Rehabilitation of Common Foot and Ankle Problems An Active Exercise Guide for Return to Function.

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Pro-Active Physical Therapy in Tampa, Florida Past Director of Rehab at University of South Florida 500 Lectures and Inservices for Physical and Occupational

1 Rehabilitation of Common Foot and Ankle Problems An Active Exercise Guide for Return to Function. John Hisamoto P.T./A.T.,C. Pro-Active Physical Therapy Tampa, Florida John Hisamoto P.T./A.T.,C. Pro-Active Physical Therapy in Tampa, Florida Past Director of Rehab at University of South Florida 500 Lectures and Inservices for Physical and Occupational Therapist in the U.S. and Internationally (c) Pro-Active Physical Therapy 2013 Begin with the End in Mind Begin with the End in Mind: means to begin each task, or project with a clear vision of your desired direction and destination. 3 Major things I want to Accomplish today! Teach on a concepts basis 1

2 Anyone can follow a protocol How do you treat dysfunction? Dysfunction Assessment is Critical 2

structure Restore muscle balance of weak and tight muscles Improve CNS control Improve endurance in coordinated movement pattern Biomechanics

3 Biomechanical vs Neurological Kendall/Sahrmann s Biomechanical Approach Treatment: Shorten Long muscles, Reduce load on weak muscles. Emphasize correct use of muscles in postural and functional activities Janda Neurological Approach Treatment Normalize function of peripheral structure Restore muscle balance of weak and tight muscles Improve CNS control Improve endurance in coordinated movement pattern Biomechanics Always check Alignment: Above and below Muscle Imbalance Continuum Tissue Damage and Pain Muscle Imbalances (tightness or weakness) Altered movement pattern 3

4 Mobility Stability Strength Control Mobility: Stability: Strength: Where Do We Start? Control: Is it a Mobility or Stability Problem? Mobility Stability Emphasize joint and soft tissue mobility Emphasize strength, stability, motor control Tools & Techniques Mobility Stability Movement 4

Stability Tools & Techniques Elastic Resistance = Isotonic Resistance Similar physiologic responses to training Aboodarda et al. 2011; Hostler et al. 2001; Nash et al.

2001; Vinstrup 2015 No significant difference in strength outcomes Aboodarda et al. 2011; Behm, 1991; Calatayud et al. 2015; Colado & Triplett 2008; Takeshima et al.

5 Stability Tools & Techniques Elastic Resistance = Isotonic Resistance Similar physiologic responses to training Aboodarda et al. 2011; Hostler et al. 2001; Nash et al. 2002, Sexsmith, 1992 Similar electromyography (EMG) profiles Andersen et al. 2010; Jakobsen et al. 2012, 2014; LeBlanc et al. 2003; Lim, 1998; Matheson et al. 2001; Vinstrup 2015 No significant difference in strength outcomes Aboodarda et al. 2011; Behm, 1991; Calatayud et al. 2015; Colado & Triplett 2008; Takeshima et al. 2002; Smockum 2003; Colado 2015 Plantar Fasciitis Myth vs Reality Plantar Fascia Functions passively to store and return energy Tension increases to PF (up to 7 times body weight) during push off phase. Research confirms best predictor of PF is not height of arch but speed in which the toes move upward during the propulsive phase. Which occurs when FDB is weak. (uphill running, toe running) Wearing S et al, Med Sci Sports Exerc. 2004; 36: Flexor Digitorum Brevis Dynamic role in variable load sharing Tenses to distribute pressure away from the PF, loading in the Eccentric mode of contraction. Study of 22 heel bones with spurs revealed that bone spurs form at the origin of the FDB not the PF. Abreu M. et al, Skeletal Radiol 2003;32:

Foot Roller Foot Intrinsic Exercise Mobility Eccentric

Load muscle in shortened position by stretching CLX 3.

6 Foot Roller Foot Intrinsic Exercise Mobility Eccentric contraction to facilitate collagen realignment Eccentric Stretch Attach one end of CLX to extremity 1. Shorten muscle to be stretched WITHOUT resistance 2. Load muscle in shortened position by stretching CLX 3. Slowly lengthen muscle against CLX 4. Hold stretch at end 1. Shorten 2. Load 3. Eccentric 4. Stretch Achilles Eccentric Stretch 6

Great Toe Stretch Tissue Specific Plantar Fascia stretching exercises

Balance Training Balance Training The Missing Link IASTM IASTM in

7 Great Toe Stretch Tissue Specific Plantar Fascia stretching exercises enhances outcomes in patients with chronic heel pain. A prospective, randomized study. Journal Bone and Joint Surgery 2003:85-A: DiGiovanni B, et al. Balance Training Balance Training The Missing Link IASTM IASTM in conjunction with stretching produced superior outcomes compared to stretching alone. Renan-Ordine R, et al: JOSPT 2011:41:43 7

9(5):666-73 Mechanism of action unclear Research supports short-term pain relief (Lim & Tay 2015) Other outcomes remain unproven (Page 2015)

8 Show me your Exercises 31 websites on kinesiology taping reviewed 58% had anecdotal testimonials to promote Websites are poor quality and present misleading, imbalanced information Buetel & Cardone IJSPT. 9(5): Mechanism of action unclear Research supports short-term pain relief (Lim & Tay 2015) Other outcomes remain unproven (Page 2015) Specific patterns, directions, and tensions are not substantiated Tape tension is important; less is probably better (Lim & Tay, 2015) You don t need certification or a training course to tape! Kinesiology Tape Facts 8

you!! Be the Best Body Mechanic Use your Tools and

9 Re-focus on your Home Exercise Prescription Assess and progress home exercises each visit Show Me Thank you!! Be the Best Body Mechanic Use your Tools and Talent Time for YOU to be powerful in your profession 9

New Techniques for Treating Plantar Fasciitis

New Techniques for Treating Plantar Fasciitis by Thomas C. Michaud, DC Published Nov. 16, 2016 by Competitor Magazine Plantar fasciitis is the most common cause of heel pain in runners, eventually affecting