Navicular drop
- greater than 1cm is cause for concern
- this measure should consider foot size
- indicate excessive pronation, MLA maybe RF
Hamstring flexibility
- 70-90 deg is normal
- external rotate, semimembranosus and semitendinosus
- internally rotate, biceps femoris
- check asymmetry for in toeing or out toeing
- Stretches, supine, edge of table and foot on object
what are the normative values for hip joint transverse rotation?
-45 deg internal rotation/external rotation
-5 deg necessary for gait
-external rotation limited
TFL, gluteus Medius and minimus tight
-Internal rotation limited
sartorius, gluteus maximus and piriformis
MTJ ROM
- 2:1 FP & TP
- increase FP, Low OA
- increase TP, High OA, difficult to control with orthoses
1st MPJ motion
- greater than 65 deg is normal
- Hallux limitus or hallux rigidus, if BF congenital
- Position of met heads, PF/DF or neutral
- If you want a proper measure use a Roukis goniometer: it doesn’t lock MTJ properly but its better than a kick in the dick
Aetiologies
- Weak gastroc
- hypertonicity of peroneus longus
- weak tib ant
- 2 deg uncompensated forefoot varus
- weak intrinsic muscle
Ankle joint DF
- > 10 deg both muscles
- KJ flexion eliminate gastroc due to insertion points
- KJ flexion soleus, KJ extended gastroc + soleus
- 3 stretches, wall lunge, staircase, bend knee stance
STJ ROM Normative values?
10 inversion, 28 eversion (2:1 ration generally but it varies)
what are the normative values for Ffoot-Rfoot position?
6 deg varus normal
what are the normative values for 1st ray ROM?
“thumbs breadth”
when we are testing AJ DF why do we slightly supinate the foot ?
to take out STJ , so making it harder for the talocrural joint
when testng gastroc/sol tightness- why does bending the knee “take out” gastrocnemius?
because of its origin (femur) and insertion (calc via achilles tendon) it would be pulling in a 90 degree angle which it can’t actually do..
what would you do for a patient that has structural LLD?
- if it is less than 1cm i might just to a heel raise internally e.g. add to orthotic
- if greater than 1cm then external full length
what are the 3 things we look for with the knee?
- FP alignment: using the tape measure: ASIS–> middle of AJ
- SP alignment: hyperextension?
- patella (ew): should move a 1/3 of a width medial nd lateral and should be = both sides
how would you get a proper measurement for looking at alignment of the whole leg/knee FP
WB x-ray of hip–> foot and take a measure
what does crepitus in the knee/patella suggest?
OA changes potential
Patella
- Side to side 1/3 of width each way
- proximal-distal motion
- proximal distal while tilted
Malleolar torsion?
- Normal, 13 -18 degrees
- TP torsion of malleoli relative to proximal shaft of tibia
- pediatrics to identify potential cause for in or out toeing
