MANUAL TERAPI MANUAL TERAPI ANKLE AND FOOTANKLE AND FOOT

INTERVENSIINTERVENSI

Oleh:Oleh:SugijantoSugijanto

Disampaikan pada kuliah reguler Disampaikan pada kuliah reguler Manualterapi IIManualterapi II

TUJUAN INSTRUKSIONALTUJUAN INSTRUKSIONAL Mahasiswa memahami Intervensi pada Mahasiswa memahami Intervensi pada

kasuistik Ankle and foot complex dengan kasuistik Ankle and foot complex dengan cara :cara :

Mampu menjelaskan metoda dan dosis Mampu menjelaskan metoda dan dosis intervensi manualterapi kasus intervensi manualterapi kasus Ankle and Ankle and foot complexfoot complex

Mampu membedakan indikasi antara Mampu membedakan indikasi antara metoda dengan pemeriksaan khusus.metoda dengan pemeriksaan khusus.

Mampu mempraktek intervensi Mampu mempraktek intervensi manualterapi kasus Ankle and foot complexmanualterapi kasus Ankle and foot complex

Mampu menilai tentang hasil intervensi Mampu menilai tentang hasil intervensi manualterapi kasus Ankle and foot complex. manualterapi kasus Ankle and foot complex.

PERTANYAAN STUDIPERTANYAAN STUDI Sebutkan indikasi intervensi metoda Sebutkan indikasi intervensi metoda

manualterapi bila dijumpai patologi muscle pain manualterapi bila dijumpai patologi muscle pain sec. Tendinitis, Muscle tightness/contracture, sec. Tendinitis, Muscle tightness/contracture, Capsular pattern hypomobility, Joint Capsular pattern hypomobility, Joint hypermobility, Joint instability, dan sensoric hypermobility, Joint instability, dan sensoric deficit sec nerve entrapment.deficit sec nerve entrapment.

Uraikan dan praktekkan Teknik transverse Uraikan dan praktekkan Teknik transverse friction pada: lig. Talofibulare; lig. friction pada: lig. Talofibulare; lig. Talocalcaneal, lig. Tibiofibulare, lig. tibiotalare; Talocalcaneal, lig. Tibiofibulare, lig. tibiotalare; tendon achilles; m. peroneus longus, m. tendon achilles; m. peroneus longus, m. peroneus brevis, m. tibialis anterior; m. tibialis peroneus brevis, m. tibialis anterior; m. tibialis posterior. posterior.

Uraikan dan praktekkan Joint mobilisation Uraikan dan praktekkan Joint mobilisation traksi, translasi dan roll slide pada sendi traksi, translasi dan roll slide pada sendi Ankle, subtalar, chopard, MTP and PIP-DIP.Ankle, subtalar, chopard, MTP and PIP-DIP.

Uraikan dan praktekkan mobilisasi otot Uraikan dan praktekkan mobilisasi otot dan contract relax stretching pada dan contract relax stretching pada tightness/contracture m. Gastrocnemius, tightness/contracture m. Gastrocnemius, m. soleus, m tibialis anterior.m. soleus, m tibialis anterior.

Jelaskan dan praktekkan terapi latihan Jelaskan dan praktekkan terapi latihan pada Ankle and foot complex.pada Ankle and foot complex.

Jelaskan dan praktekkan pengukuran hasil Jelaskan dan praktekkan pengukuran hasil pada intervensi Ankle and foot complex.pada intervensi Ankle and foot complex.

INTERVENTIONINTERVENTION MASSAGEMASSAGE

Oedeme reduce massageOedeme reduce massage

MUSCLE MOBILIZATIONMUSCLE MOBILIZATION Muscle manipulationMuscle manipulation

MUSCLE STRETCHINGMUSCLE STRETCHING Gastroc nemius m.Gastroc nemius m. Soleus m.Soleus m.

TRANSVESE FRICTIONTRANSVESE FRICTION Gastrocnemius mGastrocnemius m

Achilles tendon:Achilles tendon: Permukaan posteriorPermukaan posterior Permukaan lateral-medialPermukaan lateral-medial Permukaan anteriorPermukaan anterior

Anterior tibial m.Anterior tibial m. Aterior tibial tendonAterior tibial tendon Peroneus longus and Peroneus longus and

brevis msbrevis ms Peroneus longus and Peroneus longus and

brevis tendonbrevis tendon

JOINT MOBILIZATIONJOINT MOBILIZATION Translation of distal Translation of distal

tibiofibular jointtibiofibular joint Dorsal translationDorsal translation

Traction of Ankle joint :Traction of Ankle joint : In MLPPIn MLPP (Awal mobilisasi/ aktualitas tinggi)(Awal mobilisasi/ aktualitas tinggi)

In Limited dorsal flexionIn Limited dorsal flexion (Menambah ROM dorsal flexion)(Menambah ROM dorsal flexion) In Limited plantar flexionIn Limited plantar flexion (Menambah ROM dorsal flexion)(Menambah ROM dorsal flexion)

Translation of Ankle joint :Translation of Ankle joint : In Limited dorsal flexionIn Limited dorsal flexion (Menambah ROM dorsal (Menambah ROM dorsal

flexion)flexion) In Limited plantar flexionIn Limited plantar flexion (Menambah ROM dorsal (Menambah ROM dorsal

flexion)flexion)

