1. Copyright © 2013. F.A. Davis Company Part IV: Exercise Interventions by Body Region Chapter 22 The Ankle and Foot

2. Copyright © 2013. F.A. Davis Company STRUCTURE AND FUNCTION OF THE ANKLE AND FOOT

3. Copyright © 2013. F.A. Davis Company  Leg  Foot – Hindfoot – Midfoot – Forefoot Anatomical Characteristics

4. Copyright © 2013. F.A. Davis Company  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 Motions of the Foot and Ankle Defined

5. Copyright © 2013. F.A. Davis Company  Tibiofibular Joints – Superior tibiofibular joint characteristics – Inferior tibiofibular joint characteristics – Accessory motions  Ankle (Talocrural) Joint Characteristics and Arthrokinematics: Leg, Ankle, and Foot Joint

6. Copyright © 2013. F.A. Davis Company  Subtalar (Talocalcaneal) Joint  Talonavicular Joint  Transverse Tarsal Joint  Remaining Intertarsal and Tarsometatarsal Joints  Metatarsophalangeal and Interphalangeal Joints of the Toes Characteristics and Arthrokinematics: Leg, Ankle, and Foot Joint (cont'd)

7. Copyright © 2013. F.A. Davis Company  Structural Relationships – Interdependence of leg and foot motions – Arches – Effect on posture – Abnormal foot postures Function of the Ankle and Foot

8. Copyright © 2013. F.A. Davis Company  Muscle Function in the Ankle and Foot – Plantarflexors – Secondary plantarflexors – Dorsiflexors – Intrinsic muscles – Stability in standing Function of the Ankle and Foot (cont'd)

9. Copyright © 2013. F.A. Davis Company  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 The Ankle/Foot Complex and Gait

10. Copyright © 2013. F.A. Davis Company  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 Referred Pain and Nerve Injury

11. Copyright © 2013. F.A. Davis Company MANAGEMENT OF ANKLE AND FOOT DISORDERS AND SURGERIES

12. Copyright © 2013. F.A. Davis Company  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 Joint Hypomobility: Nonoperative Management

13. Copyright © 2013. F.A. Davis Company  Management: Protection Phase – Educate the patient and provide joint protection – Decrease pain – Maintain joint and soft tissue mobility and muscle integrity Joint Hypomobility: Nonoperative Management (cont'd)

14. Copyright © 2013. F.A. Davis Company  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 Joint Hypomobility: Nonoperative Management (cont'd)

15. Copyright © 2013. F.A. Davis Company  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 Joint Hypomobility: Nonoperative Management (cont'd)

16. Copyright © 2013. F.A. Davis Company  Indications for Surgery  Contraindications  Procedure – Implant design, materials, and fixation – Operative overview  Complications Total Ankle Arthroplasty

17. Copyright © 2013. F.A. Davis Company  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 Total Ankle Arthroplasty (cont'd)

18. Copyright © 2013. F.A. Davis Company  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 Arthrodesis at the Ankle and Foot

19. Copyright © 2013. F.A. Davis Company  Complications  Postoperative Management – Immobilization – Weight-bearing considerations – Postoperative exercises  Outcomes – Short-term and long-term outcomes – Return to physical activities Arthrodesis at the Ankle and Foot (cont'd)

20. Copyright © 2013. F.A. Davis Company  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 Leg, Heel, and Foot Pain: Nonoperative Management

21. Copyright © 2013. F.A. Davis Company  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 Leg, Heel, and Foot Pain: Nonoperative Management (cont'd)

22. Copyright © 2013. F.A. Davis Company  Common Structural and Functional Impairments, Activity Limitations, and Participation Restrictions  Acute Ankle Sprain Management – Protection phase – Controlled motion phase – Return to function phase Ligamentous Injuries: Nonoperative Management

23. Copyright © 2013. F.A. Davis Company  Indications for Surgery  Procedures – Types of stabilization procedures Direct repair Reconstruction with augmentation Arthroscopic thermally assisted capsular shift – Operative overview Repair of Complete Lateral Ligament Tears

24. Copyright © 2013. F.A. Davis Company  Postoperative Management – Immobilization and weight-bearing considerations – Exercise Maximum protection phase Moderate and minimum protection phases  Outcomes Repair of Complete Lateral Ligament Tears (cont'd)

25. Copyright © 2013. F.A. Davis Company  Indications for Surgery  Procedures – Primary versus delayed repair – Operative overview Repair of a Ruptured Achilles Tendon

26. Copyright © 2013. F.A. Davis Company  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 Repair of a Ruptured Achilles Tendon (cont'd)

27. Copyright © 2013. F.A. Davis Company  Outcomes – Comparison of nonoperative versus operative management – Comparison of open versus percutaneous repair – Traditional versus accelerated rehabilitation Repair of a Ruptured Achilles Tendon (cont'd)

28. Copyright © 2013. F.A. Davis Company EXERCISE INTERVENTIONS FOR THE ANKLE AND FOOT

29. Copyright © 2013. F.A. Davis Company  Flexibility Exercises for the Ankle Region – Increase dorsiflexion of the ankle – Increase inversion – Increase ankle plantarflexion and eversion – Increase eversion and ankle dorsiflexion Exercise Techniques to Increase Flexibility and Range of Motion

30. Copyright © 2013. F.A. Davis Company  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 Exercise Techniques to Increase Flexibility and Range of Motion (cont'd)

31. Copyright © 2013. F.A. Davis Company  Activities to Develop Dynamic Neuromuscular Control Exercise to Develop and Improve Muscle Performance and Functional Control

32. Copyright © 2013. F.A. Davis Company  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 Exercise to Develop and Improve Muscle Performance and Functional Control (cont'd)

33. Copyright © 2013. F.A. Davis Company  Closed Chain (Weight-Bearing) Exercises – Stabilization exercises – Dynamic strength training – Resisted walking – Functional progression for the ankle and foot Exercise to Develop and Improve Muscle Performance and Functional Control (cont'd)

34. Copyright © 2013. F.A. Davis Company  Critical Thinking and Discussion  Laboratory Practice  Case Studies Independent Learning Activities