Course Description
This course features a review of the development and biomechanics of the foot and ankle complex in the open and closed chain, with minimum soft tissue extensibility requirements for efficient lower extremity functional mobility. Musculoskeletal assessment procedures are reviewed in seminar and in supervised lab sessions, as the findings apply to proper documentation of casting results and a systematic approach to clinical decision-making regarding alignment and posting in casts and orthoses.
Rationale for various hypoextensibility management interventions is supported by a literature review regarding muscle transformation secondary to chronic recruitment as it is currently understood. Spasticity is distinguished from tone and from soft tissue pathophysiologic adaptation, with clinical implications. Discussion includes the use of the contoured plaster footboard, the R-Wrap© orthosis, neurolytics, positioning, stretching, and serial casting. Gait kinetics principles are discussed and applied to a review of orthotic designs, including pros and cons of currently available, prefabricated and non-cast-molded orthoses. |
Attendees at a recent tutorial show off their handiwork. (Dance steps are optional.) |
This course is designed for the practitioner who has experience in working with children or adults with foot and ankle alignment problems associated with CNS dysfunction and ligament laxity. Physical therapists, orthotists, pediatric orthopedists, physicians in physical medicine and rehabilitation are welcome. Ms. Cusick believes that team education fosters more effective teamwork.
As this program is a tutorial, enrollment is limited to 6 clinicians.
Course Objectives
Participants completing this course are expected to be able to:
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Describe, in plane-based terminology, the motions of the joints and various bones of the foot in the open and closed kinetic/kinematic chains.
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Discuss the relationship between joint alignment and related muscle function in terms of joint axis inclination, muscle and loading force vectors, lever arm, and resultant moment.
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Explain the clinical rationale for using specific assessment techniques to identify features of soft tissue extensibility, joint mobility and structural alignment in the ankle and foot.
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Explain the swing-limb torque generator as it relates to the closed kinetic and kinematic chains in gait.
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Bring the principles of orthotic posting and kinetics to below-knee cast and orthotic design.
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Explain the rationale for lifting and loading the heel under a plantarflexed ankle to reduce calf muscle contracture (equinus deformity).
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Identify the deformities of the foot and ankle that occur most commonly in children and adults with upper neuromotor dysfunction, and describe the components of deformity at each joint in plane-based terms.
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Discuss the physiology and functional significance of R1 (first-catch) end range encountered on assessing passive extensibility in healthy and in chronically over-recruited muscle groups.
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Discuss the physiologic and structural changes that occur in muscle and its surrounding tissues in the context of the active length-tension relationship.
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Explain the physiologic rationale for undertaking serial casting and comparable orthotic interventions gradually and without force.
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Discuss whether a deformity meets the criteria for intervention with serial casts, neurolytic injection or medication, an R-wrap orthosis, a plantarflexed AFO with heel lift, stretch splinting, and/or positioning.
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Define kinetics and kinematics as they pertain to gait.
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Name the 5 attributes of normal gait according to Perry and Gage.
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Explain the contribution of ankle plantarflexion at propulsion to energy cost in gait, and discuss the normal development of same.
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Achieve novice skill level in musculoskeletal assessment of the ankle and foot in the open and closed chains.
- Achieve novice skill in fabricating and posting a FlexCast© Preparatory AFO, with or without a footboard insert; a plaster footboard (optional); and a combination, below-knee cast using plaster and SoftCast.
Anticipated Course Schedule
| "The 5-day schedule allows attendees ample time to review handouts, use the library, repeat lectures if needed, and/or practice procedures. This schedule will flex to try to accommodate the abilities and interests of the group. As instructor, I will be on site and available from 8:00AM until 5:30PM each day of the course." — Beverly (Billi) Cusick |
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Day 1: Seminar
Start Time |
Description |
Contact |
| 8:15 | Register and settle in. | 0.0 |
| 8:30 | Subtalar & Midtarsal Joint Anatomy & Ideal Function | 1.5 |
| 10:00 | Break | 0.0 |
10:15 |
Ideal Ankle, STJ and MTJ Function in Gait – The Swing Limb Torque Generator | 1.75 |
| 12:00 | Lunch and Library Time | 0.0 |
| 1:00 | Kinesiologic & Physiologic Requirements for Optimum Muscle Function | 0.5 |
| 1:30 | Length/Weakness Relationships & Muscle Balance Theory (MBT) (Sahrmann) for the Ankle & Foot | 0.5 |
| 2:00 | Muscle Transformation in the Presence of Chronic, Excessive Recruitment (or, why muscles R stupid) | 0.5 |
| 2:30 | Break | 0.0 |
| 3:00 | Hypoextensibility Management: Weight-line Training, MBT, Positioning, Neurolytics, Orthoses | 1.0 |
| 4:00 | Serial Casting: Precautions, Contraindications, Limitations, and Guidelines | 1.0 |
| 5:00 | Discussion/questions | 0.25 |
| 5:15 | Adjourn | |
Subtotal – Day 1 Contact (Didactic) Hours: |
7.0 |
|
 |
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Post- Session |
Optional Independent Study |
Day 2: Seminar
Lab participants, bring shorts or stretch pants tomorrow!
