Practical #2 Ankle Flashcards
Tests & Measure
Closed Chain Ankle ROM:
- Toes in tandem stance with lead foot toes against the wall.
- Elbows flexed to 90d with fist against the wall. Bend back knee as far as possible without the heel lifting off.
- Back knee should clear the lead leg malleous if the ankle has 40d DF.
- 35-40d is normative number
Ankle Anterior Drawer Test
Tests & Measure
Ankle Anterior Drawer Test: Anterior talofibular ligament
External Rotation Test
Tests & Measure
External Rotation Test: Special tests for syndesmotic sprain.
Syndesmotic Squeeze Test
Tests & Measure
Syndesmotic Squeeze Test: Special tests for syndesmotic sprain.
Forced Dorsiflexion Impingement Test
Tests & Measure
Forced Dorsiflexion Impingement Test: Ankle impingement special test.
Hyper Plantar Flexion Thrust Test
Tests & Measure
Hyper Plantar Flexion Thrust Test: Ankle impingement special test.
Royal London Hospital Test
Tests & Measure
Royal London Hospital Test: Positive test if the painful spot moves w/ plantarflexion and no pain is felt dorsiflexing.
Windless Test
Tests & Measure
Windless Test: Test for PF.
- Stand with the toe over the edge of the table.
- Extend the big toe
- (+) Reproduction of pain in the insertion of the plantar fascia
Dorsiflexion Eversion Test
Tests & Measure
Dorsiflexion Eversion Test: Tarsal tunnel syndrome special test (Posterior tibial nerve).
Triple Compression Test
Tests & Measure
Triple Compression Test: Tarsal tunnel syndrome special test.
- Nerve glides w/ external rotation = pt. has compression
- Neutral nerve glides = pt. has tension
Foot Squeeze Test
Tests & Measure
Foot Squeeze Test: Morton’s Neuroma
- Morton’s neuroma, also known as Morton metatarsalgia, is a benign condition that occurs when the intermetatarsal plantar nerve becomes trapped.
Functional Hallux Limitus Test
Tests & Measure
Functional Hallux Limitus Test:
- Patient is NWB
- Examiners uses one hand to maintain the subtalar joint in neutral while maintaining first ray in DF.
- Moving hand DF’s proximal phalanx.
- (+) Test = Limited movement at the toe. Immediate PF of the first ray with DF of the proximal phalanx
Grade:
- Grade 0: 40-60 deg. of DF
- Grade I: 30-40 deg. of DF
- Grade II: 10-30 deg. of DF
- Grade III: 0-10 deg. of DF
- Functional hallux limitus is a loss of metatarsophalangeal joint extension during the second half of the single-support phase, when the weightbearing foot is in maximal dorsiflexion
Promote Ankle Dorsiflexion
Therapeutic Exercise
- Rocker Board
- Banded Self A-P Ankle Mobilization for restoring DF
Promote Basic Ankle Balance activities
Therapeutic Exercise
- Floor - SL
- AIREX - SL
Promote Advanced Ankle Balance/Proprioception Activities
Therapeutic Exercise
- Add specific activity to SL balance
- SL balance on Aerex w/ opposite leg, band resisted hip flexion
Promote Higher Level Eccentric Gastroc / Soleus Strength
Therapeutic Exercise
- Two-up / One-down loaded eccentric heel raise
- Insertional stops at floor
Promote Plantar Fascia specific heel raises/lowering
Therapeutic Exercise
Promote Basic Foot intrinsic strengthening
Therapeutic Exercise
- Doming
- ” “ w/ mini band resistance
- Toe Yoga
Promote Abductor digiti minimi & Abductor Hallucis strengthening
Therapeutic Exercise
- Toe spreading with pencils
Promote Advanced short foot strengthening
Therapeutic Exercise
- Tripod reinforcing band challenge for short foot
- Planter flexed Dome w/ mini-band march
- Planter flexed Dome w/ iso-hold
Promote Ankle Dorsiflexion Eccentric Strengthening
Therapeutic Exercise
Tibialis Anterior Strengthening:
- Ecc. Tib raise on slant board
- Ecc. toe raise w/ band or KB
Standing Lunge for ankle Dorsiflexion mobility
Therapeutic Exercise
Standing Lunge for ankle Dorsiflexion mobility:
- 3x30 sec.
