1. Muscle and Joint Tests for Lower Extremity Ankle Joint and Foot Group 6 Kevin, Jonathan, Heather, Sybil, Andrew, and Chris

2. Introduction Test to be completed ► 1) Anterior Draw Test ► 2) Homan’s Sign ► 3) Tibialis Anterior/Posterior Test ► 4) Flexor Hallucis ► 5) Flexor Digitorum ► 6) Pes Planus ► 7) Gastrocnemius and Soleus ► 8) Peroneus longus and brevis ► 9) Gastrocnemius soleus ► 10) Extensor Hallucis longus

3. Anterior Draw Test ► Have patient sit on edge of table with ankle in approximately 20 degrees of plantar flexion ► Grasp posterior of calcaneus with one hand and the anterior distal tibia with the other ► Apply pressure posteriorly on tibia and anteriorly on calcaneus ► Positive test is defined by posterior translation of the tibia on the talus and outlines a large majority tears or ruptures to both anterior talofibular and calaneal fibular ligaments, and possible injury to post talofibular ligament ► Posterior talofibular injury is usually associated with level three sprains and fractures ► Partial tears to the anterior talofibular ligament will show a negative anterior draw test

4. Homan’s Sign ► Patient lies supine on bed with knees flexed at approximately 90 degrees ► Clinician grasps distal portion of lower leg with one hand and metatarsals with the other hand ► Clinician then forcibly and abruptly dorsiflexes the clients ankle ► Pain in gastrocnemius and popliteal region is a sign of deep venous thrombosis (DVT) and is caused by traction being placed on the posterior tibial vein

5. Tibialis Anterior ► Test: Dorsiflexion of the ankle joint and inversion of the foot, without extension of the great toe. Pressure is applied against the medial side, dorsal surface of the foot, in the direction of plantar flexion of the ankle joint and eversion of the foot. ► Nerve Supply: Deep peroneal, L4, 5, S1

6. Tibialis Posterior ► Test: Inversion of the foot with plantar flexion of the ankle joint. Pressure is applied against the medial side and plantar surface of the foot, in the direction of dorsiflexion of the ankle joint and eversion of the foot. ► Nerve Supply: Tibial L4, 5, S1

7. Flexor Hallucis Longus ► Test: Flexion of the interphalangeal joint of the great toe. Pressure is applied against the plantar surface of the distal phalanx in the direction of extension. ► Nerve Supply: Tibial, L5, S1, 2

8. Flexor Hallucis Brevis ► Test: Flexion of the metatarsophalangeal joint of the great toe. Pressure is applied against the plantar surface of the proximal phalanx in the direction of extension. ► Nerve Supply: Tibial L4, 5, S1

9. Flexor Digitorum Brevis ► Test: Flexion of the proximal interphalangeal joints of the second, third, fourth, and fifth digit. Pressure is applied against the plantar surface of the middle phalanx of the four toes in the direction of extension. ► Nerve Supply: Tibial, L4, 5, S1

10. Flexor Digitorum Longus ► Test: Flexion of the distal interphalangeal joints of the second, third, fourth, and fifth digits. Pressure is applied against the plantar surface of the distal phalanges of the four toes in the direction of extension. ► Nerve Supply: Tibial L5, S1, 2

11. Pes Planus ► Flat foot test ► Patient sits in chair and raises one foot off the ground, clinician observes longitudinal arch on foot. Patient places foot on ground, clinician observes longitudinal arch. ► 2 types of flat foot:  Rigid – Foot lacks arch at all times.  Subtle – Foot lacks arch only when in contact with ground.

12. Soleus ► Tests strength of soleus muscle ► Patient lies prone with knee flexed to 90 degrees( eliminates gastrocnemius muscle) clinician supports leg proximal to the ankle ► Patient then plantar flexes the ankle without inversion or eversion of the foot ► Examiner applies pressure against the calcaneus pulling the heel in a caudal direction ► If there is marked weakness, patient may not be able to hold against the pressure at the heel; if there is no weakness more leverage in necessary and obtained by applying pressure simultaneously against the sole of the foot

13. Soleus (con’t) ► Nerve supply  Tibial nerve, L5, S1, S2  Note this test can also be performed in the same way to test the gastrocnemius except the knee is extended

14. Gastrocnemius ► This test is to test the strength of the muscle ► Patient is standing with knee in extension (may balance themself with a hand on a table or wall); patient then rises on their toes pushing body weight directly upward ► Nerve supply: Tibial nerve, S1, S2 ► Note: this test can also be performed to test the soleus in the exact same way, but with knee partially flexed

15. Peroneus Longus ► The patient lies in a supine position with their lower extremities medially rotated on the opposite side. ► The kinesiologist then supports the leg right above the ankle joint. ► The test is done to demonstrate the patient’s ability to evert the foot while plantar flexing the ankle joint. ► Pressure should be applied against the lateral border and sole of the foot in the direction of the inversion of the foot and the dorsiflexion of the ankle joint. ► Nerve Supply: The peroneus longus is innervated by the superficial peroneal nerve, L4, L5 and S1

16. Peroneus Brevis ► To test the strength of the Peroneus brevis, a kinesiologist would use the same procedure as with the peroneus longus. ► If there is any weakness in the peroneus brevis or longus, there will be a decrease in the strength of the eversion of the food and a decrease in the strength of the plantar flexion of the ankle joint. It allows for a varus position of the food and it lessens the ability to rise on the toes. The lateral stability of the ankle is also decreased. ► Nerve Supply: The peroneus brevis is innervated by the same nerves as the peroneus longus. It is innervated by the superficial peroneal nerve, L4, L5 and S1.

17. Extensor Hallucis Longus and Brevis ► Test: Extension of the metatarsophalangeal and interphalangeal joints of the great toe. Pressure is applied against the dorsal surface of the distal and proximal phalanges of the great toe in the direction of flexion. ► Nerve Supply: Both the extensor hallucis longus and brevis are innervated by the deep peroneal, L4, 5, S1

18. References ► Kendell, F. P., McCreary E. K., Provance, P. G. (1993) Muscle Testing and Function (4 th ed.) Williams and Wilkins: Baltimore.