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MANUAL TERAPI ANKLE AND FOOT INTERVENSI Oleh: Sugijanto Disampaikan pada kuliah reguler Manualterapi II TUJUAN INSTRUKSIONAL Mahasiswa memahami Intervensi pada kasuistik Ankle and foot complex dengan cara : Mampu menjelaskan metoda dan dosis intervensi manualterapi kasus Ankle and foot complex Mampu membedakan indikasi antara metoda dengan pemeriksaan khusus. Mampu mempraktek intervensi manualterapi kasus Ankle and foot complex Mampu menilai tentang hasil intervensi manualterapi kasus Ankle and foot complex. PERTANYAAN STUDI Sebutkan indikasi intervensi metoda manualterapi bila dijumpai patologi muscle pain sec. Tendinitis, Muscle tightness/contracture, Capsular pattern hypomobility, Joint hypermobility, Joint instability, dan sensoric deficit sec nerve entrapment. Uraikan dan praktekkan Teknik transverse friction pada: lig. Talofibulare; lig. Talocalcaneal, lig. Tibiofibulare, lig. tibiotalare; tendon achilles; m. peroneus longus, m. peroneus brevis, m. tibialis anterior; m. tibialis posterior. Uraikan dan praktekkan Joint mobilisation traksi, translasi dan roll slide pada sendi Ankle, subtalar, chopard, MTP and PIP-DIP. Uraikan dan praktekkan mobilisasi otot dan contract relax stretching pada tightness/contracture m. Gastrocnemius, m. soleus, m tibialis anterior. Jelaskan dan praktekkan terapi latihan pada Ankle and foot complex. Jelaskan dan praktekkan pengukuran hasil pada intervensi Ankle and foot complex. INTERVENTION MASSAGE MUSCLE MOBILIZATION Oedeme reduce massage Muscle manipulation MUSCLE STRETCHING Gastroc nemius m. Soleus m. TRANSVESE FRICTION Gastrocnemius m Achilles tendon: Permukaan posterior Permukaan lateral-medial Permukaan anterior Anterior tibial m. Aterior tibial tendon Peroneus longus and brevis ms Peroneus longus and brevis tendon JOINT MOBILIZATION Translation of distal tibiofibular joint Dorsal translation Traction of Ankle joint : In MLPP (Awal mobilisasi/ aktualitas tinggi) In Limited dorsal flexion (Menambah ROM dorsal flexion) In Limited plantar flexion (Menambah ROM dorsal flexion) Translation of Ankle joint : In Limited dorsal flexion (Menambah ROM dorsal flexion) In Limited plantar flexion (Menambah ROM dorsal flexion) Intermetatarsal Translation Dorsal and plantar translation MT1, MT3, MT4 and MT5 Koreksi transverse arc Traction to MTP joint I (II,III,IV & V): In MLPP In Limited dorsal flexion Awal mobilisasi/aktualitas tinggi (Menambah ROM dorsal flexion) In Limited plantar flexion (Menambah ROM plantar flexion) Translation to MTP joint I (II,III,IV & V): In Limited dorsal flexion (Menambah ROM dorsal flexion) In Limited plantar flexion (Menambah ROM plantar flexion) Manipulation to lesion. Passive stabilization Elastic bandage Tapping Medial arc support Medial wedge shoe AFO EXERCISE MUSCLE REEDUCATION. Active stabilization exercises. Active strengthening exercises EVALUASI Pain: VAS/ VRS/ VDS ROM: Goneometer Strength: MMT/Hand held dynamometer/Spigmomanometer. Flat foot Bawaan Nyeri medial foot (knee) Antalgi gait Navicular nonjol medial Calcaneal valgus Pronation foot Over weight Palpasi nyeri navicular Stretch test lig. Plantar foot Strength test Pengukuran longit arc External rotated leg Medial arc support shoes Strengthening exc. Toes flexors Plantar fasciitis – calcaneal spur Degenerasi Over weight Repetitive Stretching apponeurosis plantaris Nyeri tumit/plantar Antalgic gait, heel strike-foot flat ± Palpasi nyeri plantar fascia & calcaneus Stretch test Plantar fascia Strength test otot flexors US Transverse friction Donnut pad-medial arc suport shoes Ankle sprain Active unstable foot Nyeri lateral (medial) foot Riwayat injury Inversion injury Rest Acute Akt. tinggi Acute edema Compression Elevation Antalgic gait Nyeri inversi (eversi) ROM ± Ice KronikAkt. rendah Joint mobilization Active stabilization Gouty arthritis Metabolism Endapan purin Inflamasi Awal MTP I Nyeri tajam ibu jari kaki Gait analysis Toe off Medicamentosa ROM MTP I terbatas Non capsular pattern Palpasi: Tenderness Joint blockade arah tertentu US under water Joint mobilization DAFTAR PUSTAKA Cook CE, Osthopaedic Manual Therapy, Pearson Prentice Hall, New Jersey, 2007 Goodmann & Boissaunnault, Pathology implication for physiotherapy. WB Saunders co, London, 2000. Helting D & Kessler RM, Management of common musculoskeletal disorder, ippincott Williams and Wilkins, Philadelphia, 2006. Makofsky HW, Spinal Manual Therapy, Slack inc, NJ USA, 2003 Meadows JTS, Orthopaedic Differential Diagnosis in Physisal therapy, Mc Graw-Hill, NY, 1999. Van der El, A, Lunacek, P and Wagemaker, A, Manuele therapie, wervelkolom onderzoek, deel 1, Uitgeverij Manuwel, Roterdam, Ed. I, 1983. Van der El, A, Lunacek, P and Wagemaker, A, Manuele therapie Wervelkolom Behandeling, deel 2, Uitgeverij Manuwel, Roterdam, Ed. I, 1989. Dvorak, J and Dvorak, V, Medical checklists Manual Medicine, Gerg Thieme Verlag Stuttgart, New York, 1991.