PTA135-Unit 3-2-Ankle, Foot, Toes Flashcards
(35 cards)
Describe 1st degree ligament sprain of the ankle
- 1 ligament is completely torn
- anterior talofibular ligament (ATFL)
Describe 2nd degree ligament sprain of the ankle
- 2 ligaments are completely torn
- ATFL and calcaneofibular ligament (CFL)
Describe 3rd degree ligament sprain of the ankle
- 3 ligaments are completely torn
- ATFL, CFL and posterior talofibular ligament (PTFL)
State the most common MOI for sprains of the lateral aspect of the ankle
Inversion of the foot and ankle in a weight bearing position
discuss rehab following a lateral ankle sprain - Maximum Protection Phase
- RICE 3-5 times daily
- joint protection with brace, air sitrrup, taping in neutral or in DF with slight eversion
- WBAT
- AROM without pain, avoiding PF/inversion
- strengthening with isometrics and proximal PRE’s
- progress to WB without assistive device
discuss rehab following a lateral ankle sprain - Moderate Protection Phase
- begins when able to WB w/out assist; perform ROM/isometrics w/out increased pain
- RICE
- continue taping or bracing as needed
- WB exercise progression
- begin concentric/eccentric exercises
- stationary bike
- PF/inversion as pain allows
- calf and achilles stretches (to not lose flexibility)
- proprioceptive & balance exercises initiated
discuss rehab following a lateral ankle sprain - Minimal Protection Phase
- begins when pt can perform all resistive exercises and ambulate w/out pain or deviations and swelling is reduced
- continue progression of proprioception and neuromuscular activities
- return to functional activities - jogging, jumping, cutting exercises
- bracing during functional activities PRN
What is the most common cause of Achilles Tendonitis?
overuse (injury from repetitive microtrauma and overloading of the tendon)
discuss rehab for Achilles Tendonitis
- NSAIDs
- relative rest
- ice
- aerobic exercise - biking,swimming
- flexibility to increase DF
- strengthening - submaximal with limited ROM to begin, progress as symptoms allow
- eccentric exercises (in some studies)
- foot orthoses
- heel lift
- massage
- US/phonophoresis
- severe cases get immobilization for 10 days, then rehab progresses slowly
discuss the medical management of an Achilles Tendon Rupture
- surgery or cast immobilization
- with surgery, there is lower rate of re-rupture and greater return of strength, power, endurance
- rehab will be physician dependent
discuss the rehabilitation of an Achilles Tendon Rupture
- immobilization for up to 8 wks
- maximum protection phase for 6 more wks after immobilization
- aerobic exercise, strengthening of uninvolved leg, quads/hams of involved leg
- follow gradual process of regaining DF and PF ROM
- proprioception training, progression of strength
- when strength up to 70%, begin progressive jogging program
- in general, return to full activity in 6-9 months
define Compartment Syndrome
a condition in which increased pressure within an enclosed space compromises the circulation of the tissue contained within that space
list the four compartments of the lower leg
- anterior
- lateral
- superficial posterior
- deep posterior
list the components of the Anterior Compartment
- Tibialis Anterior, Extensor Hallucis Longus, Extensor Digitorum Longus, Peroneus Tertius
- Deep Peroneal Nerve
- Anterior Tibial Artery and Vein
list the components of the Lateral Compartment
- Peroneus Longus, Peroneus Brevis
- Superficial Peroneal Nerve
list the components of the Superficial Posterior Compartment
- Gastrocnemius, Soleus, Plantaris
- Sural Nerve
list the components of the Deep Posterior Compartment
- Tibialis Posterior, Flexor Hallucis Longus, Flexor Digitorum Longus, Popliteus
- Tibial Nerve
- Peroneal Artery and Vein, Posterior Tibial Artery and Vein
discuss the medical management of Compartment Syndrome
- Surgical fasciotomy (esp acute)
- Nerve and muscle ischemia lasting > 12 hours will produce severe and irreversible damage
- Pressure relieved with 4 hours usually avoids permanent damage
discuss the conservative management of Compartment Syndrome
- Relative rest
- NSAIDs
- Flexibility
- Strengthening
- Foot orthotic device as needed
discuss the rehab of Compartment Syndrome
• Referral for medical treatment if encountered in clinic
• Post surgery
o ice and elevation
o walking as tolerated
o A/PROM of ankle can begin 2 days post surgery
o Early ROM is important to avoid contractures
• Light resistance ankle motions once the pain and swelling are under control
• Avoid heavy resistance exercises that cause muscle hypertrophy (contraindicated after fasciotomy for acute compartment syndrome)
discuss the signs of Plantar Fasciitis
inflammation
discuss the symptoms of Plantar Fasciitis
- Pain and tenderness upon palpation along the medial border of the calcaneus or along entire fascia
- Increased pain with the foot in DF and toes extended
- Pain worse in the morning at first contact with floor
- Pain worse with first several steps after prolonged sitting
- Pain worse with prolonged weight bearing activity or exercise
discuss the PT treatment for Plantar Fasciitis
- Eliminate/modify causative factors
- Ice massage
- NSAIDs
- Night splints
- Arch taping, orthotics
- US, phonophoresis, iontophoresis
- Manual therapy
- Stretching of the calf and toe extensors
- Foot muscle strengthening
- Ankle strengthening
discuss the medical treatment for Plantar Fasciitis
- Steroid injections
- Extracorporeal shockwave therapy to break up adhesions, improve soft tissue extensibility
- Last resort is surgery – plantar fasciotomy or partial release and excision of bone spur if present
