Comp 10 Ankle/Foot

Question 1

10b: perform HVLA treatments for posterior/anterior lateral malleolus ankle somatic dysfunction

Answer 1

• diagnostic: grab lateral malleolus to glide it anteriorly and posteriorly
• for posterior lateral malleolus, ease of motion is to posterior glide relative to distal tibia, and restrictive barrier is to anterior glide relative to distal tibia.
• for anterior lateral malleolus, ease of motion is to anterior glide relative to distal tibia, and restrictive barrier is to posterior glide
• for posterior lateral malleolus dysfunction, pt prone with ipsilateral hip and knee extended and student at foot of table. Wrap hands around foot and ankle, placing both thumbs (one on top of the other) onto posterior aspect of lateral malleolus (distal fibula). Engage restrictive barrier by applying anterior force on lateral malleolus and applying a simultaneous plantarflexion force to ankel. Once barrier is engaged, apply anterior HVLA thrust to lateral malleolus with thumbs
• for anterior lateral malleolus dysfunction, pt supine with ipsilateral hip and knee extended and student at foot of table. Wrap hands around foot and ankle, placing both thumbs (one on top of other) onto anterior aspect of lateral malleolus (distal fibula). Engage restrictive barrier by applying posterior force on lateral malleolus and applying some dorsiflexion force to ankle. Once barrier is engaged, apply a posterior HVLA thrust to lateral malleolus with thumbs.
• reassess anterior/posterior glide of lateral malleolus and note restoration of normal motion.
• document in plan portion of SOAP note as HVLA of ankle

Question 2

10c: Perform HVLA treatment for plantarflexed/dorsiflexed talus somatic dysfunction

Answer 2

• diagnostic for plantarflexed talus: ease of motion of talus is to plantarflexion and restrictive barrier to dorsiflexion. 50-65 plantarflexion expected. Note this dysfunction is due to changes in talus mechanics, not distal tibia
• diagnostic for dorsiflexed talus: ease of motion of talus is to dorsiflexion and restrictive barrier to plantarflexion. 15-20 expected for dorsiflexion. Note this dysfunction is due to changes in talus mechanics, not distal tibia
• pt supine with ipsilateral hip and knee extended and student at foot of table
• interlock fingers and grasps dorsum of foot so that the 4th or 5th digit of both hands contacts head of talus, and thumbs are contacting plantar surface.
• for plantar flexed talus: engage restrictive barrier by applying a dorsiflexion force to ankle with simultaneous axial traction. Once barrier is engaged, apply axial leg tug HVLA thrust toward student. This reseats talus in ankle mortise
• for dorsiflexed talus: engage restrictive barrier by applying plantarflexion force to ankle with simultaneous axial traction. Once barrier is engaged, apply axial leg tug HVLA thrust toward student. This reseats talus in ankle mortise.
• reassess plantarflexion/dorsiflexion of talus and note restoration
• document in plan portion of SOAP note as HVLA of foot

Question 3

10a: Perform HVLA treatments for a posterior tibia on talus ankle somatic dysfunction and anterior tibial on talus somatic dysfunction

Answer 3

• diagnostic for posterior tibial on talus: distal tibia is restricted to anterior glide relative to talus with ease of motion toward posterior glide and has associated ease of motion to ankle plantarflexion. Note this ankle dysfunction is due to changes in distal tibia mechanics, not the talus
• diagnostic for anterior tibia on talus: distal tibia is restricted to posterior glide relative to talus with ease of motion toward anterior glide and has associated ease of motion to ankle dorsiflexion. Note this ankle dysfunction is due to changes in distal tibia mechanics, not the talus
• place pt supine with ipsilateral hip and knee extended (leg flat on table) and stand at foot of table
• for posterior tibia: contact foot and ankle by wrapping hands around foot with fingers interlaced on dorsum of foot, and thumbs are placed on plantar aspect of ball of foot. Engage restrictive barrier by dorsiflexing at ankle and applying and axial traction while increasing dorsiflexion of foot. Once restrictive barrier is engaged, apply axial tug HVLA thrust
• for anterior tibia on talus: cup calcaneus with one hand and contact anterior aspect of distal tibia with other. Engage restrictive barrier by applying a distractive force caudally on calcaneus with some plantarflexion and applying a simultaneously posterior force on distal tibia. Once restrictive barrier is engaged, apply axial tug HVLA thrust to calcaneus and a posterior thrust on distal tibia
• reassess anterior/posterior glide of distal tibia and note resolution
• document on plan portion of SOAP note as HVLA of anle

Question 4

10d: Perform HVLA treatment for inverted calcaneus somatic dysfunction and everted calcaneus somatic dysfunction

Answer 4

• diagnostic for inverted: ease of motion of calcaneus is to inversion and restrictive barrier is to eversion. Note expected talocalcaneal inversion is 5, and dysfunction is due to changes in subtalar mechanics.
• diagnostic process for everted: ease of motion of calcaneus is to eversion and restrictive barrier is to inversion. Note expected talcalcaneal eversion is 5, and dysfunction is due to changes in subtalar mechanics.
• pt supine with ipsilateral hip and knee extended and student at foot of table
• Cup calcaneus with one hand with other hand draped over dorsum of foot (mid-tarsal region)
• For either calcaneus dysfunction, engage restrictive barrier by applying axial traction force to calcaneus first with hand in contact with it and then adding traction force with other hand on dorsum of foot
• once restrictive barrier is engaged, apply axial leg tug HVLA thrust toward self. This re-seats the calcaneus with the talus.
• Reassess inversion and eversion of calcaneus and note restoration of normal motion
• document in plan portion of SOAP note as HVLA of foot