Start Time |
Description |
Contact |
| 8:15 | Assessing the Foot & Ankle - Review of Open- Chain Assessments to Identify Structural Deviations & Muscle Imbalances | 1.5 |
| 9:45 | Break | 0.0 |
| 10:00 | Pathomechanics of Triceps Surae Hypoextensibility & Various Foot Design Problems: Posting Implications | 2.0 |
| 12:00 | Lunch, library | 0.0 |
| 1:00 | Developmental Features of the Foot & Ankle | 1.0 |
| 2:00 | Kinetics in Gait – Power Sources, Load Line Characteristics | 0.5 |
| 2:30 | Break | 0.5 |
| 2:45 | Review of Orthotic Design Options Relative to Kinetics & the 5 Attributes of Normal Gait | 2.25 |
| 5:00 | Questions / discussion | .25 |
| 5:15 | Adjourn (Independent Study (optional) | |
Subtotal – Day 2 Contact (Didactic) Hours: |
8.0 |
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Post- Session |
Optional Independent Study |
Day 3: Ankle and Foot Assessments Lab (Bring Shorts Today)
Bring shorts today and tomorrow.
Start Time |
Description |
Contact |
| 8:45 | Open-Chain Assessments: Foot Geometry, Joint Mobility, and Soft Tissue Extensibility – Demo and Lab | 1.25 |
| 10:00 | Break | 0.0 |
| 10:15 | Resume Open Chain Foot Assessments | 1.75 |
| 12:00 | Lunch | 0.0 |
| 1:00 | LAB : Ankle DFROM | 1.0 |
| 2:00 | LAB : Closed-Chain Foot Assessments | 1.5 |
| 3:30 |
Stay and practice, use the library, watch a case on DVD, and sign out when you’re done. | varies |
Subtotal - Day 3 Contact Hours (minimum): |
5.5 |
|
|
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| Bring shorts or stretch pants tomorrow! |
Day 4: Lab Session
Wear clothes you don't mind getting plastered in!
Start Time |
Description |
Contact |
| 8:30 | Review of Casting Materials | 0.75 |
| 9:15 | FlexCast Fabrication & Posting Demo & Lab | 2.0 |
| 11:15 | Footboard Fabrication Demo | 0.75 |
| 12:00 | Lunch | 0.0 |
| 1:00 |
Footboard/FlexCast Fabrication Demo and Lab | 2.0 |
| When you’re done, clean up, stay and practice, use the library, watch a case on DVD, and sign out. | varies |
|
Subtotal – Day 4 Contact Hours (minimum): |
5.5 |
|
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Bring shorts or stretch pants tomorrow! |
Day 5 - Continued Labs
Bring shorts today!
Start Time |
Description |
Contact |
| 9:00 | Positioning the Patient and Rehearsing the Cast Molding Grip | 0.5 |
| 9:30 | Plaster and SoftCast Combo Cast Fabrication and Posting Demo and Lab | 3.0 |
| 12:30 | Lunch | 0.0 |
| 1:30 | Choose your task: read, practice assessment procedures, cast fabrication procedures, etc. | 3.0 |
| 4:30 | Clean-Up | 1.00 |
| 5:30 | Adjourn | 0.0 |
Subtotal – Day 5 Contact Hours: |
7.50 |
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Thank you, and safe travels home! |
Restrictions
ENROLLMENT POLICY: Seats will be filled upon — and in order of — our receipt of tuition deposit and enrollment form. Free housing with Instructor is offered to one enrollee on the same basis.
CANCELLATION POLICY: An administration fee of $50 will be deducted from refunds for cancellation up to and including February 24, 2009. 50% of tuition deposit will be refunded for any cancellation occurring after February 24, 2009.
VIDEO RECORDING POLICY : Videotaping of this program is prohibited. Audiotaping for personal review is permitted with permission from the Instructor.
