Ankle/Foot Mobilization Techniques

Case StudyUsing ankle/foot joint

mobilization techniques in rehabilitation of a talar

fracture

Fracture of the Talar Body

• Patient is 28 year old male• Mechanism of Injury

– Motor Vehicle -High Impact Injury

• Patient is six weeks post op.• Cast remove one day ago.

Orthopedic Procedure

• Internal Fixation with lag screws across the talar body facture to produce anatomic reduction

• Fracture of the talar body must be stably fixed to restore subtalar joint congruity

Rehabilitation Objectives

• Range of Motion– Restore ROM to the ankle

Restore ROM to the subtalar joint

• Restore ROM to the metatarsophalangel joints

• Muscle Strength• Tibialis posterior

• Pernoneus longus & brevis

• Tibialis anterior• Extensor hallucis longus

• Gastrocnemius• Soleus• Flexor digitorum

Important Consideration

Intraarticular fracture of the talar body

involving the subtalar joint may have residual loss of range motion.

Mobilization Techniques

TalocruralAnterior glide of TalusPosterior glide of

Subtalar Joint• Inversion of Calcaneus

• Eversion of Calcaneus

• Calcaneus Distraction

Ankle Joint

• Ankle Distraction good start to restore general motion at the ankle.

Ankle

Anterior glide of talusrestore the component motion for ankle plantar flexion & STJsupination

Ankle Joint

• Posterior glide of talus

• To restore component motion for ankle dorsi flexion & STJ

• pronation.• Position similar to

distraction except you do posterior glide of

talus. See lab disc

Subtalar Joint

• Calcaneal distraction– General technique to restore all motion in the STJ

.

Sub Talar Joint

Calcaneal inversionsubtalar joint inversion

useful to help in restoring push of the foot

Subtalar Joint

Calcaneal eversionsubtalar joint eversion

useful to help in storing pronation at the foot.

Mobilization Techniques

• Mid- tarsal joints– Plantar& Dorsal glides of the cuboid & cuneiforms

Dorsal & plantar glide of the navicular on talus

• Metatarsophalangel– Distraction– Plantar glide-flexion

– Dorsal glide-extension

Mid-tarsal Joint

• Plantar& Dorsal glides of the cuboid & cuneiforms– Restore general mobility of the mid foot Plantar & Dorsal glides of the cuboid & cuneiforms

Mid-tarsal Joints

Dorsal & plantar glide of the navicular on talus.Used to improve ankle dorsi flexion and general motion at the mid foot.

Metatarsophalangel Joints

• Distraction of toes restore joint play

• Good initial technique

for pain& movement.

Metatarsophalangel Joints

• Plantar glide of the MTP, PIP and DIP– To increase flexion of the toes

Metatarsophalangel Joints

• Dorsal Glide of the MTP, PIP and DIP– Useful to increase toe extension ( push off)

Plantar Glide of the MTP, PIP and DIP

MTP Plantar glide shown