Knee- ankle- foot Lab

Question 1

Patellar tap test

Answer 1

Purpose: to assess knee swelling

Patient: supine with leg extended
Look for temp, color
- PT puts pressure on the proximal side of the knee in an effort to squeeze the fluid out of the suprapatellar pouch. the fluid can be moved under the patella while maintaining the pressure on the suprapatellar pouch.. PT can add additional pressure to medial and lateral joint line forcing the fluid under the patella. tap down the patella with the index finger.

Pos test- palpable click as the patella hits the underlying femur

neg test- the femur and the patella are already in contact. the test can be false positive; therefore, we must always test both sides to compare

Question 2

Bulge, wipe, or stroke test/ fluid displacement test

Answer 2

purpose: to assess knee swelling
Patient: supine with leg extended
- PT strokes upwards with the edge of the hand on the medial side of the knee to “milk” the fluid 10 cm proximal of the patella into the lateral compartment. PT continues pushing the fluid downwards on the lateral side. the test is pos if the PT sees fluid moving towards the medial side of the knee

Question 3

knee flexion with OP

Answer 3

Purpose: to assess joint mobility and rule out associated joint problems
Patient: supine, head on pillow
-Patient is asked to actively flex their knee as far as they can. PT holds the patients foot at the dorsum and places other hand on patient’ anterior thigh right above the knee. PT adds flexion pressure to the patient’s knee. PT asks the patient if they have any pain at each progression into deeper flexion, ex “any pain, any pain, any pain”

Question 4

knee flexion abduction with overpressure

Answer 4

Purpose: to assess joint mobility and rule out associated joint problems

-PT holds the patients foot at the dorsum and places their other hand on the patient’s thigh slightly superior to the knee. PT points the patients calcaneus laterally, away from the center of the patient’s body. PT gives aan abduction force to the foot while knee is taken into deep flexion. PT asks the patient if they have any pain at each progression into deeper flex/abduction, ex “any pain, any pain, any pain”

Question 5

knee flexion adduction with OP

Answer 5

Purpose: to assess joint mobility and rule out associated joint problems

• PT holds the patinet’s foot at the dorsum and places their other hand on the patient’s thigh slightly superior to the knee. PT points the patient’s calcaneus medially , toward the center of the patient’s body. PT gives an adduction force to the foot while knee is taken into deep flexion. PT asks the patient if they have any pain at each progression nto deeper flexion/adduction ex “any pain x3”

Question 6

Knee extension with OP

Answer 6

Purpose: to assess joint mobility and rule out associated joint problems

-Patient is asked to actively extend their knee. PT holds the patients leg at the ankle and places their other hand on patient’s tibial tuberosity. PT gives a posterior force to the patients above the knee and an anterior force at the ankle. PT asks the patient if they have any pain at each progression

Question 7

knee extension abduction with OP

Answer 7

Purpose: assess joint mobility and rule out associated joint problems
. Patient is supine heel facing out
-PT holds the patients leg at the ankle and place other hand on patient’s anterior thigh slightly below the knee. PT takes the patient’s leg into IR. PT then gives a post force to the patient below the knee and a anterior force at the ankle. therapist asks if they have any pain at each progression

Question 8

extension add with OP

Answer 8

Purpose: knee clearing

• Patient is supine with tibia ER. heel facing in
• Patient is asked to relax. place cephalad hand on prox tibia and caudad hand under medial side of distal tibia/fibula. stabilize prox tibia with cephalad hand. gently pull up on distal tibia with caudad hand in three increments of OP. asks patient if they feel any pain with each increase in force

Question 9

Tibiofemoral anterior and posterior glides

Answer 9

Purpose: knee clearing
patient is supine with knee flexed to 25 deg
- Patient is asked to relax. PT places both hands on the tibia and grasps the tibia. PT stabilizes the patient’s foot by sitting on foot. therapist pulls anteriorly and pushes posteriorly. assess for joint accessory mobility and pain reproduction.

