Module Three: Interventions of the Foot/Ankle

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Evidence-Based Treatment of the Foot Presented by Alexis Wright, PT, PhD, DPT, FAAOMPT Practice Sessions/Skill Check-offs Module Three: Interventions of the Foot/Ankle (75 minutes) Skilled Process a

The clinician grasps the foot just distal to the talar dome. The clinician applies a distraction forces at the talocrural joint by shifting his or her weight away from the patient.

1 Evidence-Based Treatment of the Foot Presented by Alexis Wright, PT, PhD, DPT, FAAOMPT Practice Sessions/Skill Check-offs Module Three: Interventions of the Foot/Ankle (75 minutes) Skilled Process a rearfoot distraction thrust a talocrural anterior to posterior Review in Chapter Slide 2 Slide 3 Photo Description Check Off The patient lies in supine. The clinician grasps the foot just distal to the talar dome. The clinician applies a distraction forces at the talocrural joint by shifting his or her weight away from the patient. The movement is applied and a preload force is held at the end range of the distraction. The is performed by applying a quick thrust at the end range. The thrust is targeted purely into distraction The therapist uses one hand to firmly stabilize the lower leg at the malleoli. The therapist then grasps the anterior, medial, and lateral talus with the other hand and applies an anterior to posterior oscillatory force to the talus 1

a talocrural anterior to posterior with movement subtalar lateral glide/ eversion mobiliation medial glide of the subtalar joint Slide 4 Slide 5 Slide 6 The clinician grasps and supports the arch of

A belt is placed over the patient s distal posterior tibia and fibular and around the clinician s buttock region.

the belt. The patient is placed in sidelying. The affected extremity is placed closest to the plinth. The clinician cradles the lower leg in one arm.

2 a talocrural anterior to posterior with movement subtalar lateral glide/ eversion mobiliation medial glide of the subtalar joint Slide 4 Slide 5 Slide 6 The clinician grasps and supports the arch of the foot and applies a stabilizing force (anterior to posterior directed force) over the anterior talus. A belt is placed over the patient s distal posterior tibia and fibular and around the clinician s buttock region. The patient is guided into dorsiflexion of the involved ankle, while, simultaneously, the clinician produces a posterior to anterior directed force to the distal leg by leaning backwards/pulling on the belt. The patient is placed in sidelying. The affected extremity is placed closest to the plinth. The clinician cradles the lower leg in one arm. The fingers stabilize the talus by looping the first digit and thumb around the dome of the talus. A lateral glide is performed using the nonstabilization hand. As with all techniques, repeated movements are performed at the first point of pain at near end range, whichever elicits the most reduction of symptoms The patient is placed in sidelying. The affected extremity is placed furthermost from the plinth. The clinician cradles the lower leg in one arm. The fingers stabilize the talus by looping the first digit and thumb around the dome of the talus. A medial glide is performed using the nonstabilization hand. As with all techniques, repeated movements are performed at the first point of pain at near end range, whichever elicits the most reduction of symptoms 2

distal tibiofibular joint cuboid whip sesamoid with movement Slide 7 Slide 8 Slide 9 The therapist places the distal leg of the patient at the edge of the table, the therapist s thigh is used to

The therapist places the thenar eminence over the lateral malleolus and uses his/her body to impart an anterior-toposterior directed mobilizing force through the arm and thenar eminence The patient

The thumbs of the clinician are placed on the cuboid on the plantar aspect of the foot. The knee is flexed to approximately 70 degrees and the ankle is dorsiflexed to end range.

3 distal tibiofibular joint cuboid whip sesamoid with movement Slide 7 Slide 8 Slide 9 The therapist places the distal leg of the patient at the edge of the table, the therapist s thigh is used to stabilize the patient s foot (move into dorsiflexion). The therapist grasps and stabilizes the distal tibia with one hand. The therapist places the thenar eminence over the lateral malleolus and uses his/her body to impart an anterior-toposterior directed mobilizing force through the arm and thenar eminence The patient assumes a prone position. The clinician grasps the foot by stabilizing the medial and lateral sides of the foot within his or her webspaces. The thumbs of the clinician are placed on the cuboid on the plantar aspect of the foot. The knee is flexed to approximately 70 degrees and the ankle is dorsiflexed to end range. In a quick movement, the clinician moves the knee into extension, the ankle into plantarflexion and supination. Concurrently with the physiological movements, the clinician also applies a plantar to dorsal thrust with his or her thumbs The therapist places one thumb on the proximal aspect of the sesamoid and applies a proximal to distal force causing the sesamoid to reach the end range of available motion. You can also ask the patient to perform concurrent MTP extension 3

proximal tibiofibular joint thrust balance training (single leg stance) Slide 10 Section 3 Slide 16 The therapist places the 2 nd MCP joint in the popliteal fossa, then pulls the soft

The therapist uses his/her other hand to grasp the foot and ankle, and externally rotates the leg and flex the knee to the restrictive barrier.

on the injured limb, with arms abducted and eyes open for 30 seconds.

closed, throwing and catching a ball low dye taping Section 3 Slides 52-58 The patient begins in supine. Wrap a full strip from the 5 th metatarsal head to the 1 st MTP as an anchor strip.

4 proximal tibiofibular joint thrust balance training (single leg stance) Slide 10 Section 3 Slide 16 The therapist places the 2 nd MCP joint in the popliteal fossa, then pulls the soft tissue laterally until the MCP is firmly behind the fibular head. The therapist uses his/her other hand to grasp the foot and ankle, and externally rotates the leg and flex the knee to the restrictive barrier. Once at the restrictive barrier, the therapist applies a highvelocity, low amplitude thrust through the tibia (direct the patient s heel towards the ipsilateral buttock) 1-legged standing on the injured limb, with arms abducted and eyes open for 30 seconds. This exercise can be progressed from arms abducted to arms crossed; eyes open to eyes closed; and more dynamic balance including standing on balance/wobble board with eyes open/eyes closed, throwing and catching a ball low dye taping Section 3 Slides The patient begins in supine. Wrap a full strip from the 5 th metatarsal head to the 1 st MTP as an anchor strip. Using several ½ strips, wrap from the 5 th metatarsal head diagonally across the bottom of the foot, wrapping around the calcaneus and back up alongside the foot to the same side you started on. Alternate your starting side from the metatarsal heads overlapping the previous strip by ½. Repeat until the tape cover the 5 th through 1 st metatarsal heads. Next, add full width strips across the arch of the foot pulling from lateral to medial pulling the arch up. Overlaps each 4

5 strip by ½ and avoid wrinkles in the tape on weightbearing surfaces. Last, complete by adding a cover strip around the edge of the foot starting at the 5 th metatarsal head, wrapping around the calcaneus to the 1 st metatarsal head. Notes: 5

Evidence-Based Examination of the Foot Presented by Alexis Wright, PT, PhD, DPT, FAAOMPT Practice Sessions/Skill Check-offs

Evidence-Based Examination of the Foot Presented by Alexis Wright, PT, PhD, DPT, FAAOMPT Practice Sessions/Skill Check-offs Module Five: Movement Assessment of the Foot/Ankle (1 hour CEU Time) Skilled