ENDTERM

MODULE 2: THE ANKLE AND FOOT, AND SPECIAL

CONDITIONS
MODULE OUTCOMES

At the end of Module 1, the students will be able to:

Module Outcomes

1. Named the basic knowledge of musculoskeletal Anatomy, Physiology, and

kinesiology of the body

2. Distinguished relevant examination procedures and usage of algorithm approaches

as a guide for formulating the PT diagnosis

3. Discussed information regarding Upper extremity orthopedic conditions, using an

evidence-based rehabilitation approach.

4. Interpreted the physical impairments developed by each disease process.

5. Related the connection between physical impairment and the role of physical therapy

6. Formulated a treatment plan, applying a technique when given a specific problem.

LESSON 1 – ANKLE AND FOOT CONDITIONS

INTENDED LEARNING OUTCOMES

1. Described the anatomy and biomechanics of the ankle and foot.

2. Identified impairments, activity limitations, and participation restrictions for different

ankle and foot cases

3. Exemplified the assessment process for different ankle and foot cases

4. Organized a plan of care for different ankle and foot cases

5. Program a treatment approach for different ankle and foot cases

LEARNING ACTIVITIES

ENGAGE

(Non-graded activity: lecture)

Read through the case for our lecture in this link:

LABORATORY

 Read through our laboratory notes will be posted on the assignment tab.

EXPLORE

(Graded activity: laboratory)

View the Video posted on the General Channel and Answer the Following
Questions:

Critical Thinking and Discussions

1. Compare and contrast an exercise program for a patient who has had a repair or
reconstruction of torn lateral ligaments of the ankle versus a patient who has had a repair of a
ruptured Achilles tendon. How will precautions and selection of exercises differ after these two
types of surgical repairs?

After a repair of a ruptured Achilles tendon, all unilateral weight bearing exercises on the
operated side are all postponed until full weight bearing s- pain is possible. In doing stretching
exercises, it is usually initiated in a NWB position c a limited DF of no > 10 deg beyond neutral
until 8-12 wks p the surgery, and it may be progress in sitting position c the feet on the floor or
a rocker board before progressing in a bilateral stance on a wedge, only if pain-free. With
Resistance exercises, NWB strengthening exercises of the ankle and foot mm are initiated c
only using low load elastic resistance a progressing to CKC exercises. Lastly, functional training
should begin c plyometric training in a pool (chest-deep ->waist -deep) while land-based
plyometric training that requires high impact activities or movements are postponed until 16 wks
after the surgery. On the other hand, patient who has had a repair or reconstruction of torn
lateral ligaments of the ankle will be immobilized initially for max of 10 days then will be replaced
with short-leg walking cast that will continues to immobilize the ankle in neutral position for 4 to
6 wks duration -> air-stirrup-type splint. For approx. 8 to 12 wks patient may discontinue
wearing an immobilizer during ambulation. During weight bearing, it is permitted immediately
after the surgery c NWB operated limb same with the Achilles tendon rapture but in a matter of
3 to 4 wks, patient may already perform protected weight bearing and can be gradually progress
to full weight bearing by 6 wks a lot shorter timeline as compare with the other case.

2. Discuss the benefits and limitations of total ankle arthroplasty versus arthrodesis of the ankle.

- In total ankle arthroplasty, it provides pain relief while preserving the functional motion of the
ankle, and further causes stress relief on the adjacent joints which is more preferable than the
arthrodesis which also provides pain relief but commonly associated with a limited mobility on
the involved joint.

CASE STUDIES

4. Dr. A is a 43 year-old dentist with a relatively active lifestyle, who ruptured his (L) Achilles
tendon during a weekend tennis match. At the time of the injury, he experienced acute pain
above his heel which persisted for a brief period of time. After the pain subsided, he was able to
ambulate and returned home, where he rested for the remainder of the day and applied ice to
the posterior aspect of the lower leg. Dr. A decided to go to an urgent care facility the next day,
because he was having some difficulty walking and ascending and descending stairs. Physical
examination suggested a ruptured Achilles tendon, which was confirmed by an MRI. An open
primary repair of the tendon was performed two days later on an outpatient basis. Following
surgery, the involved ankle was immobilized in a short-leg cast with the ankle positioned in
plantarflexion for two weeks. The patient has been ambulating nonweight bearing with crutches
since surgery. At the 2-week postoperative visit to the surgeon, the cast was removed and
replaced with an ankle-foot orthosis, which was set in slight plantarflexion. The patient is now
permitted to bear partial weight on the involved foot within pain tolerance while wearing the
orthosis. The patient has been referred to physical therapy to begin rehabilitation, using an early
remobilization and weight-bearing approach. The patient is allowed to remove the orthosis for
ankle ROM exercises.

 Identify the components of your initial examination.

- ROM of the ankle joint and the adjacent joints
- MMT of the ankle joint and the adjacent joints
- Limb girth measurement to assess for limb selling
- ocular inspection to assess if there is any irregularities that can be seen
 Describe a sequence of exercises and criteria for progression that you would teach Dr. A
consistent with this accelerated functional approach to management.
Max Protection Phase: initial use of low impact exercises to initiate mobility of the involved and adjacent
joint by using NWB exercises
Mod Protection Phase: initial exercises given will be subjected for progression based on the recovery of
the patient or the outcome of the assessments or outcome measures
Min Protection Phase: this section of the treatment, exercises given will be more functional and patient
will be subject to various obstacles to test patient’s capability to do things independently.

 What precautions would you include in your treatment plan?

- All unilateral weight bearing exercises on the operated side are all postponed until full weight
bearing s- pain is possible

- Stretching exercises can only do limited DF of no > 10 deg beyond neutral until 8-12 wks p
the surgery

- Resistance exercises, NWB strengthening exercises of the ankle and foot mm are initiated c
only using low load elastic resistance a progressing to CKC exercises

- Functional training: should begin c plyometric training in a pool (chest-deep ->waist -deep)
while land-based plyometric training that requires high impact activities or movements are
postponed until 16 wks after the surgery

EXTEND

(Graded activity: laboratory)

 The group for the Ankle and Foot conditions will be presenting their Assessment
and Plan of Care.

EVALUATE

(Graded activity: laboratory)

 The group for the Ankle and Foot cases will be presenting their problem-based
learning presentation, Return Demonstration and Practical Examination.