Question 10

Tibial IR and ER

Answer 10

Purpose: knee clearing
Supine with hip and knee flexed to 90 deg
- Patient is asked to relax.lock leg under medial arm and support medial side of tibia/fibula with hand under calcaneus. place lateral hand around forefoot and lock ankle into DF (close pack). rotate tibia through foot with lateral hand. assess motion as you rotate foot internally and externally

Question 11

Tibial torsion

Answer 11

Purpose: measure tibial torsion
sitting at edge of table
- PT places the goniometer at the heel of the foot. stationary arm is lined up with an imaginary line through the femoral condyles. Moving arm is lined up with an imaginary line through the malleoli. normal is 12-18 deg

Question 12

Superior tibia-fibula mobility assessment

Answer 12

Purpose: assess mobility and treatment of superior tibia-fibula
-patient is supine and relaxed. knee is flexed to 90 deg. push gastroc head out. grasp the fibular head. assess the mobility of the fibular head in a posterior/medial and anterior/lateral direction.
(+) test = decreased mobility or reproduction of symptoms

Question 13

eccentric step test

Answer 13

purpose: quality of movement. provocative test for patella femoral pain
- Patient stands on top of 8 in platform or step. subject asked to step forward and down toward the floor. the descending limb brushed the floor with the heel and then is brought back up to the step. that is one rep. make sure each rep such that the step limb is not used to accelerate back onto the step. the number of reps the subject performs in 30 sec is recorded. both limbs are tested. (+) test is pain reproduction

Question 14

grind scour test

Answer 14

Purpose: provocative test for patellofemoral pain

-apply a compression load to the patella. apply a rotational grinding force. (+) test is reproduction of the patient’s patellofemoral pain

Question 15

Clarke’s sign

Answer 15

Purpose: provocative test for patellofemoral pain
- Patient is supine with knees extended. PT applies pressure distal with the web space of their hand over the superior pole of the patella. PT asks the patient to contract the quadriceps muscle while maintaining pressure on the patella. (+) is failure to complete contraction because of pain; my indicate patellofemoral pain syndrome

Question 16

Patellar lateral tilt test

Answer 16

Purpose: provocative test for patellofemoral pain, knee pain with mobility deficit
- Patient is supine. stabilize ankle in neutral rotation. lift lateral edge of patella from the lateral femoral condyle , using thumb and index finger on both hands
(+) if patella moves out of the trochlear groove
(+) for hypomobility if the patella cannot tilt >15 deg from the neutral plane

Question 17

medial patellar plica test

Answer 17

Purpose: special test for medial patellar plica

-supine fully flex the knee
- internally rotate the tiia with the grasping hand at the ankle. add a medial glide to the patella. then extend the knee
(+) Popping or clicking or reproduction of symptoms

Question 18

Gerdy’s tubercle palpation

Answer 18

-Purpose: identify irritation or tenderness of iliotibial band

identify and palpate tibial tuberosity. identify and palpate head of the fibula. between tibial tuberosity and head of fibula, below the joint line, palpate for gerdy’s tubercle. palpate for gerdy’s tubercle for symptoms reproduction

Question 19

Thessaly’s test

Answer 19

Purpose: provocative test for meniscus pathology

have patient stand on one leg and flex knee to about 20 deg. PT supports patient by holding patient’s outstretched hand. while holding take patient through 3 full rotations. (+) with medial or lateral joint line discomfort; may have a sense of locking or catching

Question 20

McMurray’s Test

Answer 20

Purpose: Provocative test for meniscus pathology
1. Examiner stands to the side of the patient’s involved knee 2. Examiner grasps the patient’s heel and flexes the knee to end range with one hand while using the thumb and index finger of the other hand to palpate the medial and lateral tibiofemoral joint line 3. To test medial meniscus, examiner rotates the tibia into external rotation, then slowly extends the knee with a varus stress 4. To test the lateral meniscus, examiner flexes the knee again, internally rotates the tibia and slowly extends the knee while applying a valgus stress 5. (+) Test is indicated by an audible or palpable “thud” or “click”

