hip and foot

3PTA Batch 2015 1

HIP SPECIAL TESTS

TESTS Structure/Condition

Being Tested Patient

Position Stabilization Maneuver (+) Sign

Patrick’s Test (Faber or Figure-Four Test)

Sometimes referred to as “Jansen’s test”

If (+), the following may be affected:

a. Hip joint b. Iliopsoas

spasm c. Sacroiliac

joint

Supine; Faber is the beginning position of

the hip.

None mentioned (According to picture, PT holds the knee of test leg and the opposite ASIS.)

PT places pt’s test leg so that the foot is on top of the knee of opposite leg. PT then slowly lowers the knee of test leg down toward table.

(+) Test- Test leg’s knee remains above the opposite straight leg. (-) Test- Test leg’s knee falling to the table or at least being parallel with the opposite leg.

Flexion-Adduction Test

Used in older children and young adults

Quadrant or Scouring Test

The test compresses the femoral neck against acetabulum; pinches adductor longus, pectineus, ilipsoas, Sartorius or tensor fascia lata.

Supine None mentioned PT flexes pt’s hip to 90 with knee flexed. PT then adducts the flexed leg.

(+) Test- Adduction is limited accompanied by pain or discomfort. (-) Test- Knee will pass over opposite hip without rolling the pelvis.

Trendelenburg’s Sign

-Stability of the hip and ability of hip adductors to stabilize pelvis on femur -Weak gluteus medius

Standing None The pt is asked to stand on one lower limb.

Pelvis on opposite side drops

Stinchfield Resisted Hip flexion Test

Intra-articular pathology which may include:

a. Labral tear b. Synovitis c. Arthritis d. Occult

femoral neck fractures

e. Iliopsoas tendinitis/bursitis

f. Prosthetic failure or loosening

Supine None mentioned Pt actively elevates the straight leg to 20-30 while PT applies gentle resistance.

Pain may be referred to sensory distribution of femoral, obturator, or sciatic nerves.

Anterior Labral Tear Test (FADDIR- Flexion, Adduction, and Internal Rotation Test)

Tests: a. Anterior-

superior impingement syndrome

b. Anterior labral tear

c. Iliopsoas tendinitis

Supine PT takes hip into full flexion, lateral rotation, full abduction as a starting position. PT then extends hip combined with medial rotation and adduction.

Production of pain or reproduction of pt’s symptoms with or without a click.

3PTA Batch 2015 2

TESTS Structure/Condition Being Tested

Patient Position Stabilization Maneuver (+) Sign

Posterior Labral Tear Test

Labral tear/ Anterior hip instability/

Posterior-inferior impingement

Supine

One hand: on the knee

Other hand: distal

leg, above the ankles

-Starting position: PT fully flexes, adducts, and medially rotates

hip -Final position:

PT extends, abducts, and laterally rotates hip

groin pain, apprehension, reproduction of

the patient’s symptoms with or

without a click

McCarthy Hip Extension Sign N/A

Supine w/ both hips

flexed N/A

-PT takes unaffected hip, extends and laterally rotates it.

-Procedure is repeated, but extension is

combined w/ medial rotation.

-The test is repeated with the affected hip.

reproduction of the pt’s pain

Craig’s Test

*also called Ryder method

Femoral anteversion (forward torsion of

femoral neck)

Prone w/ knee flexed

to 90°

One hand: palpates for

greater trochanter of femur

Other hand: distal

leg, above the ankles

-PT medially and laterally rotates the hip

until the greater trochanter is parallel w/

the table (or when it reaches its most lateral

position).

The degree of anteversion can

be estimated based on the

angle of the lower leg w/ vertical. (an angle >15°)

Torque Test

To test stability of hip and its capsular

ligaments

Supine w/ femur of test leg extended over edge of

the table

One hand: distal leg, above the

ankles

Other hand: femoral neck

-Test leg is extended until the pelvis begins

to move. -PT uses one hand to

medially rotate femur to end range, and the

other hand to apply a slow posterolateral

pressure along the line of femoral neck for 20

secs. (to stress capsular ligaments and test the stability of the

hip joint)

N/A

Nelaton’s Line hip dislocation or coxa vara

-It is an imaginary line from ischial tuberosity of the pelvis to ASIS of the pelvis on the same side.

