Evaluation/Intervention for Common Conditions of the Foot and Ankle

“Dedicated to the bearer of the “optimal foot,” the hobbit Frodo Baggins, who once walked barefoot across an entire continent to rid the world of evil without a single complaint of foot pain.”

By: Conner Heermann, SPT

 

Background 

The structure of the foot and ankle is quite miraculous.  It’s easy to forget about this extensive, intricate collection of joints, bones, ligaments, tendons, muscle, and fascia when they’re swaddled in socks and securely sealed within a shoe.  Given 2,000 years, I don’t believe the brightest minds in science could devise a structure capable of doing its job so uniquely robust, versatile, and complex.  Each minute component has a job, and when they all cooperate, what you have is a structure capable of seamless, dynamic adaptation to environmental challenges, all while supporting the weight of the entire body on its shoulders.  When we walk, run, jump, or skip, it’s the first point of contact in our perpetual battle with gravity, and the last point of contact in our thrust against it.  It’s the foundation, the wheels on which the body soars.  Its complexity makes it highly adaptable, compensating when and where it needs to “get the job done;” however, its complexity also means there’s more that can go wrong.  Additionally, it can make determining what exactly has gone wrong, and what is needed to fix it, similarly ambiguous.  This dichotomy is what makes the foot and ankle unit so interesting to me.  It is equally fascinating as it is perplexing.  And so, for my capstone, I decided to fill in some gaps in my knowledge and understanding of this area of the musculoskeletal system, as well as provide a framework for understanding some key features of anatomy, biomechanics, evaluation and intervention in this area.  I hope these materials spark in you the same kind of wonder that I described above, and that the concepts presented are helpful to you in your educational and professional journey.  Cheers!

 

Statement of Need

The foot and ankle joints are a highly complex region of the musculoskeletal system.  I remember being particularly challenged and intimidated by this unit in MSK II.  Dr. Gross’ verbal and demonstrational instruction in this unit during our classroom time was invaluable, but a number of my classmates, including myself, found the formatting of the lecture material for this unit challenging to follow.  Specifically, these are students that are more visual or experiential learners.  Therefore, it is my intention to draw on Mike’s clinical expertise and search the literature to devise a set of learning materials for the foot and ankle unit of MSK II that will compliment previous material in this unit, benefiting all learning styles, and improving comprehension and retention of important principles of anatomy, biomechanics, tissue behavior, pathomechanics, and evaluation/intervention strategies for five common conditions of the foot and ankle. The presentation will also include recommendations for the appropriate role of orthoses and footwear in the management of foot and ankle conditions.

 

Purpose 

My hope is that these materials will aid in instruction of future students during the foot and ankle unit of the MSK II course, as well as provide a user-friendly reference for graduates to guide PT evaluation and treatment for common conditions of the foot and ankle in early practice as we work to develop our clinical skills. I also hope that ideas and strategies related to PT evaluation and intervention presented in this material will be useful for the learner in other areas of practice and with other conditions, as they have been for me.

 

Health Literacy 

My materials will be directed at DPT students and practicing clinicians as opposed to the general public, so my capstone will not directly address health literacy.  However, is it my hope that the visuals and explanations I include in the presentation will enhance the learners understanding of the foot and ankle so that they may better communicate this information to their patients in a fresh way that will likely benefit health literacy of the patient.

 

Products

PDF of PPT Presentation: Evaluation/Intervention for Common Conditions of the Foot and Ankle

VoiceThread for PPT Presentation: https://unc.voicethread.com/myvoice/thread/22828050

Videos for Manual Techniques: h?dl=0&rlkey=avh5r4wbjh9ox5hw6ehsw074g

 

Self-Reflection 

After graduation, I hope to work in the orthopedic setting.  Early on, I identified the foot and ankle as being an area of weakness for me because of its complexity.  I also had little experience treating patients with foot/ankle conditions on clinical rotations.  Therefore, my personal goals for this project were to hone my understanding of anatomy, biomechanics, pathomechanics, assessment, and intervention, including orthotics, for the foot and ankle, in preparation for PT practice.  I also hoped that in conjunction with my time in ICE with Dr. Gross, this project would be an important first step to incorporating fabrication of custom foot orthoses into my clinical practice.

At the beginning of my project, I wanted to reimagine and recreate all of the slides for the foot and ankle unit in MSK II; however, I quickly realized that this undertaking was far too ambitious a goal for a single semester.  With the help of my advisors, I decided to narrow my topic to outline evaluation and intervention for five commonly encountered conditions of the foot and ankle.  This seemed appropriate, as general feedback from DPT students is frequently in favor of more information on interventions.  This being said, I wanted to include some broader concepts relating to evaluation/intervention at the foot and ankle which I learned from Mike, which could be extrapolated to other clinical conditions or scenarios.  Finally, I was interested in revisit some manual techniques for the foot and ankle, as it had been a while since I’d practiced them, and the videos posted for the manual course were due for an update.

This project has considerably improved my understanding of all concepts relating to the foot and ankle!  The skills we developed in our evidence-based practice courses were utilized in the literature review I conducted for information regarding intervention for the five conditions included in my presentation.  Overall, this project has improved my ability to evaluate and treat the foot and ankle, strengthened my understanding of concepts relating to PT evaluation and treatment for musculoskeletal conditions in general, improved my manual skills for the foot/ankle, and improved my ability to quickly locate current, evidence-based literature for PT interventions.  I hope that working through these materials will promote the same kind of learning for those that receive them!

 

Acknowledgements 

Dr. Michael Gross, PT, PhD, FAPTA

Dr. Jeffery O’Laughlin, PT, DPT, OCS, FAAOMPT

Thank you both for your support of this project, your unwavering dedication to your craft, your hard-earned expertise, and practical wisdom, in life and in physical therapy.  You’ve helped me immensely on this academic journey and have provided for my classmates and I, through your teaching and example, models of excellent clinicians after which to strive.

 

To my dear classmates,

It’s hard to believe we’ve reached the end of the road.  We’ve been through a lot together: a global pandemic, countless hours of studying, UV-less days in the perilous dungeons of Bondurant Hall, seemingly endless perusing the infinite library of PubMed, even Mike’s MSK II exam! (Sorry Mike, I had to.) Each and every one of you has unique talents, traits, interests, perspectives, and experiences that are going to serve you well in this profession and in life!  Every one of you has been a blessing to me in some way.  Your determined spirits and colorful personalities will mold and paint the future of this great profession, and the pages of each of your lives outside of the clinic.  I feel exceptionally lucky to have been able to enjoy these past three years with you.  Because of each of you, it’s been a happy struggle.  I wish you all the absolute best.  You’re the smartest people I know.

Cheers, Class of 2023!

 

References

From Presentation:

1) Slides adapted from Dr. Mike Gross, MSK II, Foot and Ankle Biomechanics

2) Slides adapted from Dr. Mike Lewek, Biomechanics, Foot and Ankle and Lower Quarter Screen

3) Babu D, Bordoni B. Anatomy, Bony Pelvis and Lower Limb: Medial Longitudinal Arch of the Foot. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 11, 2022.

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