Question 21

Apley’s Compression

Answer 21

Purpose: Provocative test for meniscus pathology
1. Therapist stabilizes patient’s femur with one hand and grasps heel with other hand 2. Therapist medial and laterally rotates tibia with compressive force 3. (+) Test = pain/clicking; may indicate meniscal lesion

Question 22

Lachman’s test

Answer 22

Purpose: Provocative test for ACL pathology
1. Flex patient’s knee to 15 degrees 2. Examiner stabilizes the distal femur with one hand and grasps behind the proximal tibia with the other hand 3. Examiner then applies an anterior tibial force to the proximal tibia 4. Assess for joint displacement with thumbs on the joint line 5. (+) Test is indicated by greater anterior tibial displacement on the affected side when compared to the unaffected side

Question 23

Anterior Drawer Test

Answer 23

Purpose: Provocative test for ACL pathology
1. Knee is flexed between 60 degrees and 90 degrees with the foot on examination table 2. Examiner draws tibia anteriorly 3. (+) Test indicated by greater anterior tibial displacement on the affected side when compared to the unaffected side

Question 24

Posterior Sag Test

Answer 24

Purpose: Identify PCL pathology
1. Patient is supine with knee flexed to 90 degrees and hips at 45 degrees flexion 2. (+) Test = tibia sagging back on femur and may indicate posterior cruciate ligament injury

Question 25

Posterior Drawer Test

Answer 25

Purpose: Provocative test for PCL pathology
1. Patient is supine with knees flexed to 90° and the hip flexed to 45° 2. Therapist stabilizes the lower leg by sitting on the forefoot 3. Therapist grasps patient’s proximal tibia with both hands, thumbs on tibial plateaus, and administers posterior force 4. (+) Test = excessive posterior translation, diminished, or absent end point.; may indicate PCL injury

Question 26

Varus stress Test

Answer 26

Purpose: Provocative test for LCL pathology
1. Patient is supine with knee flexed 20-30° 2. Therapist places one hand on lateral ankle and the other hand on medial knee 3. A varus force is applied with distal hand 4. (+) Test = excessive varus movement, may indicate LCL ligament sprain

Question 27

Valgus Stress test

Answer 27

Purpose: Provocative test for MCL pathology
1. Patient is supine with knee flexed 20-30° 2. Therapist places one hand on medial ankle and the other hand on lateral knee 3. A valgus force is applied with distal hand 4. (+) Test = excessive valgus movement, may indicate MCL ligament sprain

Question 28

Apley’s Distraction

Answer 28

Purpose: Provocative test for ligamentous pathology
1. Therapist stabilizes patient’s femur with 1 hand and grasps heel with other hand 2. Therapist medial and laterally rotates tibia with distractive force 3. (+) Test = pain or laxity may indicate collateral ligament lesion

Question 29

Anterior- Posterior Glide with Distraction

Answer 29

Purpose: To increase extension or flexion
1. Therapist applies a distraction force to the ankle with a mobilization belt or with the therapist’s knees 2. An anterior glide mobilization or posterior glide mobilization force is applied on proximal tibia

Question 30

Anterior Glide Tibial Mobilization

Answer 30

Purpose: To increase extension
1. Patient is positioned at end of table with femur stabilized on a towel 2. The uninvolved limb stabilized with a mobilization belt 3. The therapist grasps the involved ankle 4. Apply anterior glide force to the proximal tibia

Question 31

MWM Internal Rotation with Knee Flexion

Answer 31

Purpose: Pain control and increase in weightbearing ROM of knee; increase knee flexion
1. With patient in standing have them step up onto a 6” step 2. Apply a posterior force through the tibia and an anterior force through the fibula 3. Have the patient move forward to increase knee flexion 4. Return to original position and release the pressure

Question 32

MWM Posterior Glide with Knee Flexion

Answer 32

Purpose: To increase pain free knee flexion
1. Therapist interlocks their hands over the tibia and femur anteriorly and posteriorly 2. Apply a posterior glide to the anterior tibia 3. Ask the patient to actively flex the knee 4. A mobilization belt can be used by the patient to apply the over pressures 5. Multiple repetitions should be done 6. Modify the angle of mobilization force to abolish pain

