SECTION VII: ORTHOPEDIC TESTS OF THE ANKLE
Eversion talar tilt test This tests for an injury to the deltoid ligament on the medial side of the ankle inferior to the medial malleolus. The client should be supine on the table with their feet dangling off the end. The therapist will stabilize the tibia proximal to the ankle with one hand while everting/abducting the foot with the other hand. Pain in the area of the deltoid ligament Inversion talar tilt test This tests for an injury to one of the ligaments on the lateral side of the ankle inferior to the lateral malleolus. The client should be supine on the table with their feet dangling off the end. The therapist will stabilize the tibia proximal to the ankle with one hand while inverting/adducting the foot Thompson’s test This tests for a rupture of the calcaneal/Achilles’ tendon. The client should be in the prone position with their feet dangling off the end of the table. The massage therapist squeezes the belly of the posterior calf muscles, the plantar flexors (gastrocnemius and soleus) and looks to see if the client’s ankle goes into plantar flexion. A failure of the heel to rise indicates a ruptured tendon or may signal severe hypertonicity of the ankle’s dorsiflexors, such as tibialis anterior. To treat hypertonicity of the tibialis anterior and the muscles of the anterior compartment of the lower leg, apply directional massage, trigger point therapy, or perform PNF stretches (Cleland et al., 2020).
and/or ROM greater than 15-20 degrees during eversion is an indication that the deltoid ligament is injured. Injuries to the ankle’s deltoid ligament are common as it is the only ligamentous structure on the medial side of the ankle. In the absence of inflammation, cross-fiber friction of the area is indicated (Cleland et al., 2020). with the other hand. Pain in the area of the lateral ligaments and/or ROM greater than 20-30 degrees during inversion is an indication that one of the ligaments is injured. In the absence of inflammation, cross-fiber friction of the area is indicated (Cleland et al., 2020).
Self-Assessment Quiz Question #4 What structure on the medial side of the ankle is commonly injured? a. The interosseus membrane.
b. The medial malleolus. c. The deltoid ligament. d. The plantar fascia.
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 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 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 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?
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). planus is indicated if the medial longitudinal arch is restored 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). 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.
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Book Code: MLA1225
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