MSK - Lower Leg, Ankle, Foot

Question 1

What are the active movements, normal ranges and end feels in the lower leg, ankle and foot?

Answer 1

Plantarflexion 50° - tissue stretch
Dorsiflexion 20° - tissue stretch
Supination (Inversion) 45-60° - tissue stretch
Pronation (Eversion) 15-30° - tissue stretch
Toe Flexion 40-60° - tissue stretch
Toe Extension 30-40° - tissue stretch
Toe Abduction and Adduction

Question 2

MMT - Soleus

Answer 2

Tibial Nerve L5-S2
Prone, knee to 90
Resistance applied to calcaneus in DF direction

Question 3

MMT - Peroneus Longus and Brevis

Answer 3

Superficial Peroneal Nerve L4-S1
Side lying on non test side with LE medially rotated, evert and PF ankle
Resistance on lateral border into DF and inversion

Question 4

MMT - Tib Post

Answer 4

Tibial Nerve L4-S1
Supine with LE laterally rotated, invert and PF ankle
Resistance against medial plantar surface into eversion and DF - Watch for toe flexion (substitution by FHL and FDL)

Question 5

MMT - Tib Ant

Answer 5

Deep Peroneal Nerve L4-S1
Supine or sitting, DF and invert without big toe ext
Resistance on medial, dorsal surface of foot into PF and eversion

Question 6

MMT - Extensor Digitorum Longus and Brevis

Answer 6

Peroneal and Deep Peroneal Nerve L4-S1
Supine or sitting, extend all joints of 2-5 digits (stabilize ankle in slight PF)
Resistance on dorsal surface into flexion

Question 7

MMT - Extensor Hallucis Longus and Brevis

Answer 7

Deep Peroneal Nerve L4-S1
Supine or sitting, extend MTP and IP of toe (stabilize in slight PF)
Resistance on dorsal aspect

Question 8

MMT - Flexor Hallucis Longus

Answer 8

Tibial Nerve L5-S2
Supine or sitting, flex IP joint (stabilize MTP and ankle in neutral)
Resistance against distal phalanx into ext

Question 9

MMT - Flexor Digitorum Longus

Answer 9

Tibial L5-S2
Supine or sitting, flex DIP of digits 2-5 (stabilize MTs and neutral foot and ankle)
Resistance against plantar surface into ext

Question 10

MMT - Flexor Digitorum Brevis

Answer 10

Tibial L4-S1
Supine or sitting, flex PIP of 2-5 (stabilize proximal phalanges and neutral ankle)
Resistance against plantar surface into ext

Question 11

Knee to Wall Test

Answer 11

Pt standing with toes pointing towards wall, keep pelvis square and foot flat. Bend knee toward wall. Measure where they are able to touch knee to wall without lifting heel.
Functional DF measure

Question 12

Standing Heel Raise Test

Answer 12

Stand on one foot and perform repeated heel raises to fatigue
Measure of PF strength and endurance

Question 13

SL Balance Test

Answer 13

Stand on one foot with eyes open for 30s. Note perturbations, talar movement, etc. Repeat with eyes closed for 30s.
Measure of balance and proprioception (may indicate poor muscular control of foot and ankle)

Question 14

Anterior Drawer Test

Answer 14

Structure: ATFL (primary) – will also be ant translation if CFL torn
Technique: Pt in long sitting or supine with heel over end of bed. Ankle in 20° PF. Stabilize distal tibia and fibula and glide talus and calcaneus anteriorly. Can also also have knee flexed to 90 and glide tibia posteriorly.
Positive Test: Symptom reproduction, excursion, endfeel

Question 15

Talar Tilt Test

Answer 15

Structure: CFL, ATFL, deltoid (different positions/movements)
Technique: CFL - Prone with ankle in 90° DF. Invert calcaneus. ATFL – PF and invert talus. Deltoid – Ankle in 90 DF and evert talus/calcaneus
Positive Test: Symptom reproduction, excursion, endfeel

Question 16

Squeeze Test

Answer 16

Supine, from midcalf squeeze tibia and fibula together. Continue moving distally toward ankle.
+ve = pain in lower leg
Indicates: syndesmosis injury (if r/o #, contusion and compartment syndrome)

Question 17

External Rotation Test

Answer 17

Sitting with legs over edge of table, knee at 90. Stabilize leg with one hand and hold foot and ankle at 90 and passively ER.
+ve = pain over ATFL, PTFL or IM.
Indicates: high ankle sprain

Question 18

Thompson’s Test

Answer 18

Prone, squeeze calf.
+ve = absence of PF
Indicates: ruptured Achilles

Question 19

Tinel’s Sign of the Ankle

Answer 19

Percuss posterior tibial nerve behind medial malleolus.
+ve = tingling or parasthesia distal to site.
Indicates: Tarsal Tunnel Syndrome

Question 20

Morton’s Test

Answer 20

Squeeze MT heads together
+ve = pain
Indicates: stress fracture or neuroma