Question 33

Supine MWM Medial and Lateral Glide with Knee Flexio

Answer 33

Purpose: To increase pain free knee flexion
1. A lateral glide or medial glide is applied to the tibia manually 2. Patient is asked to actively flex the knee 3. The patient can use a mob belt attached at the ankle to add passive overpressures at end range of flexion 4. Multiple repetitions can be done 5. Modify direction of glides abolish symptoms

Question 34

Prone MWM Medial and Lateral Glide with Knee Flexion

Answer 34

Purpose: To increase pain free knee flexio
1. A lateral glide or medial glide is applied to the tibia via the mobilization belt 2. Therapist fastens the belt around their bottom and sits into the belt to apply the mobilization 3. Patient is asked to actively flex the knee 4. The therapist can apply a passive overpressure force at the end range 5. Multiple repetitions can be done 6. Modify direction of glides to abolish symptoms

Question 35

Patellar accessory mobility assessments/mobilization

Answer 35

Purpose: Assess patellar mobility
1. Cup the patella between the two hands forming a diamond shape with the thumb and index finger 2. Glide the patella superior/inferior 3. Glide the patella medial/lateral 4. Tilt the patella medial and lateral 5. Compare the uninvolved to involved side

Question 36

Lateral Patellar Glides

Answer 36

Purpose: Improve patellar mobility
1. Shoulders over patient’s knee, caudad hand supporting distal leg, cephalad over the medial border of the patella 2. Therapist’s thenar eminence of the more cephalad hand should be on the medial border of the patella 3. Therapist keeps cephalad elbow extended and applies downward force to medial patella 4. Assess motion relative to the uninvolved side

Question 37

Medial Patellar Glides

Answer 37

Purpose: Improve patellar mobility
1. Shoulders over patient’s knee, caudad hand supporting distal leg, cephalad over the lateral border of the patella 2. Therapist’s thenar eminence of the more cephalad hand should be on the lateral border of the patella 3. Therapist keeps cephalad elbow extended and applies downward force to lateral patella 4. Assess motion relative to the uninvolved side

Question 38

Medial Tilt Patellar Glides

Answer 38

Purpose: Improve patellar mobility
1. Therapist applies a force with the thenar eminence on the medial half of the patella, creating a medial tilt 2. The stabilizing hand is on the popliteal fossa 3. Apply sustained glide or oscillate to tilt the patella medially and stretch the lateral retinaculum

Question 39

Apprehension Test

Answer 39

Purpose: Provocative test for patellar dislocation
1. Patient is supine and relaxed 2. Examiner uses hand to push patient’s patella as lateral as possible 3. Start with knee flexed to 30 degrees 4. Examiner grasps leg at ankle/heel with other hand 5. Examiner performs a slow, combined flexion in the knee and hip 6. Lateral glide is sustained through the test 7. (+) Test if pain or apprehension is present

Question 40

Distal Tibial-Fibular Posterior Glide

Answer 40

Purpose: Assess and treat accessory motion of the fibula on the tibia
1. Patient is positioned in supine position. Resting symptoms are assessed 2. Examiner uses the thenar eminence to post the medial malleolus 3. The therapist then uses the thenar eminence of opposite hand on the anterior aspect of the fibula to add a posterior glide. 4. Therapist assessing joint mobilityà Posterior glide associated with Dorsiflexion

Question 41

Distal Tibial-Fibular Anterior Glide

Answer 41

Purpose: Assess and treat anterior glide of the distal tib-fib joint
1. Patient is positioned in prone position. Resting symptoms are assessed 2. Examiner uses the thenar eminence to post the medial malleolus 3. The therapist then uses the thenar eminence of opposite hand on the posterior aspect of the fibula to add an anterior glide. 4. Therapist assessing how the fibula glides on the tibia

