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Ankle & Foot (2). Inversion: Tarsal Joints.  Range of motion 0° – 35 ° Testing position Short sitting with knee flexed to 90° & the lower leg over the edge of the supporting surface Stabilization Stabilize the tibia and fibula to prevent:

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Ankle foot 2

 Range of motion

0° – 35 °

Testing position

Short sitting with knee flexed to 90° & the lower leg over the edge of the supporting surface

Stabilization

Stabilize the tibia and fibula to prevent:

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


Ankle foot 2

 Goniometer Alignment

Fulcrum

Anterior aspect of the ankle midway between the malleoli

Proximal Arm

Anterior midline of the lower leg, using the tibial tuberosity for reference

Distal Arm

Anterior midline of the second metatarsal


Ankle foot 2

 Patient Instruction

Ask the patient to turn their foot in.


Ankle foot 2

 Normal End Feel

Firm, because of tension in:

  • Joint capsule

  • Anterior & posterior talofibular ligaments

  • Calcaneofibular ligament

  • Anterior, posterior & interosseous talocalcaneal ligament

  • Dorsal calcaneal ligaments

  • Dorsal calcaneocuboid ligament

  • Dorsal talonavicular ligament

  • Lateral band of bifurcate ligament

  • Transverse metatarsal ligament

  • Dorsal, planter, interosseous cuboidonavicular, cuneonavicular, intercuneiform, cuneocuboid, TMT, & intermetatarsal joints

  • Peroneus longus & brevis muscles


Inversion muscle
Inversion Muscle

Tibialis posterior


Tibialis posterior
Tibialis Posterior

Origin:

Shaft of tibia + interosseous membrane + shaft of fibula + deep transverse

fascia + intermascualr septum

Insertion:

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

Innervation:

Tibial Nerve (L4-L5, & sometimes S1)


Ankle foot 2

 Patient Position

Short sitting with ankle in slight planter flexion

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

 Therapist and Patient Instructions  

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 is placed around the posterior ankle just above the malleoli. Resistance is given in the direction of eversion and toward slight 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 let me push it out.”


Ankle foot 2

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

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

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

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

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

Grade 0 (Zero): no palpable contraction

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


Ankle foot 2

 Substitution 


Ankle foot 2

Eversion: relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longus

Tarsal Joints


Ankle foot 2

 Range of motion relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longus

0° – 25 °

Testing position

Short sitting with knee flexed to 90° & the lower leg over the edge of the supporting surface

Stabilization

Stabilize the tibia and fibula to prevent:

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


Ankle foot 2

 Goniometer Alignment relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longus

Fulcrum

Anterior aspect of the ankle midway between the malleoli

Proximal Arm

Anterior midline of the lower leg, using the tibial tuberosity for reference

Distal Arm

Anterior midline of the second metatarsal


Ankle foot 2

 Patient Instruction relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longus

Ask the patient to turn their foot out.


Ankle foot 2

Normal End Feel relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longus

Hard, because of tension in:

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

    Or

    Firm, because of tension in:

  • Joint capsule

  • Deltoid ligament

  • Medial talocalcaneal ligament

  • Planter calcaneonavicular ligament

  • Calcaneocuboid ligament

  • Dorsal talonavicular ligament

  • Medial band of bifurcate ligament

  • Transverse metatarsal ligament

  • Dorsal, planter, interosseous cuboidonavicular, cuneonavicular, intercuneiform, cuneocuboid, TMT, & intermetatarsal joints

  • Tibialis posterior muscles


Ankle foot 2

Foot Eversion With Planter Flexion relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longus


Foot eversion with planter flexion muscles
Foot Eversion With Planter Flexion Muscles relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longus

Peroneus Longus

Peroneus brevis


Peroneus longus
Peroneus Longus relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longus

Origin:

Head & shaft of fibula + lateral condyle of tibia + fascia cruris +

intermascular septum

Insertion:

1st metatarsal + medial cuneiform + occasionally from other metatarsals

Innervation:

Superficial Peroneal Nerve (L5-S1)


Peroneus brevis
Peroneus Brevis relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longus

Origin:

Shaft of fibula + crural intermascular septum

Insertion:

5th metatarsal

Innervation:

Superficial Peroneal Nerve (L5-S1)


Ankle foot 2

 Patient Position relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longus

Short sitting with ankle in neutral position

Test For Grades 5, 4, 3 and 2

 Therapist and Patient Instructions  

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


Ankle foot 2

Grade 5 (Normal): relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longuscompletes full range of motion and holds against maximal resistance.

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

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

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

Grading


Ankle foot 2

 Patient Position relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longus

Short sitting or supine

 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 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.

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 5th metatarsal. The belly of the muscle can be palpated on the lateral surface of the distal leg over the fibula

Test For Grades 1 and 0


Ankle foot 2

Grade 1 (Trace): relaxed to prevent substitution by the Flexor digitorum longus & Flexor hallucis longuspalpation will reveal contractile activity in either or both muscles, which may cause the tendon to stand out. No motion occurs

Grade 0 (Zero): no palpable contraction

Grading


Ankle foot 2

  • To Isolate Peroneus Longus give resistance against the planter surface of the head of the 1st metatarsal in a direction toward invesion & dorsiflexion.

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

 Notes 


Ankle foot 2

Inversion: Subtalar Joint planter surface of the head of the 1

(Rearfoot)


Ankle foot 2

 Range of motion planter surface of the head of the 1

0° –5 °

Testing position

Prone

Stabilization

Stabilize the tibia and fibula to prevent:

lateral rotation of knee + lateral rotation & abduction of hip


Ankle foot 2

 Goniometer Alignment planter surface of the head of the 1

Fulcrum

Posterior aspect of the ankle midway between the malleoli

Proximal Arm

Posterior midline of the lower leg

Distal Arm

Posterior midline of the calcaneus


Ankle foot 2

 Patient Instruction planter surface of the head of the 1

Ask the patient to turn their foot in.


Ankle foot 2

 Normal End Feel planter surface of the head of the 1

Firm, because of tension in:

  • Lateral Joint capsule

  • Anterior & posterior talofibular ligaments

  • Calcaneofibular ligament

  • Anterior, posterior & interosseous talocalcaneal ligament


Ankle foot 2

Eversion: planter surface of the head of the 1

Subtalar Joint (Rearfoot)


Ankle foot 2

 Range of motion planter surface of the head of the 1

0° –5 °

Testing position

Prone

Stabilization

Stabilize the tibia and fibula to prevent:

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


Ankle foot 2

 Goniometer Alignment planter surface of the head of the 1

Fulcrum

Posterior aspect of the ankle midway between the malleoli

Proximal Arm

Posterior midline of the lower leg

Distal Arm

Posterior midline of the calcaneus


Ankle foot 2

 Patient Instruction planter surface of the head of the 1

Ask the patient to turn their foot out.


Ankle foot 2

Normal End Feel planter surface of the head of the 1

Hard, because of tension in:

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

    Or

    Firm, because of tension in:

  • Deltoid ligament

  • Medial talocalcaneal ligament

  • Tibialis posterior muscles


Ankle foot 2

 Good Luck To You All  planter surface of the head of the 1