Ankle and Foot ROM/MMT` Flashcards
what occurs at the tibiofibular joint during dorsi/plantar
dorsi - fibula moves proximally / slightly poseriorly to tibia
plantar - fibula moves distally and slightly anteriorly to tibia
what is the talocrual joint
articulation between distal tib-fib and talus
talocrual degrees of freedom
1 - dorsi and plantarflexion in sagittal
what axis do inversion/eversion occur around
oblique
what motions make up inversion
adduction, plantar flexion and supination
what motions make up eversion
abduction, dorsiflexion, pronation
what joint allows for inversion/eversion
subtalar (talocaneal)
what is the subtalar joint composed of
three articulations between calcaneus and talus
what makes up the midtarsal joint?
talonavicular and calcaneocuboid joints
what is the transitional link between the forefoot and hindfoot?
transverse tarsal joint / midtarsal jt
motions at TMT joints
flexion/extension minimal ab/add or rotation
DoF at the MTP
2
flexion/extension
ab/add
DoF at the IP jt
1
flexion/extension
ROM for dorsiflexion / end feel
20
firm
goniometer alignment for ankle ROM (dorsi/plantar)
axis - lateral malleolus
SA - midline of fibula aimed at head of fibula
MA - parallel to lateral aspect of 5th metatarsal
what is the mean ROM for ankle plantarflexion? end feel?
50
firm
what plane are inversion/eversion measured in for ROM
frontal plane
ant-posterior axis
goniometer placement for inversion/eversion
axis - anterior ankle between malleoli
SA - midline of lower leg aimed at tibial tuberosity
MA - along midline of 2nd metatarsal
average ROM for inversion and eversion in the rearfoot? end feel?
5 each way
firm
how is rearfoot inversion/eversion measured w goniometer?
axis - posterior aspect of ankle between malleoli
SA - posterior midline of leg
MA - posterior midline of calcaneus
what would rearfoot inversion/eversion testing be for?
to see what the resting position of one’s ankle is
ensure subtraction of resting from end angle when testing
mean ROM for inv/eversion at forefoot? end feel?
inversion - 35
eversion - 15
normal ROM for 1st TMT flexion / extension
flex - 45
extension - 70
normal ROM for 2-5 TMT flex vs 2-5 TMT ext
flex- 40
extension - 40
goniometer placement for TMT flex/exten
axis - dorsal surface of MTP joint
SA - midline of metatarsal
MA - midline of proximal phalanx
goniometer placement for MTP abd/add
axis - dorsal aspect of MTP joint
SA - dorsal midline of metatarsal
MA - dorsal midline of proximal phalanx
mean 1st IP flexion/extension ROM
flex - 90
ext - 0
mean 2nd-5th PIP flex/ext ROM
flex - 35
ext - 0
mean 2nd-5th DIP flex/ext ROM
flex - 60
ext - 0
goniometer placement for IP flex/ext
axis - dorsal aspect of joint
SA - midline of phalanx proximal to jt
MA - midline of distal phalanx of JT
what muscles contribute to plantarflexion
gastrocnemius
soleus
how many raises = what strength grade for gastroc/soleus
2+ = clear the heel but not a full rep
3 = 1 to 9 full reps
4 = 10 to 24 full reps
5 = >25 reps
what could examples of fatigue be in the gastroc/soleus gravity resisted test
lack of full ROM
non-smooth reps
ratcheting on the way down
compensation of momentum
leaning on / putting too much weight into support
what is the gravity eliminated position for gastroc? soleus?
G =
side-lying on testing limb
hip/knee extended
S =
knee flexed instead of extended
how may someone substitute in the plantarflexion wb test
FHL or FDL - toe flexion / lack of calcaneus movement
fib long/brevis - eversion
tib posterior - invert
if knee is flexed, ______% of activity decreases in the ________
70% of activity in gastrocnemius
if a patient has a NWB restriction, how is plantarflexion tested?
prone with knee extended
foot off end of table
resistance applied to superoposterior aspect of calcaneus in direction of dorsiflexion
differentiation = knee flexed for soleus
what muscle does dorsiflexion/subtalar inversion
tibialis anterior
gravity resisted position for dorsiflexion/subtalar inversion?
seated w knees flexed off edge of table
asked to pull foot up and in
resistance applied over the dorsal surface of medial foot in direction of plantar flexion and eversion
gravity eliminated testing of dorsiflexion/subtalar inversion
supine with hips/knees extended ankle in neutral with foot off of table
told to pull foot up and in
what muscle produces subtalar inversion
tibialis posterior
gravity resisted position for tibialis posterior
sidelying on side of tested limb with foot hanging off of the table
asked to turn bottom of foot toward ceiling
resistance applied to medial aspect of foot in direction of eversion
gravity eliminated testing position of tibialis posterior
supine with foot of testing limb extended off edge of table
patient asked to invert
what muscles may be substituted when testing tibialis posterior
long toe flexors
what muscles allow for subtalar eversion?
fib long/brevis
gravity resisted fibularis longus / brevis test
sidelying with uppermost limb being the tested limb
ankle in neutral with foot off of the table
asked to turn bottom of foot toward the ceiling
resistance applied over lateral border of foot and plantar surface toward inversion
how are fibularis longus / brevis resistance points different
brevis - at 5th metatarsal
longus - at 1st metatarsal
gravity eliminated test for fibularis longus/brevis
supine with limb being tested off of the table
asked to evert
what muscles contribute to MTP flexion
lumbricals
flexor hallucis brevis
gravity resisted test for lumbricals and flexor hallucis brevis
seated or supine with ankle in neutral and feet off edge of table
patient asked to bend toes at first knuckle
resistance over proximal phalanx of
1st toe = flexor hallucis brevis
2-5 toe = lumbricals
gravity eliminated positioning for lumbricals and flexor hallucis brevis
no test for below 3
2 = flex through partial range
muscles that contribute to IP flexion
big toe = flexor hallucis longus
every other = FDL / FDB
gravity resisted test for flexor hallucis longus, FDL or FDB
supine or sitting with feet extended off of table
patient is asked to curl toes down
resistance applied against toward extension
FDL/B = middle / distal phalanges of lateral 4 toes
FHL = distal phalanx of big toe
gravity eliminated test for FDL/B or FHL
no gravity eliminated test
what muscles perform MTP extension
Extensor Digitorum Longus
Extensor Digitorum Brevis
gravity resisted test for EDL/B
seated or supine with feet extended off of table
patient asked to extend their toes
resistance applied over dorsum of proximal phalanx toward flexion
muscle that performs IP extension
extensor hallucis longus
gravity resisted positioning for extensor hallucis longus
seated or supine with feet extended off of table
patient asked to extend their toes
resistance applied over dorsum of distal phalanx toward flexion
