PT Solutions Evidence Based Practice Clinical Focus on the Foot and Ankle Course

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Godwin Wilcox
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1 Course LEARNING OBJECTIVES: 1. By the end of the course the participants will be able to correctly list all of the myotomes and dermatomes for the lower extremity. 2) By the end of the course the participants will be able to list the 3 most common categories of foot and ankle dysfunction, as discussed in class. 3) By the end of the course the participants will be able to list the 3 primary ligaments involved with lateral ankle sprains. 4) By the end of the course the participants will be able to describe the mechanism for lateral ankle sprain. 5) By the end of the course the participant will be able to describe the biomechanical cause for plantar fasciitis/posterior tibialis tendonopathy. 6) By the end of the course the participants will be able to describe the etiology of Achilles tendonopathy. 7) Given a patient with lower extremity injury, the participants will correctly perform the following special tests: anterior drawer, posterior drawer, plantar flexion strength, windlass dorsiflexion, nonwindlass dorsiflexion, STAR excursion 8) By the end of the course the participant will be able to defend the importance dorsiflexion for proper foot mechanics. COURSE DESCRIPTION: An evidence based approach to the diagnosis and treatment of lower extremity dysfunction and the indications and barriers of treatment given the current health care model. This course will combine lecture and lab to teach evaluation methods, manual intervention techniques, and verbal skills for communication of approach to the patient. INTENDED PARTICPANTS: PT Solutions clinical employees to include Physical Therapists, Physical Therapist Assistants, Occupational Therapist, Occupational Therapist Assistants, and Athletic Training. The Physical Therapist Assistant, Occupational Therapist Assistants, and Athletic Training will not be expected to deliver advanced manual skills and must understand that these skills should not be delivered without supervision of the Physical Therapist and/or Occupational Therapist. METHODS: Didactic, lab and manual techniques. Pre-reading material. Manual techniques will be performed under supervision medical difficulties related to orthopaedic difficulties of the foot and ankle should be relayed to the instructor. TIME: Pre reading material and didactic, lab & manual therapy techniques. Applied for Physical Therapists, Physical Therapist Assistants, Occupational Therapist, Occupational Therapist Assistants, and Athletic Training PLACE: PT Solutions Physical Therapy Clinics

2 Course Pre Reading Articles 1. Efficacy of Thrust and Nonthrust Manipulations and Exercise With or Without the Addition of Myofascial Therapy for the Management of Acute Inversions Ankle Sprain: A Randomized Clinical Trail; May 2013 volume 43 number 5 journal of orthopaedic & sports physical therapy 2. Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis: J Orthop Sports Phys Ther. 2010:40(9):A1-A26. Doi: /jospt Heel Pain Plantar Fasciitis: Clinical Practice Guidelines Linked to the international Classification of Functioning, Disability, and Health form the Orthopaedic Section of the American Physical Therapy Association; J Orthop Sports Phys Ther. 2008:38 (4). Doi: /jospt Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains; J Orthop Sports Phys Ther. 2013;43(9):A1-A40.doi: /jospt Bibliography 1. Guide to Physical Therapy Practice 3.0, APTA 2. Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability; Jay Hertel; J Athl Train Oct-Dec; 37(4): Motor Patterns in Human Walking and Running; G. Cappellini, Y. P. Ivanenko, R. E. Poppele and F. Lacquaniti; J Neurophysiol 95: , Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association; ROBROY L. MARTIN, PT, PhD TODD E. DAVENPORT, DPT STEPHEN PAULSETH, DPT, MS DANE K. WUKICH, MD JOSEPH J. GODGES, DPT, MA; J Orthop Sports Phys Ther. 2013;43(9):A1-A40. doi: /jospt Efficacy of Thrust and Nonthrust Manipulation and Exercise With or Without the Addition of Myofascial Therapy for the Management of Acute Inversion Ankle Sprain: A Randomized Clinical Trial; SEBASTIÁN TRUYOLS-DOMÍNGUEZ, PT, PhD1 JAIME SALOM-MORENO, PT2 JAVIER ABIAN-VICEN, PT, PhD1 JOSHUA A. CLELAND, PT, PhD3-5 CÉSAR FERNÁNDEZ-DE-LAS-PEÑAS, PT, PhD2; journal of orthopaedic & sports physical therapy volume 43 number 5 may 2013

