Ankle & Foot (2)

Ankle & Foot Ankle & Foot (2)(2)

Inversion: Inversion: Tarsal Tarsal JointsJoints

Range of motionRange of motion0° – 35 °0° – 35 °

Testing positionTesting positionShort sitting with knee flexed to 90° & the Short sitting with knee flexed to 90° & the

lower leg over the edge of the supporting lower leg over the edge of the supporting surfacesurface

StabilizationStabilizationStabilize the tibia and fibula to prevent:Stabilize the tibia and fibula to prevent:

Medial rotation & extension of knee + lateral Medial rotation & extension of knee + lateral rotation & abduction of hiprotation & abduction of hip

Goniometer AlignmentGoniometer Alignment

FulcrumFulcrumAnterior aspect of the ankle midway between Anterior aspect of the ankle midway between

the malleoli the malleoli

Proximal ArmProximal ArmAnterior midline of the lower leg, using the tibial Anterior midline of the lower leg, using the tibial

tuberosity for referencetuberosity for reference

Distal ArmDistal ArmAnterior midline of the second metatarsalAnterior midline of the second metatarsal

Patient Patient InstructionInstruction

Ask the patient to turn Ask the patient to turn their foot in.their foot in.

Normal End FeelNormal End Feel

Firm, because of tension in:Firm, because of tension in:

Joint capsuleJoint capsule Anterior & posterior talofibular ligamentsAnterior & posterior talofibular ligaments Calcaneofibular ligamentCalcaneofibular ligament Anterior, posterior & interosseous talocalcaneal Anterior, posterior & interosseous talocalcaneal

ligamentligament Dorsal calcaneal ligamentsDorsal calcaneal ligaments Dorsal calcaneocuboid ligamentDorsal calcaneocuboid ligament Dorsal talonavicular ligament Dorsal talonavicular ligament Lateral band of bifurcate ligamentLateral band of bifurcate ligament Transverse metatarsal ligamentTransverse metatarsal ligament Dorsal, planter, interosseous cuboidonavicular, Dorsal, planter, interosseous cuboidonavicular,

cuneonavicular, intercuneiform, cuneocuboid, TMT, cuneonavicular, intercuneiform, cuneocuboid, TMT, & intermetatarsal joints& intermetatarsal joints

Peroneus longus & brevis musclesPeroneus longus & brevis muscles

Inversion MuscleInversion Muscle

Tibialis posteriorTibialis posterior

Tibialis PosteriorTibialis Posterior

Origin:Origin:

Shaft of tibia + interosseous membrane + shaft of fibula + deep transverseShaft of tibia + interosseous membrane + shaft of fibula + deep transverse fascia + intermascualr septumfascia + intermascualr septum

Insertion: Insertion:

Navicular tuberosity + cuneiform bones + suntestaculum tail + 2-4 Navicular tuberosity + cuneiform bones + suntestaculum tail + 2-4 metatarsalmetatarsal

Innervation: Innervation:

Tibial Nerve (L4-L5, & sometimes S1)Tibial Nerve (L4-L5, & sometimes S1)

Test For Grades 5, 4, 3, 2, 1 and 0Test For Grades 5, 4, 3, 2, 1 and 0

Patient PositionPatient PositionShort sitting with ankle in slight Short sitting with ankle in slight

planter flexionplanter flexion Therapist and Patient Instructions Therapist and Patient Instructions

Sitting next to test limb place the resistance hand over the dorsum and Sitting next to test limb place the resistance hand over the dorsum and medial side of the foot at the metatarsal heads. The stabilizing hand medial side of the foot at the metatarsal heads. The stabilizing hand is placed around the posterior ankle just above the malleoli. is placed around the posterior ankle just above the malleoli. Resistance is given in the direction of eversion and toward slight Resistance is given in the direction of eversion and toward slight dorsiflexion, almost as if pulling up and around laterally. Ask the dorsiflexion, almost as if pulling up and around laterally. Ask the patient to, “turn your foot down and in, toward your other foot, don’t patient to, “turn your foot down and in, toward your other foot, don’t let me push it out.” let me push it out.”

Test For Grades 5, 4, 3, 2, 1 and 0Test For Grades 5, 4, 3, 2, 1 and 0Grade 5 (Normal): Grade 5 (Normal): completes full range of motion and holds against completes full range of motion and holds against

maximal resistance.maximal resistance.

Grade 4 (Good): Grade 4 (Good): completes available range of motion and holds against completes available range of motion and holds against strong to moderate resistance.strong to moderate resistance.

Grade 3 (Fair): Grade 3 (Fair): the patient will be able to invert the foot through full the patient will be able to invert the foot through full available range of motion.available range of motion.

Grade 2 (Poor): Grade 2 (Poor): completes only partial range of motion.completes only partial range of motion.

