HVLA

Question 1

Posterior fibular head

Answer 1

• flex hip and knee to 90
• place MCP of one hand on posterior aspect of fibular head
• use other hand to evert, dorsiflex, abduct, and externally rotate the leg
• exert rapid knee flexion with anterior thrust on fibular head

Question 2

Anterior fibular head

Answer 2

• pt supine
• us one hand to inver, adduct, IR, and slightly plantar flex foot
• place thenar eminance over anterolateral aspect of fibular head
• slightly flex the knee
• exert posteromedial thrust through fibular head

Question 3

Posterior tibia on talus

Answer 3

• restricted to anterior glide; ankle prefers plantarflexion
• pt supine[; wrap hands around foot with fingers interlaced on dorsum of foot
• thumbs are placed over the ball of the foot
• dorsiflex at the ankle
• apply traction while increasing dorsiflexion of foot
• apply an HVLA axial “tug”

Question 4

Anterior tibial on talus

Answer 4

• Restricted to posterior glide; ankle prefers dorsiflexion
• One hand cups the calcaneus, other hand over distal tibia
• distract caudally
• thrust is posterior on the distal tib-fib complex with axial “tug” on calcaneus

Question 5

Posterior lateral malleolus

Answer 5

• pt prone, doc at foot of table
• contacts with hand of same side of df foot
• wraps fingers around dorsal foot
• plantarflex the foot
• thumb of lateral hand contacts the posterior aspect of distal fibula, with thumb of opposite hand on top
• thrust with thumbs is anterior

Question 6

Anterior lateral malleolus

Answer 6

• pt supine, doc at foot
• contacts with opposite hand of df foot, wrapping fingers around calcaneus
• dorsiflex the foot
• thumbs of lateral hand contact the anterior aspect of distal fibula, with thumb of other hand on top
• thrust with thumbs is posterior

Question 7

Plantar flexed talus

Answer 7

• pt supine
• interlock fingers and grab dorsum of foot so that the 4th or 5th digit of both hands contacts the head of the talus
• thumbs are placed over the ball of the foot
• dorsiflex at the ankle
• apply traction
• apply HVLA axial tug to re-seat the talus in the mortise of the ankle

Question 8

Dorsiflexed talus

Answer 8

• pt supine
• interlock fingers over dorsum of foot
• plantar flex at the ankle
• apply traction
• apply HVLA tug to reseat the talus in the mortise of the ankle

Question 9

Eversion-inversion calcaneus “Ankle Tug”

Answer 9

• pt supine, doc at foot of table
• contact calcaneus with one hand
• other hand contacts the dorsum of foot in mid-tarsal region
• distract and thrust in a linear directoin

Question 10

Plantar metatarsal

Answer 10

• pt supine
• grab both sides of MTP joint
• Engage restrictive barrier and distract
• apply hyperflexion HVLA thrust

Question 11

Transtarsal thrust of navicular cuboid

Answer 11

• pt supine with ipsilateral extremity slightly flexed, ER, and abducted, lateral aspect of foot flat on the table
• contact calcaneus with one hand
• contact the talus and first metatarsal/cuneiform/navicular with the other hand
• for cuboid: invert the fore-foot/mid-foot into barrier
• for navicular: evert
• thrust: cuboid (inversion); navicular (eversion)

Question 12

HIss Whip

Answer 12

• can apply this technique to any of the plantar tarsal dfs
• pt pron, flex hip and knee slightly and drop pt’s leg off side of table
• grab foot with both hands and place thumbs in V shape over plantar surface of affected tarsal
• plantar flex ankle and induce dorsal force on df tarsal
• thrust dorsally with thumbs in a whip-like manner