3 Course 6. Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association; CHRISTOPHER R. CARCIA, PT, PhD ROBROY L. MARTIN, PT, PhD JEFF HOUCK, PT, PhD DANE K. WUKICH, MD; J Orthop Sports Phys Ther. 2010:40(9):A1-A26. doi: /jospt Heel Pain Plantar Fasciitis: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association; Thomas homas G. McPoil, PT, PhD RobRoy L. Martin, PT, PhD Mark W. Cornwall, PT, PhD Dane K. Wukich, MD James J. Irr gang PT, PhD Joseph J. Godges, DPT; J Orthop Sports Phys Ther. 2008:38(4). doi: /jospt ACSM s Guidelines for Exercise Testing and Prescription Fifth Edition Moore, Keith; Clinically Oriented Anatomy Third Edition Spatial Temporal Gait Characteristics; Maria Constantiou, Rod Barrett, Mark Brown, Peter Mills; JOSPT April Association Between Plantar Fascia Vascularity and Morphology and Foot Dysfunction in Individuals with Chronic Plantar Fasciitis; Hongying Chen, Hok-Ming Ho, Michael Ying, Siu Ngor Fu; JOSPT October Association Between Foot Type and Lower Extremity Injuries: Systematic Literature Review; Jasper Tong, Pui Kong; JOSPT October A Comparison of Negative Joint Work and Vertical Ground Reaction Force Loading Rates in Chi Runners and Rearfoot-Striking Runners; Donald Goss, Michael Gross; JOSPT October Influence of Stride Frequency and Length on Running Mechanics: A Systematic Review; Amy Schubert, Jenny Kempf, Bryan Heiderscheit; Sports Health May-June 2014

Course Agenda 7:00am - Breakfast 7:25am Welcome 7:30am Self Reflection 7:45am Pre Test 8:00am 12:00pm Didactic lecture on anatomy of lower leg Posture & Gait Mechanics Clinical Practice Guidelines

4 Course Agenda 7:00am - Breakfast 7:25am Welcome 7:30am Self Reflection 7:45am Pre Test 8:00am 12:00pm Didactic lecture on anatomy of lower leg Posture & Gait Mechanics Clinical Practice Guidelines Evidence for Interventions o Sprains and Strains of the foot and ankle o Achilles Tendonitis o Plantar Fasciitis Cost of Care Treatment Planning Muscle & Tissue Physiology Pain Science Treatment planning, progression & outcome goals 12:00pm - Manual Lab focused exercise and assessment 10:30am 10:45am Break 1:00pm Post Test & Assessment Review and Questions & Course Evaluation 2:00pm Adjourn

Skills Checkout Form Name of Resident: Date: Module 1: Foot/Ankle Foot/Ankle Pass Fail Evaluator s Initials Anterior Drawer Test Notes Ankle ROM Standing/Supine/Prone Neurological Assessment Fibular

5 Skills Checkout Form Name of Resident: Date: Module 1: Foot/Ankle Foot/Ankle Pass Fail Evaluator s Initials Anterior Drawer Test Notes Ankle ROM Standing/Supine/Prone Neurological Assessment Fibular Mobilizations Talar Mobilizations/Manipulations Talar Tilt/Inversion Stress Test Palpation of ATFL Posterior Tibial Dys Too Many Toes Calcaneal Mobilizations Navicular Mobilizations ROM Assessment: 1 st MTP Extension Patient Counseling Evaluator s Initials: Evaluator s Signature: 2014 PT Solutions Foot and Ankle Symposium

