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The Ankle and Foot Chapter 22 Part IV: Exercise Interventions by Body Region Copyright © 2013. F.A. Davis Company STRUCTURE AND FUNCTION OF THE ANKLE AND FOOT Copyright © 2013. F.A. Davis Company Anatomical Characteristics Leg Foot – Hindfoot – Midfoot – Forefoot Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company Characteristics and Arthrokinematics: Leg, Ankle, and Foot Joint Tibiofibular Joints – Superior tibiofibular joint characteristics – Inferior tibiofibular joint characteristics – Accessory motions Ankle (Talocrural) Joint Copyright © 2013. F.A. Davis Company Characteristics and Arthrokinematics: Leg, Ankle, and Foot Joint (cont'd) Subtalar (Talocalcaneal) Joint Talonavicular Joint Transverse Tarsal Joint Remaining Intertarsal and Tarsometatarsal Joints Metatarsophalangeal and Interphalangeal Joints of the Toes Copyright © 2013. F.A. Davis Company Function of the Ankle and Foot Structural Relationships – Interdependence of leg and foot motions – Arches – Effect on posture – Abnormal foot postures Copyright © 2013. F.A. Davis Company Function of the Ankle and Foot (cont'd) Muscle Function in the Ankle and Foot – Plantarflexors – Secondary plantarflexors – Dorsiflexors – Intrinsic muscles – Stability in standing Copyright © 2013. F.A. Davis Company The Ankle/Foot Complex and Gait Function of the Ankle and Foot Joints During Gait Muscle Control of the Ankle and Foot During Gait – – – – – Ankle dorsiflexors Ankle plantarflexors Ankle evertors Ankle inverters Intrinsic muscles Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company MANAGEMENT OF ANKLE AND FOOT DISORDERS AND SURGERIES Copyright © 2013. F.A. Davis Company Joint Hypomobility: Nonoperative Management Common Joint Pathologies and Etiology of Symptoms – – – – RA DJD and joint trauma Post-immobilization stiffness Gout Common Functional and Structural Impairments, Activity Limitations, and Participation Restrictions Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company Total Ankle Arthroplasty Indications for Surgery Contraindications Procedure – Implant design, materials, and fixation – Operative overview Complications Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company Arthrodesis at the Ankle and Foot Indications for Surgery Procedures – Common types of arthrodesis • • • • Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company Repair of a Ruptured Achilles Tendon Indications for Surgery Procedures – Primary versus delayed repair – Operative overview Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company EXERCISE INTERVENTIONS FOR THE ANKLE AND FOOT Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company Exercise to Develop and Improve Muscle Performance and Functional Control Activities to Develop Dynamic Neuromuscular Control Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company Independent Learning Activities Critical Thinking and Discussion Laboratory Practice Case Studies Copyright © 2013. F.A. Davis Company