Ankle/Foot ROM, MMT, Flexibility

TALOCRURAL JOINT DORSIFLEXION

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: sitting, supine, prone, standing

axis: medial-lateral

fulcrum: lateral malleolus

stationary arm: lateral midline of fibula (use fibular head)

moveable arm: parallel to lateral aspect of fifth metatarsal

normal values: 0-20

end feel: firm

what joint do plantarflexion and dorsiflexion happen at?

talocrural (joint)

___________ dorsiflexion with knee flexed than extended. why?

more, slackens gastroc(nemius)

___________ dorsiflexion when weight bearing. this tells us about what?

more, functional performance

TALOCRURAL JOINT PLANTARFLEXION

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: sitting, supine

axis: medial-lateral

fulcrum: lateral malleolus

stationary arm: lateral midline of fibula (use fibular head)

moveable arm: parallel to lateral aspect of fifth metatarsal

normal values: 0-50

end feel: firm or hard

in talocrural dorsiflexion and plantarflexion, keep the knee ______________ to avoid gastroc action

bent

TARSAL INVERSION

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: sitting

axis: anterior-posterior

fulcrum: anterior midway between malleoli

stationary arm: anterior midline of lower leg (use tib tub)

moveable arm: anterior midline of second metatarsal

normal values: 0-35

end feel: firm

in talocrural joint plantarflexion, do not apply resistance on the _____________

toes

tarsal & subtalar inversion is a combination of these three motions:

supination, adduction, plantarflexion

TARSAL EVERSION

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: sitting, supine

axis: anterior-posterior

fulcrum: anterior midway between malleoli

stationary arm: anterior midline of lower leg (use tib tub)

moveable arm: anterior midline of second metatarsal

normal values: 0-20

end feel: hard or firm

tarsal & subtalar eversion is a combination of these three motions:

pronation, abduction, dorsiflexion

typical inversion/eversion happens at what joint?

tarsal (joint)

SUBTALAR JOINT INVERSION

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: prone

axis: anterior-posterior

fulcrum: posterior midway between malleoli

stationary arm: posterior midline of lower leg

moveable arm: posterior midline of calcaneus

normal values: 0-5

end feel: firm

SUBTALAR JOINT EVERSION

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: prone

axis: anterior-posterior

fulcrum: posterior midway between malleoli

stationary arm: posterior midline of lower leg

moveable arm: posterior midline of calcaneus

normal values: 0-5

end feel: hard or firm

for subtalar inversion/eversion, use a ________-shaped grip on the _______________

U, calcaneus

the subtalar joint focuses on movement at the ___________________

calcaneus

in subtalar inversion/eversion, make sure you move the calcaneus, not the _______________

fat pad

MTP JOINT FLEXION - HALLUX

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: sitting, supine

axis: medial-lateral

fulcrum: dorsal MTP joint

stationary arm: dorsal midline of metatarsal

moveable arm: dorsal midline of proximal phalanx

normal values: 0-45

end feel: firm

which ROM's should you use the toe goni for?

MTP flexion, MTP extension, MTP abduction

when testing MTP flexion ROM, where should you be moving the hallux? & don't put your fingers where?

proximal phalanx, toe crease

MTP EXTENSION - HALLUX

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: sitting, supine

axis: medial-lateral

fulcrum: dorsal MTP joint

stationary arm: dorsal midline of first metatarsal

moveable arm: dorsal midline of proximal phalanx

normal values: 0-80

end feel: firm

which ROM is important to take for push off/walking performance?

hallux MTP extension

MTP ABDUCTION - HALLUX

testing position:

axis:

fulcrum:

stationary arm:

moveable arm:

normal values:

end feel:

testing position: sitting, supine

axis: vertical

fulcrum: dorsal MTP joint

stationary arm: dorsal midline of metatarsal

moveable arm: dorsal midline of proximal phalanx

normal values: 0-15

end feel: firm

measuring MTP abduction is important for what?

hallux valgus/bunions

true/false: you can measure hallux MTP abduction with hallux valgus from its resting position

true

when do +'s and -'s not apply with MMT?

(when there is) no gravity min position

why do we use +'s and -'s in MMT grading?

to show patient is improving (progress can be small)

ankle plantarflexion MMT measures what muscles?

gastroc(nemius), soleus

substitutions for ankle plantarflexion MMT (3)

knee flexion, rock forward, weight into hands

testing position for ankle plantarflexion MMT

stand on testing leg, straight knee, 2 fingers on wall/table

if a patient's fingers are on the wall for ankle plantarflexion MMT, what height should they be at? why?

above head, avoid weight bearing

ankle plantarflexion MMT grading:

5:

4:

3+:

3:

3-:

2+:

2:

2-:

1:

0:

5: 25 consecutive heel raises, full ROM

4: 2-24 heel raises, at least 50% of initial height

3+: 1 full heel raise then one

which MMT tests DO have +'s and -'s?

foot inversion, foot eversion/plantarflexion

muscle tested with foot dorsiflexion/inversion MMT

tibialis anterior

substitutions for foot dorsiflexion/inversion MMT

extensor digitorum longus, extensor hallucis longus

muscle tested with foot inversion MMT

tibialis posterior

substitutions for foot inversion MMT

flexor digitorum longus, flexor hallucis longus

foot inversion MMT position

grades 5-3:

grades 2-0:

sitting (ankle in slight PF), supine

where do you palpate the tibialis posterior tendon?

between medial malleolus and navicular

true/false: you should palpate muscles instead of tendons

false (should palpate tendons)

the dysfunction of what muscle would make it painful/impossible to do a single heel raise?

tibialis posterior

what muscles are tested with foot eversion/plantarflexion MMT?

peroneus longus, peroneus brevis

what muscles are tested with foot eversion/dorsiflexion MMT?

peroneus tertius

true/false: foot eversion/plantarflexion MMT tests peroneus longus/brevis/tertius

false (just longus and brevis)

is eversion primarily peroneus longus or brevis?

(peroneus) brevis

how would you isolate peroneus longus?

resist inversion/DF of first metatarsal head

foot eversion/plantarflexion MMT position

grades 5-3:

grades 2-0:

sitting, supine

where do you palpate peroneus longus and brevis?

posterior to lateral malleolus

what muscles are tested for hallux MP flexion MMT?

lumbricales, flexor hallucis brevis

what muscles are tested for toe MP flexion MMT?

lumbricales, interossei

are lumbricales even in strength?

no

if flexor hallucis longus is not functional, what will flexion look like?

MTP will flex, IP will not

if flexor hallucis brevis is not functional, what will flexion look like?

IP will flex, MTP will hyperextend

main idea for hallux and toe MP flexion

bend toes over finger

muscles tested for hallux DIP/PIP flexion

flexor hallucis longus

muscles tested for toe DIP/PIP flexion

flexor digitorum longus, flexor digitorum brevis

main idea of hallux and toe DIP/PIP flexion MMT

hold foot like sandwich, thumbs under middle or distal phalanges

muscles tested with hallux MP/IP extension

extensor hallucis longus

muscles tested with toe MP/IP extension

extensor digitorum brevis, extensor digitorum longus

for toe MMT's, 5 and 4 are against ______________ resistance, 3 is against _________ resistance, and 2 is a ______________ ______________

variable, no, partial range

normal values for gastroc length test

22-25 degrees

how long should you wait during the gastroc length test to take measurement? why?

30 seconds, allow time to stretch