Question 42

Talar Posterior Glide

Answer 42

Purpose: Assess and treat accessory motion of the talus
1. Patient is positioned in supine position. Resting symptoms are assessed 2. Examiner passively places the joint into 10 degrees of plantar flexion 3. The examiner palpates the anterior talus using a dummy thumb 4. Stabilize distal tib-fib joint, use 2nd metacarpal head to posterior glide talus; assessing DF); 5. Therapist assesses posterior glide of the talus. (Posterior glide of the talus is associated with dorsiflexion. 6. Treatment should be performed using 2nd metatarsal head (web-space between thumb and index finger. Start treatment in open pack position and then continue treatment into more dorsiflexion

Question 43

Talar Anterior Glide

Answer 43

Purpose: Assess and treat accessory motion of the talus
1. Patient is positioned in prone position. Resting symptoms are assessed 2. Examiner passively places the joint into 10 degrees of plantar flexion 3. The examiner grasps the anterior talus using a pincer grip to “pull anteriorly” 4. Therapist assesses anterior glide of the talus, while pushing anteriorly on the calcaneus with the opposite hand (pushing on talus via the calcaneus) 5. Mobilizations can be applied in the same fashion

Question 44

Talocrural Distraction

Answer 44

Purpose: Assess and treat for mobility deficit
1. Patient is positioned in supine position. Resting symptoms are assessed 2. Examiner grabs the calcaneus with one hand and the anterior portion of the talus with the other. 3. The examiner adds a distraction force 4. Therapist observing for excess laxity compared to the uninvolved side. 5. Also considered treatment (Grade I-IV)

Question 45

Subtalar Medial and Lateral Tilt

Answer 45

Purpose: Assess and treat accessory motion of the calcaneus
1. Patient is positioned in supine position. Resting symptoms are assessed 2. Examiner grabs the calcaneus with one hand and stabilizes the distal tib-fib joint with the other. 3. The examiner passively moves the calcaneus into a medial tilt and a lateral tilt 4. Therapist compares the motion to the uninvolved side.

Question 46

Calcaneal Medial and Lateral Glides

Answer 46

Purpose: Assess and treat mobility of subtalar joint as well as improve mobility of the calcaneus.
1. Stabilize distal tib fib joint with one hand 2. Use thenar eminence of other hand to grab calcaneus 3. Add glide of calcaneus in lateral direction

Question 47

Longitudinal Midtarsal Join

Answer 47

Purpose: Assess whether longitudinal joint axis unlocks and locks relative to inversion/eversion of subtalar joint
1. Patient is sitting with ankle off the edge of table. Assess resting symptoms. 2. Examiner passively moves the calcaneus into inversion and grabs the midfoot with the opposite hand (as if holding onto a golf club). 3. The examiner the gives the midfoot a twist. Midfoot locks up with inversion. 4. Examiner passively moves the calcaneus into eversion and grabs the midfoot with the opposite hand (as if holding onto a golf club). 5. The examiner then gives the midfoot a twist. Midfoot should unlock when in eversion and lock when calcaneus is inverted

Question 48

Talonavicular Accessory Mobility

Answer 48

Purpose: Assess and treat accessory motion of the talonavicular joint
1. Patient is sitting with ankle off the edge of table. Resting symptoms are assessed 2. Examiner palpates the tuberosity of the navicular and the talus 3. The examiner stabilizes the talus over the dorsal aspect of the foot and hooks onto the tuberosity of the navicular with the base of second metacarpal. 4. Examiner then performs a dorsal/plantar glide to the talonavicular joint to assess mobility

Question 49

Navicular-1st Cuneiform

Answer 49

Purpose: Assess and treat accessory motion of the navicular on 1st cuneiform
1. Patient is sitting with ankle off the edge of table. Resting symptoms are assessed 2. Examiner uses second metacarpal to stabilize the tuberosity of the navicular 3. Examiner then performs a dorsal/plantar glide of the 1st cuneiform while stabilizing the navicular