6 Lower Quarter Functional Assessment Functional Squat Overhead/Lunge/Hinge Pass Fail Evaluator s Initials Notes Single Leg Squat Step Down Assessment Heel Raise Single Leg Trendelenberg Test Hop Test Unilateral/Triple/Zigzag Single Leg Balance Ankle v Hip Strategy Star Excursion Gait Assessment Arm Swing/Early Toe Off/Short Stride Patient Counseling Evaluator s Initials: Evaluator s Signature: Grading Criteria: Pass: Three or less verbal cues required, patient has full understanding as to what pathology is detected by each test, patient independently positions patient safely. Fail: More than 3 verbal cues required, patient has less than full understanding as to what pathology is detected by each test, patient requires at least 2 verbal cues in positioning patient safely 2014 PT Solutions Foot and Ankle Symposium

7 Course Evaluation PT Solutions Evidence Based Practice Please rate experience today on the following scale from Instructor Poor Excellent 2. Content Poor Excellent 3. Pre-course Reading Material Poor Excellent 4. Usefulness of Material Poor Excellent 5. Clarity of Discussion Points Poor Excellent 6. Ability to relate to my clinic/hospital Poor Excellent 7. Meeting Room Poor Excellent 8. I felt today was valuable Poor Excellent 9. I would like to see future meetings/seminars discussing the following topics: 10. How will the course change the way you practice and treat your patients? 11. I suggest the following improvements to today s presentation:

8 Symposium Pre Post Test 1. What is the most common foot and ankle diagnosis according to JOSPT's "Clinical Practice Guidelines"? a. lateral ankle sprains b. achilles tendonitis c. diabetic neuropathy d. plantar fasciitis 2. What is the most common tendon to rupture in a human population? a. Quadriceps tendon b. Supraspinatus tendon c. Achilles tendon d. Biceps Femoris 3. Which of these risk factors fall into moderate evidence, per the clinical practice guideline, for achilles tendonpathy? a. dorsiflexion less than 11.5 degrees b. abnormal subtalar mobility c. decreased plantar flexion strength, less than 28 heel lifts d. inability to control pronation e. all of the above 4. Which two functional scales demonstrate "strong evidence", according to the clinical practice guideline, for outcome measure with ankle ligament sprains? a. LEFS and FAAM b. LEFS and FABQ c. FAAM and FABQ d. FABQ and VAS 5. According to the Ottowa Ankle Rules, which of the following would require radiographs to rule out fracture? a. Isolated Malleolar pain b. Malleolar pain and inability to bear weight c. Midfoot pain and 5 th metatarsal tenderness d. Midfoot pain and pitting edema e. All of the above f. B & C only g. B & D only

9 Symposium 7. According to Clinical Practice Guidelines, which of the following is true regarding external supports in acute ankle sprains? a. There is no evidence supporting their effectiveness b. Clinicians should consider ankle braces throughout episode of care until ankle is completely healed before progressing to weight bearing. c. There is strong evidence for their use in the short term following acute ankle sprain. d. None of the above 8. True or False: Ultrasound is recommended for the management of acute ankle sprain? a. True b. False 9. According to clinical practice guidelines, which of the following manual therapy techniques are recommended following acute ankle sprain? a. Non weight bearing mobilizations < grade 5 b. Non weight bearing grade 5 mobilizations/manipulation c. Weight bearing mobilization with movement d. All of the above 10. True or False: Custom orthotics and proven to provide superior relief from plantar pain than pre-fabricated orthotics or taping. a. True b. False 11. Which of the following have been proven to provide improvement in pain and function in patients with Achilles tendinopathy: a. Eccentric tendon loading b. Dry needling c. Ice massage d. All of the above e. None of the above

PT Solutions Evidence Based Practice Clinical Focus on the Foot and Ankle Course

PT Solutions Evidence Based Practice Clinical Focus on the Foot and Ankle Course LEARNING OBJECTIVES: 1. By the end of the course the participants will be able to correctly list all of the myotomes and dermatomes for the lower extremity. 2) By the end of the course the participants