Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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22.3 Foot and Ankle
Table of Contents

BIOMECHANICS OF THE FOOT AND ANKLE FOR THE PHYSICAL THERAPIST

Abstract:

CONTENT: Author Dr Jeff Houck sheds light on recent research findings and also clarifies some previously misunderstood studies with regard to the biomechanics of the foot and ankle complex. He first establishes common ground for the reader by defining terminology common to the foot and ankle complex. In the next section, Dr Houck provides an excellent review of key anatomical structures and biomechanical concepts of the ankle and foot, and creates a strong foundation for the reader. Throughout the monograph, Dr Houck integrates past literature and research findings to create an evidence-based approach to examination, treatment, and rehabilitation exercises. A separate section is dedicated to foot and ankle biomechanics during running. The influence of abnormal foot and ankle biomechanics is also discussed in detail. This monograph is an excellent addition to this series and the reader will benefit from the author's critique and summarization of the literature in this area. CASE ANALYSES: Five case studies are presented at the conclusion of the monograph. They include (1) a 65-year-old woman presents with gradual and insidious onset of right medial ankle pain, (2) a 41-year-old male presents with a swollen and discolored lateral ankle, (3) a 37-year-old female runner presents with gradual onset of posterior heel pain, (4) a 46-year-old female postsurgical patient who has undergone bunionectomy surgery and second interphalangeal joint fusion for a hammer toe, and (5) a 32-year-old male with bilateral heel pain.

Keywords:​

kinesiology, gait, ankle, injury

References:​

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ADULT ACQUIRED FLATFOOT DISORDERS

Abstract:

CONTENT: Drs Crim and Wukich have specifically highlighted the importance of identifying and treating adult acquired flatfoot disorders. They have provided an excellent topic that I feel warrants greater understanding with regard to physical therapy management of this disorder. They first discuss the normal anatomy and function of the posterior tibial tendon. This information is then applied to the etiology and pathophysiology associated with adult acquired flatfoot deformity. A systematic physical examination to evaluate patients with flatfoot deformity is then described in detail along with clinical staging of the deformity. Nonoperative and surgical treatment options for adult acquired flatfoot deformity are then reviewed. A section of the monograph is dedicated to rigid flatfoot deformity secondary to tarsal coalition and treatment options associated with the disorder are presented. In addition, the authors describe how patients with inflammatory and noninflammatory arthritis develop flatfoot deformity. In addition, treatment options for these patients are described. After reading the monograph, you will gain valuable insight into not only how the ankle foot complex functions but also how to most effectively examine, treat, and manage patients with flatfoot disorders. CASE ANALYSES: Two case studies conclude the monograph. The first case describes a 68-year-old female who presents with severe ankle pain to the left lower extremity. The second case is a 69-year-old male with pain in his right foot and ankle of 2 years duration. For both cases, the authors describe the examination findings, treatment, and outcomes.

Keywords:​

pes planus, ankle, surgical

References:​

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EXAMINATION OF THE FOOT AND ANKLE

Abstract:

CONTENT: Excellent coverage of the complex features and unique pathologies of the foot and ankle region. Dr Davenport first introduces the reader to the functional anatomy of the foot and ankle complex. Naming conventions are discussed and then bones, joints, and muscular structures are reviewed in detail so the reader can gain a full appreciation of the unique mechanics of the foot and ankle. The World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) model is then applied as it pertains to ankle foot function and health. Dr Davenport then summarizes the current research evidence related to the validity, reliability, and diagnostic accuracy of the physical examination for the foot and ankle. Detailed discussion regarding the procedures for common physical examination tests for the foot and ankle are reviewed. An emphasis is placed on developing an organized and methodical approach for examination of the foot and ankle. Common pathologies are then discussed. CASE ANALYSES: Two case studies provide an opportunity to apply the didactic material presented. The first case is a 50-year-old female nurse who complains of pain in the plantar aspect of the left heel after initiating a walking program. The second case is a 55-year-old female who works as an office manager who has a recent history of pain in her right forefoot region. Dr Davenport takes the reader through his evaluation and decision making process for each case.

