Condition

Causes

Patient presentation

Management and Treatments

Pes Planus (flat foot)

structural and biomechanical

Loss of longitudinal arch

Supportive footwear, orthotics, calf stretching

Hypomobility

(stiff foot)

structural and biomechanical; degenerative changes

Impaired joint mobility and ROM, pain, impaired gait cycle or balance reactions

Restore ROM, restore joint accessory motions, stretch tight/shortened musculature, strengthen weak musculature, footwear and orthotics with added cushion (soft shoe)

Lateral inversion sprain

(Link to 15 minute tutorial)

excessive ligament loading during inversion

swelling, tenderness, and brusing (Grade III)

Protection phase: Pain and swelling control, PRICE, gentle ROM, toe intrinsic AROM, casting or splinting as needed and reduce weight bearing

Controlled motion phase: basic balance training exercises, calf strengthening (from double to single limb support), lower extremity strengthening

Return to function phase: progressive balance activities with multi-directional challenge, agility drills and sports-specific training

Lateral ligament surgical repairs: always start with open kinetic chain strengthening, everter strength is the most important to recover, and no proprioception and balance training until weight bearing is fully pain free. The maximum protection phase last 4-6 weeks. ROM of the ankle is often not allowed at this time. The moderate protection phase allows for restoring ROM, and at 6 weeks post-op, full weight bearing is commonly allowed.

High Ankle Sprain

(Link to 5 minute video)

Closed captioning (CC) may help with the accent

excessive loading during eversion, straining the syndesmosis between tibia and fibula; may require surgical intervention

Tenderness above ankle

Protection phase: Use of crutches and walking boot to allow ligaments to heal; rehab course following immobilization is similar to lateral ankle sprain

Controlled Motion Phase:

Progress weight bearing as tolerated

Increase ROM

Begin strengthening-isometric to eccentric-concentric, OKC to CKC

Begin proprioception training and simple balance training

Return to Function Phase:

Add resistance to strengthening exercises

Utilize BAPS/Wobble boards full WB

Progress jogging to running, straight lines before incorporating turning/changing directions

Progress jumping beginning with eccentric loading phase, moving on to concentric jumping

Plyometric strengthening

Achilles Tendon Rupture

(Link to 5 minute video)

Pain, swelling and palpable defect along posterior calcaneus. Plantar flexion weakness, inability to climb stairs, jump or rapidly change directions with affected extremity.

+Thompson Test

Maximum Protection:

Maintain immobilization as directed by MD/surgeon.

Instruct crutch ambulation as weight bearing restriction, PWB non surgical, non-weight bearing surgical

RICE

Maintain ROM of non-immobilized structures

Prevent reflex inhibition by use of gentle isometric setting of immobilized tissues

Maintain fitness

Achilles conventional repair: Weight bearing will be prohibited for 4-6 weeks and immobilization will usually last 6 weeks, low intensity resistance exercises don't begin until 6-8 weeks, and no closed chain exercises until full weight bearing is pain free. This approach is utilized with anyone who had delayed repair of the the rupture.

Plantar fasciitis (PF) or Plantar heel pain

Link to 10 minute tutorial

prolonged standing and walking, obesity, foot structure (planus or cavus)

Pain on plantar surface of foot, near fascial insertion on medial heel. Results in pain upon palpation, pain with weight bearing, especially first thing in morning, climbing inclines, or with toe extension

Rest, may need walking boot

Cushioned footwear and possible rocker bottom shoe and/or medial heel wedge, strengthening of foot intrinsics, particularly toe flexors, gastroc and plantar foot stretching, soft tissue mobilization

A clinical treatment recommendation: For applying cross friction massage for plantar fasciitis, a golf ball is an excellent tool that can be used by both the therapist and the patient.

Tibialis anterior tendonitis ("shin splints")

kicking in plantar flexion, running hills or hard surfaces

Pain in anterior shin with active dorsiflexion or plantar flexion stretching. Weak anterior tibialis, hypomobile gastrocnemius/soleus, and excessive pronation

icing, stretching tibialis anterior and gastroc soleus, strengthening, orthotics as needed

Tibialis posterior tendonitis

over pronation and pes planus; activities that stress control of pronation (e.g. rapid pivoting)

Pain posterior to medial malleolus; may extend into the musculotendinous junction into medial shin

icing, stretching tibialis anterior and gastroc soleus, strengthening, orthotics as needed