1. Biomechanical Examination

2. Femoral Anteversion
How far in can the femur be rotated? How far out? Does the halfway point leave the femur internally or externally rotated?

3. Internally Rotated Hips

4. Intoe Gait Causes
Internally rotated hips
Internal tibial torsion
Metatarsus adductus

5. Tibial Torsion

6. Tibial Torsion

7. Tibial Torsion

8. Arch Height NWB
High, normal, low?

9. Arch Height WB Did the arch go from high to normal or low?
Did it go from normal to low?
If so, it is a flexible flat foot.

10. Subtalar Joint ROM
Normal
Inversion 35o
Eversion 15

11. Subtalar Joint ROM Place one thumb under 5th metatarsal head
Place one thumb on the medial side of the subtalar joint.
Pronate and supinate the foot and palpate the head of the talus popping in and out. When the head just dissappears, the STJ is in neutral position.
Now push up on the 5th metatarsal to lock the Midtarsal joint.
This is the position that the foot should be in to take an impression for orthotics.

12. Cast with STJ in Neutral position and MTJ locked

13. Supination Resistance Test
Place two fingers under navicular and lift superiorly.
In a foot which has a normal STJ axis location, the examiner will only have to exert a few pounds of digital force to cause STJ supination.

14. Midtarsal Joint ROM Place STJ in neutral position
Pronate and supinate forefoot
Is range of motion normal, limited, or hypermobile?

15. Relaxed Calcaneal Stance Position Non-Weight Bearing
Rearfoot varus, valgus, or normal?

16. Relaxed Calcaneal Stance Position Weight Bearing

17. Relaxed Calcaneal Stance Position

18. Forefoot to Rearfoot Position
With STJ in neutral position, what is FF position?
Forefoot varus with plantarflexed first ray
Forefoot valgus

19. Forefoot Position: Valgus

20. Forefoot Position: Varus
With STJ in neutral position, what is FF position?

21. 1st Ray Position plantarflexed first ray
Forefoot varus with plantarflexed first ray

22. Position of Digits

23. Claw Toes

24. Hammertoe

25. Mallet Toe

26. Ankle Dorsiflexion
Measure with knee extended and again with knee flexed. Push hard to dorsiflex!
Normal
Dorsiflexion 20°
Plantarflexion 50°

27. Hallux Dorsiflexion
Normal
Flexion 30o

28. Knee Position
Genu varus
Genu valgus
Genu recurvatum

29. Genu varum
Bow Legs

30. Genu valgum

31. Genu Recurvatum

32. Patellas pointing inward or outward due to femoral rotation

33. Leg Length Discrepancy
Measure from ASIS to bisection of medial malleolus

34. Base of Gait
narrow, normal or wide?

35. Angle of Gait
straight, abducted or adducted

36. Jack Test
The Hubscher maneuver or Jack Test refers to a method of evaluating the flexibility of a pes planus (flat foot type).
The test is performed with the patient weight bearing while the clinician dorsiflexes the hallux and watches for the formation of an arch. A positive result (arch formation) results from the flatfoot being flexible.
A negative result (lack of arch formation) results from the flatfoot being rigid.

37. Jack Test

38. