Lower Extremity Treatment Flashcards
Femorotibial dysfunction (BLT)
cephalad hand on femur, caudad on tibia.
compress down, applying an anterior/posterior force.
induce internal or external rotation to obtain BLT
Inhale, exhale whichever one until air hunger
reassess
Boot-Jack Technique (BLT)
Patient supine with knee under physicians axilla
have medial hand holding calcaneus with thumb and index finger.. fingers of lateral hand wrap around the medial foot
Lean back, inducing further flexion of hip and knee while distracting the calcaneus from the talus
induce plantar flexion with other hand to obtain BLT (with breathing in or out and air hunger stuff)
Anterior Tibia on Femur - Supine (HVLA)
Flex the knee to 90 degrees
sit on patients foot
thumbs an anterior tibia with fingers wrapped around leg and thrust posteriorly
Anterior tibia on Femur - Seated (HVLA)
Seated with leg off table
thumbs on anterior tibial plateau with fingers wrapped around leg
deliver thrust straight toward floor with a posterior pressure with the thumbs.. so posterior and inferior
Posterior Tibia on Femur - Prone (HVLA)
Patient is prone, you flex their leg to 90, with the dorsum of their foot on your shoulder
interlace fingers around the tibia distal to the popliteal region
lean forward to plantar flex the foot and relax gastrocnemius
thrust with both hands parallel to the table toward the physician.
Posterior Tibia on Femur - Seated (HVLA)
Seated with leg off table
thumbs on anterior tibial plateau with fingers wrapped around leg
this time pull down and anterior thrust.. so inferior and anterior thrust
Posterior Fibular Head BLT
patient supine, physician on same side as dysfunction
thumb of cephalad hand on the SUPEROLATERAL aspect of the fibular head… caudad hand inferior to the distal fibula
thumb on fibular head applies pressure straight towards the foot while caudad hand INVERTS THE FOOT to point of BLT
(breathing in and out till air hunger)
Anterior Fibular Head (MET/HVLA)
patient supine with a pillow under the knee
cephalad thenar eminence on the anterior aspect of the fibular head, caudad hand on the ipsilateral foot
SUPINATE FOOT (invert, internally rotate, plantar flex)
patient activating force - pronation of foot
final round of MET, direct thrust into table with associated supination of foot
Posterior Fibular Head - Supine (MET/HVLA)
cephalad hand –> 1st MCP on POSTERIOR aspect of the fibular head. caudad hand on ipsilateral foot
PRONATE FOOT (evert, dorsiflex, externally rotate)
have the patient supinate
HVLA - fully flex hip and knee and provide anterior thrust on fibular head
Tibiotalar Dysfunction (BLT)
press down at the tibiotalar joint.. internally and externally rotate feeling ease of motion
find a nice place to hold and air hunger thing for BLT
Tibiotalar Gapping (HVLA)
fingers interlaced on the dorsum of the foot, thumbs on the balls of the feet
Caudad traction then engage barrier (plantar flex the talus, dorsiflex, or
engage barrier and thrust into barrier.
(if plantar flexed talus, use a scooping motion)
Anterior Tibia on Talus (HVLA)
one hand cups the calcaneus with slight traction
the other hand on the anterior tibia proximal to the ankle
deliver thrust with the hand on the tibia INTO THE TABLE
Calcaneus Inversion/Eversion HVLA
one hand on calcaneus, other on dorsum of the foot
Inversion SD: caudad traction with HYPEREVERSION of the ankle
Eversion SD: Caudad traction with HYPERINVERSION of the ankle
cuboid, navicular, or cuneiform dysfunction - Hiss Whip (HVLA)
cuboid, navicular, or cuneiform dysfunction
both thumbs are over the plantar surface of the affected structure with fingers on dorsum of the foot
SLIGHTLY ABDUCT patients lower extremity off the table and FLEX the knee
thrust downward through thumbs with a “whip-like” motion at ankle and knee
Plantar Navicular Dysfunction “Transtarsal Thrust” (HVLA)
Patient supine with the knee flexed, abducted and externally rotated
your cephalad thenar eminence over the calcaneus, pinning calcaneus to the table
caudad hand over FIRST metatarsal and navicular with finger tips on plantar medial aspect of navicular.
EVERSION/rotational thrust with hand in contact with forefoot. (pushing it more dorsally)
Plantar Cuboid Dysfunction “Transtarsal thrust” (HVLA)
Same as plantar navicular except on the cuboid:
Patient supine with the knee flexed, abducted and externally rotated
your cephalad braces the calcaneus
caudad hand over FIFTH metatarsal and cuboid with finger tips on plantar medial aspect of CUBOID
INVERSION/rotational thrust with hand in contact with forefoot. (pushing it more dorsally)
Cuneiform & Metatarsal Dysfunction (BLT)
thumbs on dorsum of the distal metatarsal and fingers on plantar aspect of the foot.
PRESS THUMBS DOWN toward the metatarsals until reaching BLT
Plantar/Dorsal Metatarsal Function (HVLA)
one hand stabilizing the ankle
with other hand, grasp the dysfunctional metatarsal, thumb on the dorsal aspect, index finger on the plantar aspect
Thrust BOTH fingers simultaneously
thumb toward sole of foot, index finger toward dorsum of the foot
Phalanx Dysfunction (BLT)
use index finger and thumb of one hand to grasp the proximal end of phalanx
add compression or traction to disengage joint
add rotational component, side bending component, maintain position until release is felt –> to BLT
breathing remember.