Question 50

Calcaneocuboid

Answer 50

Purpose: Assess and treat accessory motion of the cuboid
1. Patient is positioned in supine position. Resting symptoms are assessed 2. Examiner stabilizes the calcaneus with one hand 3. The examiner runs their hand along the lateral border of the foot, palpating for the tuberosity of the fifth metatarsal 4. Just proximal to the tuberosity of the fifth metatarsal is the cuboid 5. Movement of the cuboid is in a dorsal lateral and plantar medial direction 6. The examiner grabs the cuboid with a pinch grip and glides it dorsal lateral and plantar medial 7. Therapist assesses for mobility compared to the uninvolved side

Question 51

Oblique Midtarsal Joint

Answer 51

Purpose: To assess whether or not the oblique mid tarsal joint can lock and unlock relative to calcaneal inversion or eversion, for pronation and supination of the foot during gait
1. With left hand place calcaneus in inversion, and assess mobility of the cuboid on the calcaneus with right hand by abducting and adducting the cuboid parallel with the plane of the plantar surface of the foot. 2. With left hand place calcaneus in eversion, and assess mobility of the cuboid on the calcaneus with the right hand in the same plane of motion. 3. It should be expected that there is more mobility with calcaneus being placed in eversion because it is in the unlocked position

Question 52

1st Metatarso-Phalangeal Accessory Mobility

Answer 52

Purpose: Assess and treat accessory motion of the 1st metatarsal-phalange joint
1. Patient is positioned in supine position. Resting symptoms are assessed 2. Examiner stabilizes the metatarsal with one hand and grabs the proximal phalange with the other 3. The examiner assess anterior and posterior glide 4. To increase dorsiflexion or extension of the great toe, plantar flex the metatarsal and add a dorsal glide to the proximal head of the phalanx

Question 53

Ankle

Anterior Drawer

Answer 53

Purpose: Assess for laxity in Anterior Talofibular ligament
1. Patient is positioned in supine position. Resting symptoms are assessed 2. Examiner grabs the anterior and dorsal aspect of the foot with one hand and stabilizes the distal tib-fib joint with the other. 3. The therapist draws against the pull of the anterior talofibular ligament 4. Therapist looking for pain reproduction as well as excess laxity compared to the uninvolved side

Question 54

Talar Tilt

Answer 54

Purpose: Assess for laxity in calcaneofibular and deltoid ligament
1. Patient is positioned in supine position. Resting symptoms are assessed 2. Examiner stabilizes the distal tib-fib with one hand and grabs the calcaneus with the other. 3. The therapist passively moves the calcaneus into eversion to stress the deltoid ligament and inversion to stress the calcaneofibular ligament. 4. Therapist looking for pain reproduction as well as excess laxity compared to the uninvolved side

Question 55

Fibular Translation Test

Answer 55

Purpose: Screening out/Ruling in damage to the syndesmosis
1. Patient is positioned in sidelying position. Resting symptoms are assessed 2. Examiner applies anterior and posterior forces on the fibula at the level of the syndesmosis 3. Positive test is pain during translation and more displacement to the fibula than on the compared side

Question 56

Squeeze Test

Answer 56

Purpose: Assess for a high ankle sprain (syndesmosis sprain)
1. Patient is positioned in supine or side lying position. Resting symptoms are assessed 2. Examiner squeezes at the midway point of the calf with both hands (squeezing the tibia and the fibula together) 3. Therapist looking for reproduction of symptoms

Question 57

Dorsiflexion–Eversion Test

Answer 57

Purpose: Screening out Tarsal Tunnel Syndrome
1. Patient is in a sitting position. Resting symptoms are assessed 2. Ankle is placed in dorsiflexion, eversion of the foot, and dorsiflexion of all the toes 3. Patient is queried about any change in symptoms 4. Positive test is a reproduction of intensification of the patient’s symptoms 5. Can increase tension by adding SLR as well as Tinel to tarsal tunnel (tibial nerve)

