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 Outlines ãCommon diagnosisãPre-operative rehabilitationãPost-operative rehabilitation Handout can be download at 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  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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