Physical Conditioning During Recovery From Foot Surgery

Physical Conditioning During Recovery From Foot Surgery Blog

Background

Likely as a result of continuous running and cutting while playing field hockey, a 25 year-old female experienced a plantar fascia tear. The tear was discovered via diagnostic imagining after the athlete had been suffering from painful plantar fasciitis for approximately six months.

Goals for Rehabilitation

After undergoing surgery in order to repair the fascia, a conditioning regimen was created with the athlete’s physician to incorporate the AlterG Anti-Gravity Treadmill. Designed to run concurrently with her normal program of post-surgical rehabilitation, this conditioning program would enable an early start to gait recovery and the neuromuscular training necessary for proprioception. The athlete began post-operative rehabilitation with the following basic goals:

  • Following the surgery, de-weighting would be an important part of the conditioning
  • The athlete would maintain cardiovascular fitness and muscular strength throughout the rehabilitation process
  • The athlete would progressively return to her normal athletic activity

Rehabilitation

The athlete received traditional rehabilitation therapy that included therapeutic movement, mobilization of joints, and NSAIDs.

While receiving this therapy, she began the additional conditioning program that included workouts on the AlterG Anti-Gravity Treadmill. This four-phase program began in the fifth week after surgery and was scheduled for 10 weeks.

Phase One

Full weight bearing began in phase one, along with beginning work on range of motion, gait re-education, pain management, and proprioception.

The AlterG Anti-Gravity Treadmill was introduced during this phase to enable conditioning with minimal impact to the affected extremity.

Phase Two

From weeks seven through nine, this phase continued the work from phase one and initiated a beginning cardiovascular training regimen. Additionally, phase two began to increase:

  • Load bearing
  • Foot strike frequency
  • Volume of conditioning
  • Strength and endurance

Phase Three

Phase three continued the work of phases one and two, including increases in volume and intensity.
This phase also decreased the angle of the surface on the AlterG Anti-Gravity Treadmill and initiated a full foot strike.

Phase Four

From weeks 13 through 15 after surgery, phase four maintained levels of volume and conditioning along with the same angle of surface from phase three. However, load was increased, and work toward proper proprioception became more challenging. The athlete was allowed to gradually return to sports activity during this phase.

Feedback from the athlete was important to the conditioning regimen. Pain levels were recorded before and after each session in each phase of the program. This data was then used to determine the speed of the treadmill workouts as well as the force of the impact the athlete would endure with each foot strike.

Results of the Program

The rehabilitation program was successfully completed on schedule, and the athlete was given a green light by her physician to resume participation in her sport in the 15th week after surgery. The incorporation of the AlterG Anti-Gravity Treadmill enabled the athlete to maintain a high level of fitness during the rehabilitation process. Additionally, the treadmill’s ability to restrict body weight on impact allowed her to manage her gait and increase impact incrementally as pain levels allowed.

Four weeks after completion of the combined programs, the athlete returned to unrestricted activity. She continued to use the AlterG Anti-Gravity Treadmill in conjunction with her normal conditioning program.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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