Keywords:​

diagnosis, International Classification of Function, decision-making

References:​

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MANUAL THERAPY, TAPING, AND EXERCISES FOR THE FOOT AND ANKLE

Abstract:

CONTENT: Clinicians are always interested in learning more about therapeutic exercise. Dr Brown integrates regional anatomical and kinesiological imperatives to therapeutic exercise for the foot and ankle. Adaptations of the neuromuscular system are specifically discussed as well as the underlying physiology of exercise. The facets of exercise progression as they pertain to specificity, safety, and gait are highlighted. The author has also included a bonus DVD featuring exercises to enhance the application of instituting the exercise protocols discussed in the monograph. CASE ANALYSES: Three case studies conclude the monograph. The first case is a 16-year-old male basketball player presenting to the clinic following a lateral malleolus fracture. Case two is a 16-year-old female referred to physical therapy following a traumatic ankle sprain. The final case is a 42-year-old female in need of rehabilitation following an Austin bunionectomy of the great toe. Each case details the examination process and describes interventions to assist the reader in applying the material presented in the monograph.

Keywords:​

therapeutic, rehabilitation, kinesiology

References:​

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THE EFFECTIVENESS OF FOOT ORTHOSES FOR THE TREATMENT AND PREVENTION
OF LOWER EXTREMITY OVERUSE INJURIES

Abstract:

CONTENT: The topics of manual therapy procedures, taping techniques, and exercise intervention strategies for the foot and ankle are brought to the forefront. Paulseth and Martin explain the role of each intervention in foot and ankle care. Common foot and ankle pathologies are covered according to structural regions of the forefoot, midfoot, and hindfoot. Coverage of each joint region is organized into the major headings of pathomechanics, risk factors, evaluation considerations, and interventions. The authors place strong emphasis on critically appraising the benefits of manual therapy intervention for the foot and ankle complex. In addition, they assess the effects of taping interventions on proprioception, alterations in lower extremity biomechanics, and treatment-directed testing consistent with the available evidence-based literature. A biomechanical approach during the examination process is also highlighted. CASE ANALYSES: Two case studies conclude the monograph. The first case describes a 55-year-old female who presents with forefoot pain during weight-bearing activities. The second case is a 50-year-old female with heel pain. Both cases detail the examination process and propose interventions consistent with the material presented in the monograph.

Keywords:​

therapeutic, treatment, intervention

References:​

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EXERCISE CONSIDERATIONS FOR THE FOOT AND ANKLE

Abstract:

CONTENT: Clinicians are commonly faced with patient conditions that may require the use of orthotic intervention. In this highly relevant monograph, Dr Matheson describes the utility of foot orthoses in patients with musculoskeletal overuse injuries. He discusses the history and the dilemmas associated with the different classifications used globally to classify and describe foot orthoses. Dr Matheson applies recent research evidence to support the premise that inexpensive prefabricated orthoses should be considered as an alternative to more expensive custom orthoses for the prevention and treatment of lower extremity overuse injuries. Along these lines, he differentiates between the historical Balanced Foot Orthotic Theory and the more recent Total-contact Foot Orthotic Theory models. The use of comfort measures in predicting orthosis success is also reviewed. Application is then made to examine the effectiveness of foot orthoses in several selected overuse conditions of the lower limb. Dr Matheson emphasizes appropriate examination and diagnostic reasoning. He also believes that clinicians need to be grounded in the theoretical and practical premise of orthotic prescription if a successful outcome is to be achieved. CASE ANALYSES: Two case studies are included in the monograph. The first case describes a 55-year-old female who presents with a one-month history of right plantar heel and foot pain. The second case is a 38-year-old male recreational runner with a two-month history of insidious onset of left anterior knee pain. Each case details the exam process and describes the rationale for orthotic interventions used to treat each patient.

Keywords:​

pronation, ankle, orthotics

References:​

Click here.

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