PHTY206 Lecture Notes - Lecture 13: Neural Oscillation, Plantar Fascia, Podiatry
Physiotherapy management: Leg, ankle, foot
• Describe how you would manage some of the biomechanical factors which may contribute
to the development of an overuse injury in the leg, ankle or foot regions
• Describe the various treatment approaches to address impairments of function that are
related to disorders of the leg, ankle and foot region
• Provide a rationale for the selection of treatment that is directed to specific impairments
of function as related to disorders of the leg, ankle and foot region
• Treatment planning
o Will depend on findings from patient interview and physical examination
o Identification of
• Impairment(s)
• Functional limitation(s)
• Participation restriction(s)
o Treatment directed to address these
o Diagnosis is still important
• Need to be aware of pathology and stage
• Consider acute ankle injury: ligament sprain vs fracture
▪ Both present with pain limited ankle ROM
▪ But….fatue ill euie ioilisatio heeas ligaet spai ealy
gentle AROM exercises within pain recommended
• Consider leg pain: tibial stress # vs periostitis
▪ Both may present with functional limitation of painful gait
▪ However – a stress fracture will need rest, whereas a periostitis may be
able to keep patient walking and reduce pain with external support
(tape/orthoses)
o Also need to consider
• Psychosocial (contextual) factors
• Patient's goals
▪ Reduce pain
▪ Increase stability
▪ Improve strength
▪ Mobilise independently around house, inc. stairs
▪ Prevent recurrence of injury
▪ 10km fun run in 1 month
▪ Resources
▪ Social support
o Principles of management
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• Treatment aim: pain relief
• Treatment aim: tissue healing
o Advice and education
• Rest/load modification to allow adequate healing/recovery
• Use of POLICE
• Role of external devices/walking aids to de-load affected structures to allow
healing (compliance with use)
o External devices
• Immobilisation and protection
▪ Stress #
• NWB util liially stale: iial o o palpale pai at # site,
minimal or no pain with activities in brace
• Generally 6-8wks
• If poor response, surgery may be required (e.g. navicular)
▪ Lis franc (6-8 weeks)
▪ High ankle sprain (4-6 weeks)
• Only if separation of syndesmosis
• Taping and bracing
▪ De-loading/protection of injured structures e.g.
• Ankle ligament sprain
• Tendinopathies (tibialis anterior, tibialis posterior, soleus, plantar
fasciitis)
• Devices in shoes
▪ Heel cup for fat pad contusion, heel spur
• Heel spur at insertion of plantar fascia
▪ Hell raise for
• Calf strain
• Achilles Tendinopathy
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▪ Temporary felt for Morton's neuroma (disc shape or donut)
o Electrophysical agents
• Minimise extent of damage (POLICE)
▪ Cryotherapy, IFT
• When?
▪ Acute injuries
▪ Acute swelling
▪ Inflammation
▪ Muscle spasm
• Stimulate tissue healing & blood flow
▪ Ultrasound (Pulsed), IFT, Laser, Heat, ESWT
• When?
▪ Localised inflammation
▪ Superficial injuries
▪ E.g. muscle strains, ligament sprains, tendon injuries (PF, AT)
o Manual therapy and therapeutic exercise
• Mobilisation
▪ Joints
▪ Soft tissue (massage)
▪ Neural structures (neurodynamics)
• Stretching (muscle length)
• Early, pain-free AROM should be encouraged
• Treatment aim: improve joint ROM
o DF
• When
▪ Anterior impingement
▪ Post immobilisation
▪ Post ankle sprain
• What techniques
▪ AP talar glide (WB/NWB)
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Document Summary
Improve strength: reduce pain, mobilise independently around house, inc. stairs, prevent recurrence of injury, 10km fun run in 1 month, resources. Stress : nwb u(cid:374)til (cid:858)(cid:272)li(cid:374)i(cid:272)ally sta(cid:271)le(cid:859): (cid:373)i(cid:374)i(cid:373)al o(cid:396) (cid:374)o palpa(cid:271)le pai(cid:374) at # site, minimal or no pain with activities in brace, generally 6-8wks. If poor response, surgery may be required (e. g. navicular) Superficial injuries: e. g. muscle strains, ligament sprains, tendon injuries (pf, at, manual therapy and therapeutic exercise, mobilisation. Stretching (muscle length: early, pain-free arom should be encouraged, treatment aim: improve joint rom, df, when, anterior impingement, post immobilisation, post ankle sprain, what techniques, ap talar glide (wb/nwb, talar glide. Speeds up recovery rate: 13/19 (68%) subjects discharged at 4th treatment in ap mob group compared to 3/19, df improved earlier in treatment group (11 compared to 6 from baseline to treatment, mwm, influences rom rather than pain. Inversion/eversion: when, rigid foot, post immobilisation, post ankle sprain, which techniques. S-t joint transverse mobilisation: medial glide to improve eversion.