Question 5

10e: Perform HVLA treatment for plantar metatarsal somatic dysfunction

Answer 5

• diagnostic: ease of motion of distal metatarsal is to plantar glide and restrictive barrier is to dorsal glide. Note food dysfunction is due to changes in forefoot (metatarsal heads) mechanics
• pt supine with ipsilateral hip and knee extended with student at foot of table
• grasp metatarsal head with thumb and index finger of one hand and other thumb and index finger grasps proximal phalanx
• engage restrictive barrier by applying a distractive force to metatarsal phalangeal joint
• once restrictive barrier is engaged, apply a hyperflexion HVLA thrust force on metatarsal head
• reassess dorsal/plantar glide of distal metatarsal and note restoraion of normal motion
• document in plan portion of SOAP note as HVLA of foot

Question 6

10f: perform trans-tarsal HVLA treatment for a plantar navicular somatic dysfunction

Answer 6

• Diagnostic: ease of motion of navicular to plantar glide, and restrictive barrier is to dorsal glide. Note lateral aspect of navicular drops plantar and that this dysfunction is most common navicular dysfunction
• pt supine with ipsilateral extremity slightly flexed, externally rotated and abducted to lateral aspect of foot is on table
• stabilize ankle (hind-foot) to table by contacting calcaneus/talus with one hand
• use other hand to contact talus and first metatarsal/first cuneiform/navicular (mid-foot/fore-foot)
• engage restrictive barrier by everting fore-foot/mid-food (roll fore-foot toward table)
• once restrictive barrier is engaged, provide HVLA thrust toward eversion of fore-foot
• reassess navicular plantar and dorsal glide and note restoration of normal motion
• document in plan portion of SOAP note as HVLA to foot

Question 7

10g: Perform trans-tarsal HVLA treatment for a plantar cuboid somatic dysfunction

Answer 7

• diagnostic process: ease of motion of cuboid is to plantar glide and restrictive barrier is to dorsal glide. Note medial aspect of cuboid drops plantar and that this foot dysfunction is the most common cuboid dysfunction
• pt supine with ipsilateral extremity slightly flexed, externally rotated, and abducted so lateral aspect of foot is on the table
• stabilize ankle (hind-foot) to table by contacting calcaneus/talus wiht one hand
• use other hand to contact talus and first metatarsal/first cuneiform/navicular (mid-foot/fore-foot)
• engage restrictive barrier by inverting fore-foot/mid-foot
• once engaged, provide HVLA thrust toward inversion of fore-foot
• reassess cuboid plantar and dorsal glide and note restoration of normal motion
• this will be documented in plan portion of SOAP note as HVLA to foot

Question 8

10h: Perform Hiss-Whip HVLA treatment for a plantar cuneiform somatic dysfunction

Answer 8

• diagnostic: ease of motion of cuneiforms is to plantar glide and restrictive barrier is to dorsal glide. Note this is the most common cuneiform dysfunction
• Pt prone with ipsilateral extremity off edge of table and hip and knee slightly flexed
• grasp forefoot by wrapping fingers around dorsum of foot. thumbs (one on top of other) contact plantar aspect of named cuneiform dysfunction
• engage restrictive barrier by providing plantar flexion force at ankle and a simultaneous dorsal force to plantar aspect of dysfunctional cuneiform through thumbs
• once engaged, provide HVLA thrust toward plantar flexion at ankle and simultaneous dorsal glide on dysfunctional cuneiform in a whip-like fashion
• reassess cuneiform plantar and dorsal glide and note restoration of normal motion
• document in plan portion of SOAP note as HVLA to foot
• procedure could be applied to cuboid and navicular plantar dysfunctions

Question 9

10i: Perform ME treatment for a plantarflexed/dorsiflexed talus somatic dysfunction

Answer 9

• diagnostic for plantarflexion: ease of motion of talus is to plantarflexion and restrictive barrier is to dorsiflexion. 50-65 plantarflexion expected. Note ankle dysfunction is due to changes in talus mechanics, not distal tibia
• diagnostic for dorsiflexion: ease of motion of talus is to dorsiflexion and restrictive barrier is to plantar flexion. 15-20 dorsiflexion expected. Dysfunction due to changes in talus mechanics, not distal tibia
• pt supine with ipsilateral hip and knee extended. Student at foot of table
• for plantar flexed: stabilize ankle to table by contacting anterior aspect of distal tibia. Other hand contacts plantar aspect of foot. Engage restrictive barrier by applying a dorsiflexion force to ankle. Once engaged, pt provides activation force against resistance toward plantar flexion for 3-5s then relax (isometric relaxation). Engage new restrictive barrier by increasing dorsiflexion at talus. Repeat until no new barriers are met or full motion is restored.
• for dorsiflexion talus dysfunction: stabilize ankle by contacting anterior aspect of distal tibia. Other hand contacts dorsum of foot. Engage restrictive barrier by applying a plantar flexion force to ankle. Once engaged, pt provides activation force against resistance toward dorsiflexion for 3-5s then relax. Engage new barrier by increasing plantarflexion. Repeat until no new barriers.
• reassess plantarflexion/dorsiflexion of talus and note restoration of normal motion
• document in plan portion of SOAP note