Ankle injuries

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Ankle injuries

  1. 1. Ankle Injuries
  2. 2. Ankle Arthritis <ul><li>Debridement and motion </li></ul><ul><li>Lateral gutter inflammation versus chondral pain </li></ul><ul><li>Spur impingement </li></ul><ul><li>Chondroplasty versus cartilage grafting </li></ul><ul><li>Hardware pain </li></ul>
  3. 3. Ankle Arthritis Hardware Pain
  4. 4. Ankle Arthritis <ul><li>X-ray worse than the disease </li></ul><ul><li>Pain not related to the x-ray </li></ul><ul><li>Odd joint – never primary arthritis </li></ul><ul><li>Gait and mechanics always bad </li></ul><ul><li>Therapy first second and third </li></ul>
  5. 5. Ankle Arthritis <ul><li>Cases of cartilage grafting </li></ul><ul><li>Treat the worst lesion </li></ul><ul><li>Source of graft –tibia proximal and distal </li></ul><ul><li>Running trampoline (Orbiter) </li></ul><ul><li>Balance </li></ul><ul><li>Proprioception </li></ul><ul><li>Bike and Pool </li></ul>
  6. 6. Articular Cartilage Paste Grafting: Talus
  7. 7. Articular Cartilage Paste Grafting: Talus
  8. 8. Articular Cartilage Paste Grafting: Talus
  9. 9. Articular Cartilage Paste Grafting: Talus
  10. 10. Articular Cartilage Paste Grafting: Talus
  11. 11. Articular Cartilage Paste Grafting: Talus 2 nd Look LA 07-14-1999
  12. 12. Articular Cartilage Paste Grafting: Talus 2 nd Look LA 07-14-1999
  13. 13. Talus Articular Cartilage Paste Grafting: Rehabilitation <ul><li>Non-weight bearing for 4-wks </li></ul><ul><li>CPM, 6hrs/day for 4-wks </li></ul><ul><li>Regular soft tissue mobilization </li></ul><ul><li>Early push for full ROM </li></ul>
  14. 14. Ankle Ligaments <ul><li>Anterior Talo fibular ligament (99%) </li></ul><ul><li>Calcaneo fibular ligament </li></ul><ul><li>Deltoid (more with fractures) </li></ul><ul><li>Posterior ligaments and capsule </li></ul>
  15. 15. Ankle Ligaments <ul><li>Exam: Shuck, motion, pain, crepitus </li></ul><ul><li>Treatment: Splint, motion, strengthening </li></ul><ul><li>Rehabilitation: Dynamic and functional </li></ul><ul><li>Surgery 1% </li></ul>
  16. 16. Ankle Ligaments <ul><li>Brostrom modification (99%) </li></ul><ul><li>Deltoid repair in fractures and dislocations </li></ul>
  17. 17. Ankle Ligaments <ul><li>Prevention </li></ul><ul><ul><li>Training </li></ul></ul><ul><ul><li>Shoe wear </li></ul></ul><ul><ul><li>Bracing </li></ul></ul><ul><ul><li>thinking </li></ul></ul>
  18. 18. Chondral Defect MC 03-27-2001
  19. 19. Treated Chondral Defect MC 03-27-2001
  20. 20. ANKLE SURGERY SUMMARY • Treat the lesion • Treat it early with minimal tissue disruption • Treat instability if chronic • Rehabilitate the ankle thoroughly
  21. 21. ANKLE REHABILITATION GENERAL CONSIDERATIONS • Protection in all phases • Appropriate joint mechanics and gait • Proprioceptive and functional training • Goal is to restore and improve patients function
  22. 22. Talus Articular Cartilage Paste Grafting: Rehabilitation <ul><li>Non-weight bearing for 4-wks </li></ul><ul><li>CPM, 6hrs/day for 4-wks </li></ul><ul><li>Regular soft tissue mobilization </li></ul><ul><li>Early push for full ROM </li></ul>
  23. 23. ANKLE: POST-INJURY & POST-OPERATIVE PROTECTION AIR CAST walker boot AIR CAST splint ASO Ankle stabilizer
  24. 24. ANKLE: POST-OPERATIVE REHAB bi-lateral leg biking feet on ball bridges
  25. 25. ANKLE: EARLY REHAB soft tissue mobilization (edema control) soft tissue mobilization
  26. 26. ANKLE: MID REHAB fibular glide talo-crual glides
  27. 27. ANKLE: MID REHAB ankle PNF monster walk
  28. 28. ANKLE: MID REHAB single leg bridging proprioceptive training
  29. 29. ANKLE: LATE REHAB Trampoline jog proprioceptive challenge
  30. 30. ANKLE: LATE REHAB bongo board lateral excursion test
  31. 31. ANKLE REPAIR: PLYOMETRICS lateral leaps diagonal leap
  32. 32. ANKLE REHABILITATION TIMING CONSIDERATIONS • Progress according to constant re-assessment • Phase can last from 2-days to 2-wks or more • Be as aggressive as possible without doing harm • Educate the patient at every phase

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