Lower Leg / Ankle / Foot

Question 1

Soleus MMT

Answer 1

Patient pos - Patient is in the prone position, knee flexed at 90 degrees.

Fixation - Examiner supports leg just proximal to ankle.

Pressure - Against the platar surface of the foot, pushing in the dirrection of dorsiflexion of the ankle.

Question 1

Thump Test

Answer 1

Patient Pos - Supine

Force - Thge examiner strikes the heel of the foot, a large vibratory force is sent through the limb that stimulates the injured site.

Positive findings - A positive test is reproduction of the patients worst pain. Stress fracture.

Question 2

Flexor Hallicus Longus MMT

Answer 2

Patient pos - The patient is in the seated or supine position.

Fixation - Stabilize the metatarsophalangeal joint and ankle in a neutral position.

Test - Flexion of interphalangeal joint of the great toe.

Pressure - Plantar surface of the distal phalanx, in direction of extension

Question 2

Dorsiflexion Maneuver

Answer 2

Patient pos -Patient sits on the edge of the table.

Force - passively and forcefully dorsiflex the foot by holding onth the heel and using forearm to dorsiflex foot.

Positive Findings - Pain on forced dorsiflexion. Indicates a positive test for syndesmosis problem.

Question 3

Extensor Hallicus Longus/Brevis MMT

Answer 3

Patient pos - Patient is seated or lying supine.

Fixation - Stabilization of the foot in slight plantar flexion

Test - Extension of the metatarsalphalangeal and interphalangeal joints of the great toe.

Pressure - Against the dorsal surface of the distal and proximal phalanges in the direction of flexion.

Question 4

Peroneus (Fibularis) Tertius MMT

Answer 4

Patient pos - The patient is in the seated or lying supine

Fixation - examiner supports leg just above the ankle.

Test - Eversion of the foot with plantar flexion of the ankle.

Pressure - Against the lateral border and plantar surface of the foot, in the direction of inversion and dorsiflexion of the ankle.

Question 5

Stork Test

Answer 5

Patient pos - Standing

Test - Patient plces their hands on their hips. stands on one foot and places the other foot on the medial aspect of the standing leg.

looking for lower kinetic chain disorger with loss of balance.

Question 7

Tibialis Anterior MMT

Answer 7

Patient pos - Sitting, knees flexed 90 degrees, foot is dorsiflexed and inverted.

Stabilization - Stabilization is provided by holding the patients lower leg still with hand just proximal to the posterior portion of the ankle.

Pressure - Applied on the dorsal surface of the foot in the direction of platarflexion. Eccentric test of the tibialis anterior.

Question 7

Squeeze Test of the Leg

Answer 7

Patient position - Supine, short sit, prone

Stabilization - the examiner grasps the patient’s leg midway up the calf at the tibia and fibula.

Force - Compression and release

Positive Findings - A positive test is considered if the patient experiences pain in the area of the syndesmosis

Question 8

Peroneus Longus/Brevis MMT

Answer 8

Patient pos -Sitting, knees flexed to 90 degrees, foot is platarflexed and everted.

Fixation - Stabilization is provided by holding the patient’s lower leg still with the hand just distal to the anterior portion of the ankle.

Pressure - Applied to the platar surface of the foot under the head of the big toe, pushing into dorsiflexion and inversion (return to neutral)

Question 10

Tibialis Posterior MMT

Answer 10

Patient pos - Sitting, knees flexed at 90 degrees, foot is plantarflexed and inverted.

Fixation - Stabilization is provided by holding the patient’s lower leg still with hand just distal to the anterior portion of the ankle.

Pressure - Applied to the platar surface of the foot in the direction of dorsiflexion. Eccentric test.

Question 10

Talar Tilt

Answer 10

Patient Pos - Supine or sitting with the legs over the edge of the table.

Stabilization - One hand grasps the calcaneus while the other stabilizes the the lower leg.

Force - The hand holding the calcaneus rolls it laterally, tilting the talus, causing a gap on the medial side of the ankle.

Implications - A positive finding would be if the talus tilts or gaps excessively compared bilaterally. If pain is described during this test it is indicative of the deltoid ligament.

Question 11

Subtalar Neutral

Answer 11

Patient Pos - Patient is seated or standing with feet on floor and leg to be tested in a non-weight bearing position.

