Lower Leg, Ankle and Foot


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Unformatted text preview: exercises with light resistance provide little detrimental effects on the ligaments during healing • Isokinetic exercises and PNF exercises should be used in the later stages of rehabilitation Ankle Sprains Ankle Rehabilitation Progressions • Proprioceptive exercises should be facilitated to regain balance, coordination, and neuromuscular control • Cardiorespiratory endurance is a key concept of rehabilitation that must be maintained throughout the entire rehabilitation • Functional progressions should be incorporated from the beginning of the rehabilitation process Slowly increase the stress placed on the ligaments to provide optimal healing (Wolff’s Law) Ankle Sprains Ankle Return to Play Guidelines • Athlete should have regained normal ROM compared to the unaffected side • At least 80 – 90 percent of pre­injury strength must be regained • Be able to participate in full practice without further damage to injured structures • Should be able to perform functional activities without pain or limp • Protective bracing and/or taping may be utilized Ankle Fractures and Dislocations Dislocations Mechanism of Injury • • • Can be similar to that of ankle sprains Fractures will result from either compression or avulsion forces Dislocations most often occur in conjunction with fractures Rehabilitation Concerns • Undisplaced fractures will typically be treated with rest and immobilization until fracture has healed • Displaced fractures are treated with open reduction and internal fixation • After immobilization (~ 6 weeks), the rehabilitation is similar to that of ankle sprains Ankle Fractures and Dislocations Dislocations Rehabilitation Progression • Following open reduction and internal fixation of a displaced fracture, a posterior splint should be applied with the ankle in neutral and athlete non­weight bearing (~ 2 weeks) • Efforts to control swelling during this period should be conscious, as well as wound management • Athlete may be placed in walking brace after 2 – 3 weeks to allow partial weight bearing which should last for ~ 6 weeks • AROM for plantarflexion and dorsiflexion should begin, and repeated 2 – 3 times per day • General strengthening exercises for the rest of the lower extremity should be implemented Ankle Fractures and Dislocations Dislocations Rehabilitation Progression • After 6 weeks the athlete can be weight bearing in the walking brace, which should continue for 2 – 4 weeks • Progression of isometric to isotonic exercises should be made • Stretching exercises to gain ROM should be incorporated • Joint mobilizations can also be used to reduce capsular tightness • Exercises that increase proprioception and neuromuscular control should progress as tolerated • Functional closed­kinetic chain exercises should begin as strength and neuromuscular control increase Ankle Fractures and Dislocations Dislocations Return to Play Guidelines • • • • Normal Strength Normal ROM & flexibility Neuromuscular control has been regained Progression through a functional progression has been completed Subluxation and Dislocation of the Peroneal Tendons the Mechanism of Injury • Can be a result of a rupture to the superior retinaculum, which can be caused by any sudden forceful contraction of the peroneals Rehabilitation Concerns • Compression should be initially placed, creating pressure over the peroneal tendons • Athlete sho...
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