Prac Viva

• Sport exercise, occupation
• - area of pain accurately represented:
• - medial v lateral
• - superior v inferior
• - proximal v distal
• - can the pt touch the pain

• - walking- uneven ground
• - up/down hills or stairs
• - squatting
• - haunches
• - jumping, running, changing direction

EASING- NWB

• - inv/ever
• - DF/PF
• - rot- ext + DF= ITF

• - effects of shoes
• - xrays- stress for instability/ talar dome fracture

• - bodyweight
• - WB (what part of foot)
• - LL alignment
• - hindfoot varus/ valgus
• - forefoot varus/ valgus
• - arches (flattening)
• - swelling bruising
• - shoe wear pattern
• - hallux alignment position (?valgus)
• -subtalar jt neutral position (supine/ st)- canhelp if pt inverts
• - malleolar torsion- if not middle can be int rot of tib
• - feiss line- line tip of malleolus tip of metatarsal - where navicular sits
• 
• 

• - walking (change pace or direction)
• - forwards/ backwards walking
• - walking on toes/ heels
• - walking inside/ outside of feet (inv/ev)
• - walking sidways
• - running (what surface pt runs on)
• - jumping, hoping
• - squatting (heels on/ off)
• - sit on haunches
• - rotation inweight bearing
• up/down steps

• test both feet at the same time +/- OP
• Take gastrocs off stretch
• - DF +/- knee flexion
• - PF
• - Inversion- hold on forefoot
• - Eversion
• - Conbined pfl/ inv + dfl/ev
• - toe flexion, ext, abd, add

Look at paper

• - tendon sheaths- palpate for crepitus, swelling
• - used for tendonopathy
• - palpate tendons for selling and pain

• - as indicated by acitve movements
• - in/ext rot 11*
• - differentiate movements
• - supination- PF/Add/Inv/IR
• - Pronation- DF/Abd/ev/ER
• - different jts:
• - hindfoot (STJ/ TC)
• - T/Tarsal jts
• - TMT jt
• Flick at EOR of plantar fleion
• - add compression throgh range (differntiates intra v periarticular structures) Compress first

• - articular margins
• - boney prominences:
• - tubercle of navicular- lump to arch
• - sustentaculaum tali
• - malleoli
• - head talus
• - 5th MT tubercle

• - between to leg bones
• - A/P- stabilise tib
• - P/A
• - compress- push together
• - distraction- done by pushing down on calcaneous
• WHAT DOES ALL THIS HELP?

• -
• Pt prone
• A/P- increase DF- stabilise crus (tib and fib)
• PA- increase PF- a/a
• IR/ medial rot- the right hand grasps the lower leg to stabilise the tibia while the left hand holds the talus posteriorly and rotates the talus medially
• ER/ lateral rot- the right hand grasps the lower leg to stabilise the tibia while the left hand holds the talus posteriorly and rotates the talus laterally
• - distraction- using your leg to stabilise when pulling the talus up
• -compression- press down

• - medial lateral glide
• - medial lateral tilt
• -longitudinal caudad

• - between talus and calcaneus/ navicular and cuboid bones
• - AP, PA
• Med/ Lat glide
• Ad/Ab
• IR/ER

• AP, PA
• med/ lat glide
• Ab/Ad
• IR/ER

• AP, PA
• Med/lat glide
• IR/ER
• Ab/Ad
• distraction/ compression

• AP
• PA
• MED/LAT glide
• IR/ER
• Ab/Ad
• distraction and compression

- DF/PF

• - Inversion
• - Eversion

further continues in/eversion

• - deltoid ligament
• - posterior tibiotalar
• - tibiocalcaneal
• - tibionavicular

Strong ligaments

ATFL

• - calcaneofibular
• - calcaneocuboid
• - Anterior draw test

• - calcaneofibular (heel varus in DF)
• - calcaneocuboid (adduction and inversion)

