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Evidence-Based Examination of the Foot Practice Session & Skills Check-offs

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Evidence-Based Examination of the Foot Presented by Alexis Wright, PT, PhD, DPT, FAAOMPT Practice Sessions/Skill Check-offs

Module Five: Movement Assessment of the Foot/Ankle (1 hour CEU Time)

Skilled Process Review

in Chapter

Photo Description Check Off

Perform bilateral squat

Slide 7

Look for heel lift, foot rotation, leaning away from painful side

Passive physiological plantarflexion (whole foot, midfoot, forefoot)

Slide 10

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the postero-plantar calcaneus and the anterior hand on the dorsal forefoot. The foot and ankle are then passively plantarflexed to the first point of concordant pain (if present). Repeated movements or sustained holds are applied to determine if the symptoms increase or decrease. Differentiation of whole foot and midfoot can be made with hand placement changes. The clinician stabilizes the hindfoot and


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passively applies a plantarflexion force on the midfoot. The same is true for the forefoot by stabilizing the midfoot and forcing the forefoot into plantarflexion. A comparison of the patient’s reaction to pain with the various positions implicates which anatomical region is the likely source of the pain

Passive physiological dorsiflexion (whole foot, midfoot, forefoot)

Slide 11

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the postero-dorsal calcaneus (over the calcaneal tendon) and the other hand on the palmar surface of the foot. The foot and ankle are then passively dorsiflexed to the first point of concordant pain (if present). Repeated movements or sustained holds are applied to determine if the symptoms increase or decrease. Differentiation of whole foot and midfoot can be made by stabilizing the hindfoot and promoting dorsiflexion of the midfoot. Differentiation of the forefoot from the midfoot is made by stabilizing the midfoot and applying a dorsiflexion force to the forefoot.


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Passive physiological inversion (whole foot, midfoot)

Slide 12

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the calcaneus (fingers medially, thumb laterally) and the anterior hand on the forefoot (fingers medially, and thumb laterally). The foot and ankle are then passively inverted as the clinician pushes the foot away from his or her body in a curvilinear fashion. This movement occurs to the first point of pain and the process is repeated at end range as well. Behavior with repeated movements or sustained holds is recorded. The midfoot is differentiated from the hindfoot by blocking the hindfoot and promoting an inversion movement at the midfoot. The forefoot can be differentiated by stabilizing the midfoot and promoting inversion at the forefoot.

Passive physiological eversion (whole foot, midfoot)

Slide 13

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the calcaneus (fingers medially, thumb laterally) and the anterior hand on the forefoot (fingers medially, and thumb laterally). The foot and ankle are then passively everted as the clinician pushes the foot away from his or her body in a curvilinear fashion. This movement occurs to the first point of pain and the process is repeated at end range as well. Behavior with repeated


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movements or sustained holds is recorded. The midfoot is differentiated from the hindfoot by blocking the hindfoot and promoting an eversion movement at the midfoot. The forefoot can be differentiated by stabilizing the midfoot and promoting eversion at the forefoot.

Passive physiological first MTP flexion

The patient is in supine. The examiner grasps the distal metatarsal and proximal distal phalanx applying a perpendicular force in plantar direction

Passive physiological first MTP extension

The patient is in supine. The examiner grasps the distal metatarsal and proximal distal phalanx applying a perpendicular force in dorsal direction

Perform anterior to posterior passive accessory glide of the inferior tibiofibular joint

Slide 15

The patient assumes a sidelying position with the medial border of the foot placed on the plinth, the clinician is standing in front of the patient facing the foot. Resting symptom level is assessed. The clinician places one thumb on the anterior border of the distal fibula whereas the


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other hand stabilizes the tibia. The clinician performs a joint play movement by mobilizing the distal fibula directly posteriorly until the patient first reports concordant discomfort. The movement is then performed near end range. The movement is also repeated or sustained to assess the response of the movement on the concordant sign