Grade 1 (Trace): Grade 1 (Trace): palpate tendon of tibialis posterior between the medial palpate tendon of tibialis posterior between the medial malleolus & navicular bone, or above the malleolu. If palpable malleolus & navicular bone, or above the malleolu. If palpable activity occurs with no movement, the grade is 1.activity occurs with no movement, the grade is 1.

Grade 0 (Zero): Grade 0 (Zero): no palpable contractionno palpable contraction

Substitution Substitution

Substitution by the Flexors of the toes Substitution by the Flexors of the toes should remain relaxed to prevent should remain relaxed to prevent substitution by the Flexor digitorum longus substitution by the Flexor digitorum longus & Flexor hallucis longus& Flexor hallucis longus

EversionEversion : :

Tarsal JointsTarsal Joints

Range of motionRange of motion0° – 25 °0° – 25 °

Testing positionTesting positionShort sitting with knee flexed to 90° & the Short sitting with knee flexed to 90° & the

lower leg over the edge of the supporting lower leg over the edge of the supporting surfacesurface


Lateral rotation & flexion of knee + Medial Lateral rotation & flexion of knee + Medial rotation & abduction of hiprotation & abduction of hip


FulcrumFulcrumAnterior aspect of the ankle midway between Anterior aspect of the ankle midway between

the malleoli the malleoli

Proximal ArmProximal ArmAnterior midline of the lower leg, using the tibial Anterior midline of the lower leg, using the tibial

tuberosity for referencetuberosity for reference

Distal ArmDistal ArmAnterior midline of the second metatarsalAnterior midline of the second metatarsal


Ask the patient to turn Ask the patient to turn their foot out.their foot out.


Hard, because of tension in:Hard, because of tension in:

Contact between the calcaneus & the floor of the sinus Contact between the calcaneus & the floor of the sinus tarsitarsi

OrOr


Joint capsuleJoint capsule Deltoid ligamentDeltoid ligament Medial talocalcaneal ligamentMedial talocalcaneal ligament Planter calcaneonavicular ligamentPlanter calcaneonavicular ligament Calcaneocuboid ligamentCalcaneocuboid ligament Dorsal talonavicular ligament Dorsal talonavicular ligament Medial band of bifurcate ligamentMedial band of bifurcate ligament Transverse metatarsal ligamentTransverse metatarsal ligament Dorsal, planter, interosseous cuboidonavicular, Dorsal, planter, interosseous cuboidonavicular,

cuneonavicular, intercuneiform, cuneocuboid, TMT, & cuneonavicular, intercuneiform, cuneocuboid, TMT, & intermetatarsal jointsintermetatarsal joints

Tibialis posterior musclesTibialis posterior muscles

Foot Eversion Foot Eversion With Planter With Planter

FlexionFlexion

Foot Eversion With Planter Foot Eversion With Planter Flexion MusclesFlexion Muscles

Peroneus LongusPeroneus LongusPeroneus brevisPeroneus brevis

Peroneus LongusPeroneus Longus

Origin:Origin:

Head & shaft of fibula + lateral condyle of tibia + fascia cruris + Head & shaft of fibula + lateral condyle of tibia + fascia cruris + intermascular septumintermascular septum


11stst metatarsal + medial cuneiform + occasionally from other metatarsal + medial cuneiform + occasionally from other metatarsalsmetatarsals


Superficial Peroneal Nerve (L5-S1)Superficial Peroneal Nerve (L5-S1)

Peroneus BrevisPeroneus Brevis

Origin:Origin:

Shaft of fibula + crural intermascular septumShaft of fibula + crural intermascular septum


55thth metatarsal metatarsal


Superficial Peroneal Nerve (L5-S1)Superficial Peroneal Nerve (L5-S1)

Test For Grades 5, 4, 3 and 2Test For Grades 5, 4, 3 and 2

Patient PositionPatient PositionShort sitting with ankle in Short sitting with ankle in

neutral positionneutral position

Therapist and Patient Instructions Therapist and Patient Instructions

Sitting on stool beside the patient’s test limb, one hand stabilizes Sitting on stool beside the patient’s test limb, one hand stabilizes by gripping around the ankle. Resistance is given around the by gripping around the ankle. Resistance is given around the dorsum and lateral border of the foot. Resistance is in the dorsum and lateral border of the foot. Resistance is in the direction of inversion and slight dorsiflexion, or in an up and direction of inversion and slight dorsiflexion, or in an up and medial direction. Ask the patient to, “turn your foot down medial direction. Ask the patient to, “turn your foot down and out, don’t let me push it in.” and out, don’t let me push it in.”

GradingGrading

Grade 5 (Normal): Grade 5 (Normal): completes full range of motion completes full range of motion and holds against maximal resistance.and holds against maximal resistance.

Grade 4 (Good): Grade 4 (Good): completes available range of completes available range of motion and holds against strong to moderate motion and holds against strong to moderate resistance.resistance.

Grade 3 (Fair): Grade 3 (Fair): the patient will be able to invert the patient will be able to invert the foot through full available range of motion the foot through full available range of motion but tolerate no resistance.but tolerate no resistance.