• - lateral lig test
• - tests the integrity of the ATFL
• - pt sits with foot over end of bed- approx 20* PF
• - one hand is placed over the anterior aspet of the lower tib and the other hand grasps the calcaneous posteriorly
• - the tibia is pushed posteriorly as the posterior aspet of the calcaneous is pulled forward
• - excessive translation is indication of ATFL- clunking sound may also be produced
• 

• - used to detect a rupture of the achilles tendon
• - pt lie prone with feet resting over edge of the table
• - gently squeeze the calf mm
• - a normal finding is that the foot will plantar flex
• - absence of PF is considered a +ve finding

• - mm strengthening
• - eccentric training for tendinitis
• - proprioceptive retraining
• - mm stretching
• - passive physiological movements- DF, PF, Inv, Ev

• - pt prone, knee @90*
• - physio stands by the pts knee, holds the calcaneus posteriorly and ant over the neck of the talus
• - place left knee on couch to support pts shin
• - with right hand, hold calcaneus with thumb around the lateral surface, the medial three fingers around the medial surface and the index finger (particullarly the volar aspect of the MCP jt) firmly contacting the sole
• - place the web of the first interosseous space of the left hand over the neck talus adj to the ankle so that the thumb rests against the lateral side of the foot and the fingers against the medial malleolus
• Method:
• - movement performed by the physios arms
• - elbows out to prevent compressionEnsure 2 isnt into resistence

• - pt lies prone with feet near the end of the couch
• - physio stands by the feet, facing the head and holding the right foot in both hands
• - place thumb, pointing proximally, along the medial and lateral borders of the soles of the heel, while thefingers meet over the dorsum of the foot and complete the grasp from in front
• - the tips of the thumbs provide a fulcrum for movement
• Method
• - physio raises the pts leg through approx 20* of knee flex why pt partially DF
• - leg is then dropped through those 20* at the same time strongly PF at the limit of range (the flick?)

• - the pt with the right knee flexed to slightly more than 90*
• - physio standing by the pts right knee with their left knee on the bed to support the pts shin
• - hold calcaneus in the right hand with the thub along the lateral surface and the ingers along the medial surface. Use the web of the first interosseous space of the right to grip the calcaneum around its superior surface posteriorly
• - place the web of the first interosseous space of the leftacross the plantar surface of thecalcaneum distally and laterally, with the thumb passing laterally around the foot and the fingers medially
• - direct the right elbow toward the floor and the left towards the ceiling
• Method:
• - the oscillatory movement is gained by the forearms moving in opposite directions, producing a DF movement around the ankle
• - as the limit of range is approached, flexion of the knee beyond 90* may be necessary to take gastrocs off stretch

- for technigues, the physio changes the left hand position to use the heel of the hand against the pts metatarsal heads. This change in position incorporates intertarsal movement with talocrural movement

• - pt is prone with knee flexed to 90*
• - physio standing by the knee and supporting the shin, grasp the calcaneum with both hands, thumbs adj to each other posisioting roximally on the lateral surface while the fingers hold over the medial surface
• - the main grasp is between the index and middle fingers medially and the thumb laterally of each hand. This isolates movement of the talocalcaneal, talocrural and inferior tiboofibula jts

• Method:
• - phyios holds pts foot away and perform themovement by pulling the leg towards while at the same time inverting the calcaneus. The movement is performed in such a way that the rotation of the hip through an arc of around 15* assists the inversion action produced by the physios wrist

• - pt is prone with knee flexed to 90*
• - physio standing by the knee and supporting the shin, grasp the calcaneum with both hands, thumbs adj to each other posisioting roximally on the lateral surface while the fingers hold over the medial surface
• - the main grasp is between the index and middle fingers medially and the thumb laterally of each hand. This isolates movement of the talocalcaneal, talocrural and inferior tiboofibula jts
• eversion of the calcaneum is produced by movement of the physio wrist coinciding with swinging the pts leg away
• the leg swinging is lateral rot of the hip