*two sides should be compared

If greater trochanter is

palpated above the line



1. Bryant’s Triangle

To determine the upward displacement of the trochanter in fracture of the neck of the femur

Supine PT drops an imaginary perpendicular line from ASIS to table. Second imaginary line from the tip of greater trochanter to meet the first line at a right angle. Measure lines and compare two sides.

Differences may indicate coxa vara or congenital dislocation of hip

3PTA Batch 2015 3

2. Rotational Deformities

Rotation of femur or tibia Fick Angle – normal feet angle 5° - 10° out for better balance

Supine with lower limbs straight

Examiner looks at the patellae

Squinting patella is a possible indication of medial rotation of femur or tibia Grasshopper/Frog Eyes is a possible indication of lateral rotation of femur or tibia Pigeon toes (feet face in) indicates that the tibia is affected, rotates medially and face out more than 10° excessive lateral rotation of tibia

PEDIATRIC TESTS FOR HIP PATHOLOGY


Patient Position

Stabilization Maneuver (+) Sign

1. Ortolani’s Sign

- To determine whether an infant has a CDH *Valid only for first few weeks after birth and only for dislocated and lax hips, not dislocations

Supine -PT’s thumbs against the insides of the knees and thighs; fingers are placed along the outsides of the thighs to buttocks

- Examiner flexes the hip and grasps the legs. -With gentle traction, thighs are abducted and pressure is applied against the greater trochanters *Should not be repeated too often because it could lead to damage of articular cartilage of femoral head

- Resistance to abduction and lateral rotation felt at 30° - 40°. - PT may feel a click, clunk or jerk - Femoral head slips over the acetabular ridge into acetabulum (normal abd = 70-90°) *If (-), does not necessarily rule out CDH

2. Barlow’s Test - Modification of Ortolani’s Test - To determine DDH (developmental dysplasia of the hip)

- For infants up to 6 months

- Should not be repeated too often because it may result in a dislocated hip or articular damage to

Supine with legs facing the examiner; hips flexed to 90°; knees are fully flexed

- One hand: evaluate hip - Other hand: steadies the opposite femur and pelvis - PT’s hand placed over the greater trochanter; thumb is adjacent to the inner side of the knee and thigh opposite the lesser trochanter

- Each hip is evaluated individually Part 1. Hip is taken into abduction while PT’s middle finger applies forward pressure behind greater trochanter Part 2. PT uses thumb to apply pressure backward and outward on the inner thigh

- Part 1. Femoral head slips forward into the acetabulum with a click, clunk, jerk - Part 2. Hip is unstable is the femoral head slips out over the posterior lip of the acetabulumand then reduces again when pressure is removed

3PTA Batch 2015 4

the head of femur

3. Galeazzi Sign (Allis or Galleazi Test)

- good for assessing unilateral CDH or DDH - used in children from 3-18 months

Supine with knees flexed and hips flexed to 90°

- One knee is higher then the other

4. Telescoping Sign (Piston or Dupuytren’s Test)

- evident in children with dislocated hip

Supine PT flexes knee and hip to 90°; femur is pushed down onto the table; femur and leg are then lifted up and away from the table

- Excessive movements called Telescoping or Pistoning

5. Abduction Test (Hart’s Sign)

Congenital dislocation of hip or developmental dysplasia (Evident when one leg does not abduct as far as the other when changing the child’s diaper)

Supine • Patients hip and knees flexed to 90 deg

• Examiner passively abducts both legs

• Asymmetry or limitation of movement

• IF one hip is dislocated, child often shows asymmetry of fat folds in gluteal and upper leg area because of riding up of femur on affected side

TEST FOR LEG LENGTH

TESTS Structure/Condition being tested


Weber-Barstow maneuver

Leg length discrepancy Supine • Patient hips and knees flexed

• examiner stands at pt’s feet and palpates distal aspect of medial malleoli with his/her thumbs

• pt. then lifts pelvis from examining table and returns to starting position

• Examiner passively extends patient’s legs and compares positions of malleoli using borders of thumbs

Different level of malleoli that indicate asymmetry

3PTA Batch 2015 5

TEST FOR MUSCLE TIGHTNESS OR PATHOLOGY

TESTS Structure/Condition being tested


Sign of the Buttock

Ischial Bursitis, Neoplasm, abscess in the buttock, hip pathology

Supine • pt. performs a straight leg raising test.

• If there is limitation of SLR, examiner flexes pt’s knee to see whether further hip flexion can be obtained

• If hip flexion does not increase, lesion is in buttock or hip, not sciatic nerve or hamstrings

• There may also be limited trunk flexion

Thomas Test Hip flexion contracture (Most common contracture of hip)

Supine Examiner checks for excessive lordosis, usually present with tight hip flexors

• Examiner flexes one of the patient’s hips, bringing knee to chest to flatten out lumbar spine and stabilize pelvis

• Pt. holds the flexed hip against the chest

• If no contracture, the hip being tested(the one which is straight on the mat) will remain flat on the mat

• If contracture present : = pt’s straight lef rises off table = muscle end feel will be felt • If lower limb is pushed

down onto the table, pt. may exhibit increased lordosis, thus it is also a + sign

• When pt flexes knee and other leg abducts instead of lifting off the mat, this is called a J sign or stroke and is indicative of a tight ITB on the straightened leg

Rectus Femoris Contracture Test (Kendall Test Method 1)

Name is indicative of condition being tested

Supine • In starting position, pt knees are bent over the edge of examining table

• Pt then flexes one knee to chest and holds it

• Angle of knee that is still hanging at the edge of the table should be at 90deg when opposite knee is flexed to chest

• Examiner may attempt to passively flex the dangling knee to see if it is able to remain at 90deg on its own

• Examiner should ALWAYS palpate for muscle tightness when doing any contracture test

• If knee extends and angle increases, there is probable presence of contracture

• If no palpable tightness, probable cause is tight joint structures and end feel will be different

3PTA Batch 2015 6

Ely’s Test (Tight Rectus Femoris, Method 2)

Prone Examiner passively flexes pt’s knee

On flexion of the knee done by examiner, the ipsilateral hip also flexes, there is a tightness of the Rectus Femoris

Ober’s Test Tensor Fascia Latae AKA ITB

Side-lying • Pt’s lower leg is flexed at hip and knee for stability

• Examiner passively abducts and extends pt’s upper leg with knee straight or flexed at 90deg.

• Examiner slowly lowers leg, and if leg remains abducted, the test is positive for a contracture of ITB

*When doing this test, extend hip slightly so that ITB passes over greater trochanter of femur • If neurological signs

are elicited, examiner should consider pathology of femoral nerve

• Tenderness over greater trochanter, examiner must consider trochanteric bursitis



Noble Compression Test

ITB Friction Syndrome

Supine One Hand: Thumb applying pressure 1-2cm proximal to the lateral femoral epicondyle

Patient slowly extends knee up to 30° flexion while PT maintains pressure

Pt feels pain over lateral femoral condyle

Adduction Contracture Test

Adductor Muscles Contracture

Supine PT attempts to balance the lower limb with the pelvis by shifting the pelvis up on the affected side or down on the unaffected side

Contraction if : the affected leg forms an angle of less than 90° with the line joining the two ASISs. Functional shortening if: ASIS moves before 30-50° of abduction and the end feel is tight

Abduction Contracture Test

Abductor Muscles Contracture

Supine PT attempts to balance the lower limb with the pelvis by shifting the pelvis up on the affected side or down on the unaffected side

Contraction if: the affected leg forms an angle of more than 90° with the line joining the two ASISs. Functional Lengthening: if the ASIS moves before 30 of hip adduction

3PTA Batch 2015 7

Piriformis Test Piriformis Syndrome Sidelying One hand: On the hip Other hand: Apply downward pressure to the knee

Pt flexes test hip to 60°, knee flexed. The PT applies downward pressure to the knee

Pt feels pain in the buttock, sciatica may also be experienced

90-90 SLR Hamstrings Contracture

Supine Patient grasps behind the knees with both hands to stabilize hips at 90° flexion.

