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Achilles disorders
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Maneesh Bhatia, Nicholas Eastley, Kartik Hariharan
Conservative management is the first line treatment for IAT. This includes activity modification, shoe adjustments (to include shock-absorbing insoles and adequate space to prevent direct AT compression), ice packs, analgesia (including topical or oral non-steroidal anti-inflammatory drugs [NSAIDs]) and 1–2 cm heel lifts (to reduce tensile and compressive strain). Orthoses should also be used to correct suboptimal biomechanical alignment. These may include medial arch supports for patients with flatfeet or lateral heel wedges for those that bear weight through the lateral border of their feet. Occasionally a walking aid such as a pneumatic walking boot with heel wedges, or a dynamic hinged boot fixed in mild plantarflexion may be required to relieve pain.
Modern Rehabilitation Techniques for COVID-19
Published in Wenguang Xia, Xiaolin Huang, Rehabilitation from COVID-19, 2021
In the standing position, keep the body upright with one heel touching the ground and do dorsal-flexion in maximum degrees. Then transit to the end part of the forefoot, raise the heel of the foot for plantar flexion in maximum degrees. And step forward with alternative usage of forepart, middle part, and back of the entire soles. Keep breathing evenly. If patients cannot perform these exercises, they can do the heel lift training (i.e., “lifting the heel”) in the standing position. Then lift the feet when exhaling, gradually put down halfway when inhaling and then continue to lift them. A set consists of 8–12 reps. Patients can rest after each set. It is recommended to do this exercise two to three times a week.
The Many Facets of Chronic Pain
Published in Michael S. Margoles, Richard Weiner, Chronic PAIN, 2019
Michael S. Margoles, Lawrence A. Funt
Dr. M. begins diagnostic therapy by using noninvasive mechanical or physical therapy. This usually consists of a heel lift, a wrist splint, or the like. If the person plays tennis, and the shoulder-arm pain is a real problem, then a sling and rest for the right arm may be in order. Also, Dr. M. may want to suggest the person stay off of the tennis team. If the low back was a problem area, then a program that includes whirlpool treatments to the back might be considered.
Impaired mechanical properties of Achilles tendon in spastic stroke survivors: an observational study
Published in Topics in Stroke Rehabilitation, 2019
Caroline Pieta Dias, Bruno Freire, Natália Batista Albuquerque Goulart, Camila Dias De Castro, Fernando De Aguiar Lemos, Jefferson Becker, Anton Arndt, Marco Aurélio Vaz
Biomechanically, ankle elasticity may improve walking by redirecting the body’s center-of-mass velocity before heel strike. This mechanism reduces heel strike collision by storing energy from the forward motion of the body’s center-of-mass and produces a pre-emptive heel lift-off, resulting in an elastic push-off.1 This elastic energy does not replace ankle muscle activity, but it works as a catapult in which Achilles tendon stretches slowly during stance before recoiling rapidly during the push-off stage. This mechanism facilitates energy dissipation while subsequently amplifies power generated by the calf muscles.2 As spasticity is related to increased ankle joint stiffness and decreased range of motion at the ankle,3,4 it is expected that individuals after stroke might have changes in ankle elasticity. Previous study observed a higher ankle joint stiffness in affected limb of individuals after stroke (0.43 ± 0.08 N/°) compared to healthy individuals (0.32 ± 0.07 N/°) which may explain the limited ankle range of motion observed in stroke people.4 Thus, the elastic energy stored during walking previous described as a catapult mechanism might be compromised due to spasticity after stroke.
The effects of locomotor training in children with spinal cord injury: a systematic review
Published in Developmental Neurorehabilitation, 2019
Jennifer Glenna Donenberg, Linda Fetters, Robert Johnson
Nine studies reported more than one form of LT. Forms of training included treadmill21,28,30–33,35–37, over ground21,28,33–37, robotics29,32,34, FES33,34,38, and a virtual reality over ground system.31 Four of the studies used treadmill and over ground training only21,28,35–37, and the remaining seven studies used a single form of LT or a combination beyond just treadmill and over ground training including treadmill training and a virtual reality over ground system, FES, or robotics training, or used robotics training combined with functional electrical simulation and over ground training without the use of the treadmill.29–34,38 All studies that involved treadmill training utilized a trunk harness for body-weight support. A harness was added to over ground training in one study,35 a walking frame for over ground training in one study,26 and a reverse rolling walker was added to over ground training in two studies.30,36 In robotics LT, body-weight support was provided within the system itself for two studies32,34, and body-weight support was also provided in the virtual reality over ground training system.31 Additional components added to LT included unilateral or bilateral ankle foot orthoses, a heel lift to accommodate for a leg length discrepancy, and handlebars.33,35,36
Review of ankle rehabilitation devices for treatment of equinus contracture
Published in Expert Review of Medical Devices, 2022
Kamila Dostalova, Radek Tomasek, Martina Kalova, Miroslav Janura, Jiri Rosicky, Marek Schnitzer, Jiri Demel
Functional shortening of the gastroc-soleus complex is commonly called Equinus contracture (EC). EC, the ankle disability to perform physiological dorsiflexion range of motion (ROM), is more present in the muscular portion than in the tendinous portion [1]. Generally, the shortening of gastrocnemius muscle alone or the of the gastrocnemius muscle and soleus muscle, the so-called gastroc-soleus complex, in the combined form, is considered the originator of EC [2]. The junction of the structure of the gastroc-soleus complex with the Achilles tendon, accompanied by the EC disrupts the normal gait process by adopting compensatory gait patterns [3]. The Achilles tendon and gastroc-soleus complex yield in tightness and therefore the stance phase is affected by an early heel lift resulting from increased plantar pressure of the forefoot. Right before heel lift, the foot acts as a base over which the limb and the body must rotate in forward manner provided by the ankle. At the same time, the gastroc-soleus complex is stretched with the knee in full extension. Although mobility of the ankle is limited, rotation movement must still be performed and accordingly compensated. DiGiovanni and Langer [1] stated that limited dorsiflexion of the ankle must be compensated and excessive pronatory malrotation of the hindfoot through the oblique axis of the subtalar joint is one of the possibilities. Compensatory motion could cause failure of the medial column of the foot, producing a flatfoot deformity due to forced subtalar joint into an everted position. The foot loses the function of a rigid lever arm during push-off, thus the repetitive stress during gait increases, resulting in deformation of the medial structures of the foot [3].