Perform posterior to anterior glide of the inferior tibiofibular joint

Slide 16

The patient assumes a sidelying position with the medial border of the foot placed on the plinth, the clinician is standing behind the patient facing the heel. Resting symptom level is assessed. The clinician places one thumb on the posterior shelf of the distal fibula whereas the other hand stabilizes the tibia. The clinician performs a joint play movement by mobilizing the distal fibula directly anteriorly until the patient first reports concordant discomfort. The movement is then performed near end range. The movement is also repeated or sustained to assess the response of the movement on the concordant sign

Perform caudal glide of the inferior tibiofibular joint

Slide 17

The patient assumes a sidelying position with the medial border of the foot placed on a plinth. The clinician stands cephalically to the foot of the patient. The clinician performs a caudal glide of the fibula by inverting the hindfoot until the patient reports concordant discomfort. The movement is sustained or repeated to assess the outcome


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of the technique.

Perform cephalic glide of the inferior tibiofibular joint

Slide 18

The patient assumes a sidelying position with the medial border of the foot placed on a plinth. The clinician stands caudally to the foot of the patient. The clinician performs a cephalad glide of the fibula by everting the hindfoot until the patient reports concordant discomfort. The movement is sustained or repeated to assess the outcome of the technique.

Perform anterior to posterior glide of the talocrural joint

Slide 19

The patient is placed in prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the distal tibia and fibula and the anterior hand on the head of the talus with the elbows pointing out away from each other. With the tibia and fibula stabilized, an anterior to posterior force is exerted on the talus until the patient reports concordant pain. If the pain reported is concordant, the movement is repeated or sustained to determine the effect of the technique. The movement is then taken beyond the first point of pain toward end range. If the pain is concordant, the technique is repeated or sustained at end range

Perform posterior to anterior glide of the talocrural joint

Slide 20

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the head of the talus and the anterior hand on the distal tibia and fibular with the elbows pointing out away from


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each other. With the tibia and fibula stabilized, a posterior to anterior force is exerted on the talus until the patient reports concordant pain. If the pain reported is concordant, the movement is repeated or sustained to determine the effect of the technique.

Perform medial rotation of the talocrural joint

Slide 21

The patient is placed in prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the distal tibia and fibula and the anterior hand on the head of the talus with the elbows pointing away from each other. With the tibia and fibular stabilized, medial rotation of the talus is performed until the patient reports concordant pain. If the pain reported is concordant, the movement is repeated or sustained to determine the effect of the technique.

Perform lateral rotation of the talocrural joint

Slide 22

The patient is placed in prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the distal tibia and fibula and the anterior hand on the head of the talus with the elbows pointing away from each other. With the tibia and fibula stabilized, lateral rotation of the talus is performed until the patient reports concordant pain. If the pain reported is concordant, the movement is repeated or sustained to determine the effect of the technique.


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Perform longitudinal distraction of the talocrural joint

Slide 23

The patient is placed in a prone position with the knee flexed to 90 degrees. Resting pain is assessed. The knee of the clinician is placed on the posterior thigh of the patient for stabilization. The examiner places one hand under the foot, cupping the calcaneus and the other hand on the dorsum of the foot with the 5th digit on the head of the talus. The clinician lifts up with his or her body to distract the talocrural joint.

Perform posterior to anterior glide of the subtalar joint

Slide 24

The patient is placed in prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the calcaneus and the anterior hand on the head of the talus with the elbows pointing out away from each other. With the talus stabilized (anteriorly), a posterior to anterior force is exerted on the calcaneus until the patient reports concordant pain.

Perform anterior to posterior glide of the subtalar joint

Slide 25

The patient is placed in prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the talus and the anterior hand on the anterior calcaneus with the elbows pointing out away from each other. The calcaneus is stabilized and the talus is mobilized anteriorly (from its posterior contact) until the patient reports concordant pain


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Perform medial rotation of the subtalar joint

Slide 26

The patient is placed in prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the calcaneus and the anterior hand on the head of the talus with the elbows pointing out away from each other. With the talus stabilized, medial rotation of the calcaneus is performed until the patient reports concordant pain

Perform lateral rotation of the subtalar joint

Slide 27

The patient is placed in prone position with the knee flexed. Resting pain is assessed. The examiner places the posterior hand on the calcaneus and the anterior hand on the head of the talus with the elbows pointing out away from each other. With the talus stabilized, lateral rotation of the calcaneus is performed until the patient reports concordant pain.