(1)Both hips are flexed to 90 with knees bent. (2) Pt actively extends knee

Unable to extend the knee within 20° full extension

90-90 SLR (Gluteus Maximus Length)

Gluteus Maximus Tightness

Supine One hand: ASIS on the same side Other hand: Knee of same side

PT flexes the hip with knee flexed

ASIS moves before the thigh reaches the trunk

90-90 SLR ( Gluts Max Strength)

Gluteus Maximus Weakness

Prone One hand: Hip Other hand: Posterior thight, applying anterior force

From straight hip and 90° knee flexion, the patient is asked to extend the hip keeping the knee flexed. An anterior force is applied by the PT to the posterior thigh

Pt attempts to further flex the knee



1. Hamstrings Contracture Test (Method 2)

Muscle tightness or pathology

Sitting Pt’s one knee flexed against chest to stabilize pelvis and the other knee extended

Pt attempts to flex the trunk and touch the toes of the extended lower limb with the fingers

Pt is unable to touch toes (tight hamstrings on the straight leg)

2. Tripod Sign (Hamstrings Contracture, Method 3)


Sitting (Pt’s both knees are flexed to 90o over the edge of the examining table)

PT passively extends one knee

Extension of the spine

3. Bent-Knee Stretch Test for Proximal Hamstrings


Supine PT flexes the hip and knee of the test leg maximally. The PT then slowly extends the knee

Pain in the hamstrings at the ischial origin

4. “Taking Off the Shoe” (TOST) Test


Standing (affected hip is laterally rotated about 90o with 20o to 25o flexion at the knee)

Pt is asked to remove the shoe on the affected side with the help of the shoe on the opposite side by putting the heel of the affected side into the medial longitudinal arch of the stance (good) leg to pry the shoe off.

Sharp pain in the biceps femoris (1o or 2o muscle strain)

3PTA Batch 2015 8

5, Phelp’s Test Muscle tightness or pathology

Prone with knees extended

The PT passively abducts both of the pt’s legs as far as possible. The knee are then flexed to 90o and the PT tries to abduct the hips further

Abduction increases (contracture of the gracilis muscle)

6. Tightness of Hip Rotators


Supine (hip and knee flexed to 90o)

For tightness of lateral rotators: The pt is asked to medially rotate the hip by rotating the leg outward. For tightness of medial rotators: The pt is asked to laterally rotate the hip by rotating the leg inward.

Lateral rotators: medial rotation is less than 30o to 40o and end feel will be muscle stretch rather than tissue (capsular) stretch. Medial rotators: lateral rotation is less than 40o to 60o and the end feel will be muscle stretch rather than tissue (capsular) stretch.

Tests Structure or Condition

Being Tested

Patient Position

Stabilization

Maneuver

(+) Sign

Lateral Step Down Maneuver (Pelvis Drop Test)

Hip rotators (lateral)

Standing One foot on an 8 inch stool, arms on the side and erect trunk, no hip adduction or IR

N/A

Pt in initial position is asked to slowly lower non weight bearing leg to the floor

Arms abducted, trunk inclines forward, weight bearing hip adducts or IR; pelvis flex forward or rotates backward

Fulcrum Test of the Hip

Femoral shaft Sitting dangling

N/A PT’s arm under the pt’s thigh moves from distal to proximal as a gentle pressure is applied on the dorsal knee

Sharp pain and apprehension when the fulcrum arm is under the fracture site

ANKLE AND FOOT SPECIAL TESTS

Tests Structure/Condition

Being Tested Patient

Position

Stabilization

Maneuver

(+) Sign Neutral Position of the Talus (Standing)

