Download structure and function of the ankle and foot

The Ankle and Foot
Chapter 22
Part IV: Exercise Interventions by Body
Region
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STRUCTURE AND FUNCTION OF THE
ANKLE AND FOOT
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Anatomical Characteristics
 Leg
 Foot
– Hindfoot
– Midfoot
– Forefoot
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Motions of the Foot and Ankle
Defined
 Primary Plane Motions
– Sagittal plane motion around a frontal (coronal) axis
– Frontal plane motion around a sagittal (anteroposterior)
axis
– Transverse plane motion around a vertical axis
 Triplanar Motions
– Pronation
– Supination
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Characteristics and Arthrokinematics:
Leg, Ankle, and Foot Joint
 Tibiofibular Joints
– Superior tibiofibular joint characteristics
– Inferior tibiofibular joint characteristics
– Accessory motions
 Ankle (Talocrural) Joint
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Characteristics and Arthrokinematics:
Leg, Ankle, and Foot Joint (cont'd)
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Subtalar (Talocalcaneal) Joint
Talonavicular Joint
Transverse Tarsal Joint
Remaining Intertarsal and Tarsometatarsal
Joints
 Metatarsophalangeal and Interphalangeal
Joints of the Toes
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Function of the Ankle and Foot
 Structural Relationships
– Interdependence of leg and foot motions
– Arches
– Effect on posture
– Abnormal foot postures
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Function of the Ankle and Foot
(cont'd)
 Muscle Function in the Ankle and Foot
– Plantarflexors
– Secondary plantarflexors
– Dorsiflexors
– Intrinsic muscles
– Stability in standing
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The Ankle/Foot Complex and Gait
 Function of the Ankle and Foot Joints During Gait
 Muscle Control of the Ankle and Foot During Gait
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Ankle dorsiflexors
Ankle plantarflexors
Ankle evertors
Ankle inverters
Intrinsic muscles
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Referred Pain and Nerve Injury
 Major Nerves Subject to Pressure and Trauma
– Common fibular (peroneal) nerve
– Posterior tibial nerve
– Plantar and calcaneal nerves
 Common Sources of Segmental Sensory
Reference in the Foot
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MANAGEMENT OF ANKLE AND
FOOT DISORDERS AND SURGERIES
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Joint Hypomobility:
Nonoperative Management
 Common Joint Pathologies and Etiology of Symptoms
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RA
DJD and joint trauma
Post-immobilization stiffness
Gout
 Common Functional and Structural Impairments,
Activity Limitations, and Participation Restrictions
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Joint Hypomobility:
Nonoperative Management (cont'd)
 Management: Protection Phase
– Educate the patient and provide joint protection
– Decrease pain
– Maintain joint and soft tissue mobility and muscle
integrity
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Joint Hypomobility:
Nonoperative Management (cont'd)
 Management: Controlled Motion and Return
to Function Phases
– Increase joint play and accessory motions
• Joint mobilization techniques
– Improve joint tracking of the talocrural joint
• MWM: Plantarflexion
• MWM: Dorsiflexion
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Joint Hypomobility:
Nonoperative Management (cont'd)
 Management: Controlled Motion and Return
to Function Phases (cont’d)
– Increase mobility of soft tissues and muscles
– Regain a balance in muscle strength and prepare
for functional activities
– Improve balance and proprioception
– Develop cardiopulmonary fitness
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Total Ankle Arthroplasty
 Indications for Surgery
 Contraindications
 Procedure
– Implant design, materials, and fixation
– Operative overview
 Complications
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Total Ankle Arthroplasty (cont'd)
 Postoperative Management
– Immobilization and weight-bearing considerations
– Exercise
• Maximum protection phase
• Moderate and minimum protection phases
 Outcomes
– Pain relief, functional improvement, and patient
satisfaction in different populations
– Participation in physical activities
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Arthrodesis at the Ankle and Foot
 Indications for Surgery
 Procedures
– Common types of arthrodesis
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Arthrodesis of the ankle