Grade 2 (Poor): Grade 2 (Poor): completes only partial range of completes only partial range of eversion motion.eversion motion.

Test For Grades 1 and 0Test For Grades 1 and 0

Patient PositionPatient Position

Short sitting or supineShort sitting or supine

Therapist and Patient Instructions Therapist and Patient Instructions

Sitting on stool beside the patient’s test limb, or standing at the end of table. To palpate Peroneus longus, place Sitting on stool beside the patient’s test limb, or standing at the end of table. To palpate Peroneus longus, place fingers on the lateral leg over the upper one-third just below the head of the fibula. The tendon of the fingers on the lateral leg over the upper one-third just below the head of the fibula. The tendon of the muscle can be felt posterior to the lateral malleolus behind the tendon of the Peroneus brevis.muscle can be felt posterior to the lateral malleolus behind the tendon of the Peroneus brevis.

To palpate tendon of Peroneus brevis place the index finger over the tendon as it comes forward from behind To palpate tendon of Peroneus brevis place the index finger over the tendon as it comes forward from behind the lateral malleolus, proximal to the base of 5the lateral malleolus, proximal to the base of 5thth metatarsal. The belly of the muscle can be palpated on the metatarsal. The belly of the muscle can be palpated on the lateral surface of the distal leg over the fibula lateral surface of the distal leg over the fibula

GradingGrading

Grade 1 (Trace): Grade 1 (Trace): palpation will reveal palpation will reveal contractile activity in either or both contractile activity in either or both muscles, which may cause the tendon to muscles, which may cause the tendon to stand out. No motion occursstand out. No motion occurs

Grade 0 (Zero): Grade 0 (Zero): no palpable contractionno palpable contraction

Notes Notes To Isolate Peroneus Longus give resistance To Isolate Peroneus Longus give resistance

against the planter surface of the head of the 1against the planter surface of the head of the 1stst metatarsal in a direction toward invesion & metatarsal in a direction toward invesion & dorsiflexion.dorsiflexion.

Foot Eversion With Dorsiflexion: if peroneus tertius Foot Eversion With Dorsiflexion: if peroneus tertius is present, it can be tested by asking the patient is present, it can be tested by asking the patient to evert & dorsiflex the foot. In this motion, to evert & dorsiflex the foot. In this motion, however, Extensor digitorum longus participates. however, Extensor digitorum longus participates. The tendon of peroneus tertius can be palpated on The tendon of peroneus tertius can be palpated on the lateral aspect of the dorsum of the foot, lateral the lateral aspect of the dorsum of the foot, lateral to the tendon of Extensor digitorum longus.to the tendon of Extensor digitorum longus.

Inversion: Inversion: Subtalar JointSubtalar Joint

((RearfootRearfoot))

Range of motionRange of motion0° –5 °0° –5 °

Testing positionTesting positionProneProne


lateral rotation of knee + lateral rotation & lateral rotation of knee + lateral rotation & abduction of hipabduction of hip


FulcrumFulcrum

Posterior aspect of the ankle midway between Posterior aspect of the ankle midway between the malleoli the malleoli

Proximal ArmProximal Arm

Posterior midline of the lower legPosterior midline of the lower leg

Distal ArmDistal Arm

Posterior midline of the calcaneus Posterior midline of the calcaneus


Ask the patient to turn Ask the patient to turn their foot in.their foot in.



Lateral Joint capsuleLateral Joint capsule Anterior & posterior talofibular Anterior & posterior talofibular

ligamentsligaments Calcaneofibular ligamentCalcaneofibular ligament Anterior, posterior & interosseous Anterior, posterior & interosseous

talocalcaneal ligamenttalocalcaneal ligament

EversionEversion : :Subtalar Joint Subtalar Joint

(Rearfoot)(Rearfoot)

Range of motionRange of motion0° –5 °0° –5 °

Testing positionTesting positionProneProne


Medial rotation flexion of knee + Medial Medial rotation flexion of knee + Medial rotation & abduction of hiprotation & abduction of hip


FulcrumFulcrum

Posterior aspect of the ankle midway between Posterior aspect of the ankle midway between the malleoli the malleoli

Proximal ArmProximal Arm

Posterior midline of the lower legPosterior midline of the lower leg

Distal ArmDistal Arm

Posterior midline of the calcaneus Posterior midline of the calcaneus

Patient InstructionPatient Instruction

Ask the patient to turn Ask the patient to turn their foot out.their foot out.


Hard, because of tension in:Hard, because of tension in:

Contact between the calcaneus & the floor Contact between the calcaneus & the floor of the sinus tarsiof the sinus tarsi

OrOr


Deltoid ligamentDeltoid ligament Medial talocalcaneal ligamentMedial talocalcaneal ligament Tibialis posterior musclesTibialis posterior muscles

Good Luck To You All Good Luck To You All

Ankle & Foot (2)

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