Course Description
This course features a review of the development, biomechanics, and pathomechanics of the foot and ankle complex in the open and closed chain, with implications for designing casts and orthoses for optimum effectiveness. Musculoskeletal assessment procedures are reviewed in seminar and in supervised lab sessions, as the findings apply to proper documentation of casting results and to a systematic approach to clinical decision-making regarding foot and ankle alignment and posting in casts and orthoses.
Rationale for various hypoextensibility management interventions is supported by a discussion of current theories concerning muscle transformation secondary to chronic recruitment. Spasticity is distinguished from tone and from soft tissue pathophysiologic adaptation, with clinical implications. The Instructor discusses the relationship between contracture formation and habitual distribution of the body center of mass and the load-bearing foot in standing and gait, and reviews heel-wedging, the contoured plaster footboard, the R-Wrap© orthosis, neurolytics, positioning, stretching, and serial casting.
Gait kinetics principles are presented and applied to a review of common and new orthotic designs and posting options.
This course is designed for the practitioner who has experience in working with children 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.
Course Objectives
Participants completing the seminar portion of 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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Identify the deformities of the foot and ankle that occur most commonly in children with upper neuromotor dysfunction, and describe the components of deformity at each joint.
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Relate the primary planar bias of a foot deformity to optimum orthotic design.
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. -
Discuss the relationship between muscle imbalance and strength.
Bring the principles of orthotic posting and kinetics to below-knee cast and orthotic design. -
Explain the physiologic rationale for undertaking serial casting and comparable orthotic interventions gradually and without force.
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Name the 5 attributes of normal gait according to Perry and Gage.
- Explain the contribution of ankle plantarflexion at propulsion to energy cost in gait.
Lab participants are expected to be able to:
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Achieve novice skill level in musculoskeletal assessment of the ankle and foot in the open and closed chains.
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Achieve novice skill in fabricating a FlexCast© Preparatory AFO, with or without a footboard insert.
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Achieve novice skill level in fabricating and posting a submalleolar stabilizing foot splint using Aquaplast-T.
Restrictions
Capacity of this workshop is limited. Completed and paid registrations will be processed on a first-come, first served basis. The lab on the last day has limited capacity. Therapists not participating in the lab can observe.
Video Recording policy: Videotaping of this program is prohibited. Audiotaping for personal review is permitted with permission from the Instructor.
