Pt supine or long-sitting;PT stabilizes the tibia and fibula at malleoli, holds the Pts foot in 20 deg of PF, and draws ant.Compare L/R, excessive movement indicates + test for med+lat ligamentous instability(can also add inversion to test calcaneofibular and ant tibiocalcaneal lig)
Talar tilt for lig integrity
For ankle sprains-Pt S/L with injured leg on top, facing away from PT. PT sitting on corner of table, take pt’s foot in lap. Foot in neutral, one hand around front, one hand grasping heel, 2 thumbs on top forming triangle over the lat malleolus, fingers on bottom, tilt w/ both hands. Laxity indicates 2nd degree sprain.
(+Posterior laxity indicates 3rd degree sprain)*Adduction tests the calcaneofibular lig and maybe the talofibular lig. Abduction stresses DELTOID lig (“…tibio______” ligaments)
Squeeze/Compression test (Flynn calls this the “Squeeze and ER Test”)
Pt Supine. Examiner grasps the lower leg at midcalf and squeezes the tibia and fibula together. Move down to the ankle doing the same thing.pain indicates + test for possible fx, syndesmosis injury, compartment syndrome*Flynn does this w/ pt foot in DF/ER.
Prone. While the Pt is relaxed the examiner squeezes the calf muscles. The absence of PF when the muscle is squeezed indicates a + test for ruptured Achilles tendon
Pt long-sits or supine, knee ext.PT applies passive DF.Pain in the calf indicates a + sign for DVT. Tenderness also elicited on palpation of calf.
Pt prone, feet off edge of table.
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PT forcefully strikes the pt heel w/ heel of own hand. Pain indicates + test for tibia fx
Lateral Compression/Interdigital Neuroma Test
Pt supine, PT grasps the foot around the metatarsal heads and squeezes.Pain is suggestive of neuroma between 3 and 4.
Too Many Toes sign
Pt standing, PT behind – should see 2 to 2 ? toes; if you see 4 toes, indicates possible tortional pathology.
Tibial Torsion test/measureNormal?
-Pt to sit w/knees flexed to 90 deg over EOT. Measure axis of knee (down through the femoral condyles) and the axis of the ankle (thru malleoli). Normal angle is 12 – 18 deg. -Pt can lie supine with the proximal arm of the goni parallel to the floor and the distal arm thru the malleoli
Feiss Line test/measure
Pt supine. Draw imaginary line btwn med mal and head 1st metatarsal. Mark navicular tuberosity, note distance from the line (should be very close).
Pt stands, note distance of navicular tubercle from floor. -If the tuberosity drops, + test for flat-foot (1/3 of the distance to the floor= 1st deg; 2/3 = 2nd deg; Resting on floor = 3rd deg).
Navicular drop test
Pt standing. PT locates subtalar neutral (rock ankle laterally, then medially, then stop them in the middle).
Mark on index card the distance btwn navicular tuberosity and floor.Have pt stand naturally. Mark card again. Can quantify navicular drop this way- if there is a large difference, indicates + test for flatfoot.
Tinel’s Sign (ankle)
Pt supine;- 2-finger percussion in hollow of anterior ankle/foot. N/T indicates + sign for damage to tibial branch of deep peroneal nerve.
– 2-finger percussion just posterior to med mal; N/T indicates + sign for damage to post tibial nerve.
Test for Peroneal Tendon dislocation
Pt prone with knee flexed 90 degrees;Pt active PF with eve against the PT manual resistance.PT palpates dist to lat mal; If tendon subluxes from behind the lateral malleolus, indicates + test for peroneal tendon dislocation.
Joint play – talocrural traction; follow with talocrural AP glide
Pt supine, foot off EOT;Traction(distraction): PT seated, both hands grasp distal to malleoli & distract.AP: PT standing. Stabilize prox to malleoli.
Glide Ant/PF, and Post/DF to follow curvature of talus (or, up/out and down/in).
Joint play – subtalar rock
Pt S/L with injured leg on top, facing away from PT. PT sitting on corner of table, take pt’s foot in lap. Foot in neutral, one hand around front, one hand grasping heel, 2 thumbs on top forming triangle over the lat malleolus, fingers on bottom, tilt w/ both hands.
Apply slight distraction and then rock PF/DF. May feel clunk at end of range.
Joint play – subtalar side-tilt (general assessment – not for ankle sprain)
Pt supine. PT to grasp both sides of ankle and rock back and forth (fingers should cup around the Achilles tendon, both thumbs point up the leg)
Joint play – Midtarsal AP glide + rotation
Stabilize distal to malleoli. Other hand grasps around distal row of tarsals (cuneif’s + cuboid) ; Displace A/P then rotate back and forth
Joint play – Tarsometatarsal AP + rotation
Pt supine. Stabilize prox carpals (cuneif’s + cuboid). Other hand grasps around metatarsals; Displace A/P then rotate back and forth
Joint plays – Distal tibiofibular joint
Pt supine, feet/ankles off EOT. Do anterior glide only. Stabilize tibia.
Pt long-sitting w/ ankle and lower leg off EOT. Start btwn tib ant tendon and lat mal -> medial, distal to navicular tub -> around foot to just prox of base of 5th meta (tuberosity) -> medial ankle just distal to mal -> across achilles to lateral ankle just distal to mal ->starting position. Record 3X and take average.