REHAB Foot, Ankle & Lower Leg UNIT 6 FOOT, ANKLE, AND, LOWER LEG Sports Medicine.
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Transcript of REHAB Foot, Ankle & Lower Leg UNIT 6 FOOT, ANKLE, AND, LOWER LEG Sports Medicine.
REHAB Foot, Ankle & Lower Leg
UNIT 6
FOOT, ANKLE, AND, LOWER LEG
Sports Medicine
Rehab. Ankle ROM
● Ankle pumps- ● elevated (above heart) have athlete plantar flex all the
way hold 3 sec, then dorsiflex all the way hold 3 sec● Perform for 1 min do 3 sets
● ABC’s- ● have athlete “write” with their big toe, the alphabet.● They should do capital letters and make them large to
work a greater ROM.● Perform for 1 min do 3 sets
● Both of these exercises are done to increase ROM and reduce swelling after acute injury.
Stretches
● All stretches should be held 20-30 seconds with NO bouncing
● Calf- (Gastrocnemius & Soleus)● Can be performed against wall, push up position
or standing (knee should be straight)● Against wall can add turn to isolate Medial or
Lateral head of the Gastrocnemius
Stretches
● Achilles- (Tendon of Soleus and Gastrocnemius)
● performed the same way as calf, but with knee bent● Push knee closer to wall
Stretches
Arch● Arch- need corner of wall or step● Athletes position will be similar to Achilles stretch● Athlete should push down so that they are trying
to flatten arch into corner or wall or step.● *This stretch may only be felt by someone with an
inflamed/tight arch
Stretches
● Tib Ant- (Tibialis Anterior)● Have Patient in “sit up” position● Hold their feet down to the floor or table● Have them “scoot” their butt away from their feet
Stretches
● Peronials- (Peroneus Longus, Brevis & Tertius)
● Should be performed with a shoe on.● Bare feet or sandals do not work● While athlete is standing have them purely invert
their ankle● They should lean the hips toward side being
stretched and lean their shoulders away from side being stretched
● *This stretch may only be felt by someone with an inflamed/tight Peroneus
● For greater stretch push butt posteriorly
Stretches
● Tibialis Posterior -(Tib Post)● Standing, with hand resting on table or wall● Feet staggered similar to Achilles stretch but
both feet are on the ground● Have athlete bend (flex) both knees as they
bring their weight forward (trying to keep back heel on ground)
● For greater stretch externally rotate foot● Should feel stretch on med/post side
Stretches
● Toe extensors- (Extensor Digitorum)● foot plantar flexed ● fully flex toes● Grab athletes distal foot over toes and slowly pull down into
plantar flexion● Great Toe Flexors- (Flexor Hallicus Longus- Flexor
tendon of Great toe)● Grab big toe and pull into extension● To get greater stretch dorsiflex ankle
● 3 times for 30 seconds
Stretches
● Great Toe Extensors- (Extensor Hallicus Longus- Extensor tendon of Great toe)
● Grab big toe and pull into flexion● To get greater stretch plantar flex ankle
Rehab Proprioception
● Proprioception-Body awareness, knowing where your body (limb) is in space.
● Dyna-disc● Blue disc designed to challenge athlete to maintain
balance● Can also use no equipment (basic), foam half rolls,
foam pads, pillows, or other soft/uneven surface● Perform 3x 30 sec ● How do you increase the resistance/challenge?
●play catch or close eyes● w/ Dyna disc, wobble board, Bosu ball
Rehab. Strengthening Ankle Program
● Eversion/Dorsiflexion- ● seated, knees straight,● feet shoulder width apart, ● band loop around foot of injured leg, ● band wrapped around uninjured foot, ● band held in hand● Muscles worked Peroneus Tertius ● Important for Lat. ankle sprains● ** Strengthening exercises are done for 3 sets of
10 reps**
Rehab. Ankle Program
● Plantar Flexion/Eversion● Seated, injured leg straight● Bend knee of uninjured leg● Heel of uninjured leg resting on the table● band loop around foot of injured leg, ● band wrapped around uninjured foot, ● band held in hand● Muscles worked Peroneus Longus and Brevis
Rehab. Ankle Program
● Dorsiflexion- ● seated, uninjured knee straight,● knee of injured foot bent, ● Heel of injured foot resting on table, ● band loop around foot of injured leg, ● band wrapped around uninjured foot, ● band held in hand● Muscles worked Tib. Ant., Peroneus tertius,
Extensor Digitorum
Rehab. Ankle Program
● Plantarflexion/Inversion● seated, injured knee straight, ● cross uninjured leg over injured leg (good over
bad), ● Heel of uninjured foot resting on table, ● loop around foot of injured leg (high on toe, ● band wrapped around uninjured foot, ● band held in hand
● Very important for Shinsplints and flat feet injuries
● Works Tib Post, Flexor Digitorum and Flex. Hallicus
Rehab. Ankle Strengthening cont
● Lateral T-band walks● Circular band (tied)- is wrapped around both feet● Athlete is to keep feet in neutral (pointing straight
ahead) position● Athlete walks Laterally (Side shuffle) done slowly● Works Lateral Low leg (Peronials), and Lat hip
(Glut Med, Tensor)● Done for distance or reps (do till fatigued)
Rehab. Ankle
● Toe walks- on balls of feet, have athlete walk (works Plantar flexors)
● Heel walks- on heels, toes pointed to the sky (works Dorsi flexors)
● Can be done straight, backwards or laterally to work different muscles
● Great for Functional testing for return to play and shinsplints
● Done for distance or reps (do till fatigued)
With both the steps should be small (4 inches)
Rehab. Ankle
● Calf Raises- 3 way● Hip externally Rotated- (medial Gastroc., Tib Post)● Hip Neutral- (Gastroc, works most plantar flexors)● Hip internally rotated- (Lat. Gastroc. ,peronials)
● Should do 3 sets of 15 can do less depending on readiness
Foot Rehab.
