Faraz Sethi - Demystifying the Foot and Ankle, Step by Step
Nov 28, 2023
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Faraz Sethi, a first-contact physical therapist in the UK specializing in the foot and ankle, discusses the scarcity of research in this area, common conditions, diagnosis, treatment approaches, and how physical therapists differentiate foot and ankle treatment. The conversation covers the complexities of foot anatomy, challenges in ankle sprains, managing plantar heel pain, resilience in patient care, and the importance of patient communication and clinical reasoning in physiotherapy.
The foot and ankle, despite appearing simple, are complex structures requiring a nuanced understanding for diagnosis and treatment.
Ankle sprains pose challenges in treatment, suggesting incorporating training in provocative positions to strengthen the ankle and prevent long-term instability.
Plantar fasciopathy management should focus on education, load management, and adjunct treatments, with shared decision-making for persistent symptoms.
Deep dives
Understanding the Complexity of the Foot and Ankle
The foot and ankle present a complex structure with around 26 bones, over 30 joints, and extensive soft tissues like muscles, ligaments, tendons, and nerves. Due to its continuous weight-bearing nature, the foot is always active, containing approximately 200,000 nerve endings on the sole. Despite appearing simple, the foot is intricate, requiring a nuanced understanding for proper diagnosis and treatment.
Optimizing Rehabilitation for Lateral Ankle Sprains
Lateral ankle sprains pose challenges in treatment as research often yields inconclusive evidence regarding the best management strategies. Traditional protocols may not effectively address the root causes of recurrent ankle instability or chronic issues. To enhance rehabilitation, it is proposed to incorporate training in provocative positions, focusing on loading principles that replicate real-life movements. This approach aims to strengthen the ankle in positions that are prone to injury, promoting better outcomes and preventing long-term instability.
Managing Plantar Fasciopathy with a Comprehensive Approach
Plantar fasciopathy, commonly known as plantar heel pain, requires a multifaceted management approach. Emphasizing education and load management as primary interventions, followed by considering adjunct treatments like footwear modifications, orthoses, and shockwave therapy. Imaging, such as ultrasound, can aid in confirming the diagnosis if needed. In cases of persistent symptoms, shared decision-making involving options like activity empowerment, injection therapy, or orthopedic consultation can guide further treatment decisions.
Diverse Foot Pathologies and Treatment Approaches
Various foot conditions like morton's neuroma, big toe osteoarthritis, and gout may benefit from steroid injections based on research findings. High volume injections can be effective for thickened tendons, providing a smoother tendon glide. The discussion emphasizes the importance of tailoring treatment based on individual patient needs and expectations, considering factors like elite athlete status or everyday functional requirements.
Clinical Decision-Making and Patient-Centered Care
Patient history plays a crucial role in diagnosis and treatment planning, helping to identify red flags and differentiate pathologies like fat pad atrophy or spinal masqueraders. The importance of building a comprehensive patient picture is highlighted to guide appropriate clinical decisions and referrals for imaging when necessary. The conversation emphasizes the significance of listening to patients, maintaining therapeutic alliances, and using clinical reasoning to tailor treatment plans, fostering patient trust and engagement.
Faraz Sethi joins Noah to add some clarity to one of the more complex areas of the body - the foot and ankle.
Faraz is a first-contact physical therapist in the UK and has 18 years of experience as a clinician. He has a special interest in the foot and ankle and is passionate about applying the biopsychosocial model with his patients.
Today, Noah and Faraz discuss:
The scarcity of research around the foot and ankle
Common conditions of the foot and ankle based on region
How to diagnose and treat various conditions of the foot and ankle
How physical therapists tend to treat this region different from other body parts