ANKLE PLANTAR

FLEXION

Evaluation and Measurements

By Isabelle Devreux

1

Ankle Plantar Flexion: Gastrocnemius and Soleus

ROM: 0° to 40°- 45°

A. Soleus:

◘ Origin:

Posterior of head of fibula and proximal1/3 of its body.

Soleal line & middle 1/3 of medialborder of tibia.

Tendinous arch between tibia and fibula.

◘ Insertion: Posterior surface of the calcaneum (w/ gastrocnemius).

◘ Nerve: Tibial nerve: L5, S1, S2

◘ Action: Plantar flexes the ankle joint.

2

Ankle Plantar Flexion: Gastrocnemius and SoleusB. Gastrocnemius:

◘Origin:

Medial Head: Proximal & posterior of part of medial

condyle of femur.

Capsule of knee joint.

Lateral Head: Lateral condyle and post. surface of femur.

Capsule of knee joint.

◘ Insertion: Middle part of posteriorsurface of the calcaneum

◘ Nerve: Tibial nerve: L5, S1, S2

◘ Action: Plantar flexes the ankle joint + assists in flexion of the knee joint.

3

Ankle Plantar Flexion:

C. Plantaris muscle:

◘ Origin:

Distal part of lateral supracondylar line of the femur + popliteal surface.

Oblique popliteal ligament of

the knee joint.

◘ Insertion: Posterior part of calcaneum.

◘ Nerve: Tibial Nerve: L4,L5, S1

◘ Action: Plantar flexes the ankle + assists in flexion of the knee joint.

4

Ankle Plantar Flexion:

ROM: +- 45° to 45°

Limitation by:

Tension of talofibular ligament.

Tension of the dorsifexor ms.

Contact of posterior portion of talus bone on the tibia.

Accessory ms.:

Tibialis posterior

Peroneus longus

Peroneus Brevis

Flexor hallucis longus

Flexor digitorum longus

Forefoot &

ankle joint

plantar flexors

Toe, forefoot

& ankle joint

plantar flexors

5

Ankle Plantar Flexion: Grade 3, 4, 5

Pt.: Standing on leg to be tested , knee straight.

Therapist stands beside the patient.

Grade 3:« Rise on your toesclearing your heel off the floor---relax »(one time).

Grade 4 & 5: »Same + repeat 4 to 5 times ».

Needs sufficient stabilization to the forefoot on the ground.

Good = if patient has difficulty to complete the ROM or if he fatigues easily.

• Weight bearing

Or

•Non Weight Bearing

Tests

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Ankle Plantar Flexion: Grade 3

Non Weight Bearing:

Pt. is in prone with foot to be tested

over end of the table.

Ph.Th. stands beside foot.

Proximal hand is placed on the

L.L., proximal to the ankle to

stabilize.

« Pull the heel upward and push

backwards with your toes---relax ».

7

Ankle Plantar Flexion: Grade 4-5

Pt. Is in prone as in gr. 3.

Therapist applies resistance:

Proximal hand hods the sides of the heel.

Distal hand is on plantarsurface of the foot.

Moderate ( gr. 4) and Maximal + hold ( gr. 5) push of resistance simultaneously atheel + forefoot through full ROM.

8

Ankle Plantar Flexion: Grade 2 – 1 - 0

Pt. in sidelying position:with

lateral border of the foot to be

tested resting on the table.

Therapist is beside the foot,

proximal hand grasps the lower leg

just above the ankle joint to

stabilize it.

« Push your foot down through full

ROM. »

Grade 1: Palpation of the

contraction of the ms. fibers and on

tendon above calcaneum.

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Ankle Plantar Flexion:Effects of weakness:

Hyperextension of the knee.

Nonweightbearing position in standing.

Gastrocnemius limp: inability to riseon toes and to transfer weight normallyforward.

Effects of contracture & shortness:

Equinus position( ankle joint plantarflexed) of the foot and flexion of the knee.

Muscle shortness: restriction of the ankledorsiflex. when knee is extended & a restriction of the knee extension when the ankle is dorsiflexed.