Promote Ankle Pronation and supination
Therapeutic Exercise
- Chops & Lifts for the Foot & Ankle w/ MB, Band, Cable
- FMS Chops & Lifts Video
Promote Ankle Eversion Strengthening
Therapeutic Exercise
Promote Posterior Tibialis Strengthening
Therapeutic Exercise
Triplanar Dynamic Calf Stretching
Therapeutic Exercise
1) Sagital = Front & Back
2) Frontal = Chest to hands on wall
3) Transverse = Rotation / Shoulder to outside of knee
Promote Advanced Gastroc Soleus Strengthening for insertional Achilles tendonitis
Therapeutic Exercise
- Seated - heal raise with DB/KB’s on knees
- Standing - heal raise with DB/KB’s on knees
- Iso → Ecc → Concentric → Landing
Advanced Ankle/Foot motor control exercises involving the entire LE/Trunk
Therapeutic Exercise
- Y-Balance
- Lunge matrix
- Rotation w/ KB
Peroneus Longus Strengthening on slant board
Therapeutic Exercise
- TheraBand strengthening:
- Slant Board neuromuscular re-education: SL Balance 3x30-45 sec
- Reactive Neuromuscular Reeducation:
Board & Arch up
Basic Ankle AROM exercises
Therapeutic Exercise
- Ankle Pumps
- Ankle “A,B,C’s”
- Banded 4-way ankle
Bosu Therex progression
Therapeutic Exercise
Beginner:
- DL Balance - 3x30 sec.
- ”” w/ eyes closed
- ”” w/ eye closed and head rotations
Return to sport agility drills for ankle
Therapeutic Exercise
- Sports cord resisted jogging with multiple leg movement challenges.
- Single leg lateral hops lower level
Low level Gastroc / Soleus strengthening
Therapeutic Exercise
- Seated DL Heel Raise - 3x12-15 (RPE 8)
- Standing DL Heel Raise - 3x12-15 (RPE 8)
Mobilization for Increased Ankle Dorsiflexion (Grade III)
Mobilization with movement for Increased Ankle Dorsiflexion (Grade III)
Mobilization w/ movement for Increased Ankle Dorsiflexion (Grade III):
- Place a mobilization belt around the posterior inferior tibia and fibula.
- Anchor the belt around therapist at hip level.
- Place the web space of the therapists hand on the anterior talus.
- Have the patient squat (if performed in standing) or move anteriorly over the foot (if in tall kneeling).
- A posterior glide is applied to the talus during the motion of the patient.
- Progress from NWB to weight bearing.
Mobilization for Increased Ankle Plantar Flexion (Grade IV)
Talocrural Anterior Glide of Talus: Apply an anterior force through the calcaneus driving the talus in an anterior direction.
- Indications:
- Limited Talocrural mobility (plantarflexion)
Mobilization for Increased Ankle Eversion (Grade IV)
- Indications:
- Hypomobility of the subtalar joint, limited pronation / eversion of the foot and ankle.
- If ankle Talocrural ROM is limited assess the subtalar join
Rearfoot Distraction manipulation (Grade V)
Rearfoot Distraction manipulation (Grade V)
- Indications: Overall decrease in ROM in the Talocrural joint
- Possible conditions:
- Ankle Sprain
- Impingement syndrome
- Plantar Fasciitis
- Impairments:
- Decreased PF & DF
- Decreased Closed Chain DF Test
Plantar fascia Manual Release
Soft tissue mobilization plantar fascia
- PhysioU Plantar Fascia : Forefoot Eversion Stretchin - Video
Distal tibiofibular posterior mobilization
Distal Tibiofibular Posterior Mobilization: Posterior glide of the tibiofibular joint.
* Use thenar eminence of hand to apply pressure to the distal tibiofibular joint
- Indications:
- Ankle sprains (NOT Syndesmotic)
- Difficulty with dorsiflexion, inversion, and eversion.
Cuboid Whip manipulation
Cuboid Whip manipulation:
PhysioU Video
Cross Friction to the Achilles
Cross Friction to the Achilles:
Medial glide to the calcaneous
Medial glide to the calcaneous: Apply a glide of the calcaneus into the medial direction.
- Indications:
- Limited Talocrural joint mobility
- Limitations in Inversion & supination.
- Realize this looks just like the lateral glide but the difference is if you are working on the top leg or the bottom leg.
Pin and stretch to the Gastroc/Soleus
Pin and Stretch to the Gastroc/Soleus:
First Toe Mobilization to promote MTP Extension
First Toe Mobilization to promote MTP Extension: First toe mobilizations for limited mobility
- AP glides
- Medial-Lateral Glides
- Traction glides:
- Hallux rigidus
- Hallux valgus
- 1st MTP Extension Stretching
- Hallux rigidus, also known as stiff big toe, is a degenerative arthritis that causes stiffness in the joint at the base of the big toe.
- Hallux valgus, also known as a bunion, is a deformity that occurs when the base joint of the big toe develops sideways, causing the big toe to bend towards the other toes.
