STJ ROM
- Identify the motion of eversion and inversion
- Calculate ideal using total ROM divide by 3
- not a reliable measure
Hamstrings ROM
- Normal is 70-90 deg
- differentiate b/w semien/mem and biceps fem for in toe and out toeing Pt
- Medial compartment tight = in toeing
- Lateral hamstrings tight = out toeing
- Stretches (hold 30 sec):
- Supine, stretching leg two body from thigh flexed 90° position, preferably by 2nd person.
- Edge of table/coffee table, leg out straight, lean twd foot
- Foot on object (stool, chair) lean fwd to touch toes or with hands on hips
-If Pt presents with LBP advise to see physio as stretches may cause strain to lower back
SP, FP and Patella assessment
Q: why would there be arthritis under patella?
A: patella has a triangle. base & corresponding
triangle groove, when it moves outside of this,
cartilage is worn away
- Is there genu varum or valgum
- Tight posterior musculature Y/N
- Hyperextension Y/N
FF to RF assessment
- identify a varus or valgus forefoot position
- review signs an symptoms
NCSP and RCSP
-identify position of calcaneus in neutral and resting
HIP ROM
- 45 deg internal and external rotation
- External limited, internal tight (gluteus Medius, Minimus, adductors and TFL)
- Internal limited, external tight (gluteus maximus, piriformis, sartorius)
- If more motion medially than lateral cause for concern
1st Ray Position/ROM
- 1st ray PF/DF
- If thumbs line neutral
- Thumb width each way for normal ROM
-Know etiologies for 1st ray PF and DF
FPI
-foot posture pronated/supinated or neutral
Consideration of clinic exam
- easy to conduct
- time efficient
- cost value
- simple to understand
- quantifiable data
Reliability
-Moderate to good reliability, some studies found low reliability (politics?)
Validity
-Poor due to validation against measures that are un validates
-studies have shown good validity when foot is excessively pronated or supinated, but not when small differences exist (EMT and Radiographic tools)
STJ neutral measured
- Reference point for STJ ROM and other LL measurements
- used for orthotics manufacturing and casting
Ankle Joint Dorsiflexion
- Flex knee to remove gastroc, insert above the knee wont function at 90 deg
- Tightness Knee extended is gastroc, knee flexed is soleus
- Three stretches:
- wall lunge, stair stretch and soleus stretch
MTJ OA
- looking for 2:1 ratio of motion FP:TP
- Increase in FP motion, low OA
- increase in TP motion, high OA (harder to control with orthoses), advise Pt of getting a sturdy shoe build orthotics with lateral lip to keep foot in position
1st MPJ ROM
- normal is >65 deg
- Measurement WB: Roukis goniometer but cannot lock MTJ
Malleolar Torsion
- 13 to 18 deg normal
- quantifies TP torsion of malleoli relative to proximal shaft of tibia
- good for paediatrics to identify potential cause of in toeing or out toeing
LLD assessment
- If LLD present in RCSP and NCSP structural, difficult to treat
- If LLD fix when NCSP function can treat with orthoses
Navicular Drop
- Greater 1cm cause for concern
- Reliability poor as STA and foot size may impact normalize values of navicular height
Why do we measure from STJ neutral?
-Motion we measure occur from mid stance which is when the STJ is neutral, therefore we mimic this position
