14438524 Physical Therapy Protocols for Ankle and Foot Conditions[1]

SUMMARY OF ANKLE AND FOOT DIAGNOSTIC CRITERIA AND PT MANAGEMENT STRATEGIES DISORDER Ankle & Foot Mobility Deficits “Midtarsal Joint Capsulitis”

Ankle & Foot Mobility Deficits Hallux Rigidus Ankle Muscle Power Deficits Achilles Tendinitis Ankle Muscle Power Deficits “Posterior Calcaneal Bursitis” Ankle Movement Coordination Deficit “Lateral Ankle Sprain”

Ankle & Foot Radiating Pain Tarsal Tunnel Syndrome Foot Pain “Pronatory Disorder”

HISTORY Arch area pain Recent strain or repetitive wt. bearing Sx’s worse w/ SLS or prolonged wt. bearing Stiffness Pain at “toe-off” phase of gait Gradual onset of Achilles area aching Sx’s worse with activity Posterior heel pain Swelling Irritated by pressure, i.e., from a shoe Inversion stress Swelling Pain If chronic – instability

PHYSICAL EXAM SR w/: End range accessory motion Test of one or more of the midtarsal articulations

PT MANAGEMENT Joint Mob (to specific hypomobility) Ther Ex’s (Stretch/strengthen related muscles) Taping/footgear/orthotics

ROM deficit: 1 st MTP extension Pain at end range of 1 st MTP ext. Limited MTP accessory movements Swelling 1-2 inches above Achilles insertion SR w/palpation of tendon in same area

Joint Mob Ther Ex’s Patient Ed: Proper footgear Activity modification Proper footgear and/or heel lift Calf stretching Strengthening – esp. eccentric Physical agents (Ice, US, Phono, Ionto) Activity and Shoe Modifications

Swelling near Achilles insertion SR w/provocation of insertion on posterior aspect of calcaneus Antalgic gait Lateral ankle effusion SR w/: Palpation of lateral ligaments Inversion stress May have laxity w/anterior drawer

Medial foot pain Paresthesias Numbness

SR w/: Tibial Nerve bias LLTT Provocation of Tibial Nerve in Tarsal Tunnel

Aching in arch of foot Sx’s worse after prolonged weight bearing

Excessive pronation at LR, MSt, or TSt Deficient Midtarsal supination or Forefoot eversion at TSt Inability to form arch w/tibial external rotation and calcaneal inversion

P.R.I.C.E. Instructions Physical agents (Ice, E. Stim,) Friction massage Inferior Tib-Fib Mobs Proprioceptive Training Calf stretching Functional Strengthening Rx entrapment (STM/JM to Med. Ankle and Foot) Tibial Nerve Mob (PROM and AROM Ex’s) Joint mob/manip (to hypermobile of  subluxed tarsal articulations) Ther Ex’s (stretch shortened and strengthen weak myofascia of LE) Taping Proper footgear or orthotics

Joe Godges DPT

KPSoCal Ortho PT Residency

1

Achilles Tendon Repair and Rehabilitation Rehabilitation Surgical Indications and Considerations  Anatomical Considerations: The poorest blood supply to the Achilles tendon is in the central part of the tendon – approximately 2 to 6 cm proximal to the calcaneal insertion – which may account for the fact that most of the ruptures occur in this area. Pathogenesis: Tendons rupture when the mechanical loads exceed the physiologic capacity of  the tendon. The physiologic capacity of the Achilles tendon may be compromised by intrinsic factors such as hypovascularity, repetitive microtrauma and the associated inflammation and degeneration, endocrine function and nutrition. Extrinsic, mechanical forces may also exceed the physiologic capacity of the Achilles tendon, such as when 1) an individual forcefully pushes off the forefoot while extending the knee (e.g., when cutting, sprinting or jumping), 2) an individual experiences a sudden dorsiflexion with full weightbearing (e.g., a slip, fall, or sudden