Lower Leg, Ankle and Foot

Earchtaping plantar fasciitis plantar

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Unformatted text preview: habilitation Concerns • The foot must be examined biomechanically in order to determine deformities, then the appropriate use of orthotics and correct footwear should be incorporated • Footwear should also be examined to help determine biomechanical defeciencies Stress Fractures in the Foot Stress Mechanism of Injury • Stress fractures are overuse injuries • The most common bones in the foot for stress fractures to occur are the navicular, 2nd metatarsal (March fracture), and the diaphysis of the 5th metatarsal (Jones fracture) • Navicular and 2nd metatarsal fractures will typically occur with excessive pronation, where as 5th metatarsal fractures typically occur with excessive supination • Stress fractures in the navicular are most commonly seen in runners with pes planus • The March fracture is typically seen in running and jumping sports • A Jones fracture can occur due to overuse, acute inversion, or high­velocity rotational forces Stress Fractures in the Foot Stress Rehabilitation Concerns • Rehabilitation should concentrate on correcting the underlying cause or causes • 2nd metatarsal fractures tend to recover well with modified rest along with non­weight bearing exercises such as pool running, upper­body ergometer, or stationary bike in order to maintain the athlete’s CV endurance for ~ 2 to 4 weeks • The modified rest period is followed by ~ 2 to 3 weeks of a progressive return to running and jumping sports, while incorporating appropriate orthotics and showear • Stress fractures to the navicular and 5th metatarsal typically require more aggressive treatment Stress Fractures in the Foot Stress Rehabilitation Concerns • Non­weight bearing short leg casts are typically worn for 6 – 8 weeks for nondisplaced fractures • Both navicular fractures and 5th metatarsal fractures require internal fixation in cases of delayed union, nonunion, and especially displaced fractures Plantar Fasciitis Plantar Mechanism of Injury • There are may anatomical and biomechanical conditions that can cause plantar fasciitis • These include leg length discrepancy, pes planus, inflexibility of the medial longitudinal arch, tightness of the triceps surae complex (gastrocnemius, soleus, and plantaris if present), wearing shoes without sufficient arch support, a lengthened stride during running, and running on soft surfaces Plantar Fasciitis Plantar Rehabilitation Concerns • Orthotics has proven to be a successful treatment of this problem • Soft orthotics have shown to be more successful than the use of hard orthotics • Orthotics in adjunct with exercise has shown to significantly reduce pain in athletes with plantar fasciitis • Use of a heel cup alongside of soft orthotics helps to provide cushion under the area of irritation of the plantar aponeurosis • Taping may also be beneficial if soft orthotics are not feasible (i.e., arch taping) Plantar Fasciitis Plantar Rehabilitation Concerns • In extreme cases the use of a night splint to maintain a static stretch may also be incorporated in the treatment • The use of a short leg walking cast for ~ 4 to 6 weeks has also been recommended in these cases • Heel cord stretching should also be utilized to relieve tension off of the plantar fascia, as well as stretching of the plantar fascia (should be performed 3 times per day) • Exercises in which increase dorsiflexion and great toe extension may also help alleviate pain with this condition • Anti­inflammatory medications are also recommended during treatment • Corticosteroids may also be used as a last resort if symptoms fail to resolve Plantar Fasciitis Plantar Return to Play Guidelines Typically requires an extended period of treatment It is common for symptoms to last as long as 8 to 12 weeks Critical for the athlete to perform stretching exercises in order for symptoms to subside • The athlete may be able to continue to train and compete if the symptoms and pain do not prohibit performance • Once athlete seems to be pain free, full competition is allowed • • • Cuboid Subluxation Cuboid Mechanism of Injury • Often mimics plantar fasciitis • Excessive pronation along with trauma have been reported as causes for cuboid subluxation Rehabilitation Considerations • Manipulation of the cuboid to its natural position may obtain the desired treatment results • The manipulation involves thrusting the cuboid downward to move it into its dorsal position ( a pop is often felt as the cuboid moves back into place) • Orthotics will help with support of the cuboid after manipulation Cuboid Subluxation Cuboid Return to Play Guidelines • The athlete should be able to return to play immediately if the manipulation is success...
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