lower leg interventions Flashcards
Ankle sprains (primary and secondary prevention)
-Clinicians should recommend prophylactic bracing to reduce risk of first time LAS (A)
-Recommend use of prophylactic balance training exercises (C)
-Rx prophylactic bracing and proprio and balance focused TE to reduce risk of subsequent injury (A)
ankle sprains (acute and postacute protection)
-Advise pts to use external supports- bracing/taping and progressively bear weight on affected limb (A)
-Severe injury- immobilize from semi-rigid brace to below knee casting- indicated for 10 days post injury (A)
ankle sprains (acute/postacute TE)
Implement rehab programs with TE that include AROM, stretching, NM training, postural re-education, balance training (A)
BAPS board proprio training!
ankle sprains (acute and postacute occupational and sports training)
Implement RTW or RTS schedule. use brace in early rehab (B)
Ankle sprains (acute and post lateral ankle sprains: physical agents)
-Use repeated intermittent applications of ice (C)
-Use pulsating shortwave diathermy (C)
-Mod evidence for and against use of electrotherapy (D)
-Low level laser therapy to reduce pain in initial acute (C)
-Clinicians should NOT use US (A)
Ankle sprains (manual therapy, meds)
-Clinicians should use manual therapy (A)
-Clinicians may rx nonsteroidal anti-inflam meds to reduce pain and swell (C)
CAI (external support, TE)
-Should NOT use external support (bracing/taping) as a stand alone intervention (B)
-Should rx proprio and NM TE (A)
(4 plane ankle proprio/coordination)
CAI (manual and dry needling)
Clinicians should use manual (A)
May use dry needling (C)
Ankle sprains and CAI
-Can use multiple interventions to supplement balance training , including combo of exercise and manual (B)
Psych factors (E)
CAI Chochrane
NM re-ed exercises
No consensus on sx mx
Ankle Impingement syndromes
-Address identified impairments
(acute mx-inflamm, balance/coordination training-proprio)
-NSAIDS
-Sx: failure of conservative x6mnths
Arthroscopic debridement (worse prog w/ lesion)
Post-op mx: monitor entry site, acute mx, address impairments as appropriate
Hallux Rigidus
-shoe mods (rocker bottoms- limit DF stress at MTPs) (can also do stiff sole shoe/ rigid insert)
-rest/activity mods
-joint mobs (1st MTP traction,glides)
-FHL strengthen/stretch
-calf stretch
-AROM- pain relief, maintenance of motion gained
-Medical (NSAIDS, corticosteroid injection, Cheilectomy excised- dorsal part and osteophyte)
Hallux valgus
-educate: wider shoes
-shoe alterations: bunion pad, toe spacer, if pes planus also present a medial arch support
-calf stretch
-1st MTP joint mobs
-sx: realignment
Achilles tendinopathy
-Complete rest NOT indicated- continue with recreational activity w/in pain tolerance
-Use mechanical loading eccentric or concentric/eccentric program
-No recommendation w/ laser
-Iontophoresis in ACUTE tendinopathy- addresses inflam
-No recommendation on orthoses
-stretch PFs (C)
-joint mobs (F)
-dry needling (F)
-NOT use elastic taping (F)
-No recom. for heel lifts
-should NOT use night splints
Achilles tendon rupture (cast)
-Repair: cast vs boot
~Cast- commonly 6-8 wks, boot w/ heel lift for month
NWB resistance ~8-10 wk
Cycling w/o resistance at ~week 8
Achilles tendon rupture (boot)
-NWB w/ crutches x4wks
-early weeks (0-4)
passive PF and active DF (limit 20 PF)
20 deg PF w/ heel lift
ROM once incision healed
-wean from heel lift and progress to ankle neutral 4 wks
-cycling w/o resistance ~week 6
-walking boot until ~week 8
plantar faciitis
-Manual therapy- medial glides, P TC joint
-Stretch gastroc/soleus and plantar fascia (wall stretch)
-Foot taping rigid or elastic w/ other PT treatments
-1-3 month program of night splints
-low level laser
-rx TE w/ RT for foot and ankle
-dry needling to triceps surae, and plantar muscle
-orthoses
-phonophoresis
-manual therapy, stretch and foot orthoses
-iontophoresis or Estim
-education of exercise strategies
-refer to practitioner
-rx a rocker bottom shoe with foot orthosis, also shoe rotation through week
-NOT use orthoses as isolated tx, US
Metatarsalgia
-met pads
-avoid high heels
-orthotic for pes cavus
-address triceps surae length
Lower ankle sprain CPR for manual therapy and exercise
-sxs worse when standing
-sxs worse in evening
-navicular drop 5.0mm
-distal tibiofibular joint hypomob
3/4 there is a good possibility they will respond well to these things
Inversion sprain
MWM with posterior TC mobs results in greater P talar translation and DF ROM
