Title:   Clinical Management Of Biomechanical Foot/Ankle Problems

            1 credit Advanced Clinical Skills Course

 

Instructor:    Edmund M. Kosmahl, PT, EdD

Office:  LEA 016

Phone: 570 941-4314

Office hours:

Tuesday 1:00 – 2:50pm, Wednesday 3:00 – 3:50pm

 

Email: kosmahle1@scranton.edu

 

Class Meeting Days, Times and Location:

 

Tuesdays 9/7/04 thru 10/12/04, 3:00 – 4:50pm.  Leahy 1006 and Leahy 014.

 

Professional Behavior:

 

Physical therapy majors are expected to exhibit professional behavior at all times (see relevant sections of the PT Department Student Handbook and section 3.8.3.3 “Professional Behavior” of the Evaluative Criteria for Accreditation of Education Programs for the Preparation of Physical Therapists, CAPTE, Effective 1/1/98).  Briefly, students are expected to:

 

·        conform to the University of Scranton Academic Code of Honesty.

·        attend all class meetings and activities.

·        be punctual, prepared (including lab clothes and equipment when appropriate) and participative.

·        accept responsibility for their actions (eg. grades reflect each student’s effort and output).

 

Course Description:

 

This course builds upon information and techniques learned in Kinesiology and Orthopaedic PT. Students will gain the knowledge and skills needed to evaluate, diagnose and intervene for foot/ankle biomechanical problems.  As part of the course, students will learn how to perform neutral subtalar position plaster impression casting. Students will learn how to provide impression casts and evaluation information to orthotics laboratories for orthotic fabrication.

 

Course Objectives:  (indexed to Evaluative Criteria for Accreditation of Education Programs for the Preparation of Physical Therapists, CAPTE, Effective 1/1/98)

 

At the completion of this course, the student will be able to:

                       

A.                 Describe the function of foot/ankle joints, functional units, and muscles during gait. (3.8.1. instruction in the foundational sciences, . . .)

 

B.                 Describe ideal alignment of the foot/ankle complex (criteria for normalcy in the lower extremity) in open-chain (non-weight bearing) and closed-chain (weight bearing) positions. (3.8.1. instruction in the foundational sciences, . . .)

 

C.                 Perform open-chain and closed-chain biomechanical evaluation of the foot/ankle complex. (3.8.3.16. Examination – i) gait, k) joint integrity and mobility, l) motor function, m) muscle performance, o) orthotic, protective, and supportive devices, q) posture, s) range of motion, 3.8.3.17 Evaluation – Synthesize examination data . . .)

 

D.                 Recognize the following conditions and understand their relationship to abnormal foot/ankle function during gait: (Diagnosis 3.8.3.19 – engage in the diagnostic process to establish a differential diagnosis . . .)

 

·        Subtalar varus and valgus

·        Rearfoot varus and valgus

·        Tibial varum and valgum

·        Tarsal coalition

·        Forefoot varus and valgus

·        Forefoot supinatus

·        Plantarflexed first ray

·        Metatarsus primus elevatus

 

E.                  Perform neutral subtalar position plaster impression casting. (3.8.3.28. Intervention – i) prescription, application and as appropriate fabrication of . . . orthotic . . . devices and equipment)

 

F.                  Use information from the biomechanical evaluation and impression casts to develop a prescription for biomechanical orthotic devices. . (3.8.3.28. Intervention – i) prescription, application and as appropriate fabrication of . . . orthotic . . . devices and equipment)

 

Required Reading:

 

Kosmahl EM. Course Notes - Clinical Management of Ankle-Foot Biomechanical Problems.  Edmund M. Kosmahl, Scranton, latest edition, available on my web site (see below).

Kosmahl EM. Biomechanics of the Foot-Ankle Complex (unpublished chapter).  Edmund M. Kosmahl, Scranton, available on my web site (see below).

Kosmahl EM. Kinesiology PT75 Course Notes.  Edmund M. Kosmahl, Scranton, latest edition.  The edition you have from your kinesiology course is perfectly adequate for this course.

           

Other Good References:

 

Textbooks:

 

·        Donatelli R: The Biomechanics of the Foot and Ankle, ISBN: 0803600313 Philadelphia, FA Davis Co, 1996

·        Magee DJ: Orthopedic Physical Assessment, ed 4, ISBN 0721693520, Saunders, 2002

·        Root ML, Orion WP, and Weed JH: Normal and Abnormal Function of the Foot: Clinical Biomechanics Volume II, Los Angeles, Clinical Biomechanics Corporation, 1977

·        Seibel MO: Foot Function: A Programmed Text, Baltimore, Williams & Wilkins, 1988

 

Web Resources:

 

The PowerPoint presentations and course notes for this course, and my Biomechanics of the Foot-Ankle chapter can be found at my web site.  http://Academic.Scranton.edu/faculty/KOSMAHLE1/default.htm

Use the menu item for “Foot and Ankle” on the left.  You will need a usercode and password that will be distributed in class.