Pin and Stretch to the Peroneals
Pin and Stretch to the Peroneals:
Lateral Glide to the Calcaneous
Lateral Glide to the Calcaneous:
- To improve ankle eversion
- Cross the involved leg over the uninvolved leg
- Apply a lateral force through the calcaneus with a distraction force
Intertarsal mobilizations
Intertarsal Mobilizations in the Midfoot
- Piano key up and down the metatarsals.
- Assess for hypomobility and treat
- Re-test the patient for changes in pain and range of motion
- Physiotutors Video
ROM
- DF = ?
- PF = ?
- Inversion = ?
- Eversion = ?
- Great Toe Ext = ?
What am I = ?
- ↓ great toe - dorsiflexion
- ↓ great toe - extension
Functional Hallux Limits:
- ↓ great toe - dorsiflexion
- ↓ great toe - extension
- Tests:
- Functional hallux limitus test
- 1st Ray mobility
What am I = ?
- Pain - posterior heel
- Pain - worse with activity
- Abnormal dorsiflexion
- ↑ Foot pronation
Achillies Tendinosis / Tendonitis:
- Pain - posterior heel, worse with activity, and after sleeping.
- Popping heard
- Abnormal dorsiflexion (hyper/hypo)
- ↓ PF strength
- ↑ Foot pronation
- Test
- Palpation test
- Royal london hospital test
- Thompson test
- Heel raise test
What am I = ?
- Female
- Pain - Worse 1st thing in the morning
- Abnormal arch
Plantar Fascitis:
- Pain - over inferior heel and plantar surface.
- Pain - Worse 1st thing in the morning, and with activity.
- ↓ Cross-sectional area
- Females
- Abnormal arch
- Posterior chain tightness
- Tests:
- Windless test
- Palpation of proximal plantar fascia
- Heel pain with first step
What am I = ?
- Pain - Anterior, lateral ankle
- ↓ Proprioceptive awareness
- Played soccer
Chronic Ankle Instability:
- Episodes of instability
- Pain - Anterior, lateral ankle
- ↓ Proprioceptive awareness
- History of previous ankle sprains
- Sports - w/ end-range of motion, twisting and pivoting
- Impairment =
- Path - mechanical
- Sensory - percepual
- Motor - behavior
- Tests:
- No specific
- Reverse anterior drawer
What am I = ?
- Pain - Lateral ankle w/ trauna
- Popping
- ↓ ROM
Lateral Ankle Sprain:
- Pain - Lateral ankle w/ trauna
- Popping
- Forced plantar flexion and inversion
- Males
- Swelling, bruising
- ↓ ROM
- Tests
- Anterior drawer
- Reverse anterior drawer
- Talar Tilt
What am I = ?
- Medial side tenderness
- Difficulty WB
- MOI = ER, hyper dorsiflexion, axial load
Syndesmotic Ankle Sprain:
- Pain - Anterior lateral ankle, proximal to AITFL
- Medial side tenderness
- Difficulty WB
- MOI = ER, hyper dorsiflexion, axial load
- Football, rugby, westling
- Tests:
- Syndesmotic squeeze
- Cotton
- ER
What am I = ?
- Pain - Anterior jamming restriction in motion
- Dorsal/Posterior “Block”
- Previous ankle injuries/fractures
Ankle Impingement:
- Pain - Anterior and posterior with jamming restriction in motion
- Dorsal/Posterior “Block”
- Post. impingement may look like achilles tendonopthy
- Previous ankle injuries/fractures
- High impact/high stress athletic events (dance, ballet, soccer)
- Hypermobility in ankle
- Tests:
- Forced dorsiflexion impingement tests
- Hyper plantar flexion is common in eliciting factor for posterior impingement
What am I = ?
- Gradual onset
- patient demonstrates over-pronation
- Numbness in toes and foot
Tarsal Tunnel:
- Gradual onset
- Could be due to over pronation
- Smells like nerves (pain and numbness in toes and foot)
- Tests:
- Tinel’s sign
- Dorsiflexion eversion test
- Triple compression
What am I = ?
- Medial sided foot and ankle pain
- Middle aged to older adults
- Gastroc/Soleus tightness
Posterior Tibial Tendonopathy:
- Medial sided foot and ankle pain
- Floot foot and over pronation
- Middle aged to older adults
- Difficulty doing HR
- Gastroc/Soleus tightness
- Tests:
- HR Test
What am I = ?
- Runners
- Medial shin pain
- Poor running mechanics
Medial Tibial Stress Fracture:
- Runners
- Medial shin pain
- Poor running mechanics
- Over & rapid pronation
- ↑ mileage
- Tests:
- HR is hard
- Poor running mechanics
