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Monday Musings: Foot/Ankle Injuries and Physical Therapy

Posted Jul 30 2012 8:55am
It's been white some time since I typed up a “Random Thoughts” post, so I thought I'd bring it back for today. I've usually got a few dozen things rattling around my brain at all times, so if I can dump one of them here, hopefully I'll replace it with something noteworthy. Today’s question is somewhat “Andy Rooney-esque.”

Have you ever noticed that doctors are less likely to prescribe physical therapy for foot and ankle issues than any other problem? I might be skewed by my perspective in this part of the country, but I doubt it, as Boston has a great medical reputation. “Just walk on it” is the advice I often hear folks say they've gotten. Would you do that for a hip or knee replacement?  As I discuss in my e-book, The Truth About Unstable Surface Training , following inversion ankle sprains, a lot of folks wind up with functional ankle instability due to a proprioceptive deficit of the peroneals; this muscle group just doesn’t turn on quickly enough to prevent “re-sprains” from occurring.


Additionally, some individuals present with some considerable “anterior jamming” that can’t be addressed by classic ankle mobilizations, and these individuals can benefit greatly from good manual therapy and joint manipulation by a qualified professional.  Lastly, breaking a big toe can be a big deal; it's dangerous to assume that it'll just magically heal perfectly if someone walks on it for months - and it can be problematic to brace a foot in an immobile position for an extended period of time and wind up with stiffness or compensation patterns.

Along those lines, though, maybe they just aren't prescribing physical therapy for these issues because there aren't specialized physical therapists. I know of a lot of wrist/hand physical therapists, but no true foot/ankle specialists on the PT side of things. Sure, there are PTs who do foot/ankle as part of their normal practice (and some who do it very well), but you'd think that the weight-bearing joints that connect us to the ground would receive even more specific attention than wrist/hand issues. Perhaps this lack of specialization has emerged because the foot and ankle are so complex and misunderstood; it could be a good "niche" for some of you up-and-coming physical therapists to pursue.


 

Again, these are just some Monday musings off the top of my head. To the general fitness folks out there, push hard to get physical therapy after a foot/ankle issue. To the rehabilitation specialists and strength and conditioning professions out there, I’d love to hear your thoughts in the comments section.

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