Question 58

Tinel Test

Answer 58

Purpose: Assess for posterior tibial nerve entrapment in the medial tarsal tunnel
1. Patient is positioned in prone position. Resting symptoms are assessed. 2. Examiner repeatedly taps the posterior tibial nerve in the medial tarsal tunnel 3. Looking for reproduction of symptoms or an absence of symptoms

Question 59

Windlass Mechanism

Answer 59

Purpose: Assess great toe extension and how it puts tension on the plantar fascia
1. Patient is positioned standing or supine position. Resting symptoms are assessed 2. Examiner passively extends the great toe, looking for tension in the plantar fascia and reproduction of pain 3. Assess passive great toe extension in standing as well

Question 60

Subtalar Neutral in Standing

Answer 60

Purpose: Find subtalar neutral
1. Examiner palpates both sides of the talus with thumb and index finger 2. Examiner grabs the heel and ankle with other hand and uses that to manipulate the foot. 3. Move from side to side until you find that the medial and lateral aspects of the talus are even between the therapist’s fingers

Question 61

Navicular Drop Test

Answer 61

Purpose: Assess navicular drop
1. Patient is standing. Resting symptoms are assessed 2. Examiner measures the distance from the navicular to the ground in resting position 3. The examiner then passively places patient into subtalar neutral 4. Patient is asked to hold the position and the examiner re-measures the distance from the navicular to the ground 5. 6-8 mm is normal

Question 62

Feiss Line

Answer 62

Purpose: Assess navicular drop
1. Patient is supine or standing. Resting symptoms are assessed 2. Examiner finds the medial malleolus and draws a line from the medial mallelous to the base of the first metatarsal while in subtalar neutral 3. The examiner palpates the tuberosity of the navicular and makes a mark at its location 4. The therapists then observes the patient in standing, determining where the tuberosity drops to. 5. A first degree flat foot would be within 1/3rd of the distance away from the floor, a second degree flat foot would be 2/3rds of the distance, and a third degree flat foot would have the tuberoisty of the navicular sitting on the floor.

Question 63

Impingement Sign/Forced Dorsiflexion Test

Answer 63

Purpose: Assess accessory for anterior ankle impingement
1. Patient is sitting with ankle off the edge of table. Resting symptoms are assessed 2. Examiner compresses the anterior-lateral talus with thumb and adds a forced dorsiflexion force. 3. Reproduction of the patient’s pain might implicate some type of synovial anterior ankle impingement.

Question 64

Homan’s Sign

Answer 64

Purpose: Special test used to rule in DVT
1. Patient is positioned in prone position. Resting symptoms are assessed 2. Examiner firmly squeezes the calf muscle and adds a passive dorsiflexion force 3. Reproduction of pain may be indicative of a positive test

Question 65

Thompson Test

Answer 65

Purpose: Assess the integrity of the Achilles tendon
1. Patient is positioned in prone position. Resting symptoms are assessed 2. Examiner squeezes the calf muscle, looking for associated ankle plantar flexion 3. If the Achilles tendon is severed, when the calf muscle is squeezed no motion will occur at the ankle joint

Question 66

Girth Measurement

Answer 66

Purpose: Assess for edema in the ankle joint
1. Patient is positioned in supine position. 2. Start tape measure between tibialis anterior and lateral malleolus 3. Draw tape medially just distal to navicular tuberosity 4. Pull tape across arch just proximal to base of 5th metatarsal 5. Pull tape across anterior tibialis tendon around ankle joint just distal to medial malleolus 6. Pull tape across Achilles tendon just distal to lateral malleolus across start of tape

Question 67

Tibial Varus and Valgus Measurement

Answer 67

Purpose: Objectively measure tibial varus and valgus
1. Patient is weight bearing in standing 2. Examiner draws a line up the middle of the tibia. 3. Line the stationary arm of the goniometer with a line perpendicular to the floor

Question 68

Calcaneal Alignment in WB

Answer 68

Purpose: Objectively measure calcaneal varus and valgus
1. Patient is weight bearing in standing 2. Examiner draws a line along the calcaneus perpendicular to the floor 3. Line the stationary arm of the goniometer with a line perpendicular to the floor