Perform medial glide of the subtalar joint

Slide 28

The patient assumes a sidelying position with the medial border of the leg placed on the clinician’s forearm and the foot hanging off the mat, the clinician is standing facing the patient’s foot. Resting symptom level is assessed. The clinician takes the hindfoot in the distal hand with the thenar eminence firmly placed against the lateral calcaneus and the proximal hand stabilizing the lower leg (from underneath) with the forefinger on the medial malleolus and talus. The clinician performs a medial glide toward the floor while an eversion movement is provided to prevent the motion from becoming an


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inversion curvilinear movement rather than a medial glide of the calcaneus on the talus.

Perform lateral glide of the subtalar joint

Slide 29

The patient assumes a sidelying position with the lateral border of the leg placed on the clinician’s forearm and the foot hanging off the mat, the clinician is standing facing the patient’s foot. Resting symptom level is assessed. The clinician takes the hindfoot in the distal hand with the thenar eminence firmly placed against the medial calcaneus and the proximal hand stabilizing the lower leg (from underneath) with the forefinger on the lateral malleolus and talus. The clinician performs a lateral glide toward the floor while an inversion movement is provided to prevent the motion from becoming an eversion curvilinear movement rather than a lateral glide of the calcaneus on the talus.

Perform horizontal flexion of the forefoot

Slide 34

The patient is placed in prone position with the knee flexed. Resting pain is assessed. The Examiner places both hands interlaced on the dorsum of the foot with both thumbs on the plantar surface. The thenar aspect of the thumbs perform a mobilizing movement in a plantar to dorsal direction while the fingers draw the rays around the thumbs to increase the horizontal arch until the patient reports concordant pain


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Perform horizontal extension of the forefoot

Slide 35

The patient is placed in prone position with the knee flexed. Resting pain is assessed. The Examiner places both hands interlaced on the plantar surface of the foot with both thumbs on the dorsal surface. The thumbs perform a mobilizing movement in a dorsal to plantar direction while the fingers draw the rays around the thumbs to decrease the horizontal arch until the patient reports concordant pain

Perform posterior to anterior glide of the metatarsal phalangeal and interphalangeal joints

Slide 36

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner stabilized the proximal segment with one hand and grasps the distal segment of the joint that is to be assessed in the other hand. Using the thumb to generate the mobilizing force, a plantar to dorsal shearing movement is performed until the patient reports concordant pain.

Perform anterior to posterior glide of the MTP joint

Slide 37

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner stabilized the proximal segment with one hand and grasps the distal segment of the joint that is to be assessed in the other hand. Using the thumb to generate the mobilizing force, a dorsal to plantar shearing movement is performed until the patient reports concordant pain.


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Perform adduction of the MTP joints

Slide 38

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner stabilized the proximal segment with one hand and grasps the distal segment of the joint that is to be assessed in the other hand. Using the thumb to generate the mobilizing force, an adduction movement is performed until the patient reports concordant pain.

Perform abduction of the MTP joints

Slide 39

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner stabilized the proximal segment with one hand and grasps the distal segment of the joint that is to be assessed in the other hand. Using the thumb to generate the mobilizing force, an abduction movement is performed until the patient reports concordant pain.

Perform medial rotation of the MTP and IP joints

Slide 40

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner stabilized the proximal segment with one hand and grasps the distal segment of the joint that is to be assessed in the other hand. Using the thumb and forefinger to generate the mobilizing force, a medial rotational movement is performed until the patient reports concordant pain.


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Perform lateral rotation of the MTP and IP joints

Slide 41

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner stabilized the proximal segment with one hand and grasps the distal segment of the joint that is to be assessed in the other hand. Using the thumb and forefinger to generate the mobilizing force, a lateral rotational movement is performed until the patient reports concordant pain.

Perform compression and distraction of the MTP and IP joints

Slide 42

The patient is placed in a prone position with the knee flexed. Resting pain is assessed. The examiner stabilized the proximal segment with one hand and grasps the distal segment of the joint that is to be assessed in the other hand. Using the thumb and forefinger to generate the mobilizing force, a compressive movement is performed until the patient reports concordant pain.

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