10

Foot/ Ankle Deformities

Talipes equinus:

ankle joint plantar flexed

Talipes calcaneus:

ankle joint dorsiflexed.

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Inversion & Eversion

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Foot/ Ankle Deformities

Talipes Varus:

Foot is inverted &

accompanied by

an increase in the height

of the longitudinal arch.

Talipes Valgus:

Foot is everted and

accompanied by

flattening of

the longitudinal arch.

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ANKLE DORSI

FLEXION AND

INVERSION

Evaluation and Measurements

By Isabelle Devreux

14

Foot Dorsiflexion and Inversion: Tibialis AnteriorOrigin:

Lateral condyle & prox. ½ of lateral

surf. of tibia.

Interosseus membrane, deep fascia

and intermucular sceptum.

Insertion:

Medial and plantar surface of medial

cuneiform bone.

Base of first metatarsal bone.

Nerve: Peroneal nerve: L4, L5, S1

Action: Dorsiflexes and assist in inversion

of the ankle foot.15

Foot Dorsiflexion and Inversion: Tibialis Anterior

ROM : 20°

Limited ROM by:

Tension of the lateral

tarsal ligament

Tension of the peroneus

longus and peroneus

brevis ms.

Contact between tarsal

bones, medially.

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Foot Dorsiflexion & Inversion: Tibialis Anterior -

Testing Gr. 3 and 2

Pt. sits with legs over the edge of

the table.

Therapist sits on a stool near the

affected leg. Proximal hand grasps

around the ankle to stabilize the

lower leg.

« Pull your foot up and in; through

full ROM ----relax ».

Grade 3: Full ROM.

Grade 2: Partial ROM

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Foot Dorsiflexion & Inversion: Tibialis

Anterior - Testing Gr. 4 & 5 Pt. Position in sitting over the edge

of the table. His heel is supported on the thigh of the therapist.

Therapist : Proximal hand supports the lower leg above calcaneus, distal hand grasps the medial border if forefoot to give resistance.

Resistance: pushing down the medial border of the foot.

Pt. Should keep big toe flexed to avoid substitution by extensorhallucis longus.

« Pull your foot up and in throughfull ROM. »

18

Foot Dorsiflexion & Inversion: Tibialis

Anterior - Testing Gr. 1 & 0

Pt. In backlying, foot over the

edge of the table.

Therapist stands near the

edge, distal hand supports

the forefoot, the proximal

hand palpates the tibialis

anterior on its tendon on the

medial volar aspect of ankle.

« Try to pul your foot up and

in----relax.

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Foot Dorsiflexion & Inversion: Tibialis Anterior

Effects of weakness:

Decrease of the ability to

dorsiflex the ankle and allows

tendency towards the foot

eversion.

Substitution:

The extensor Hallucis Longus

which has the function of

assisting the dorsiflex. +

inversion may substitute to a

weak tibialis anterior muscle.

→Pt should keep the toes

relaxed.

20

Foot Inversion from

Plantar Flexion

21

Foot Inversion from Plantar Flexion: Tibialis Posterior

Origin:

Most of interosseus membrane.

Lat. posrtion of posterior surface of tibia. Prox. 2/3 of medial surface of fibula.

Insertion:

Tuberosity of navicular bone.

By fibrous expansions to the sustentaculum tali of calcaneusthree cuneiforms, cuboid and bases of 2nd, 3rd, 4th metatarsalbones.

Nerve: Tibial nerve ; L4, L5, S1.

Action: Inverts the foot and assists in the plantar flexion of the anklejoint.

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Foot Inversion from Plantar Flexion: Tibialis

Posterior

Accessory muscles:

Flexor digitorum longus.

Flexor Hallucis Longus.

Gastrocnemius »medial head ».

Range of Motion: 35°

But may be limited by:

Tension of lateral tarsal ligaments.

Tension of peroneal muscle group.

Contact between tarsal bones medially.

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Foot Inversion from Plantar Flexion: Tibialis

Posterior- Grade 3 « Fair strength »

Pt; is in sidelying, affected leg down,

foot in plantar flexion & resting on

lateral border.