·        Biomechanics Magazine: http://www.biomech.com/

·        Journal of the American Podiatric Medical Association: http://www.japmaonline.org/

·        Gait Research Laboratory, Department of Physical Therapy, Northern Arizona University: http://jan.ucc.nau.edu/~cornwall/grl/grl.html

·        Podiatry Sites: http://www.equusmedical.com/cgi-bin/tlsstore.cgi?user_action=link&link=links

 

Teaching Methods: Lecture, demonstration, laboratory practice, clinical problem solving.

 

How the Student is Evaluated: 

 

·        Attendance:

 

Attendance and participation in all course activities are the required norm.  Chronic absence, lateness, and/or lack of participation will result in a final grade reduction of as much as 10% at the discretion of the instructor.  Please also see PT Department Student Handbook policy on attendance.

 

·        Journal Article Review:

 

Each student will complete a written journal article review and give a brief oral presentation.  (see guidelines attached)

 

50%

 

Exam

 

50%

 

 

§         Grade Scale

 

Undergraduate

Graduate

Course, unit, and individual performance exam grades below 77% are unacceptable for progression through the curriculum and will initiate the probation policy - See PT Department Student Handbook.  Assigned grades reflect performance on tests, quizzes, assignments, etc., and are rounded to two decimal places.  Please don’t ask for adjustments to grades.

 

95

A

A

92

A-

A-

89

B+

B+

86

B

B

83

B-

B-

80

C+

C+

77

C

C

74

C-

Below 77 - F

71

D+

68

D

Below 68

F

 

 

Schedule:

 

Date

Topic

Sept. 7

Pre-test

Review biomechanics and muscle function

Ideal Alignment

Sept. 14

Rearfoot and leg pathomechanics definitions (including muscle imbalance)

Rearfoot open chain evaluation and subtalar neutral position calculation

Sept. 21

Rearfoot closed chain evaluation, neutral and relaxed calcaneal stance positions

Lab – Rearfoot open and closed chain evaluation

Journal article approval by this date

Sept. 28

Subtalar neutral position, neutral and relaxed calcaneal stance calculation reports

Rearfoot and leg pathomechanics clinical implications

Principles of neutral subtalar position plaster impression casting

Lab - neutral subtalar position plaster impression casting

Oct. 5

Midtarsal motion, function, evaluation

First ray motion, function, evaluation

Forefoot pathomechanics clinical implications

*Oral Presentations

Lab - Midtarsal and first ray evaluation

Oct. 12

Principles of orthotic prescription

*Oral Presentations

notes:  The written test will be given about one week after the last session at a mutually agreeable date and time.  There will be a field trip to local orthotics manufacturing lab sometime during the last two weeks of the course.

 

 

 

 

Journal Article Review Guidelines:

 

Pick an article related to some aspect of foot/ankle biomechanics.  The article must be approved by Dr. Kosmahl before you proceed.  Physical therapy, podiatry, biomechanics, and orthopaedic surgery journals are good sources.  Prepare a brief, written review (maximum of four double-spaced typed pages).  Your written review is due on the day of your oral presentation.  The written review should include:

 

·        The article citation

·        The category of the article (e.g. research report, literature review, case study, clinical commentary, technical report, etc.)

·        The purpose of the article (e.g. to investigate the efficacy of a treatment intervention, to identify a clinical group, to summarize the literature on a topic, to report a unique case, to introduce a device, etc.)

·        A summary of the important issues, findings, points of view, etc., presented in the article

·        Your analysis of the article and its relevance to physical therapy practice

 

Your oral presentation will be given in class.  You should talk briefly about each of the bulleted areas listed above for the written report.  You should limit your presentation to about five minutes.  After your presentation, allow a few minutes for questions.

 

Grading Criteria

 

Written Report: (also see “Guidelines for Written Work” in PT Department Student Handbook)

 

percent

     Grammar, spelling, style

10%

     AMA format (typed, double-spaced, pages numbered, etc.)

10%

     Bulleted guidelines (above)

10%

     Your analysis

40%

Oral Presentation:

 

     Clear, understandable

20%

     Questions and answers

10%

total

100%