● Towel Scrunches- ● Towel laid on floor at feet of athlete ● Athlete puts foot/feet on end of towel● Ath. Curls (flexes) toes to “scrunch” the towel up● Repeat till towel is all curled up then lay out again.● Repeat till FATIGUED then do 2 more● Ath. Should experience a BURN in shins or feet
● Marble pick ups- ● Athlete will pick up marbles with toes and drop them into
a container● Works on toes flexors and shin muscles
FOOT INJURIES
UNIT 6
FOOT, ANKLE, AND, LOWER LEG
Sports Medicine
FOOT INJURIES
Athletic Shoes
Sports Medicine
FOOT INJURIES
Arch Sprain/StrainDescription – Sprain or Strain of
supporting structures of the foot’s arch, usually the medial longitudinal arch.
Sports Medicine
FOOT INJURIES
Arch Sprain/StrainMOI
● Activity on hard playing surfaces● Sudden increase in weight bearing
exercises ● Non supportive or inappropriate shoe
wear● Overuse
Sports Medicine
FOOT INJURIES
Arch SprainMOI
● Non supportive or inappropriate shoe wear
Sports Medicine
FOOT INJURIES
Arch Sprain/StrainSigns/Symptoms ● Arch pain while weight bearing● Arch pain while running● Point tenderness on sole of foot● Swelling on sole of foot
Sports Medicine
FOOT INJURIES
Arch Sprain/StrainAIM ● Cold modality (Ice massage)● Arch Insole Support ● Longitudinal arch tape
● Teardrop or simple arch
Sports Medicine
REHAB● Stretch (How?)● Strengthen (How?)● Tape
FOOT INJURIES
Heel BruiseDescription - Contusion to heel’s fat pad.
Sports Medicine
FOOT INJURIES
Heel BruiseMOI –● Repeated starting and stopping on
hard surfaces.● Wearing athletic shoes without proper
cushion and support● Landing hard on one’s heel.
Sports Medicine
FOOT INJURIES
Heel BruiseSigns/Symptoms ● Point tenderness under calcaneus (fat
pad)● Swelling under calcaneus (fat pad)
Sports Medicine
FOOT INJURIES
Heel BruiseAIM ● Cold modality● Doughnut pad● Heel cup
Sports Medicine
FOOT INJURIES
Heel Spur
Description - Bony growth on calcaneal tuberosity.
Sports Medicine
FOOT INJURIES
Heel Spur
MOI ● Lack of gastrocnemius / soleus
flexibility.● Running on hard surfaces.● Inappropriate shoe wear.● Lack of cushion in shoes. ● Worn out shoes.
Sports Medicine
FOOT INJURIES
Heel Spur
Signs/Symptoms ● Point tenderness● Pain while weight bearing
Sports Medicine
FOOT INJURIES
Heel Spur
AIM ● Work on flexibility● Doughnut pad● Stiff soled shoe● Heel cupREHAB● Stretch (How?)
Sports Medicine
FOOT INJURIES
Plantar Fasciitis Description - Inflammation of plantar fascia
Sports Medicine
FOOT INJURIES
Plantar Fasciitis MOI
● Lack of Achilles flexibility● Chronic Overuse● Fallen arch (flat feet)
Sports Medicine
FOOT INJURIES
Plantar Fasciitis Signs/Symptoms
● Point tenderness over calcaneal tuberosity.
● Increase AM (morning) tenderness when walking.