Tests for Neutral Position of the Talus

Standing One hand: Palpates Talus on Dorsum

Pt. rotate trunk from right to left, causing tibia to medially and lat. rotate so talus supinates and pronates. If Talus doesn’t bulge on either side=subtalar is neutral

3PTA Batch 2015 9

Navicular Drop Test -a progression of the Neutral Position of Talus (Standing)


Standing Neutral Talus Position

Palpate the Talus on Dorsum

Measure Height of navicular from floor in relaxed standing, and also in the neutral talus position

Difference between neutral talus height and normal relaxed standing. If >10, Abn.

Neutral Position of the Talus (Supine)


Supine; feet over the end of table

One hand: Grasp foot on 4th and 5th Metatarsals (using thumb and index) Other hand: Palpate both sides of head of talus on dorsum (using thumb and index)

Passively dorsiflex foot until resistance is felt. Then while maintaining dorsiflexion, perform supination, then pronation. Position where the Talar head doesn’t bulge=neutral position

Neutral Position of the Talus (Prone)


Prone; foot extend over table

One hand: Grasp 4th and 5th metatarsal heads (using index and thumb) Other hand: Palpate both sides of head of talus on dorsum (using thumb and index)

Passively dorsiflex foot until resistance is felt. Then while maintaining dorsiflexion, move foot back and forth through an arc of supination and pronation. Where the foot appears to “fall off”, that is the neutral position.

Test Structure/ Condition

Being Tested


Leg Heel Alignment

Tests for Alignment (valgus or varus of the foot)

Prone with foot extending over the end of table

PT makes a calcaneal line (between midline of calcaneus and 1 cm distal to first mark), and tibial line (between two marks on lower third of leg in midline). PT places subtalar joint in prone neutral position.

PT places subtalar joint in prone neutral position. PT looks at 2 lines.

Hindfoot varus – heel is inverted Hindfoot valgus – heel is everted (N) 2o to 8o varus

Forefoot – Heel Alignment


Supine with feet extending over the end of table

PT positions subtalar joint in supine neutral position

PT pronates midtarsal joints maximally, observes relation between vertical axis of heel and plane of 2nd - 4th metatarsal heads

Forefoot varus – medial side of foot is raised Forefoot valgus – lateral side of foot is raised

Coleman Block Test - Differentiates between hindfoot varus resulting from forefoot valgus and hindfoot varus resulting from a tight tibialis posterior


Standing If pt is found to have hindfoot varus in standing, PT places a lift or block under lateral side of foot

Tight tibialis posterior (N) if hindfoot varus is corrected, hindfoot is flexible and hindfoot varus is due to a plantar flexed first ray or valgus forefoot

3PTA Batch 2015 10

Test Structure/Condition Being Tested


Tibial Torsion in Sitting

Test for Tibial Torsion

Sitting, knees flexed 90o

over the edge of the table

Thumb: Over apex of one malleolus Index finger: Over apex of the other malleolus

PT visualizes axes of knee and ankle

(N) not normally parallel; form an angle of 12o-18o

Tibial Torsion in Supine

Test for Tibial Torsion

Supine PT ensures femoral condyle lies in the frontal plane (patella facing straight up)

PT palpates apex of both malleoli with one hand and draws a line on the heel representing a line joining the 2 apices. Another line is drawn on heel parallel to floor.

Angle formed by the intersection of the 2 lines indicates amount of lateral tibial torsion.

