Rehabilitation of the Foot and Ankle
Terminology
1. Sagittal Plane
a. Medial to Lateral axis
b. Dorsiflexion and Plantarflexion
2. Frontal Plane
a. Anterior to Posterior axis
b. Inversion and Eversion
3. Transverse Plane
a. Superior to Inferior axis
b. Abduction and Adduction
Triplanar Movement
 Movement occurs simultaneously in the three body plane with motion about a
single axis
 Axes of the talocrural joint, subtalar joint, and midtarsal joint go from
posterior/lateral/inferior to anterior/medial/superior
 Movement includes pronation and supination
 Pronation =
 Supination =
 At each joint, the dominant component sof movement is based upon the
orientation of the joint axis
 Orientation of the joint axis is based on joint structure
Inferior Tibiofibular Joint
 Convex surface of medial fibula articulates with concave fibular notch on the tibia
 Syndesmosis joint
 Separates 3-5 mm with ankle dorsiflexion
Talocrural Joint
 Structure
- Distal tibia and fibula articulate with talus
 superior body of talus (trochlea) is convex from anterior to posterior and
concave from medial to lateral
 lateral aspect of talus is longer than medial aspect
- Medial concave body of talus articulates with convex medial malleolus
- Lateral concave body of talus articulates with convex lateral malleolus
 Ligaments
- Lateral
 Anterior talo-fibular
 Calcaneofibular
 Posterior talo-fibular
- Medial
 Deltoid

Motion
- Axis

-
-
Tip of lateral malleolus to tip of medial malleolus
(posterior/lateral/inferior to anterior/medial/superior)
Motion
 Pronation =
 Supination =
Abduction/Adduction component due to superior shape of talus
Requirements for gait
 10 degrees of dorsiflexion with knee extension
 20 degrees of plantarflexion
Subtalar Joint
 Structure
- Inferior talus articulates with superior calcaneous
 Posterior joint – concave posterior facet on body of talus articulates with
convex posterior facet on calcaneous
 Anterior joint – convex surfaces of middle and anterior facets on neck of
talus articulate with concave surfaces of middle facet on sustentaculum tali
and anterior facet on neck of calcaneous
 Ligaments
- Interosseous ligament
- Cervical ligament
 Motion
- Axis
 Posterior/lateral/inferior to anterior/medial/superior
- Motion
 Pronation =
 Supination =
 OKC =
 CKC =
- Subtalar joint motion during gait usually ranges between 8-12 degrees in the
frontal plane
Midtarsal Joint
 Talonavicular joint
- Convex neck of talus articulates with concave proximal portion of navicular and
middle and anterior facets of calcaneous
- Motion
 Navicular glides dorso-;ateral and plantar-medial on the talus
 Calcaneo-cuboid joint
- Convex distal calcaneous articulates with concave proximal portion of cuboid in
dorso-lateral to plantar-medial direction
- Concave distal calcaneous articulates with convex proximal portion of cuboid in
dorso-medial to planter-lateral direction
-
Motion
 Cuboid glides dorso-lateral and plantar-medial on the calcaneous
First Ray
 Structure
o Distal navicular articulates with proximal medial cuneiform
o Distal medial cuneiform articulates with proximal first metatarsal
 Motion
o Axis is anterior/lateral/plantar to posterior/medial/dorsal
o Dorsiflexion/inversion (tibialis anterior)
o Plantarflexion/eversion (peroneus longus)
 Gait
o Requires full 1st MTP joint extension
o Need to maintain contact between 1st metatarsal with ground during
propulsion phase
Second Ray
 Structure
o Distal navicular articulates with proximal middle cuneiform
o Distal middle cuneiform articulates with proximal second metatarsal
 Forms the height of the transverse arch
Third Ray
 Structure
o Distal navicular articulates with medial facet of cuboid and proximal
lateral cuneiform
o Distal letaral cuneiform articulates with proximal third metatarsal
Fourth Ray
 Structure
o Distal cuboid articulates with proximal fourth and fifth metatarsals
Plantar Fascia
 Continuation of triceps surae fascia
 Extends from tuberosities on calcaneous to plantar surface of MTP joints
FOOT AND ANKLE PATHOLOGIES
1. Forefoot varus
2. Rearfoot varus
3. Ankle equines
4. Plantar fascitis
5. Miscellaneous
a. Bunion
b. Neuroma
c. Turf Toe
d. Peroneal tendon subluxation
e. Calcaneous epiphysitis
f. Metatarsalgia, metatarsal stress fracture
6. Ankle Sprains
a. Grades of severity
b. MOI for lateral ligament complex
c. MOI for medial ligament complex
d. MOI for distal tibiofibular ligament complex
Ankle Sprain Rehabilitation:
I. Inflammatory Phase
- P.R.I.C.E.
- proprioception
- maintenance of CV fitness
II. Fibroblastic/Repair Phase
- Criteria for progression to phase II
- ROM exercises
- Flexibility
- Strengthening
- Proprioception
- Weight bearing progression
- bracing, taping, orthotics
III. Remodeling Phase
- Running, jumping, hopping drills
- CV fitness
- Sport-specific exercises
Post-Surgical Rehabilitation: Reconnect peroneus brevis tendon (reinforce lat ankle)
- Short leg cast/brace for ~6 weeks
- weight bearing progression (* emphasis on normal gait mechanics)
- Sagittal plane AROM begun @ 6 weeks
- AROM inv/ev begun @ 8 weeks
- Strengthening progression
- Return to activity
LOW LEG PATHOLOGIES
1. Achilles Tendonitis
a. Hypovascular region
b. Etiology
c. Treatment/rehabilitation
i. Inflammatory phase
1.
2.
3.
ii. Fibroblastic/Repair phase
1.
2.
3.
iii. Remodeling phase
1.
2.
d. Prevention
i.
ii.
iii.
iv.
v.
2. Tennis Leg
a. Etiology
b. Treatment/rehabilitation
i. Inflammatory phase
1.
2.
ii. Fibroblastic/Repair phase
1.
2.
3.
iii. Remodeling phase
1.
2.
3. Compartment Syndromes
a. Etiology
b. Four compartments
i. Anterior
ii. Deep posterior
iii. Superficial posterior
iv. Lateral
c. Three syndromes
i. Acute
ii. Acute-exertional
iii. Chronic
d. Faciotomy
e. Treatment/rehabilitation
i. Inflammatory phase
1.
2.
3.
4.
ii. Fibroblastic/Repair phase
1.
2.
3.
4.
iii. Remodeling phase
1.
f.
Stress Fractures
i. Etiology
ii. Tibia vs. Fibula
g. Treatment/rehabilitation
i. Inflammatory phase
1.
2.
ii. Fibroblastic/Repair phase
1.
2.
iii. Remodeling phase
1.
2.