ADVANCED FOOT AND ANKLE SPECIALISTS, PA
Jay S. Weingarten, DPM, FACFAS, FACFAOM
Podiatric Physician and Surgeon
Board Certified Physician – Treating Pediatrics to Geriatrics
Physical Therapy and Rehabilitation
Rehabilitation of the foot, and leg requires your doctor to carefully guide
you through a well-devised plan of care. Goals of this plan include relieving pain,
restoring as much function without discomfort and monitoring the social,
psychological, and vocational implications of the treatment. Rehabilitation may
be necessary following an injury, surgery, acute or chronic disease, or a
neurological deficit.
Physical medicine involves the use of electrical impulse, heat, light, and
water, as well as mechanical agents (exercise, gait training, orthotics) to
diagnose and treat disease. It can be used with, and in addition to oral or
injectable medication and surgery.
Your treatment may consist of one or more of the following modalities.
Heat
Heat, when properly administered, is quite valuable in your healing
process. It can increase blood supply to the skin and other soft tissues, which
promotes healing. Elasticity and motion of the ligaments and joint capsules is
enhanced. This is particularly important following long periods of
immobilization. The body’s response to inflammation is increased. Heat can be
applied superficially or deep. Superficial methods include hydrotherapy or
whirlpool bath. This is not only helpful for improving motion; it also cleans
wounds and ulcers, and increases local circulation. Compresses may be used,
and consist of gel packs placed over the affected region. Paraffin or wax baths
involve submerging your foot or ankle into liquid wax. After 20-30 minutes, the
cooled wax is easily removed. Deep heating is achieved utilizing a diathermy or
ultrasound. Heat is usually not used in acute injuries less than 88 hours old.
Additionally, impaired circulation and sensitivity may prevent this form of
therapy.
Ultrasound and Diathermy (Deep Heat)
Ultrasound is high frequency sound waves above the audible range. It may
be applied utilizing a transmitting gel or with the ankle or foot under water.
Diathermy produces microwaves. When either is applied to the skin, deep
heating is the primary effect. Diathermy treatments are 15-20 minutes each and
performed up to twice daily. Ultrasound treatments are given for 5-7 minutes
with the ultrasound hand piece being moved continuously over that part of the
foot or ankle, which is being tested. Please inform your doctor of any internal
metallic substance close to the skin or if you wear a pacemaker.
Cold
Cold is effective in decreasing bleeding, swelling, and pain. It produces an
anti-inflammatory effect, local anesthesia, and helps control spasticity by
slowing or partially blocking neuromuscular transmission. Cold is used
following acute trauma, such as sprains or strains of muscles, tendons,
ligaments, and joints. Also acute burns, infections, or chronic capsular and soft
tissue inflammation may require cold therapy.
Methods usually include ice packs, cooling pads, or immersion in ice. You
should notify your doctor if you have diabetes, systematic lupus, scleroderma,
rheumatoid arthritis, or ant circulation disorder prior to cold therapy.
Massage
Everyone knows the relaxation achieved following massage. However,
massage also produces analgesia by causing the body tot release its natural
painkillers, endorphins, at the site of an injury. Edema, or swelling is reduced by
stimulating fluid movement in the tissues. Muscular tension is reduced and
circulation in the skin increased. Massage is helpful with soft tissue injuries, joint
pain, joint stiffness and after immobilization (braces, casts, wheelchairs, bed
rest). Thickened scar tissue may be loosened with deeper massage. If you have a
clotting disorder, fracture, or infection, massage my not be indicated.
Electrical Stimulation
This form of physical therapy is one of the most versatile. One or more
types of electric stimulation may be utilized for a variety of problems. A few of
the conditions, which warrant this therapy, are skin disorders, arthritis, post
trauma, after surgery, and circulation disorders. Electrical stimulation is safe,
effective and not invasive. Three types are: galvanic stimulation, T.E.N.S., and
low voltage muscle stimulation.
Galvanic stimulation uses electricity to produce medical effects without
actually stimulating the muscles. Instead, medications can be introduced to
specific sites in the body using electricity as the transport vehicle; not a needle. A
wide variety of useful effects on the body tissues can be obtained in a very
controlled manner with no discomfort the patient.
T.E.N.S. is an abbreviation for Transcutaneous Electrical Nerve
Stimulation. It utilizes a small, portable nine-volt battery-operated unit. T.E.N.S.
is extremely effective in controlling both acute and chronic pain. It is operated
by the patient and is portable.
Low Voltage Muscle Stimulation uses electricity to produce small muscle
contractions without active physical exertion. The same chemical and physical
responses as normal muscle work are produced. Low Voltage muscle stimulation
is used to increase circulation, decrease swelling and pain, decrease stiffness,
and re-educate muscles.
Electrical Stimulation is not used if you have a pacemaker, irregular heat
rhythm, or some types of malignancies.
Ultraviolet Radiation
Utilized for many years, ultraviolet radiation is both anti-bacterial and
anti-fungal. Most indications are dermatological and include superficial
infections, pressure ulcers, dermatitis, psoriasis, and eczema. Application is
performed with a hot quartz lamp, mercury vapor lamp, sun lamp, or black light.
If you are photosensitive or have systemic or discoid lupus, please tell your
podiatrist.
Therapeutic Exercise
Exercise can be very helpful in maintaining wellness as well as treating
illness and disease. Your doctor will recommend exercises to help prevent
contractures and fibrous adhesions following immobilization after surgery or a
traumatic injury. Exercise will restore muscle tone and joint motion. It also helps
prevent secondary effects of inactivity such as depression and psychosocial
implications. Disuse syndromes can cause stiffness in joints, muscle atrophy,
osteoporosis, pressure ulcers, pain, and phlebitis. A program will be structured
to your needs. If you currently have severe heart disease or breathing disorders,
your exercise program may be restricted.
Intermittent Compression Pump
When walking, your leg muscles act as a pump to drain the feet and lower
legs of fluid. After an injury or surgery, swelling of the feet an legs is common.
Combined with immobilization, the swelling can be substantial due to the lack of
muscular function. The intermittent compression pump is safe, easy to operate
and painless. Large vinyl boots are placed over the legs and intermittently air
pressurized. The pump performs a milking action to remove the fluid.
How Long Do I Need Therapy?
Treatment is most effective when performed on a regular basis, 2-3 times
per week 4-6 weeks, with regular re-evaluation. The length of time for treatment
may very with your response to treatments and the severity of your condition.
1233 SE Indian St., Suite 102, Stuart, FL 34997
tel. 772-223-8313, fax 772-223-8675
1106 W Indiantown Rd, Suite 4, Jupiter, FL 33458 tel. 561-744-6683, fax 561-744-7033