Stabilization - The clinician locates the medial and lateral heads of the talus

Force - The clinician has the patient invert and evert their foot until the medial and lateral heads are equally protruding. this is the neutral position.

Question 13

Flexor Digitorum Longus MMT

Answer 13

Patient pos - Patient is seated or supine.

Fixation - The Clinician stabilizes the metatarsals and maintains nuetral foot and ankle

Test - Flexion of distal interphalangeal joints 2-5

Pressure - Plantar surface of distal phalanges in direction of extension

Question 14

Navicular Drop

Answer 14

Patient pos - Patient begins seated with both feet on the floor in a non-weight bearing position. The patient may also be standing with all of their weight on the non-tested leg. the clinician puts the patient in a neutral position.

Stabilization - In this position, the clinician locates and marks the navicular head witha pen and holds a note card or ruler up to the mark to measure the height.

Force - patient then bears weight onto the foot and the clinician mesures again to note any navicular drop that may have occured.

Positive findings - any measurement greater than 10 mm

Question 14

Tinel’s Sign

Answer 14

Patient pos - Is placed in long sitting with the feet hanging off the table.

Force - The clinician palpates the Deep Peroneal nerve laterally of the medial malleoulus. As well as the Tibial nerve posteriorly of the medial malleolus.

Positive Findings - in both cases, tingling or paresthesia felt distally is a positive sign.

Question 15

Thompson sign

Answer 15

Squeeze the calf looking for dorsi flexion signifying the achillis tendon is in tact.

Question 16

Figure 8 Measurement

Answer 16

Patient Pos - Patient is positioned in long sitting with the ankle and lower leg beyond the end of the examining table with the ankle in dorsiflexion.

Fixation - Using a 6mm tape measure. measure in a figure 8 pattern looking for swelling.

Question 18

Anterior Drawer

Answer 18

Patient pos - Test witht the patient seated on the edge of the table.

Stabilization - The examiner stabilizes the distal part of the leg with one hand while the other hand grasps the heel. (ankle is in 20 degrees of plantarflexion)

Force - An anterior force is applied to the heel while attempting to move the talus anteriorly on the tibia. Allow the foot to rotate slightly medially to relax the deltoid ligament.

Positive finding - A positive finding would be a translation of greater than 1 cm compared bilaterally. It is indicative of a complete talofibular ligament rupture.

Question 19

Rhomberg Test

Answer 19

Patient pos - standing

Test - patient stands with feet together and arms by sides with eyes open. Next the examiner asks patient to close their eyes

Question 20

Fiess line

Answer 20

basically navicular drop test draw line from medial malleoulus to base of first metatarsal and draw line. see if line drops or rises when bearing weight.

Question 21

Flexor Hallicus Bevis MMT

Answer 21

Patient pos - Patient is in the seated or supine position.

Fixation - Stabilize the foot proximal to the metatarsophalangeal joint and maintain neautral foot/ankle

Test - flex metatarsophalangeal joint of great toe

Pressure - Plantar surface of the proximal phalanx in the direction of extension.

Question 22

Mortons Test

Answer 22

Patient position - Patient is placed in long sitting position.

Force - Clinician grasps the foot around the metatarsal heads and squeezes the heads together.

Positive finds - pain is a positive sign for stress fracture or neuroma.

Question 24

External Rotation / Kleiger’s Test

Answer 24

Patient pos -patient is seated with the leg hanging over the examining table with the knee at 90

Stabilization - Examiner stabilizes the leg with one hand. with the other hand, the examiner holds the foot in neutral 90 degrees.

Force - Apply passive lateral rotation stress to the foot and ankle.

Positive Findings - If pain is produced over the anterior or posterior tibiofibular ligaments and the interosseous membrane, test is positive for syndesmosis injury. If patient has pain medially and examiner feels talus displace from medial malleolus, it may indicate a tear of the deltoid ligament.

Question 25

Holman’s Sign

Answer 25

Patient pos - The patient is placed in long sitting with the feet hanging off the table with the knee extended.

Force - The clinician passively dorsiflexes the foot and ankle.

Positive findings - The presence of pain in the calf is positive sign.

Interpretation - Tenderness with palpation is also considered a positive sign. DVT

Question 26

Distal Tibiofibular Compression test

Answer 26

Patient pos - patient lies supine

test - The examiner applies compression over the malleoli

Positive findings - pain in lower leg indicative of syndesmotic sprain if fracture and anterior compartment syndrome have been ruled out.