The Ankle and Foot

1. The Ankle and Foot Chapter 22

2. Structure and Function of the Ankle and foot

3. Anatomical Characteristics • Leg • Foot • Hindfoot • Midfoot • Forefoot

4. Motions of the Foot and Ankle Defined • Primary Plane Motions • Sagittal plane motion around a frontal (coronal) axis • Frontal plane motion around a sagittal (anteroposterior) axis • Transverse plane motion around a vertical axis • Triplanar Motions • Pronation • Supination

5. Characteristics and Arthrokinematics: Leg, Ankle, and Foot Joint • Tibiofibular Joints • Superior tibiofibular joint characteristics • Inferior tibiofibular joint characteristics • Accessory motions • Ankle (Talocrural) Joint

6. Characteristics and Arthrokinematics: Leg, Ankle, and Foot Joint (cont'd) • Subtalar (Talocalcaneal) Joint • Talonavicular Joint • Transverse Tarsal Joint • Remaining Intertarsal and Tarsometatarsal Joints • Metatarsophalangeal and Interphalangeal Joints of the Toes

7. Function of the Ankle and Foot • Structural Relationships • Interdependence of leg and foot motions • Arches • Effect on posture • Abnormal foot postures

8. Function of the Ankle and Foot (cont'd) • Muscle Function in the Ankle and Foot • Plantarflexors • Secondary plantarflexors • Dorsiflexors • Intrinsic muscles • Stability in standing

9. The Ankle/Foot Complex and Gait • Function of the Ankle and Foot Joints During Gait • Muscle Control of the Ankle and Foot During Gait • Ankle dorsiflexors • Ankle plantarflexors • Ankle evertors • Ankle inverters • Intrinsic muscles

10. Referred Pain and Nerve Injury • Major Nerves Subject to Pressure and Trauma • Common fibular (peroneal) nerve • Posterior tibial nerve • Plantar and calcaneal nerves • Common Sources of Segmental Sensory Reference in the Foot

11. management of Ankle and foot disorders and surgeries

12. Joint Hypomobility: Nonoperative Management • Common Joint Pathologies and Etiology of Symptoms • RA • DJD and joint trauma • Post-immobilization stiffness • Gout • Common Functional and Structural Impairments, Activity Limitations, and Participation Restrictions

13. Joint Hypomobility: Nonoperative Management (cont'd) • Management: Protection Phase • Educate the patient and provide joint protection • Decrease pain • Maintain joint and soft tissue mobility and muscle integrity

14. Joint Hypomobility: Nonoperative Management (cont'd) • Management: Controlled Motion and Return to Function Phases • Increase joint play and accessory motions • Joint mobilization techniques • Improve joint tracking of the talocrural joint • MWM: Plantarflexion • MWM: Dorsiflexion

15. Joint Hypomobility: Nonoperative Management (cont'd) • Management: Controlled Motion and Return to Function Phases (cont’d) • Increase mobility of soft tissues and muscles • Regain a balance in muscle strength and prepare for functional activities • Improve balance and proprioception • Develop cardiopulmonary fitness

16. Total Ankle Arthroplasty • Indications for Surgery • Contraindications • Procedure • Implant design, materials, and fixation • Operative overview • Complications

17. Total Ankle Arthroplasty (cont'd) • Postoperative Management • Immobilization and weight-bearing considerations • Exercise • Maximum protection phase • Moderate and minimum protection phases • Outcomes • Pain relief, functional improvement, and patient satisfaction in different populations • Participation in physical activities

18. Arthrodesis at the Ankle and Foot • Indications for Surgery • Procedures • Common types of arthrodesis • Arthrodesis of the ankle • Arthrodesis of the hindfoot • Arthrodesis of the first toe • Arthrodesis of the IP joints of the toes

19. Arthrodesis at the Ankle and Foot (cont'd) • Complications • Postoperative Management • Immobilization • Weight-bearing considerations • Postoperative exercises • Outcomes • Short-term and long-term outcomes • Return to physical activities

20. Leg, Heel, and Foot Pain: Nonoperative Management • Related Pathologies and Etiology of Symptoms • Heel pain • Plantar fasciitis • Achilles tendonopathy /achilles tendinitis • Tendonosis, tendinitis, tenosynovitis • Shin splints • Anterior shin splints • Posterior shin splints

21. Leg, Heel, and Foot Pain: Nonoperative Management (cont'd) • Common Structural and Functional Impairments, Activity Limitation, and Participation Restrictions • Management: Protection Phase • Management: Controlled Motion and Return to Function Phases • Educate the patient and provide home exercises • Stretch range-limiting structures • Improve muscle performance

22. Ligamentous Injuries: Nonoperative Management • Common Structural and Functional Impairments, Activity Limitations, and Participation Restrictions • Acute Ankle Sprain Management • Protection phase • Controlled motion phase • Return to function phase

23. Repair of Complete Lateral Ligament Tears • Indications for Surgery • Procedures • Types of stabilization procedures • Direct repair • Reconstruction with augmentation • Arthroscopic thermally assisted capsular shift • Operative overview

24. Repair of Complete Lateral Ligament Tears (cont'd) • Postoperative Management • Immobilization and weight-bearing considerations • Exercise • Maximum protection phase • Moderate and minimum protection phases • Outcomes

25. Repair of a Ruptured Achilles Tendon • Indications for Surgery • Procedures • Primary versus delayed repair • Operative overview

26. Repair of a Ruptured Achilles Tendon (cont'd) • Complications • Postoperative Management • Immobilization and weight-bearing considerations • Conventional versus early remobilization approach • Exercise progression • Exercise • Maximum protection phase • Moderate protection phase • Minimum protection/return to function phase

27. Repair of a Ruptured Achilles Tendon (cont'd) • Outcomes • Comparison of nonoperative versus operative management • Comparison of open versus percutaneous repair • Traditional versus accelerated rehabilitation

28. Exercise interventions for the Ankle and Foot

29. Exercise Techniques to Increase Flexibility and Range of Motion • Flexibility Exercises for the Ankle Region • Increase dorsiflexion of the ankle • Increase inversion • Increase ankle plantarflexion and eversion • Increase eversion and ankle dorsiflexion

30. Exercise Techniques to Increase Flexibility and Range of Motion (cont'd) • Flexibility Exercises for the Limited Mobility of the Toes • Passive MTP flexion • Passive IP extension • Active MTP flexion • Great toe extension • Stretching the Plantar Fascia of the Foot

31. Exercise to Develop and Improve Muscle Performance and Functional Control • Activities to Develop Dynamic Neuromuscular Control

32. Exercise to Develop and Improve Muscle Performance and Functional Control (cont'd) • Open-Chain (Non-Weight-Bearing) Strengthening Exercises • Plantarflexion • Isometric eversion and inversion • Eversion and inversion with elastic resistance • Adduction with inversion and abduction with eversion using weights • Dorsiflexion • All ankle motions

33. Exercise to Develop and Improve Muscle Performance and Functional Control (cont'd) • Closed Chain (Weight-Bearing) Exercises • Stabilization exercises • Dynamic strength training • Resisted walking • Functional progression for the ankle and foot

34. Independent Learning Activities • Critical Thinking and Discussion • Laboratory Practice • Case Studies