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The Ankle and Foot

The Ankle and Foot. Chapter 22. Structure and Function of the Ankle and foot. Anatomical Characteristics. Leg Foot Hindfoot Midfoot Forefoot. Motions of the Foot and Ankle Defined. Primary Plane Motions Sagittal plane motion around a frontal (coronal) axis

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The Ankle and Foot

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  1. The Ankle and Foot Chapter 22

  2. Structure and Function of the Ankle and foot

  3. Anatomical Characteristics • Leg • Foot • Hindfoot • Midfoot • Forefoot

  4. 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

  5. Characteristics and Arthrokinematics: Leg, Ankle, and Foot Joint • Tibiofibular Joints • Superior tibiofibular joint characteristics • Inferior tibiofibular joint characteristics • Accessory motions • Ankle (Talocrural) Joint

  6. 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

  7. Function of the Ankle and Foot • Structural Relationships • Interdependence of leg and foot motions • Arches • Effect on posture • Abnormal foot postures

  8. Function of the Ankle and Foot (cont'd) • Muscle Function in the Ankle and Foot • Plantarflexors • Secondary plantarflexors • Dorsiflexors • Intrinsic muscles • Stability in standing

  9. 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

  10. 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

  11. management of Ankle and foot disorders and surgeries

  12. 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

  13. 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

  14. 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

  15. 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

  16. Total Ankle Arthroplasty • Indications for Surgery • Contraindications • Procedure • Implant design, materials, and fixation • Operative overview • Complications

  17. 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

  18. Arthrodesis at the Ankle and Foot • Indications for Surgery • Procedures • Common types of arthrodesis • Arthrodesis of the ankle • Arthrodesis of the hindfoot • Arthrodesis of the first toe • Arthrodesis of the IP joints of the toes

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. Repair of a Ruptured Achilles Tendon • Indications for Surgery • Procedures • Primary versus delayed repair • Operative overview

  26. 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

  27. 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

  28. Exercise interventions for the Ankle and Foot

  29. 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

  30. 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

  31. Exercise to Develop and Improve Muscle Performance and Functional Control • Activities to Develop Dynamic Neuromuscular Control

  32. 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

  33. 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

  34. Independent Learning Activities • Critical Thinking and Discussion • Laboratory Practice • Case Studies

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