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Keri Zickuhr, M.D.TMPN Orthopedics
Ankle ReconstructionBunions
HammertoesFlatfoot Reconstruction
Wrist FracturesHip Fractures
Lower Extremity problemsGeneral Orthopaedics
Keri Zickuhr, M.D.TMPN Orthopedics
University of Pennsylvania, B.A.The Ohio State University College of Medicine, M.D.
UC Irvine - 5 years of Orthopedic ResidencyFellowship in Foot and Ankle Orthopedic Surgery
FootandAnkleRehabDanikaBucka,PT,DPT,OCS
SouthBayOrthoRehabatTorranceMemorial23560CrenshawBlvdTorrance,CA90505(310)784-2366
RehabIntro• Functionalanatomy
• Absorbsshock• Pushbodyforward
• Susceptibletoinjuriesbecauseoftherepetitiveload• ShaquilleO’Nealsufferedfromchronictoepain
RehabBasics• RestoreMotion/Flexibility• Strengthening• DecreasePain/Inflammation• Patienteducation/Activitymodification
ANKLE SPRAIN
SPRAIN= injury to the ligaments which connect the
bones of the ankle
ANKLE SPRAIN
1) RICE - Rest, Ice,
Compression and Elevation
2)Bracing/splinting
3)Home exercises
4)Physical therapy
** swelling can take many months to resolve after an ankle sprain
ARTHRITIS
Arthritis = “Arth” (joint) “itis” (inflammation)
Articular Cartilage Damage
Decreased Joint Range of Motion
Pain
ARTHRITIS• Joint Swelling
• Joint Tenderness
• Decreased Range of Motion
• Bone spurs
• Deformity
• Abnormal Gait
ARTHRITIS
ARTHRITISTREATMENT GOALS: • Pain Relief
• NSAIDs • Braces • Cortisone injections
• Deformity • Prevention • Correction • Lack of Progression
• Function • Preservation • Restoration
ANKLE ARTHRITISANKLE FUSION Pros
• Considered “gold standard” • Can reduce pain and
provide a stable ankle • Few complications
Cons • Can lead to Adjacent Joint
Arthritis – additional surgery in the future
• Less ROM compared to ankle replacement
• Altered gait
ANKLE ARTHRITISANKLE REPLACEMENT
Pros • Preserves ROM • Reduces Pain • Decreased chance of
adjacent joint arthritis • High patient satisfaction
ANKLE ARTHRITISANKLE REPLACEMENT Cons
• Polyethylene wear • Component
subsidence • Failure rates of early
designs • Insurance
reimbursement
AnkleSprain• Anklestability
• Joint• Ligaments• Muscles
• RICE(rest,ice,compression,elevation)
• Restoremotion/flexibility
• Strengthening• Normalizemovement• Returntosport/activity
TherapeuticExercises
PLANTAR FASCIITIS
PAIN ■first steps in the morning ■first steps after prolonged sitting ■pain that worsens with prolonged standing or walking
PLANTAR FASCIITIS
PLANTAR FASCIITIS
PAIN ■first steps in the morning ■first steps after prolonged sitting ■pain that worsens with prolonged standing or walking
PLANTAR FASCIITISBone spur: ■Not the cause of pain
■spur occurs at the origin of the flexor digitorum brevis ■50% of patients have a bone spur
PLANTAR FASCIITISTREATMENT:
■Nonsurgical treatment for most patients ■ NSAIDS (Mobic, Advil, Aleve….) ■ Physical therapy (Achilles stretching) ■ Heel cups ■ Injections ■ Night splints
■resolution of symptoms can be SLOW – 6 to 9 months of symptoms is typical
■Recurrence is common
ACHILLES TENDONITIS
• Injury
• Repetitive motions that put stress on the tendons
• Degeneration
ACHILLES TENDONITIS• Decreased area of
vascularity
• 2 to 6 cm above
attachment site
• Less capacity to
repair
ACHILLES TENDONITIS
• Can occur at the
attachment site
• “Insertional”
Tendonitis
• Bone spur
ACHILLES TENDONITIS
Non-Operative Treatment
• good response rate overall • NSAIDS • Physical Therapy • + / - walking boot • Iontophoresis • NO steroid injections • modify activities
ACHILLES TENDONITISSurgery:
• Debridement
• Removal of bone spur
• Reattachment of tendon
TendonitisandPlantarFasciitisRehab
• Activitymodification• Decreaseinflammation• Strengthening• Preventreturnofinjury
Modalities
Ultrasound
Ice/Cryotherapy
Iontophoresis
PlantarFasciitis
ExercisePrinciples• Immobilizationandresttodecreasedemandontendons• Taping• Archsupport• Castorwalkingboot
• Stretching• Strengtheninginpainfreerange
• Eccentrictrainingfortendonitis
• Pronation • Supination
TherapeuticExercises• Abs• Glutes• FootandAnkleMuscles
FAT PAD ATROPHY
In 75 years, the human foot traverses
over 100,000 miles. plantar fat pad is to protect the underlying structures (neurovascular tissues, sensitive periosteum, ligaments and tendons) from undue pressure and shocks.
FAT PAD ATROPHY
Pads to cushion the ball of the foot
Shoes with extra padding (memory foam)
Thick socks
No barefeet
No high heels
Avoid activity on the ball of your feet
Keri Zickuhr, M.D. TMPN Orthopedics