Therapeutic Exercise for Ankle and Foot

• Pes Planus


  A pronated posture of the hindfoot and decreased medial longitudinal arch, also known as flat foot.
• Pes Cavus


  A high-arched foot, also known as a supinated foot.
• Intrinsic Muscles


  Muscles providing support to the arches during gait, similar to those of the hand.
• Ankle Dorsiflexors in gait

  Muscles countering plantarflexion during initial foot contact and controlling foot lowering to the ground.
• Ankle Plantarflexors in gait

  Muscles functioning eccentrically to control tibial movement and concentrically for pushoff during gait.
• Ankle Evertors In gait

  Muscles facilitating weight shifting from the lateral to medial side of the foot in late stance phase.
• Ankle Inverters in Gait

  Muscles helping control pronation force on the hindfoot and medial longitudinal arch during gait.
• Rheumatoid Arthritis progression

  A condition affecting the forefoot early, hindfoot later, and leading to progressive instabilities and painful deformities.
• Joint Hypomobility Protection Phase

  Patient education, decrease pain, maintain joint and soft tissue mobility
• Tibiofemoral distraction

  pain control and general mobility
• Tibiofemoral posterior glide

  Increase flexion
• Tibiofemoral anterior glide

  increase extension
• Talocrural distraction

  pain control and general mobility
• Talocrural posterior glide

  increase dorsiflexion
• Talocrural anterior glide

  increase plantarflexion
• Joint Hypomobility Controlled motion

  Increase joint play and accessory motion, improve joint tracking regain balance in muscle strength, increase mobility of soft tissues and muscles, improve balance and proprioception
• Total Ankle Arthroplasty TAA indication

  End stage ankle arthritis, sufficient integrity of ligaments for stability, low-moderate physical demands, flexible deformity to be corrected, adequate vascular flow
• TAA Contraindications

  Active/ chronic ankle infection, severe osteoporosis or bone shock, avascular necrosis of talus, peripheral neuropathy, impaired vascular supply, long-term corticosteroid use, skeletally immature
• TAA Complications

  Fracture of medial or lateral malleolus, implant malpositioning, tendon laceration, nerve injury, infection, postoperative edema, tarsal tunnel syndrome, complex regional pain syndrome
• TAA Post-op Immobilization

  10-21 days
• TAA Weight Bearing

  Based on surgeon approach and pathology of tissues
• TAA Max protection

  RICE, maintain joint mobility distal and proximal to ankle, postop complication prevention, restablish independent ambulation and functional mobility, minimize atrophy, prevent stiffness
• TAA Mod to min Protection

  Achieve 100% ROM, Restore strength, muscular endurance, and balance, improve aerobic capacity, resume safe level of work activities, return to fitness and sport
• Ankle Arthrodiesis Indictions

  Debilitating pain, severe articular degeneration, marked instability or stiffness, deformity of ankle foot or toes, ostenecrosis of talus, salvage procedure after failed TAA
• Ankle Arthrodesis Contraindications

  Vascular impairment/ infection, uncontrolled diabetes, active tobacco use, severe ipsilateral subtalar arthrosis, severe contralateral ankle arthrosis
• Arthrodesis of ankle

  Fuse talus to tibia
• Arthrodesis of hind foot

  Talonavicular and talocalcaneal or talocalcaneal, talonavicular,and calcaneocuboid
• Arthrodesis of first toe

  First MTP
• Arthrodesis of IP joint

  IP joints fused in neutral
• Arthrodesis Complications

  Non-union, smaller area and poorer vascular supply, nerve damage, neuromas postop stress fracture, delayed wound healing
• Arthrodesis postop management

  Immobilization dependent on surgeo
• Tendinopathy


  Umbrella term that indicates disorder of tendon
• Tendinosis


  Long standing, chronic, degenerative tendon that is absent of inflammatory mediators or cells
• Tendonitis

  Acute inflammatory process in tendon
• Tensynovitis


  inflammation of a tendon sheath
• Anterior shin splints


  Overuse of tibialis muscle
• Posterior shin splints

  Tight gastroc-soleus complex and weak or inflamed posterior tib
• Leg, heel, foot pain protection phase interventions

  Cross friction massage, sub max muscle-setting, passive stretch plantar flexors, AROM within pain free range, supportive taping or orthotics
• Leg, heel, foot pain controlled motion education

  HEP, teach ROM before standing to reduce pain
• Leg, heel, foot pain controlled motion increase mobility

  Gastroc-soleus stretch, joint and soft tissue mobs, toe extension with ankle dorsiflexion and eversion