1

Foot and Ankle Rehabilition

..

Handout can be download at

www.ortho.chuckpaiwong.com/presentation
Outlines
Common diagnosis
Pre-operative rehabilitation
Post-operative rehabilitation
Handout can be download at
www.ortho.chuckpaiwong.com/presentation
Common diagnosis
Ankle Sprain
Lat ankle sprain, Med ankle sprain,
Syndesmotic sprain
PTTD (Posterior Tibial Tendon
Dysfunction)
Hallux valgus
Plantar fasciitis
Haglund deformity, Achilles tendinosis
Handout can be download at
www.ortho.chuckpaiwong.com/presentation
Ankle sprain
Lateral ankle sprain
Medial ankle sprain
Syndesmotic sprain
(High ankle sprain)
Ankle sprain
Grading
Grade 1: no swelling,
tenderness, microtear
of ligament
Grade 2: Mild to Mod
swelling, tenderness,
Patial tear of ligament
Grade 3: Severe
swelling, marked
tenderness, complete
tear of ligament
Ankle Sprain
3 phase rehabilitation
Inflammation: Medication, Short period
immobilization
Early motion: ROM exercise, Gentle
manipulation, modality?)
Strengthening exercise
2
Inflammation: Medication, Short
period immobilization
1 week
Early motion: ROM exercise,
Gentle manipulation, modality?)
Ankle motion
Subtalar motion
1-3 week
Ankle motion
Subtalar motion
Ankle strengthening exercise
Muscle power
Balance
Coordination
Plyometric exercise
Sports specific exercise
Muscle power
Peroneal
Tibialis
posterior
Tibialis anterior
Toe
flexor/extensor
Intrinsic
muscle
Balance and Coordination
Core exercise
Abdomen, Lateral body
Back (upper, lower)
Groin
Chest
Body balance
Single leg stance
Straight line walking
Balance board
Side walk
3
Plyometric exercise
Controlled rapid and powerful muscle
activity
Improve nerve, muscle and N-M
coordination
Requirement
Full range of motion
Strong muscle power
Good balance
Plyometric exercise
Straight running
Side running
Hopping
Run-Stop, J ump stop
Zigzag running
Different level jump
Unstable ground
jumping
Single leg with ball
activity
Plyometric exercise Sports specific activity
Ankle sprain surgery
Ankle arthroscopic debridement
Ankle ligament reconstruction (Mod
Brostormrepair)
Ankle arthroscopic debridement
Early ROM:
immediate
Stretching
Strengthening
Balance, Coordination
Agility, Plyometric
4
Ankle ligament reconstruction
(Mod Brostormrepair)
Ankle ligament reconstruction
(Mod Brostormrepair)
Slab for 2 wk then stitch
off
Toe pump
ROM once a day: 2-6 wk
Ankle
Subtalar
Strengthening: 6-8 wk
4 directions
Balance, Coordination
Agility, Plyometric
PTTD
(Posterior Tibial Tendon
Dysfunction)
Posterior tibial tendon
degeneration
Pathology
Flat foot
Achilles tightness
Peroneal impingement
Weak intrinsic muscle
PTTD staging
Stage 1
Stage 2
Stage 3
Stage 4
Rehabilitation
Achilles stretching
Ankle and Subtalar manipulation
Peroneal tendinitis
Modality and manual manipulation
Intrinsic muscle training
Grab towel
PTTD surgery
FDL Transfer
Cal OS
Lat column
lengthening
Triple arthrodesis
5
Tendon degeneration
FDL Transfer
Post operative Rehabilitation
FDL transfer and Foot osteotomy
2 wk in cast or slab then stitch off
Toe pump: swelling control
2-4 wk PO: ROM exercise once a day
Ankle and subtalar, Gentle!!
6-8 wk PO: Complete union, Full ROM,
Strengthening, balance and coordination
exercise
Be careful in Aging, Osteopenic pt.
Triple arthrodesis
2 wk in cast or slab
Toe pump: swelling control
2 wk PO: stitch off
2-4 wk PO: ROM exercise off slab one a day
Ankle ROM
6-8 wk PO: Complete union, Full ROM,
Strengthening, balance and coordination
exercise.
Post operative Rehabilitation
Hallux valgus
Most common
forefoot deformity
Hammer toe is a
common co-finding
Pre operative rehabilitation
1
st
MTP manipulation
Traction and gentle range of motion
Lateral soft tissue stretching
Modality
Hammer toe manipulation
Flex MTP
Extend PIP and DIP
Collateral ligament stretching
Manual Manipulation
6
Surgery
Soft tissue release
Chevron OS
PMO Proximal
osteotomy
Mau
Ludloff
Scarf
Lapidus
Akin
Post operative rehabilitation
PMO, Lapidus PMO, Lapidus, Akin
HV Post Op Rehab
Rehabilitation depend on fixation
Ankle pump for edematous control
SL Slab for 2 wk then stitch off
ROM exercise: traction and manipulation
Stable fixation: ROM of 1
st
MTP start at 2 wks
Unstable fixation: Slab until bone union (6-8
wk)
Hammer toe repair: Delay ROM until 6 wk
Plantar fasciitis
7
Plantar fasciitis
Major pathology: Inflexible plantar fascia
Tight Achilles tendon
Plantar fasciitis
Treatment
Shoes modification
Medication
PT
Exercise
PF specific exercise ***
Achilles stretching
Intrinsic foot muscle
Avoid steroid injection fat pad atrophy
PF specific exercise
Manual Manipulation
Haglund deformity
Achilles tendinosis
Posterior heel pain
Haglunds disease
Degenerative change
Overused
Bursal thickening
Bony prominence
Achilles tendinosis
Degenerative change
follows chronic
achilles tendinitis
8
Haglund deformity, Achilles
tendinosis
Same pathology
Different location
Similar rehabilitation
Achilles Stretching
Haglund deformity, Achilles
tendinosis
Rest
Achilles stretching
exercise
Eccentric exercise
Aggressive!! Manual
manipulation
Peritendinitis
Remove peritenon
from tendon by
manipulation
Graston technique
Graston Technique
Operation
Achilles debridement
Partial calcanectomy
Stability of the insertion: Ask surgeon
FHL transfer
9
Post operative rehabilitation
2 wk in cast: Toe pump
Gentle ROM at 2 wk, aggressive after 6
wk
Scar massage after 2 wk
Subtalar motion at 2 wk
DF, Inv, Evr strengthening exercise at 4-6
wk
Achilles strengthening after 6 wk
Balance and Coordination after 6-8 wk
(same as ankle sprain)
Take home principle
Edematous control
Soft tissue healing 4-6 wk
Bone healing 6-8 wk may delay up to 3
months
Ankle, subtalar, MTP motion
tendon stretching and strengthening
Balance and coordination
Scar massage
Take home principle
Move the joint as fast as you can
Aware of surgical fixation, do not break it
Less aggressive manipulation is preferable
Foot and Ankle Surgery
Take longer recuperation (up to 1 year)
Wound care is very important
Hygiene
Pt education and expectation
Manual Manipulation
Thank you
Handout can be download at
www.ortho.chuckpaiwong.com/presentation