Sports Medicine
FOOT INJURIES
Plantar Fasciitis AIM
● Achilles/Calf flexibility● Arch ROM/stretching ● Cold applicationsREHAB● Stretch (How?)● Strengthen (How?)
Sports Medicine
FOOT INJURIES
Jones FractureDescription - Fracture to base of the fifth
metatarsal (styloid process).
Sports Medicine
FOOT INJURIES
Jones FractureMOI
Traumatic inversion/plantar flexion of the foot.
Sports Medicine
FOOT INJURIES
Jones FractureSigns/Symptoms ● Point tender over base of 5th (styloid
process)● Painful passive inversion and active
eversion of foot.
Sports Medicine
FOOT INJURIES
Jones FractureAIM ● RICE● Refer to physician● Cast● Sometimes surgery
Sports Medicine
FOOT INJURIES
Turf ToeDescription - Sprain of
metatarsophalangeal joint of great toe.
Sports Medicine
FOOT INJURIES
Turf ToeMOI ● Forced hyperextension
of great toe, usually associated with push off or landing.
Sports Medicine
FOOT INJURIES
Turf ToeMOI ● Non-supportive soled shoes.
Sports Medicine
FOOT INJURIES
Turf ToeSigns/Symptoms ● Painful hyperextension.● Decrease metatarsophalangeal
joint flexion.
Sports Medicine
FOOT INJURIES
Turf ToeAIM ● RICE● Tape to prevent hyperextension.● Stiff soled shoe or insert.REHAB● Strengthen (How?)● Stretch (How?)● Tape (How?)● Work on ROM (How?)
Sports Medicine
FOOT INJURIES
Ingrown ToenailDescription - Nail grows into lateral nail
fold.
Sports Medicine
FOOT INJURIES
Ingrown ToenailMOI ● Lateral pressure from poorly fitting
shoes
Sports Medicine
FOOT INJURIES
Ingrown ToenailMOI ● Improper toe nail trimming● Trauma, such as repeated pressure
from the foot sliding against the end of shoe.
Sports Medicine
FOOT INJURIES
Ingrown ToenailMOI ● Trauma, such as repeated
pressure from the foot sliding against the end of shoe.
Sports Medicine
FOOT INJURIES
Ingrown ToenailSigns / Symptoms ● Lateral nail fold
becomes inflamed, painful, and swollen.
Sports Medicine
FOOT INJURIES
Ingrown ToenailAIM ● Hot water soaks followed by (fb)
insertion of cotton under nail edge to keep nail out of skin.
Sports Medicine
FOOT INJURIES
Ingrown ToenailAIM ● Trim nail to
prevent nail penetration into skin.
Sports Medicine
FOOT INJURIES
Plantar WartsDescription - Wart that appears on pressure bearing surfaces of the sole of the foot. Warts originate from a virus.
Sports Medicine
FOOT INJURIES
Plantar Warts
Sports Medicine
FOOT INJURIES
Plantar WartsMOI
● Cause by virus ● Fallen metatarsal arch
Sports Medicine
FOOT INJURIES
Plantar Warts
Sports Medicine
FOOT INJURIES
Plantar WartsMOI ● Fallen metatarsal arch
Sports Medicine
FOOT INJURIES
Plantar WartsSigns/Symptoms ● Excessive callus
formation having associated “black seeds” within callus.
Sports Medicine
FOOT INJURIES
Plantar WartsSigns/Symptoms ● Point tender as if
stepping on a piece of glass
Sports Medicine
FOOT INJURIES
Plantar WartsAIM ● Doughnut pad application● Over the counter salicylic acid ● Refer to physician
Sports Medicine
FOOT INJURIES
Athlete’s Foot (Tinea Pedis)Description ● Fungal infection appearing
between toes and on the ball of the foot.
Sports Medicine
FOOT INJURIES
Athlete’s Foot (Tinea Pedis)MOI ● Dark, warm, and moist
environment found in shoes contribute to athlete’s foot formation.
Sports Medicine
FOOT INJURIES
Athlete’s Foot (Tinea Pedis)Signs/Symptoms ● Rash with
extreme itching
Sports Medicine
FOOT INJURIES
Athlete’s Foot (Tinea Pedis)Signs/Symptoms ● Inflammation and other associated
signs of infection
Sports Medicine
FOOT INJURIES
Athlete’s Foot (Tinea Pedis)Signs/Symptoms ● Red, white, or gray
scaling of affected area.
Sports Medicine
FOOT INJURIES
Athlete’s Foot (Tinea Pedis)AIM ● Good foot hygiene● Topical creams orSprays
Sports Medicine
FOOT INJURIES
Athlete’s Foot (Tinea Pedis)AIM ● Elimination of dark,
warm, and moist environment
Sports Medicine