Rehabilitation Steps

Rehabilitation Steps

• Protect the area from further injury
• Decrease pain, swelling, and spasm
• Re-establish range of motion (ROM), flexibility, and tissue mobility
• Re-establish neuromuscular control, muscular strength, endurance, and power
• Re-establish proprioception, coordination, and agility
• Re-establish functional skills

Return to Activity Criteria

• Patient is pain-free
• Ankle is not swollen
• Ankle has full, functional ROM
• Ankle has full, functional muscle strength, endurance, and power
• Patient has adequate proprioception, balance, agility, and coordination
• Patient is psychologically ready to return to activity

Ankle Sprain

• Occurs when ligaments in the ankle get stretched or torn
• Commonly occurs when the ankle rolls, twists, or turns beyond its normal range of motion
• Ankle ligaments: Anterior Talofibular Ligament, Calcaneofibular Ligament, Posterior Talofibular Ligament, Deltoid Ligament
• Sprain Grades:
  • Grade I: Stretching of ligamentous fibers (minor)
  • Grade II: Partial tearing of ligamentous fibers (moderate)
  • Grade III: Substantial tearing of ligamentous fibers (severe)
• Types of sprains:
  • Pronation or eversion type (MED - deltoid ligament)
  • Supination and inversion type (LAT - most common, involves anterior talofibular ligament)
• Symptoms: Pain, swelling, bruising, instability, difficulty bearing weight
• Diagnosis: Physical examination, X-rays, MRI (if severe)
• Physical Examination:
  • Inspection (swelling, deformities, redness)
  • ROM (dorsiflexion, plantar flexion, inversion, eversion)
  • Palpation (malleolus, achilles tendon, base of 5th metatarsal, proximal fibula, midfoot)
  • Assess strength, flexibility, and neurovascular status
• Treatment: PRICE method, bracing, physical therapy, proprioceptive training, strengthening exercises
• Return to activity:
  • Grade I: 1-2 weeks
  • Grade II: 4-8 weeks
  • Grade III: 12-16 weeks

Plantar Fasciitis

• Inflammation of the plantar fascia, a thick band of tissue connecting the heel bone to the toes
• Contributes to the support of the arch of the foot and dynamic function during gait
• Causes: Overuse, improper footwear, biomechanical issues
• Symptoms: Heel pain, especially in the morning, tenderness over the heel
• Diagnosis: Clinical examination, imaging (X-ray, MRI)
• Assessment: Identifying risk factors (foot arch, running habits, footwear)
• Treatment: Conservative - stretching, orthotic devices, night splints, manual therapy, trigger point therapy, orthosis, and taping
• Modalities: Electrotherapy, ultrasound, and soft orthotics
• Stretching: Plantar fascia specific stretch and calf muscle stretch
• Exercises: Tennis ball roll out, tennis ball heel pump, tennis ball toe curl, calf raises, toe raises

Achilles Tendinitis

• Inflammation or irritation of the Achilles tendon
• Causes: Overuse, repetitive stress, or sudden increases in activity level
• Symptoms: Morning stiffness, Achilles tendon tenderness, variable pain
• Diagnosis: Clinical assessment, imaging studies
• Assessment: Evaluating pain levels, functional limitations
• Treatment: PRICE protocol, eccentric exercise program, physiotherapy (manual techniques, specific exercises, stretches), gradual running progression, plyometrics, and agility drills
• Takes 3-6 months
• Exercises: Standing soleus stretch, towel stretch, heel raise, step up, standing calf stretch, soleus stretching, gastrocnemius stretching, toe raise with straight leg and with bent leg, heel drop from stair stretch

Tarsal Tunnel Syndrome

• Rare compressive neuropathy of the tibial nerve or one of its branches
• Causes: Repetitive stress activities, traumas, heel varus or valgus, excessive weight
• Symptoms:
  • Burning (paresthesia) or tingling sensation in the sole of the foot
  • Pain worsened by activity and gets better with rest
  • Dysesthesia (an abnormal and unpleasant sensation) arises during the night and can disturb sleep
  • Weakness of muscles
• Diagnosis: Clinical evaluation, nerve conduction studies, imaging
• Observation: Muscle atrophy of the abductor hallucis muscle may be seen, check for arch stability, position of the talus and calcaneus
• Gait Analysis: Assess for abnormalities, excessive pronation/supination, toe out, excessive inversion/eversion, antalgic gait, etc.
• Sensory Testing: Test light touch, 2-point discrimination in the lower extremity (deficits will be in the distribution of the posterior tibial nerve)
• Palpation: Tender to palpation in between the medial malleolus and Achilles tendon (painful in 60-100% of those affected)
• Assessment: Identifying sensory deficits, muscle weakness, and gait abnormalities