Joint Mobilization • • • Superior and inferior tibiofibular joints Talocrural joint Subtalar joint Intertarsal joints Intermetatarsal joints TMT, MTP, IP joints
Resting Positions • Talocrural joint: 10° plantar flexion • Subtalar and midtarsal joints: midrange inversion- eversion • MTP joints – #1: 20° dorsiflexion – #2 -5: 20° plantar flexion • IP joints: 20 plantar flexion
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Flexibility Exercises • • Active flexibility: 15 -20 s hold 4 -5 reps Perform throughout the day (min = 3 -4 times) May require prolonged stretch
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Strength Exercises • • Isometrics Rubber band exercises Body-weight resistance exercises Equipment resistance
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Proprioception Exercises • • Especially important with joint injuries Key for kinesthesia and balance control NWB and WB activities Exercises follow a progression
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Functional Activities • • • Zigzag runs Side shuffles Figure-8 runs 90° cuts to L and R Jumps, hops, leaps All performed without hesitation or favoring of involved leg
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Acute Ankle Sprains • Sprains of anterior tibiofibular ligament require extra WB precautions. • Control of pain and edema is the first priority. • Active range of motion (AROM) begins early. • Include strength exercises for inversion and eversion. • Peroneal strains can accompany sprains.
Chronic Ankle Sprains • • • Scar tissue can limit joint or soft-tissue mobility. Chronic muscle weakness may be present. Kinesthesia can recurrence risk Compensatory gait can reinjury risk May need additional time for rehab
Peroneal Tendon Dislocation • Often overlooked • Mechanism: ankle dorsiflexion with active peroneal contraction; inversion sprain • Inversion: most susceptible to dislocation in 15° -25° plantar flexion • Usually self-reduced • If conservative management is unsuccessful, surgery may be required
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Achilles Tendon Injuries • Prolonged pronation Achilles stress • Poorest circulation on Achilles is 2 -5 cm above insertion; susceptible site • Scar tissue palpated more medially than laterally • Must correct cause to reduce risk of tendinopathy recurrence • Surgical repair of Achilles rupture usually more successful than conservative management
Other Injuries • Chronic – – Tendinopathy: peroneals, trigger points Shin splints Compartment syndromes Foot: plantar fasciitis, tarsal tunnel syndrome, sesamoiditis • Acute – Fractures: epiphyseal, stress, acute – Turf toe – Compartment syndromes
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