inversion
single leg balance
is it recommended to use a prophylactic bracing for a ankle sprain ?
yes level A evidence
what is recommended as level A evidence for patients w acute LAS
use external supports (bracing or taping )
progressively bear weight on affected limb
what kind of therapeutic exercises should be used for a ankle sprain
- focus on proprioception and balance drills
- focus ther ex on impairments
- protected AROM , stretching , NM training
is it good to do manual therapt and joint mobilization for ankle sprains
yes level A evidence
for ankle sprains use .. therapeutic exercises to reduce ____ , improve pain free ankle and foot ___ and normazlize ___ parameters
swelling , mobility , gait
can u use ultrasound for LAS
noooooonnonononnononno
what do u prescribe for chronic ankle instability
proprioceptive and NM therapeutic exercises to improve dynamic postural stability and patient perceived stability during function
what special test can u use for ankle sprain
reverse anterolateral drawer test
anterolaterla talar palpation
anterior drawer test
should u use a external support as a stand alone intervention to improve balance and postural stability in people w CAI
NOOOO
what outcome measures can u used for achilles tendinopathy
VISA-A
FAAM
LEFS
for achilles tendinopathy what should u used to decrease pain and improve function for patients with midportion Achilles tendinopathy without presumed frailty of the tendon structure.
use mechanical loading
- isometrics early for pain control
- progress to eccentric drills
For patients with nonacute midportion Achilles tendinopathy, clinicians should advise that complete rest is ___ indicated and that they should continue with their recreational activity within their pain tolerance while participating in rehabilitation
not
Use ____ with ____ to decrease pain and improve function in patients with acute midportion Achilles tendinopathy
iontophoresis with dexamethasone
what outcome measures shoudl u use for plantar fasciitis
FAAM
FHSQ
FFL
LEFS
for plantar fasciitis you should Use ___ ___ to treat relevant LE joint mobility and calf
flexibility deficits
manual therapy
what kind of stretching should u use to provide short-term (1 week to 4 months) pain relief for
individuals with heel pain/plantar fasciitis. Heel pads may be used to increase the benefits of stretching.
plantar fascia specific and gastroc and soleus stretching
for plantar fasciitis Use _____ taping for immediate (up to ___ weeks) pain reduction and improved function for individuals with heel pain/plantar fasciitis. Additionally, clinicians may use ___ therapeutic tape applied to the gastrocnemius and plantar fascia for short-term (1 week) pain reduction.
anti pronation
3
elastic
for plantar fasciitis Use foot ___, either prefabricated or custom fabricated/fitted, to support the medial longitudinal arch and cushion the heel in individuals with heel pain/plantar fasciitis to reduce pain and improve function for short- (2 weeks) to longterm (1 year) periods, especially in those individuals who respond positively to antipronation taping techniques
oorthoses
should people w heel pain/plantar fasciitis wear a night splint
yes
what is the diagnosis for plantar fasciitis
- positive windlass test (bolded)
- abnormal foot posture index score (bolded)
-tight hammy - limited active and passive talocrual joint DF ROM
pain w palpation of the proximal insertion of the plantar fascia
what is the tarsal tunnel syndrome
Pain over the tarsal tunnel radiating to the arch
and plantar foot.
Pain may radiate up to the calf.
what will a pt report if they have tarsal tunnel syndrome
sharp shooting foot pain
plantar numbness
paraesthesias alone posterior tibia never
pain at end range DF and eversion
when is tarsal tunnel syndrome worse and better
worse at night , walking standing or activity
better w rest
how is the tarsal tunnel syndrome severity rating rated
10 is normal
0 indicates that the conditions symptoms are severe
what are teh 5 symptoms for the Tarsal Tunnel Syndrome
Severity Rating
• Spontaneous pain or pain with movement
• Burning pain
• Tinel sign
• Sensory disturbance
• Muscle atrophy or weakness
where is the lisfranc joint
medial cuneiform to 2nd MT to 3rd MT to 4th MT
in the lisfranc joint where are the ligaments located
between the medial cunifomr and the 2nd MT
what are the symptoms of a lisfranc injury
- dorsum of foot is swollen/painful
- bruising on the bottom or top of foot (most commonly on plantar)
- pain that is worse w standing or walking
- abnormal widening of foot
for a post op ankle what is usually NWB and what is WBAT
plate is NWB
intramedullary nail is WBAT
what motion is likely to be limited w screws connecting tibia and fibula
DF
what has the purpose to stimulate bone growth
using distraction osteogenesis
(pulling apart bone to stimulate new
bone growth)
Ilizarov Frames
what MUST u do for a Ilizarov Frames
WBBBBBBBB
what are some DF stretching/ROM exercises
sitting - heel slide under chair
standing - knee flexed or extended near a wall
what are ROM/strtching exercseis for PF
mobs and AROM
quadruped stertch
when it MTP extension critical for and how can u increase ROM or stretch
terminal stance
heel raises in sitting
what can u use soft issue massage for
calf’s
peroneals
anterior tibialis
plantar fasciitis
what STM for dr P like for planar fascia
self massage
what are some examples of NM control for the foot/ankle
marble pick up for toe flex , PF and inv and Ev
toerl scrunches for toe flexors
rocker board/BAPD board
what is Dr. P go to for NM control and strength for post tib and foot intrinsics
arch raises (short foot)
what are some toe isolation exercises for NM control , strength
- toe yoga
- splay toes
- toe resistance activation
how can u progress CKC exercseis for the foot and ankle
start in bilateral stance and progress to SLS
add perturbations
what are dynamic strengthening for PF and DF
PF – heel raises; squats
DF – walk on heels
