This program offers experienced clinicians a range of approaches to management of lower extremity deformity as it occurs in children with developmental disabilities. The level of this course is intermediate to advanced.
Attendee Materials
All course attendees will receive:
- A copy of the 2-hour DVD Legs & Feet: A Review of Musculoskeletal Assessments.
- An Assessment Tool Kit, as featured in Legs & Feet
- Course pre-readings (Structural and Functional Anatomy of the Foot & Ankle; Michaud)
- A hefty course handout
- Serial Casting for the Restoration of Soft-Tissue Extensibility at the Foot & Ankle (2007)
In addition, participants in the Lab sessions (Days 3 & 4) will receive the one-hour FlexCast Preparatory AFO video and accompanying manual.
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.
Anticipated Course Schedule
Day 1: Seminar
8:15 |
Register and settle in. |
1:00 |
Kinesiologic and Physiologic Requirements for Optimum Muscle Function / Pathophysiology: Muscle Transformation in the Presence of Chronic, Excessive Recruitment. |
8:30: |
Review of Anatomy and Function of |
1:30 |
Length/Weakness Relationships and Muscle Balance Theory (Sahrmann) |
10:00 |
Break |
2:30 |
Break |
10:15 |
Biomechanics of the Closed Kinetic Chain |
3:00 |
Hypoextensibility Management: Movement Training, Positioning, Neurolytics, Orthotic Interventions |
11:15 |
Ideal Ankle, STJ and MTJ Function in Gait |
4:00 |
Serial Casting: Precautions, Contraindications, Limitations, and Guidelines |
12:00 |
Lunch and Library Time |
5:00 |
Discussion/questions |
5:15 |
Adjourn Independent study (optional) |
Day 2: Seminar
8:30 |
Assessing the Foot and Ankle - Review of Open- Chain Assessments to Identify Structural Deviations and Muscle Imbalances |
2:00 |
Kinetics in Gait – Power Sources, Load Line Characteristics |
10:00 |
Break |
2:30 |
Break |
10:15 |
Pathomechanics of Triceps Surae Hypoextensibility and Various Foot Design Problems: Implications for Posting Casts and Orthoses |
2:45 |
Review of Orthotic Design Options re Kinetics and the 5 Attributes of Normal Gait |
12:00 |
Lunch, library |
5:00 |
Questions / discussion |
1:00 |
Developmental Features of the Foot and Ankle |
5:15 |
Adjourn (Independent Study (optional) |
Lab participants, bring shorts tomorrow |
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Day 3: Lab (Bring Shorts Today)
8:30 |
Open-Chain Assessments: Foot Geometry, Joint Mobility, and Soft Tissue Extensibility |
2:00 |
LAB : Closed-Chain Foot Assessments |
10:00 |
Break |
3:00 |
Positioning the Patient and Rehearsing the Cast Molding Grip |
10:15 |
Resume Open Chain Foot Assessments |
4:00 |
Review of Flex-Casting and Foot Splinting Materials |
12:00 |
Lunch |
5:00 |
Adjourn |
1:00 |
LAB : Assessment of Ankle ROM |
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Lab participants, bring shorts tomorrow |
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Day 4: Lab (Bring Shorts Today)
8:30 |
Footboard Fabrication Demo and Lab |
3:00 |
Team members rotate to fabricate cast and foot splint |
10:00 |
Flexcast Fabrication Demo and Lab |
5:30 |
Clean up |
12:30 |
Lunch |
6:00 |
Adjourn |
1:00 |
Foot Splint Fabrication Demo and Lab |
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 is limited to 40 therapists. First 40 therapists can participate in the lab, the rest can observe.
Video Recording policy: Videotaping of this program is prohibited. Audiotaping for personal review is permitted with permission from the Instructor.