Intermetatarsal Intermetatarsal TranslationTranslation Dorsal and plantar Dorsal and plantar

translation MT1, translation MT1, MT3, MT4 and MT5MT3, MT4 and MT5

Koreksi transverse Koreksi transverse arcarc

Traction to MTP joint I (II,III,IV & V):Traction to MTP joint I (II,III,IV & V): In MLPPIn MLPP

Awal mobilisasi/aktualitas tinggiAwal mobilisasi/aktualitas tinggi In Limited dorsal flexionIn Limited dorsal flexion

(Menambah ROM dorsal flexion)(Menambah ROM dorsal flexion) In Limited plantar flexionIn Limited plantar flexion

(Menambah ROM plantar flexion)(Menambah ROM plantar flexion)

Translation to MTP joint I Translation to MTP joint I (II,III,IV & V):(II,III,IV & V): In Limited dorsal flexionIn Limited dorsal flexion (Menambah ROM dorsal (Menambah ROM dorsal

flexion)flexion) In Limited plantar flexionIn Limited plantar flexion (Menambah ROM plantar (Menambah ROM plantar

flexion)flexion)

Manipulation to lesion.Manipulation to lesion.

Passive stabilizationPassive stabilization

Elastic bandageElastic bandage TappingTapping Medial arc supportMedial arc support Medial wedge shoeMedial wedge shoe AFOAFO

EXERCISEEXERCISE

MUSCLE REEDUCATIONMUSCLE REEDUCATION.. Active stabilization exercises.Active stabilization exercises.

Active strengthening Active strengthening exercisesexercises

EVALUASIEVALUASI Pain: VAS/ VRS/ VDSPain: VAS/ VRS/ VDS ROM: GoneometerROM: Goneometer Strength: MMT/Hand held Strength: MMT/Hand held

dynamometer/Spigmomanometer.dynamometer/Spigmomanometer.

Flat footFlat foot

Bawaan Over weight External rotated leg

Nyeri medial foot

(knee)

Navicular nonjol medial

Calcaneal valgus

Pronation foot

Antalgi gaitMedial arc

support shoes

Strengthening exc. Toes flexors

Palpasi nyeri

navicular

Pengukuran longit arc

Stretch test lig. Plantar

foot

Strength test

Plantar fasciitis – calcaneal spurPlantar fasciitis – calcaneal spur

Degenerasi Over weight Repetitive Stretching

apponeurosis plantarisNyeri

tumit/plantarAntalgic gait,

heel strike-foot flat ±

U S

Transverse friction

Donnut pad-medial arc

suport shoes

Palpasi nyeri plantar fascia &

calcaneusStretch test

Plantar fascia

Strength test otot flexors

Ankle sprainAnkle sprain

Active unstable foot

Inversion injury

Nyeri lateral (medial) foot

Riwayat injury

Antalgic gait

Acute edema

Nyeri inversi (eversi) ROM

±

Acute Akt.

tinggi

KronikAkt. rendah

Rest Ice

Compression

Elevation

Joint mobilization

Active stabilization

Gouty arthritisGouty arthritis

Metabolism Endapan purin

Inflamasi Awal MTP I

Nyeri tajam ibu jari kaki

Gait analysis Toe off

ROM MTP I terbatas

Non capsular pattern

Joint blockade arah tertentu

Palpasi: Tenderness

Medicamentosa

US under water

Joint mobilization

DAFTAR PUSTAKADAFTAR PUSTAKA Cook CE, Cook CE, Osthopaedic Manual Therapy,Osthopaedic Manual Therapy, Pearson Prentice Hall, New Pearson Prentice Hall, New

Jersey, 2007Jersey, 2007 Goodmann & Boissaunnault, Goodmann & Boissaunnault, Pathology implication for Pathology implication for

physiotherapy. physiotherapy. WB Saunders co, London, 2000.WB Saunders co, London, 2000. Helting D & Kessler RM, Helting D & Kessler RM, Management of common musculoskeletal Management of common musculoskeletal

disorder, disorder, ippincott Williams and Wilkins, Philadelphia, 2006.ippincott Williams and Wilkins, Philadelphia, 2006. Makofsky HW, Makofsky HW, Spinal Manual Therapy,Spinal Manual Therapy, Slack inc, NJ USA, 2003 Slack inc, NJ USA, 2003 Meadows JTS, Meadows JTS, Orthopaedic Differential Diagnosis in Physisal Orthopaedic Differential Diagnosis in Physisal

therapy,therapy, Mc Graw-Hill, NY, 1999. Mc Graw-Hill, NY, 1999. Van der El, A, Lunacek, P and Wagemaker, A, Van der El, A, Lunacek, P and Wagemaker, A, Manuele therapie, Manuele therapie,

wervelkolom onderzoekwervelkolom onderzoek, deel 1, Uitgeverij Manuwel, Roterdam, Ed. , deel 1, Uitgeverij Manuwel, Roterdam, Ed. I, 1983.I, 1983.

Van der El, A, Lunacek, P and Wagemaker, A, Van der El, A, Lunacek, P and Wagemaker, A, Manuele therapie Manuele therapie Wervelkolom BehandelingWervelkolom Behandeling, deel 2, Uitgeverij Manuwel, Roterdam, , deel 2, Uitgeverij Manuwel, Roterdam, Ed. I, 1989.Ed. I, 1989.

Dvorak, J and Dvorak, V, Dvorak, J and Dvorak, V, Medical checklists Manual MedicineMedical checklists Manual Medicine, Gerg , Gerg Thieme Verlag Stuttgart, New York, 1991.Thieme Verlag Stuttgart, New York, 1991.