Therapist stands at the foot of the

table, proximal holds ankle joint

proximally to stabilize the L.L.

« Raise up the medial border of your

foot through full ROM.---relax.

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Foot Inversion from Plantar Flexion: Tibialis

Posterior- Grade 4- 5

Pt. In sidelying, foot over the edgeof the table.

Therapist: Prox. hand supports the L.L. proximal to ankle, distal hand over the medial border of the foot + resistance.

Gr.4: moderate resistance.

Gr.5: maximal resistance + hold.

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Foot Inversion from Plantar Flexion: Tibialis

Posterior – grade 2 – 1 - 0.

Pt. in backlying with foot in plantarflexion over the edge of the table.

Therapist stands at end + prox. hand grasps the leg posteriorlyjust above the akle joint.

« Move your foot medially----relax ».

Gr. 1: palpation at the tibialisposterior between medialmalleolus and navicular bone; above the medial malleolus.

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Foot Eversion from

Plantar Flexion

Evaluation and Measurements

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Foot Eversion from plantar flexion: Peroneus

longus & brevis.

Peroneus Longus:

Origin: Lateral condyle of tibia, Head of proxilmal 2/3 of lateral surface of fibula, intermuscular septa.

Insertion: lateral side of base of 1st metatarsal and medial ccuneiform bone.

Nerve : Peroneal nerve: L4, L5, S1.

Action: Everts foot and assists in plantarflexion of the ankle joint.

28

Foot Eversion from plantar flexion: Peroneus

longus & brevis.

Peroneus Brevis:

Origin:

Distal 2/3 of lateral surface of tibia.

Adjacent intermuscular septa.

Insertion: Tuberosity at base of 5th metatarsal bone, lateral side.

Nerve: Peroneal nerve: L4,L5,S1.

Action: everts the foot and assits in plantar flexion of the ankle joint.

29

Foot Eversion from plantar flexion: Peroneus

longus & brevis.

Accessory muscles: Extensor Digitorum Longus

Peroneus Tertius(evert.+dorsiflexion)

ROM: 35°

Limited ROM by: Tension of medial tarsal ligaments

Tension of tibialis anterior and tibialis posterior muscles

Contact of tarsal bones laterally.30

Foot Eversion from plantar flexion: Peroneus

longus & brevis. Test gr.3.

Pt. In side lying , upper leg is the

affected leg, foot over the edge of

the bed and in plantar flexion; leg

is resting on its medial border.

Therapist: proximal hand supports

the lower leg proximal to the

ankle joint.

« Pull your foot up through full

ROM---relax. »

31

Foot Eversion from plantar flexion: Peroneus

longus & brevis:Grade 4- 5

Pt. Position as in gr.3.

Therapist grasps the forefoot to give resistance.

Moderate (or maximal for gr.5) resistance against plantarsurface of first (or all) metatarsal head.

Extensor digitorum longusshould be relaxed.

« Raise up the lateral border of the foot through full ROM.

32

Foot Eversion from plantar flexion: Peroneus

longus & brevis:Grade 2,1,0.

Pt. In sidelying with affected foot plantar flexed and resting on itsmedial border.

Therapist stands at the foot of the table and proximal hand stabilizesthe L.L.

For GR. 1: palpation on the peroneus brevis at the joint proximal to the 5th metatarsalbone on the lateral border of foot.

For peroneus longus: palpation under the head of the 1st metatarsal bone.

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Foot Eversion from plantar flexion: Peroneus

longus & brevis: EFFECTS

Effects of Weakness:

↓ strength of eversion

of the foot and plantar

flexion of the ankle

joint.

Allows a varus position

of the foot.

↓ the ability to rise on

the toes.

Decreases lateral

stability of the foot.

Weakness of

Peroneus longus /

brevis:

=Talipes Equino Varus

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Effects of Contracture:

Contracture of

peroneus longus &

brevis:

= Talipes Equino Valgus

=Everted or valgus

position of the foot.

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THANK YOU

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