Week 10 - Part 1 - Functional Anatomy and Rehabilitation of the Ankle and Foot PDF

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WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice  EHR520 – Week 10 Functional Anatomy and Rehabilitation of the Ankle and Foot Tim Miller (ESSAM AES AEP) E: [email protected] Ph: (02) 6338 4442 Functional Anatomy and Rehabilitation of the Ankle and Foot FUNCTIONAL ANATOMY AND REHABILITATION OF THE ANKLE AND FOOT Functional Anatomy and Biomechanics Lower leg: Tibia Fibula Four muscle compartments – Proximally: Tibiofemoral joint & tibial tuberosity (patella tendon) – Distally: Talocrural (ankle) joint – plantar/dorsiflexion Subtalar joint (junction between talus & calcaneus) – pronation/supination Supination: Foot adduction, plantarflexion & inversion Pronation: Foot abduction, dorsiflexion & eversion Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 4 Functional Anatomy and Biomechanics Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 5 Functional Anatomy and Biomechanics Subtalar joint (junction between talus & calcaneus) – pronation/supination Supination: Foot adduction, plantarflexion & inversion Pronation: Foot abduction, dorsiflexion & eversion Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 6 Functional Anatomy and Biomechanics Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 7 Muscle Function 12 extrinsic and 11 intrinsic muscles of the lower leg and foot Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 8 Common Structural Deformities Pes Cavus Abnormally high longitudinal arch Rigid foot position – limited force absorption Risk of stress fractures & overuse injuries Pes Planus Abnormally low longitudinal arch May be rigid or flexible Little supination during gait places rotational stress on hip, knee, plantar fascia & achilles tendon Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 9 Ankle Ligament Sprains One of the most common sports injuries High risk: Jumping sports (e.g. basketball, netball, volleyball) Running: especially on rough or uneven surfaces (e.g. orienteering) Early treatment enhances recovery time Most common MOI is inversion & plantarflexion Ligaments commonly sprained: Anterior talofibular ligament Calcaneofibular ligament Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 10 Ankle Ligament Sprains Chronic ankle sprains Previous scar tissue creates additional adhesions limiting mobility Chronic muscle weakness due to inadequate rehab Reduced kinaesthetic awareness increases susceptibility Additional healing/rehab time Graded by the ligaments injured Grade I – ATFL Grade II – ATFL & CFL Grade III – ATFL, CFL & PTFL Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 11 Lateral Ankle Sprains – Grade I Grade I sprain Stretching of ATFL Mild pain & disability Point tenderness Mild swelling No loss of function ‐ve anterior drawer Treatment PRICE Gentle ROM exercises Gradual WB Taping Rehab exercises Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 12 Lateral Ankle Sprains – Grade II Grade II sprain Tearing sensation Snap or pop Diffuse swelling Point tenderness Ecchymosis Possible rupture of ATFL Grade I or II tear of CFL +ve anterior drawer Persistent instability Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 13 Lateral Ankle Sprains – Grade II Treatment PRICER X‐Ray Crutches Air cast/camboot PF/DF exercises ROM & proprioceptive exercises 1‐2 weeks resume WB Taping Graduated rehab Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 14 Lateral Ankle Sprains – Grade III Grade III sprain Uncommon Severe pain over lateral malleolus area Diffuse swelling Tenderness over entire lateral ankle ATFL, CFL & PTFL all torn +ve anterior drawer Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 15 Lateral Ankle Sprains – Grade III Treatment PRICER Short walking cast 4‐6 weeks Similar to grade II but longer healing time Problems can remain for 8‐10 months Or surgery due to severe laxity & instability Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 16 Medial Ankle Sprains Pronated or hypermobile feet < 10% of ankle sprains Mechanism: Usually ankle eversion Signs and symptoms: Pain Inability to WB 2⁰ and 3⁰ produce significant instability Can cause weakness in the medial longitudinal arch Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 17 Syndesmosis Sprain Second & third degree ankle sprains can cause a syndesmosis sprain Sprain between tibia & fibula Includes ATF & PTF ligaments & interosseous membrane Signs & symptoms Tenderness & swelling at junction of tibia & fibula Pain on WB which widens ankle mortise Talus may slip laterally & be unstable Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 18 Gastrocnemius Strain Medial head at musculotendinous junction most common site Mechanism: Quick starts/stops during sport (e.g. tennis, squash) Signs & symptoms: Sudden pain in calf Difficulty walking especially on toes Local tenderness & swelling Palpable gap in muscle tissue over injured area Treatment: PRICER AROM/gentle stretches Untreated muscle leads to scarring which increases risk of repeated rupture Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 19 Soleus Strain Signs & symptoms: Pain located deep in calf Pain triggered with tiptoe walking Bruising may become apparent on medial border of tibia Deep local tenderness over injured area Treatment: PRICER AROM/gentle stretches Train muscle to pain threshold with increasing load – Flexed knee (e.g. seated calf raise) Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 20 Achilles Tendinopathy ‘Overuse’ condition of either the: Achilles tendon or paratendon (peritendonitis) Can be acute or chronic Causes the most problems for LD runners, often during winter & when training on hard surfaces Mechanisms Prolonged & repeated stress Increased mileage Poor shoes Uneven surfaces Pes cavus Tight hamstrings, gastroc/soleus complex Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 21 Achilles Tendinopathy Prevention: Warmup & stretching of both gastroc & soleus Training & competition shoes of good quality Heel wedge if tension felt in achilles Signs & symptoms: Pain & swelling Crepitus felt over tendon Erythema – redness & inflammation Weakness in plantarflexion Restricted dorsiflexion (impaired function) Point tenderness Possible thickening Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 22 Medial Tibial Stress Syndrome (MTSS) “Shin splints” or “exercise‐related leg pain” Stress reaction at the periosteal & musculotendinous fascial junctions Mechanisms: Malalignment of foot or lower leg: – Pes planus (flat feet) – Muscle fatigue – Overuse stress – Imbalance between musculature – Sudden change in training habits – Poor footwear Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 23 Medial Tibial Stress Syndrome (MTSS) Signs & symptoms: Tenderness over middle to distal medial margin of the tibia Pain occurring after activity Pain occurring before & after activity but not affecting performance Pain affecting performance Pain so severe, performance is impossible Local inflammation Normal X‐ray & pressure in compartment Treatment: Rest & ice‐massage Taping Alternate heat & cold Stretch gastroc, soleus, deep PF’s Aquatic rehab Orthotics Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 24 Plantar Fasciitis One of the most common foot injuries Plantar aponeurosis is a thick fibrous band covering plantar surface of the foot running from calcaneus to MTP joints Protects structures of plantar foot Provides flexibility for shock absorption Creates windlass mechanism (rigid lever) – During push‐off PA drawn distally as toes bend (extend) PA is stretched (injury at origin) Mechanisms Pes cavus – PF usually short Pronated feet Increased mileage especially on hard surfaces Poor shoes Restricted DF – tight calf complex Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 25 Plantar Fasciitis Signs & symptoms: Heel pain under load (none at rest) Morning stiffness & limp Tenderness on pressure Pain if standing on tiptoes or heels Sometimes heel spurs form Treatment: Rest & ice in acute stages Crutches to decrease load Tape to unload Check shoes – Too stiff or too soft (increase load through aponeurosis) Self‐massage (e.g. golf ball) Orthotics (arch support) Static stretches (once pain under control) Strengthen ankle inverters & toe flexors (support the arch) Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 26 Ankle – Special Tests Talar Tilt Test https://www.youtube.com/watch?v=UHNbm6Z3XK4 Anterior Drawer Test https://www.youtube.com/watch?v=vAcBEYZKcto Thompson / Calf Squeeze Test https://www.youtube.com/watch?v=z-7cJ7LpCqY Syndesmosis Squeeze Test https://www.youtube.com/watch?v=ANgWSz0UoDg Navicular Drop Test https://www.youtube.com/watch?v=BejuNMmD7-Y Windlass Test https://www.youtube.com/watch?v=fg0PtnoAzSs Week 10 - Functional Anatomy and Rehabilitation of the Ankle and Foot 27