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