Lower Extremity Treatment

Question 1

Femorotibial dysfunction (BLT)

Answer 1

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

Question 2

Boot-Jack Technique (BLT)

Answer 2

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)

Question 3

Anterior Tibia on Femur - Supine (HVLA)

Answer 3

Flex the knee to 90 degrees

sit on patients foot

thumbs an anterior tibia with fingers wrapped around leg and thrust posteriorly

Question 4

Anterior tibia on Femur - Seated (HVLA)

Answer 4

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

Question 5

Posterior Tibia on Femur - Prone (HVLA)

Answer 5

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.

Question 6

Posterior Tibia on Femur - Seated (HVLA)

Answer 6

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

Question 7

Posterior Fibular Head BLT

Answer 7

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)

Question 8

Anterior Fibular Head (MET/HVLA)

Answer 8

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

Question 9

Posterior Fibular Head - Supine (MET/HVLA)

Answer 9

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

Question 10

Tibiotalar Dysfunction (BLT)

Answer 10

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

Question 11

Tibiotalar Gapping (HVLA)

Answer 11

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)

Question 12

Anterior Tibia on Talus (HVLA)

Answer 12

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

Question 13

Calcaneus Inversion/Eversion HVLA

Answer 13

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

Question 14

cuboid, navicular, or cuneiform dysfunction - Hiss Whip (HVLA)

Answer 14

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

Question 15

Plantar Navicular Dysfunction “Transtarsal Thrust” (HVLA)

Answer 15

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)

Question 16

Plantar Cuboid Dysfunction “Transtarsal thrust” (HVLA)

Answer 16

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)

Question 17

Cuneiform & Metatarsal Dysfunction (BLT)

Answer 17

thumbs on dorsum of the distal metatarsal and fingers on plantar aspect of the foot.

PRESS THUMBS DOWN toward the metatarsals until reaching BLT

Question 18

Plantar/Dorsal Metatarsal Function (HVLA)

Answer 18

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

Question 19

Phalanx Dysfunction (BLT)

Answer 19

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.