Foot Ankle Rehab

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  1 Foot and Ankle Rehabilition ผศ . นพ .   บวรฤทธ    จักรไพวงศ   สาขาวชา   เทาและขอเทาภาควชาศัลยศาสตรออรโธปดคสและกายภาพบาบัด คณะแพทยศาสตรศรราชพยาบาล Handout can be download at www.ortho.chuckpaiwong.com/presentation Outlines ãCommon diagnosisãPre-operative rehabilitationãPost-operative rehabilitation Handout can be download at www.ortho.chuckpaiwong.com/presentation Common diagnosis ãAnkle Sprain  –Lat ankle sprain, Med ankle sprain, Syndesmotic sprain ãPTTD (Posterior Tibial Tendon Dysfunction)ãHallux valgusãPlantar fasciitisãHaglunddeformity, Achilles tendinosis Handout can be download at www.ortho.chuckpaiwong.com/presentation  Ankle sprain ãLateral ankle sprainãMedial ankle sprainãSyndesmotic sprain (High ankle sprain)  Ankle sprain ãGrading  –Grade 1: no swelling, tenderness, microtear of ligament –Grade 2: Mild to Mod swelling, tenderness, Patialtear of ligament –Grade 3: Severe swelling, marked tenderness, complete tear of ligament  Ankle Sprain ã3 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?) ãAnkle motionãSubtalar motion 1-3 week  ãAnkle motionãSubtalar motion  Ankle strengthening exercise ãMuscle power ãBalanceãCoordinationãPlyometricexerciseãSports specific exercise Muscle power  ãPeronealãTibialisposterior ãTibialisanterior ãToe flexor/extensor ãIntrinsic muscle Balance and Coordination ãCore exercise  –Abdomen, Lateral body –Back (upper, lower) –Groin –Chest ãBody balance  –Single leg stance –Straight line walking –Balance board –Side walk  3 Plyometricexercise ãControlled rapid and powerful muscle activityãImprove nerve, muscle and N-M coordinationãRequirement  –Full range of motion –Strong muscle power  –Good balance Plyometricexercise ãStraight runningãSide runningãHoppingãRun-Stop, Jump stopãZigzag runningãDifferent level jumpãUnstable ground  jumpingãSingle leg with ball activity PlyometricexerciseSports specific activity Ankle sprain surgery ãAnkle arthroscopic debridementãAnkle ligament reconstruction (Mod Brostormrepair)  Ankle arthroscopic debridement ãEarly ROM: immediateãStretching ãStrengtheningãBalance, CoordinationãAgility, Plyometric  4  Ankle ligament reconstruction (Mod Brostormrepair) Ankle ligament reconstruction(Mod Brostormrepair) ãSlab for 2 wk then stitch off ãToe pumpãROM once a day: 2-6 wk  –Ankle  –Subtalar  ãStrengthening: 6-8 wk  –4 directions ãBalance, CoordinationãAgility, Plyometric PTTD (Posterior Tibial Tendon Dysfunction) ãPosterior tibial tendon degenerationãPathology  –Flat foot –Achilles tightness –Peroneal impingement –Weak intrinsic muscle   PTTD staging ãStage 1ãStage 2 ãStage 3ãStage 4 Rehabilitation ãAchilles stretchingãAnkle and Subtalar manipulationãPeroneal tendinitisãModality and manual manipulationãIntrinsic muscle training  –Grab towel   PTTD surgery ãFDL Transfer ãCal OSãLat column lengtheningãTriple arthrodesis
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