Orthopaedic Observations                                                                    A Matter of Medicine…         ...
When working on the above two goals, it is also                          3.    Rolling your barefoot over a frozen bottlen...
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Ortho ob common foot & ankle problems by brian tenenhaus pdf


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Ortho ob common foot & ankle problems by brian tenenhaus pdf

  1. 1. Orthopaedic Observations A Matter of Medicine… TM Pending Common Foot and Ankle Problems By Brian Tenehaus, MPT It’s a common scene. You are at support structures can overstress the ligament, especially the movies, or watching your with jogging, running, or jumping. kids’ soccer game, and you see someone hopping along on the When grading the ankle sprain, there are three grades. A sidelines on their crutches. After- grade I sprain is minor. One might not even see a doctor wards, you think to yourself, for this, depending on the patient. There could be a bit of “Thank God that’s not my kid!” swelling, with no discoloration, or slight bruising. A grade You wonder what happened to II sprain is more swollen, often with purple, green, or yel- them? It’s usually an ankle lowish bruising. The color of bruising changes over the sprain, the #1 most common in- course of the healing process. Pain is more intense, and jury in the United States. More worsens when you put weight on it. It will also be tenderoften than not, it occurs during recreational or sports ac- to the touch. A grade III sprain is considered a severetivity, however, I recently witnessed one happen as some- sprain. One should be non-weight bearing with crutchesbody missed a step while walking down the stairs. It hap- for about 6-8 weeks for this type of sprain. The discolora-pens so fast; before you realize what happened, it is too tion will be substantial. The patient might tell you, “itlate. swelled up like a balloon.”Approximately one million Americans will injure their Treatment for all three grades is similar, especially at theankle each year, not accounting for all the times you may beginning. The good ole” acronym, RICE: rest, ice, com-roll your ankle in the yard and decide not to go to the pression, elevation. The addition of an anti-inflammatorydoctor. Of the that one million, 85% will be an ankle medication is necessary as well. Rest means, “try not tosprain. walk on it, give the ankle a rest.” Ice means, “twenty min- utes on, twenty minutes off, “not” ice “til it freezes!” IThe foot and ankle is comprised of several bones, 26 to have seen frozen skin from patients who lay on the ice toobe exact. The lower leg is formed by two long bones that long. Compression with an ace wrap is effective in reduc-run parallel to one another, the tibia and fibula. They ing swelling. Be sure to wrap from the bottom up, in orderarticulate with a square-shaped bone called the talus. to push the fluid north, after all, we don’t want “Pillsbury”This bone sits atop a longer, more rectangular bone called chubby toes.the calcaneus, more commonly known as the heel bone.In front of the heel bone, sits two other awkwardly Once you get the pain and swelling under control, theshaped bones called the navicular and the cuboid, mov- treatment protocol stems around mobility and stability. Iting towards the pinky side of the foot. Just in front of is imperative to get a stiff joint moving, but too much mo-these two bones sit three more bones called the cunei- bility will mean that the ankle is prone to re-injury, thus,forms, and five long , narrow bones called metatarsals. stability is important. Therefore, strengthening becomesTogether, these bones combine to make the midfoot. just as necessary.Lastly, the forefoot is comprised of shorter, narrowerbones called phalanges, a total of fourteen. Let’s start From a therapy standpoint, we can help with both of thesewith the basics. A typical, “roll your ankle” sprain, also goals. Ultimately, therapists will help gain more motionknown as an inversion sprain, is when your foot rolls by stretching and mobilizing the ankle. With the help ofinwards and the pressure is placed on the outside of your various stretching techniques, patients achieve gains withankle. Occasionally, you can irritate muscle tendons, active motion as well as passive motion. While gainingknown as tendonitis. Tendons attach muscles to bones. motion, therapists help direct patients with a properWhen rolling your ankle, the structures usually injured strengthening program in order to help them regain stabil-are called ligaments, tissue that connects bone to bone. ity.Ligamentous tissue is relatively strong, similar to stringor rope, but the amount of weight that we place on these ( article continued on the back side…)
  2. 2. When working on the above two goals, it is also 3. Rolling your barefoot over a frozen bottlenecessary to focus on functional activities like of water has also been effective for plantarwalking, kneeling, and ascending/descending fascitis (keep your foot moving forwardsstairs. Balance strategies and proprioceptive and backwards) no more than 8 minutes.training will also be addressed. Once the patient 4. Soft tissue massage on the tender areafeels comfortable with walking on flat, smooth 5. Iontophoresis is an effective method ofsurfaces, they re-learn to walk on uneven surfaces delivering various anti-inflammatorylike gravel and grass. Eventually, they transition medications subcutaneously via an electri-from one surface to the next. cal stimulating device 6. Custom made orthotics can be made atOther than ankle sprains, a few other common The Orthopaedic Group, LLC, ProPTfoot problems that are addressed in therapy in- center which will often correct alignmentclude: hallux valgus, trauma injuries, plantar issues at the foot and ankle joint whichfascitis, and achilles tendonitis. The latter two are could be contributing to the underlyingboth common overuse injuries, often interrelated. problem.With plantar fascitis, it is typically characterizedby a sharp pain on the underside/sole of the foot, When looking at foot problems and injuries likeinitiating at the underside of the heel and running bunions, trauma, flat feet or high arches, treat-along the arch (bottom of the foot) whereas with ment plans vary, depending on the specific issuesachilles tendonitis, pain/discomfort is more often involved. The premise often revolves aroundat the back of the heel. Usually, plantar fascitis is correcting malalignments and muscle imbalancesworse after long periods of sitting or upon waking with the use of strengthening exercises and in-in the morning. Achilles tendonitis is commonly creasing flexibility. Again, the use of orthotics isseen with runners or long distance walkers. often indicated to correctly neutralize the ankle’s subtalar joint. Always keep in mind that foot andFor a treatment recipe, there are several ingredi- ankle problems could be contributing to knee, hipents which are effective in helping to aid the heal- or back pain.ing process as seen below.1. Stretching of the calf and foot musculature In conclusion, it is necessary to see the body in its is of the utmost importance entirety, realizing that the foot and ankle are the2. Rolling your barefoot on a tennis ball for a body’s foundation. Without that base of support, minutes 1-2x /day can help loosen the you’re asking for the rest of the body to follow in plantar fascia suit. Along with properly supporting shoes (or sandals in the summertime) physical therapy can be a great adjunct at providing a steady and com- fortable foundation for many years to come. http://www.cureresearch.com/a/ankle_sprain/ intro.htm Brian graduated from Quinnipiac University in 2004 with a Master of Science degree in Physical Ther- apy. Brian recently moved to Connecticut from Reston, Virginia where he worked at Georgetown Uni- versity Hospital. Brian was an accomplished collegiate tennis player and has enjoyed teaching tennis since 1999. Brian applies his sports background to the rehabilitation of his patients. Brian has been with The Orthopaedic Group, LLC since moving back to Connecticut in 2006. © 2008 The Orthopaedic Group, LLC Not to be reproduced without the express permission of the author