Arthrodesis of the hindfoot
Arthrodesis of the first toe
Arthrodesis of the IP joints of the toes
Arthrodesis at the Ankle and Foot
(cont'd)
 Complications
 Postoperative Management
– Immobilization
– Weight-bearing considerations
– Postoperative exercises
 Outcomes
– Short-term and long-term outcomes
– Return to physical activities
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Leg, Heel, and Foot Pain:
Nonoperative Management
 Related Pathologies and Etiology of Symptoms
– Heel pain
• Plantar fasciitis
• Achilles tendonopathy /achilles tendinitis
• Tendonosis, tendinitis, tenosynovitis
– Shin splints
• Anterior shin splints
• Posterior shin splints
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Leg, Heel, and Foot Pain:
Nonoperative Management (cont'd)
 Common Structural and Functional Impairments,
Activity Limitation, and Participation Restrictions
 Management: Protection Phase
 Management: Controlled Motion and Return to
Function Phases
– Educate the patient and provide home exercises
– Stretch range-limiting structures
– Improve muscle performance
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Ligamentous Injuries:
Nonoperative Management
 Common Structural and Functional
Impairments, Activity Limitations, and
Participation Restrictions
 Acute Ankle Sprain Management
– Protection phase
– Controlled motion phase
– Return to function phase
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Repair of Complete Lateral
Ligament Tears
 Indications for Surgery
 Procedures
– Types of stabilization procedures
• Direct repair
• Reconstruction with augmentation
• Arthroscopic thermally assisted capsular shift
– Operative overview
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Repair of Complete Lateral
Ligament Tears (cont'd)
 Postoperative Management
– Immobilization and weight-bearing considerations
– Exercise
• Maximum protection phase
• Moderate and minimum protection phases
 Outcomes
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Repair of a Ruptured Achilles
Tendon
 Indications for Surgery
 Procedures
– Primary versus delayed repair
– Operative overview
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Repair of a Ruptured Achilles
Tendon (cont'd)
 Complications
 Postoperative Management
– Immobilization and weight-bearing considerations
• Conventional versus early remobilization approach
– Exercise progression
– Exercise
• Maximum protection phase
• Moderate protection phase
• Minimum protection/return to function phase
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Repair of a Ruptured Achilles
Tendon (cont'd)
 Outcomes
– Comparison of nonoperative versus operative
management
– Comparison of open versus percutaneous repair
– Traditional versus accelerated rehabilitation
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EXERCISE INTERVENTIONS FOR THE
ANKLE AND FOOT
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Exercise Techniques to Increase
Flexibility and Range of Motion
 Flexibility Exercises for the Ankle Region
– Increase dorsiflexion of the ankle
– Increase inversion
– Increase ankle plantarflexion and eversion
– Increase eversion and ankle dorsiflexion
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Exercise Techniques to Increase
Flexibility and Range of Motion (cont'd)
 Flexibility Exercises for the Limited Mobility of
the Toes
– Passive MTP flexion
– Passive IP extension
– Active MTP flexion
– Great toe extension
 Stretching the Plantar Fascia of the Foot
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Exercise to Develop and Improve Muscle
Performance and Functional Control
 Activities to Develop Dynamic Neuromuscular
Control
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Exercise to Develop and Improve Muscle
Performance and Functional Control (cont'd)
 Open-Chain (Non-Weight-Bearing)
Strengthening Exercises
– Plantarflexion
– Isometric eversion and inversion
– Eversion and inversion with elastic resistance
– Adduction with inversion and abduction with
eversion using weights
– Dorsiflexion
– All ankle motions
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Exercise to Develop and Improve Muscle
Performance and Functional Control (cont'd)
 Closed Chain (Weight-Bearing) Exercises
– Stabilization exercises
– Dynamic strength training
– Resisted walking
– Functional progression for the ankle and foot
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Independent Learning Activities
 Critical Thinking and Discussion
 Laboratory Practice
 Case Studies
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