Question 69

Dorsiflexion MWM Posterior Talar Glide

Answer 69

Purpose: To increase ankle dorsiflexion; Facilitate posterior glide of the talus in the mortis
1. Patient is positioned in the supine position 2. The examiner places thumbs or 2nd metacarpal head on anterior talus and adds a posterior glide 3. Patient is asked to dorsiflex ankle 4. Therapist adds OP into dorsiflexion with thigh, maintaining anterior glide of talus

Question 70

Dorsiflexion MWM Posterior Talar Glides

Answer 70

Purpose: To improve dorsiflexion range of motion in a functional position
1. Patient is standing with treatment foot on a stool 2. Therapist places a treatment belt around patients calf and below therapists gluteal fold 3. Therapist kneels facing front of patient 4. Therapists then uses thumbs or distal portion of second metacarpal to add a posterior glide on the talus

Question 71

Plantar flexion MWM Anterior Talar Glide

Answer 71

Purpose: Increase ankle plantar flexion
1. Patient is positioned in supine position. Resting symptoms are assessed 2. Examiner grabs distal tib-fib joint with one hand and glides the distal tibial and fibula posteriorly which creates a relative anterior glide of the talus 3. The patient is asked to actively PF their ankle 4. Therapist over presses into further ankle PF, keeping posterior glide of distal tib-fib joint on

Question 72

Talar Anterior Glide

Answer 72

Purpose: Increase plantar flexion
1. Patient is in the prone position with foot hanging off 2. Examiner stabilizes distal tib-fib joint 3. Therapist palpates talus 4. Therapist then applies an anterior glide

Question 73

Inversion MWM

Answer 73

Purpose: Mobilize fibula posteriorly and to improve inversion
1. Patient is in supine position 2. Therapist post’s medial malleoli with thenar eminence cupping posterior aspect of foot 3. Examiner then grasp’s the ant and slightly inferior aspect of the fibula 4. A posterior and slightly superior glide is applied 5. Patient is asked to bring ankle into inversion 6. Therapists over press with hip into inversion 7. Perform 10 times and then reassess

Question 74

Cuboid PA Manipulation “Cuboid Whip”

Answer 74

Purpose: To reposition a hypomobile cuboid back into its anatomical position
1. Patient is asked to bend knee 90 degrees and hold onto the plinth/chair for balance 2. Therapist grabs foot with hypomobile cuboid 3. To find cuboid, palpate tuberosity of 5th metatarsal and move proximal. 4. Therapist’s thumbs are placed on the medial plantar surface of cuboid with fingers stabilizing dorsal forefoot, but not covering cuboid. 5. Therapist applies dorsal lateral force to medial side of cuboid while snapping elbows into extension with low amplitude high velocity thrust. 6. Patients end range talocrural plantar flexion should be met at the conclusion of the thrust

Question 75

Navicular PA Manipulation “Navicular Whip”

Answer 75

Purpose: To reposition a hypomobile navicular back into its anatomical position. It can be used on patient with 2nd or 3rd degree flat foot to try to return navicular dorsally.
1. Patient is asked to bend knee 90 degrees and hold onto the plinth/chair for balance 2. Therapist grabs foot with hypomobile navicular 3. To find navicular, palpate tuberosity of navicular on medial side of foot. 4. Therapist’s thumbs are placed on the plantar surface of navicular with fingers stabilizing dorsal forefoot, but not covering navicular. 5. Therapist applies dorsal medial force to navicular while snapping elbows into extension with low amplitude high velocity thrust. 6. Patients end range talocrural plantar flexion should be met at the conclusion of the thrust.

Question 76

Talocrural Distraction Manipulation

Answer 76

Purpose: Improve ankle range of motion
1. Patient is positioned in supine position. Resting symptoms are assessed 2. Examiner grabs the calcaneus with one hand and the anterior portion of the talus with the other. 3. The examiner adds a Grade V distraction force