Tibial Torsion in Prone

Excessive Toeing-in or toeing-out position (normal is 13°-18°); Tibial Torsion

Prone with knee flexed to 90°

No stabilization required

PT views from above the angle formed by foot and thigh noting the angle the foot makes with the tibia

Excssive toeing-in or toeing-out

Too Many Toes Sign

Excessive Toe-out position (tibial torsion is >18°); Tibial Torsion

Standing No stabilization required

PT stands behind pt and examines the foot from a posterior view

Heel is in valgus, forefoot abducted, or if tibia is laterally rotated more than normal

Test Structure/

Condition Being Tested


Anterior Drawer Test

Anterior talofibular ligament instability

Supine with foot relaxed

One hand: grasps tibia and fubula Other hand: holds foot of pt in 20° plantar flexion

Draws the talus forward in the ankle mortise

Excessive anterior translation Due to torn medial and lateral ligaments

Prone Anterior Drawer Test

Anterior talofibular ligament Instability

Prone with feet extending over the end of table

One hand: Grasps the ankle

PT uses other hand to push heel steadily forward

Excessive anterior movement and a “sucking in” of Achilles tendon skin

Talar Tilt Test for torn Calcaneofibular ligament

Supine or sidelying with foot relaxed

One hand: PT holds affected foot in anatomical (90°) position

PT uses other hand to tilt talus of affected foot, side to side into adduction and abduction

Excessive abduction or adduction

Test Structure/Condition Being Tested


Squeeze Test for the Leg (Distal Tibiofibular Compression Test)

Syndesmosis Injury

Supine Examiner grasps the lower leg at midcalf

Examiner squeezes tibia and fibula together. Apply at more distal locations toward the ankle.

Pain in the Lower Leg

3PTA Batch 2015 11

Compression over the malleoli rather than shaft of tibia and fibula

External Rotation Stress Test (Kleiger Test)

Syndesmosis Injury Sitting with legs hanging over table

Stabilizes leg with one hand. The other hand holds the foot in neutral (platigrade 90°) position

Passive lateral rotation stress to the foot and ankle

Syndesmosis Injury = Pain produced over the anterior or posterior tibiofibular ligaments and the interosseous membrane Deltoid Ligament Injury = pain medially and the talus displaces from the medial malleolus

Point Palpation Test

Syndesmosis injury Sitting or Supine Examiner applies gradual pressure over the anteroinferior tibiofibular ligament (anterior aspect of the distal tibia fibular syndesmosis) using the index finger

Pain in the syndesmosis area

Cotton Test Syndesmosis instability with diastasis (separation of the tibia and fibula)

Sitting Stabilize distal tibia with one hand

Apply medial and lateral translation force with the other hand (not inversion/eversion)

Any lateral translation >3-5mm Clunk

Dorsiflexion Maneuver

Sits on edge of table

Stabilize patient leg with one hand

Passively and forcefully dorsiflex the foot by holding onto the heel using the forearm to dorsiflex the foot

Pain on forced dorsiflexion

Crossed Leg Test

Syndesmosis Injury

Sitting with affected leg crossed over the opposite knee

Examiner grasps the lower leg at midcalf

Gentle force to the medial aspect of the knee of the injured leg

Pain in the area of the distal syndesmosis

Dorsiflexion Compression Test

Syndesmosis Injury Bilateral weight bearing

Patient is asked to move his or her ankle into extreme dorsiflexion (Pt. is asked to note whether this maneuver is painful while PT notes ROM) Pt. the assumes a

A decrease in pain on dorsiflexion or an increase in dorsiflexion range

3PTA Batch 2015 12

normal standing position. PT applies a compression force using two hands surrounding the malleoli of injured leg. Pt. is asked to dorsiflex when compression is maintained

Heel Thump Test

Syndesmosis injury Sitting or Supine One hand to stabilize the leg

Other hand, PT applies a firm thump on the heel with the fist so that the force is applied to the center of the heel and in line with the long axis on the tiba

Syndesmosis Injury: Pain in area of the ankle Stress Fracture: Pain along the shaft of tibia

Test Structure/

Condition Being Tested


Functional Leg Length

Other Tests/ Tests for Muscle or Tendon Affectation

Patient stands on a normal relaxed stance

PT palpates the ASIS and PSIS . PT then positions the patient’s subtalar joint in neutral position while weight bearing PT. maintains this position with the toes straight ahead and knees straight PT repalpates the ASIS and PSIS problems

