Lab 9: Ankle and Foot Treatments OSCE

Question 1

Distal Fibular Anterior ART

How do you perform this test?

Answer 1

Patient: Supine

Physician: Stand/Sit at the foot of the table

1. Stabilize patient’s foot, wrapping fingers around calcaneus and engage dorsiflexion restrictive barrier.
2. Thumb of lateral hand contacts the anterior aspect of the distal fibula with other thumb on top.
3. Engage the restrictive barrier and using articulatory technique until motion improves.
4. Reassess TART

Question 2

Distal Fibular Posterior ART

How do you perform this test?

Answer 2

Patient: Prone

Physician: Stand/Sit at the foot of the table

1. Stabilize patient’s foot, wrapping fingers around calcaneus and engage plantarflexion restrictive barrier.
2. Thumb of lateral hand contacts the posterior aspect of the distal fibula with other thumb on top.
3. Engage the restrictive barrier and using articulatory technique until motion improves.
4. Reassess TART

Question 3

Dorsiflexed Talus SD MET

How would you perform this treatment?

Answer 3

Patient: Supine

Physician: Stand/Sit at the foot of the table

1. Grasp patient’s ankle with one hand at the level of the malleoli. Other hand is placed over the dorsum on the patient’s foot.
2. Bring the patient’s foot into the plantar flexion restrictive barrier
3. Activating Force: Patient is instructed to bring their foot into dorsiflexion against isometric resistance for 3-5sec then isometric relaxation.
4. Engage a new barrier & repeat until no new barriers are met.
5. Reassess TART

Question 4

Plantarflexed Talus SD MET

How would you perform this treatment?

Answer 4

Patient: Supine

Physician: Stand/Sit at the foot of the table

1. Grasp patient’s ankle with one hand at the level of the malleoli. Other hand is placed on the plantar surface of the patient’s foot.
2. Bring the patient’s foot into the dorsiflexion restrictive barrier
3. Activating Force: Patient is instructed to bring their foot into plantarflexion against isometric resistance for 3-5 sec then isometric relaxation.
4. Engage a new barrier & repeat until no new barriers are met.
5. Reassess TART

Question 5

Talus Eversion and Iversion SD ART

How would you perform this treatment?

Answer 5

Patient: Seated with leg hanging off table

Physician: Sitting at foot of the table

1. Grasp patient’s heel with one hand and grasp the talus & dorsum of the foot with the other.
2. Maintain traction on calcaneus and articulate inversion and eversion with a “figure 8” maneuver until no new
   restrictive barriers are met or quality of ROM normalizes.
3. Reassess TART

• Talus Eversion with anteromedial glide*
• Talus Inverstion with posterolateral glide*

Question 6

Everted Cuboid, Inverted Navicular, Cuneiform with Plantar Glide SD MET

How would you perform this treatment

Answer 6

Patient: Supine/seated

Physician: Sitting at the foot of the table

1. Grasp patient’s foot with both hands on dorsum of foot, lifting the foot off the table and dorsiflex to engage restrictive barrier.
2. Adjust accordingly with inversion/eversion and dorsiflexion/plantarflexion.
3. Cross thumbs on plantar surface with one pad on cuboid & other on navicular with a separating force.
4. Instruct patient to “Push your foot into my thumbs” & maintain a counterforce for 3- 5 seconds until no new restrictive barriers are met.
5. Reassess TART

Question 7

Dorsal/Plantar Glide of Cuneiform/Metatarsal Joint SD ART

How would you perform this treatment?

Answer 7

Patient: Supine/seated

Physician: Sitting at the foot of the table

1. Isolate joint between fingers.
2. Engage barrier, alternating between restrictive barrier and ease of motion until normal physiologic motion is restored.
3. Reassess TART

Question 8

Dorsal/Plantar Glide of MTP/PIP Joint SD ART

How would you perform this treatment?

Answer 8

Patient: Supine/seated

Physician: Sitting at the foot of the table

1. Isolate joint between fingers.
2. Engage barrier, alternating between restrictive barrier and ease of motion until normal physiologic motion is restored.
3. Reassess TART.