Lecture 9 - Foot/ankle/lower leg rehabilitation

Question 1

Why is medial ankle sprain not as common as lateral ankle sprain?

Answer 1

Because of the position of the malleolus
Inversion more prone because malleolus is lower, limiting how much ROM in inversion we can get into

Question 2

MOI of high ankle sprains (position of foot)

Answer 2

Extreme dorsiflexion/eversion

Question 3

What is morton’s neuroma?

Answer 3

Neuropathy between 2nd and 3rd toe

Question 4

MOI of turf toe

Answer 4

Extreme extension of toe

Question 5

What is more effective then immobilization when managing grade 1 or 2 ankle sprains?

Answer 5

Functional rehabiliation

Question 6

Adjuncts tool in early stages of ankle sprain rehab

Answer 6

Electrical stimulation

Question 7

Rehab should include a comprehensive ___, and ___, and ____ of the surrounding musculature

Answer 7

ROM
Flexibility
Strengthening

Question 8

What type of exercise is used throughout management and follow-up to reduce risk of re-injury?

Answer 8

Balance training

Question 9

What to use to increase DF and improve function in ankle sprain rehab?

Answer 9

Passive joint mobilizations and mobs

Question 10

Why do we still need to immobilize in the case of a HAS?

Answer 10

Because we can’t avoid the MOI, which is splaying the bones in WB position, so we stabilize it

Question 11

A rehab protocol should be divided into specific stages: name them (for lateral ankle sprains- soccer)

Answer 11

1. Acute and subacute pain and swelling control
2. ROM and strengthening exercises
3. Soccer specific functional training
4. Prophylactic intervention with balance and proprioception stimulating exercises

Question 12

Upon RTP, what type of training is vital to minimize recurrence?

Answer 12

Proprioception

Question 13

Mild syndesmotic (HAS) sprains can be managed conservatively with ____ and ____

Answer 13

Protected weight-bearing
Functional rehabilitation

Question 14

What to remember about “Interventions for the prevention of first time and recurrent ankle sprains”?

Answer 14

Balance training is very important

Question 15

If turf toe is recalcitrant, leads to what injury?

Answer 15

Flexor hallucis longus tear

Question 16

Grade 1 turf toe ->

Answer 16

Return to competition as tolerated. Taping into slight PF or stiff soled shoe

Question 17

Grade 2 turf toe ->

Answer 17

Protected WB with gentle ROM
Low impact activity
Increase difficulty until able to be explosive + push off
Turf toe plate

Question 18

Kinematics of achilles tendinopathy

Answer 18

Greater rearfoot eversion (pronation collapsing in)
Contralateral pelvic drop

Question 19

Achilles tendinopathy : combining __ exercises and ____ have higher success outcomes then each intervention alone

Answer 19

Eccentric + shock wave therapy

Question 20

Kinematics of medial tibial stress syndrome

Answer 20

Rear foot eversion, longitudinal arch angle (deltoid and spring ligaments work ineffectively)

Question 21

What are 2 strategies for medial tibial stress syndrome?

Answer 21

1. Activity modification
2. Loading

Question 22

Activity modification for MTSS

Answer 22

Up to 90 days to be able to run without pain
If athlete has shin splints fo 3+ months = more like 9-12 months
Use ice massage

Question 23

Loading for MTSS

Answer 23

Plantar flexion strengthening exercises and load management to start (with proper form)
-> max 2/10 pain + ability to absorb forces

Question 24

Other name for medial tibial stress syndrome

Answer 24

Shin splint

Question 25

What muscle to strengthen for shin splints? name 3

Answer 25

Tib post Gastroc Soleus ---- which help in PF and control eversion

Question 26

What is the power muscle?

Answer 26

Gastrocnemius

Question 27

If the athlete felt a pop or felt giving away at the level of the calf, what is most likely the injury?

Answer 27

Gastrocnemius strain

Question 28

If the athlete complains of pain at level of calf, overtime, started a while ago, not getting better, what is the most likely injury?

Answer 28

Tendinopathy of the calf muscles

Question 29

T or F: start with eccentric for a strain of a muscle

Answer 29

FALSE, that's why we need to make sure we don't have a strain instead of a tendinopathy

Question 30

What are the 2 considerations in ankle/foot injuries?

Answer 30

1. Avoid stressing the joint into the MOI (ex: inversion for lat. ankle sprain) 2. Weight bearing restrictions (avoid walking with a limp = avoid secondary complications)

Question 31

Kinematics of plantar fasciitis

Answer 31

Greater rear foot eversion with lower arch increases tension on plantar fascia, decreased DF

Question 32

Purpose of the plantar fascia brace

Answer 32

Puts your toes in extension and foot in DF to allow for the calf muscles to stretch

Question 33

When do we use PROM?

Answer 33

Only if active is contraindicated or too painful

Question 34

Which type of ROM is used early typically?

Answer 34

A-AROM

Question 35

Example of strengthening exercises for intrinsic muscles of the foot

Answer 35

Toe yoga Towel toe curls Grab mini balls and put them in a cup Practice supination of foot

Question 36

Purpose of OKC in strengthening of the ankle

Answer 36

Activate the weak muscles

Question 37

Examples of functional movements of strengthening the ankle

Answer 37

Calf raises Heel walks Toe walks

Question 38

3 parts of weight bearing proprioception concept

Answer 38

Gait re-training Double leg balance Single-leg balance