Foot/Ankle Techniques

Question 1

The 2 Functions of the Foot

Answer 1

• “Loose Bag of Bones” (loading)
  ~ Dissipates force and adapts to ground
  surface during loading/pronation
• “Rigid Lever” (unloading)
  ~ Propels the body forward during
  unloading/supination

Question 2

What makes loading happen?

Answer 2

The body controlling gravity by eccentric contraction

Question 3

What makes unloading happen?

Answer 3

The body overcoming gravity by concentric contraction

Question 4

Which qualities are necessary to dissipate force? (Loading)

Answer 4

Eccentric muscle control (NMC) and mobility

Question 5

Which qualities are necessary to propel/unload?

Answer 5

Concentric muscle control (NMC) and mobility

Question 6

Relationship Between STJ and MTJ

Answer 6

• Functional loading of the subtalar joint causes the midtarsal joint to unlock and become hypermobile. (Loose Bag of Bones)
  • Functional unloading of the subtalar joint causes the midtarsal joint to lock and become hypomobile.
  (Rigid Lever)

Question 7

What qualities are necessary to maintain the STJ/MTJ relationship?

Answer 7

NMC and mobility

Question 8

Which STJ motions and plane are especially important in considering the functions of the foot?

Answer 8

• INV/EV
  ~ Unlocks and locks the foot for loading
  and unloading
• Frontal Plane

Question 9

What are the possible sources for a ROM deficit at the STJ?

Answer 9

• Weakness
• Tight joint capsule
• Swelling
• Scar tissue
• Muscle tightness
• Abnormal bony structures
• Torn structures

Question 10

How do you overcome ROM limits at STJ?

Answer 10

• Heat
• Joint mobs
• Soft tissue mobilization
• Have them move: functionally

Question 11

What is the body trying to accomplish with compensations associated with structural foot deformities?

Answer 11

Get the foot flat on the floor

Question 12

What happens when a compensation is a component of loading?

Answer 12

• Foot spends more time in loading.
  ~ Does not dissipate force well.
  ~ Increases stress on structures that
  provide stability to the joints of the
  foot and the muscles that control
  loading and unloading.

Question 13

What happens when a compensation is a component of unloading?

Answer 13

• Foot spends more time in unloading
  ~ Does not dissipate force well.
  ~ Muscles may shorten due to the
  abnormal foot position, which can
  also result in increased stress on the
  muscles that control loading and
  unloading.

Question 14

Do obvious foot deformities treated with orthotics require rehab?

Answer 14

• Yes!
  ~ Must teach proper LE NMC since
  position, motion of foot, and rest of
  chain is altered with device
  ~ To employ the “causative cure” when
  dealing with LE tendonitis, strains,
  compartment syndrome, etc

Question 15

What is the dominant plane of motion at the TCJ?

Answer 15

Sagittal

Question 16

Which motions occur at the TCJ?

Answer 16

DF and PF

Question 17

What are the possible sources for a ROM deficit at the TCJ?

Answer 17

• Weakness
• Tight joint capsule
• Swelling
• Scar tissue
• Muscle tightness
• Abnormal bony structures
• Torn structures

Question 18

How do you overcome ROM limits at the TCJ?

Answer 18

• Heat
• Joint mobs
• Soft tissue mobilization
• Have them move: functionally

Question 19

Windlass Effect

Answer 19

• Extension of the toes during the propulsive phase of gait winds the plantar fascia around the head of the metatarsals.
• This winding of the plantar fascia shortens the distance between the calcaneus and metatarsals to elevate the medial longitudinal arch and invert the calcaneus.

Question 20

What motion is especially important during the Windlass Effect?

Answer 20

• Extension of MTP
• INV/EV of STJ

Question 21

Common Injuries

Answer 21

• Sever’s Disease
• Surgically repaired Lisfranc (immobilized 6 weeks)
• Surgically repaired Achilles rupture (immobilized 2-6 weeks)
• Plantar Fasciitis
• Turf Toe
• Inversion Ankle Sprain