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Therapeutic Exercise AT 523 > Foot and Ankle > Flashcards

Foot and Ankle Flashcards

(48 cards)

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1
Q

Medial Longitudinal Arch

A

Extends from calcaneus to metatarsal heads 1-5
runs proximal to distal
Important in shock absorption

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2
Q

Transverse Arch

A 
in midfoot (cuboid, cuneiforms, base of metatarsals)
runs medial to lateral

Plantar fascia is stressed-no elastic recoil so it collapses as they start to push off

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3
Q

Ankle Dorsiflexors

A

Prime mover-anterior tibialis

Synergists-Extensor digitorum longus, extensor hallucis longus, peroneous tertius

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4
Q

Ankle Evertors

A 
Prime Mover=Peroneus Longus
Synergists= Peroneus Brevis
Perneus Tertius
EDL
Ant. Tib
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5
Q

Ankle PF

A 
Prime mover=gastroc
Synergists= soleus
Plantaros-weak
Tibilais post
FDL/FHL-weak
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6
Q

Ankle Invertors

A

Prime Mover=Tibialis Post

Synergist=FDL/FHL

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7
Q

Plantar Fascia

A

Dense, fibrous tissue located on plantar surface of foot
extends medial calcaneal tubercle and inserts via 5 bands onto each toe
Supports longitudinal arch and protects structures on plantar surface

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8
Q

Talocrural joint

A

primary motion: Dorsi/Plantarflexion

Need 10 degs. DF for normal gait

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9
Q

Subtalar joint

A

Primary motions: Pronation/Supination

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10
Q

Initial Contact

A

Ankle joint in neutral
STJ is slightly supinated
GRF posterior to ankle jt creating PF torque
Ant. Tib and EDL are on eccentrically

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11
Q

Loading Response

A

5* PF occurs
Eccentric Pretibial mm action–tibia is pulled forward
Knee flexes

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12
Q

Subtalar Jt Loading Response

A 
Calcaneus everts 5 degs (CCP)
Allows for SHOCK ABSORPTION
-calcaneal eversion
-talus horizontally adducts
-tibia IR
-knee flexes
-Femur IR

Pronation “unlocks” MTJ—shock absorption
Ant. tib and Post tib ecc. contract

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13
Q

Midstance

A

Ankle dorsiflexes 5
Gastroc and Soleus work ecc. to control forward tibial advancement
–body is able to progress forward over a stable foot & tibia
Gastroc fires to control knee extension (stabilizes knee)

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14
Q

Terminal Stance

A 
Ankle DF to 10
Peak DF torque
1st MTP extends to 30
Calf mm activity peaks 
---prevents fwd tibial advancement
---allows heel to rise
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15
Q

Terminal Stance STJ

A

STJ and MTJ go into supination towards end of TS
=make a rigid lever for push off

Causes:
calcaneal inversion
talar horizontal ABD
tibial ER
Knee ext
Femur ER
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16
Q

Terminal Stance 1st ray support

A

controlled by Peroneal longus
Stabilizes 1st ray as weight is transferred to forefoot
Also controls midtarsal supination by ecc eversion

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17
Q

Preswing

A 
knee rapidly flexing by momentum
Ankle to 15 PF
1st MTP 60-70 ext
Calf muscle activity ceases
pretibial activity now becomes concentric in prep to clear foot off ground
forefoot on ground for balance
STJ goes to neutral for all swing phases
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18
Q

Initial Swing

A

Ankle in 5 PF

Concentric contraction of ant tib, EHL, EDL

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19
Q

Midswing

A

Ankle is in neutral position

pretibial muscles active

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20
Q

Terminal swing

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A

Ankle in neutral-prepping for heel strike at initial contact

Pretibial muscles are active

21
Q

AAROM-Dorsiflexion

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A

Towel
Contralateral limb
Hand

22
Q

AAROM-PF

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A

Gravity assisted
Contralateral Limb
Hand

23
Q

AAROM Inversion

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A

Towel
Contralateral Limb
Hand
Gravity Assisted

24
Q

AAROM Eversion

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A

Towel
Contralateral Limb
Hand
Gravity assisted

25
AROM--DF,PF,Inn, Ev
Used to facilitate muscles after period of disuse/immobilization or injury Can combine with hydrotherapy Ankle pumps/Ankle ABCs
26
Syndesmosis Sprains
High Ankle Sprains | Avoid excess DF during acute and subacute phases
27
Stretching Dorsiflexors
Standing | Kneeling-more aggressive, use later in rehab, restores end-range of DF ROM
28
1st MTP extension
Must be able to achieve 65-70* for normal gait Hard to achieve if Hallux Valgus is present -shoes with a narrow toe box can cause this
29
Foot & Ankle Strengthening
Lower leg musculature has more of an endurance fxn with ADLs Sport Specific (SS) fxn require strength and power across endurance time frames Rehab must include strengthening of weak muscles to balance asymmetries---progress to strength and power mimicing SS
30
Isometrics DF
ant. tibialis & perneus tertius
31
Isometrics PF
gastroc, soleus, post. tib, FDL FHL, plantaris
32
Isometrics Invertors
post. tib, FDL, FHL
33
Isometrics Evertors
Peroneus longus, brevis, tertius
34
Towel Curls
Strengthens: Foot intrinsics Long toe flexors/extensors Towel slides with weight
35
Calf raises on leg press
strengthens gastroc and soleus | loads achilles tendon
36
Soleus Strengthening
Soleus is the dominant decelerating force | --largest PF muscle
37
Fxnal Ankle Instability
Following acute inversion ankle sprains ---chronic instability=20-30% Increased risk of sprain reoccurance ---delayed proprioceptive response of peroneals
38
Fxnal ankle instability rehab
Afferent neuromuscular pathways need retrained to eliminate the deficit and restore normal reflex joint stabilization
39
standing postural control
subjects with pronated and supinated foot structures had poorer static postural control during SL stance than those with a neutral structure
40
LE NMC Static
``` Static standing: EO/EC Bipedal/SLS Tandem Surface ```
41
LE NMC Dynamic
``` Ambulation/running Cutting/pivoting Ball toss Reaching Tasks Box hop Wobble Board/Tilt Board--incorporate UE ``` Progressions=direction, speed, bipedal/SLS, surface, predicted vs unpredicted
42
Neuromuscular Re-ed
includes balance, coordination, stability --this is key to dynamic stability to foot and ankle ``` Progressions: DL to SL EO to EC Stable to Unstable Static to dynamic-add pertubations Must activate core ```
43
Proprioception prgressions
``` DLS with EO DLS tandem SL EO SL EC Foam Seated T-ball: ABCs ```
44
resisted band walking
forward, backward, side stepping, around cones, up and over cones
45
Rehab-Inversion Ankle Sprain Acute
``` Goals: decrease pt swelling, restore ROM PRICE PF/DF ROM --avoid INV/EV -Weight bearing as tolerated ```
46
Rehab-Inversion Ankle Sprain fibroplastic repair
``` Goals: increase ROM all planes, restore NMC and proprioception PRICE PRN ROM all planes Strengthening ankle and foot progress to full weight bearing proprioception progression ```
47
Hip strengthen & ankle sprains
unilateral chronic ankle sprains had weaker hip abduction strength and less plantar-flexion ROM of involved sides Delayed G med firing Delayed G max firing after ankle sprains
48
Rehab-Inversion Ankle Sprain maturation
Goals: no pain or swelling, full ROM and strength, restore proprioception Progress ROM, strengthening and proprioception training progress with walk-jog-running protect with tape and/or brace progress with fxnal activities

Therapeutic Exercise AT 523 (3 decks)

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