3/6/2012 STATE OF THE ART: FOOT AND ANKLE GENERAL KNOWLEDGE 1. TRASP REHABILITATION CONTENTS. General knowledge Trasp Prevention
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1 STATE OF THE ART: FOOT AND ANKLE ILITATION Fabienne Van De Steene. CONTENTS General knowledge Trasp Prevention Rehab Ankle sprain CAI Achilles tendon Plantar fasciitis Take home message 2 1. TRASP Ankle injuries common (20% sports injuries) TRASP CLINICAL INVESTIGATION THERAPY CASE HISTORY ASPECTS MODALITY PRIORITY Not only treat symptomatically cause and effect 3 1
2 1. TRASP CLINICAL INVESTIGATION CASE HISTORY THERAPY MODALITY Priority (evidence based) Swelling: reflex inhibition ROM recovered Muscle function Kinetic chain ASPECTS PRIORITY 4 1. TRASP CLINICAL INVESTIGATION CASE HISTORY THERAPY MODALITY ASPECTS PRIORITY Modality (evidence based) Active therapy Neuromuscular control postural control 5 2
3 1. TRASP Surgery foot & ankle Open Closed: arthroscopy Early treatment/load Early recover function brace!!!...but cost 7 2. PREVENTION primary Alignment kinetic chain Neuromuscular control proprioception balance training evidence based!!!!!! Brace??? 8 2. PREVENTION secondary Alignment kinetic chain (insoles, arch support) Be in form (endurance-exercises) Brace sports 9 3
4 2.PREVENTION FOOT AND ANKLE : PRIMARY SECONDARY Core stability!!! CONTENTS General knowledge Trasp Prevention Rehab Ankle sprain CAI Achilles tendon Plantar fasciitis Take home message 12 4
5 Development 95% lateral, 5% medial (anatomy) Pronounced inversion with plantar flexion or rotation High relapse risk most common Lig. Talofibulare anterior Lig. Calcaneofibulare Lig. Talofibulare posterior Managment Type I - II III (O Donoghue 08) More practical classification (Clanton 99) Type I: stable ankle Type II: unstable ankle, grade 1 (non-athlete) 2 (athlete) Anterior drawer sign (talar displacement 3 mm) Inversion stress test 15 5
6 Treatment: conservative Compression: oedema... Mind!!! 16 Treatment: conservative Type 1-2 Inflammation phase: RICE Proliferation phase Early active ROM Weight bearing Proprioception neuromuscular control Strengthening (m. Peroneus, m. Tib anterior) Core stability Remodelation phase Return to activity sport (tape relapse: brace) FUNCTIONAL TREATMENT!!! 17 Complication!!! Arthritis joint Cartilage Lig tibiofiluaris ant/post Nerve problem
7 Treatment: surgery Type 3 Discussion Surgery + 3 weeks cast treatment Surgery + 6 weeks cast treatment No surgery 6 weeks cast treatment Rehab after cast: brace (evidence based???) ROM Strength Neuromuscular control Function CAI 31-40% lateral sprain CAI Previous sprain: RF!!!! Multifocal cause Giving away Mechanical/functional mechanism: ATFL torn talus translates anteriorly axis Dofl, talus hits tibia: cartilage!!! CAI Definition Dynamic stability: bones, lig, muscle-tendon units Mechanical instability: pathology ligament; the cause of different anatomical changes of the ankle (anterior drawer laxity-talar tilt laxity) exercise+brace Functional instability: subjective feeling instability, ROM normal physiological borders. Problem of neuromuscular control and proprioception exercise 21 7
8 3. ACHILLES TENDON Rupture: surgery Tendinopathy: No tendinitis Eccentric training (12 weeks) 22 Alignment 4. FASCIITIS Development: overuse multifactorial Treatment ROM MTP - ROM TT Stretch posterior chain Night splint 4 weeks : significant better (Powell 98) Autostretch (Pfeffer 99, Digiovanni 03) Strengthening program COMBINATION (Dijck 04) FASCIITIS Surgery: cut degenerative tissue Injection PRP (platelet rich plasma) Plasma + growth factor Walker boot 24 8
9 5. OTHERS You ask... I answer...probably 25 TAKE HOME MESSAGE Restore function tissue Know how this tissue heals Active treatment Integration kinetic chain 26??????????????????? 27 9
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