SECTION VIII: ADDITIONAL ORTHOPEDIC TESTS
Homan’s sign test This tests for the presence of a deep vein thrombosis (DVT) in the leg. The client should be supine on the table with their legs extended and a bolster under their knees. The therapist then passively places the foot into dorsiflexion. A DVT is indicated by pain during dorsiflexion, tenderness upon palpation of the posterior lower leg, and/or pallor of the skin of the posterior lower leg during the test. Note that if a client is suspected of having a DVT, all manual therapy is contraindicated and the client should immediately be referred to a physician (Kutz et al., 2020). Functional or structural pes planus test This tests for a functional or structural cause of pes planus, or flat feet. The client will stand with their toes facing forward without any footwear. The therapist will observe the client’s medial longitudinal arch while the client is asked to stand on their toes. Then the client is asked to sit on the therapy table. A structural pes planus is indicated if the medial longitudinal arch remains flat when the client is standing on their toes and when seated. A functional pes planus is indicated if the medial longitudinal arch is restored Case study A 40-year-old woman walks into the therapy office with a noticeable hesitation to place pressure on her right foot, and she quickly steps off it when she does. She is complaining of pain on the bottom of the right foot near her heel and would like to know what might be the cause of her situation. Questions: 1. What structures of the foot could be causing her pain? 2. What orthopedic test should be utilized? Conclusion Judging by the breadth of the common orthopedic tests given here, it should be noted that as a general rule, the greater the ROM at a joint, the higher the number of dysfunctions of that joint and the surrounding musculature becomes common. Given the number of muscles acting upon the glenohumeral and coxal joints, pinpointing the source of pain or dysfunctions becomes more difficult in the absence of orthopedic tests. In many clinical settings, particularly when dealing with clients whose employers or insurance companies may be paying for a limited number of treatments, narrowing the scope of manual therapy to the relevant structures involved becomes particularly important.
when the client is standing on their toes or when seated. Functional pes planus may be due to weakened plantar flexors or tendons of the foot. The arch may be somewhat restored through remedial exercise. Cross-fiber friction of the plantar tendons may help initiate repair of these tendons and contribute to a more normal arch (Kutz et al., 2020). Windlass test This tests for an injury to the plantar fascia resulting in plantar fasciitis. The client should not be wearing footwear and will stand on a surface that allows their toes to extend from its edge. The therapist will push or pull the client’s toes into extension. Plantar fasciitis is indicated by pain at the base of the great toe or at the anterior aspect of the calcaneus/heel. This dysfunction is normally accompanied by inflammation along the pathway of the plantar fascia on the plantar surface of the foot, so ice would be applicable before attempting cross-fiber friction. Note that in the event there is no indication of plantar fasciitis, pain on the bottom of the foot near the heel may be caused by trigger points in the deeper muscles of the plantar foot, such as flexor digitorum or quadratus plantae (Kutz et al., 2020). Reflection: Many structural and function problems at both the ankle and foot itself can cause gait issues, but having a client pinpoint the pain might help narrow the focus of the tests one might perform. Analysis: Since the client is reporting pain on the bottom of her foot near the heel and this area is an attachment for the plantar fascia, the windlass test should be performed to indicate or even rule out involvement of the plantar fascia. As many physicians who refer such clients do not specialize in soft-tissue injuries, the application of these tests enables a physician to properly evaluate a client and determine the exact scope of a client’s healthcare needs.
WORKS CITED https://qr2.mobi/Musculoskeletal
Self-Assessment Answers and Rationales
1. The correct answer is b. 2. The correct answer is d.
3. The correct answer is a. 4. The correct answer is c.
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Book Code: MGA1226
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