If the previously noted differences remain, the pelvis and sacroiliac joints should be evaluated further. If they disappeared, the PT should suspect a functional leg length difference (hip/knee/ankle/foot) Determine what causes the difference Foot Pronation seen w/ forefoot/hindofoot varus, tibial varus, tight muscles (Calf / Hamstrings/ Hip Flexors or weak muscles (Piriformis / Ankle Invertors)

Thompson’s (Simmonds’) Test (Sign for Achilles Tendon Rupture


Prone/Kneeling on a chair with feet over the edge of the table or chair

N/A PT squeezes calf muslces

Absence of plantar flexion

3PTA Batch 2015 13

Firgure-8 Ankle Measurement for Swelling


Long sitting with ankle and lower leg beyond the edge of the table; ankle in PLANTIGRADE (90o)

N/A PT places end of tape measure midway between the tibialis anterior tendon and the lateral malleolus, draws tape medially across instep just distal to the navicular tuberosity, tape is then pulled across the arch of the foot just proximal to the base of the fifth metatarsal, across the tibialis anterior tendon and then around the ankle joint just distal to the tip of the medial malleolus across the Achilles tendon and just distal to the lateral malleolus returning to the starting point.

Done 3x then averaged.

Test for Peroneal Tendon Dislocation


Prone with knee flexed to 90o

N/A Posterolateral region of ankle is inspected for swelling. Pt asked to dorsiflex and plantarflex woth eversion against PT’s resistance.

Tendon sublaxes form behind lateral malleolus.

Swing Test for Posterior Tibiotalar Sublaxation


Prone with knee flexed to 90o

One hand: Calcaneus held in eversion and ankle in dorsiflexion Other hand: Thumb contacts the plantar surface of the base of the 2nd, 3rd, 4th metatarsals with index finger and middle finger contact planter surface of navicular.

Push dorsally on the navicular and metatarsal heads

Reproduction of Pt’s symptoms.

Test Structure/Condition Being Tested Patient Position Stabilization Maneuver (+) Sign

Feiss Line Medial longitudinal arch

Initial: non weight bearing on legs Later: stands with feet 8-15 cm (3 to 6 in) apart

Instruct patient to stand straight

Initial: mark apex of medial malleolus and plantar aspect of first metatarsal; mark navicular tuberosity on medial foot

If navicular tuberosity mark falls 1/3 distance towards floor (FIRST DEGREE FLATFOOT);

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Later: observe that all points are aligned

If it falls 2/3 distance towards the floor (SECOND DEGREE FLATFOOT) If it rests on the floor (THIRD DEGREE FLATFOOT)

Hoffa’s Test Calcaneal fracture Prone, feet extended over edge of table

Prevent knee flexion Palpate Achilles tendon while pt plantar and dorsiflexes

Positive for calcaneal fracture if injured side is less taut than the other

Tinel’s Sign at the Ankle (Percussion Sign)

Nerve affectation Supine *may be elicited in two places a.) Anterior Tibial Branch of Deep Peroneal Nerve b.) Posterior Tibial Nerve

Stabilize leg a.) tap at front of ankle b.) tap at posterior part of medial malleolus

Positive if there is tingling or paresthesia felt distally (applies to both)

Duchenne Test Nerve affectation Supine, legs straight

Prevent knee flexion Push up on head of first metatarsal through the sole (towards dorsiflexion)

Positive for lesion of superficial peroneal nerve or L4, L5, or S1 nerve = when patient is asked to plantarflex, medial border of foot dorsiflexes (no resistance by patient) but lateral border of foot plantarflexes

Morton’s Test Fracture or nerve affectation

Supine Stabilize distal leg Grasp foot about metatarsal heads, squeeze heads together

Positive for stress fracture or neuroma if there is pain

Homan’s Sign Deep venous thrombosis

Supine, knee extended

N/A Passive dorsiflexion

Positive for deep vein thrombophlebitis if there is pain/tenderness at calf; positive also if pallor and swelling at leg, loss of dorsalis pedis pulse are present

hip and foot

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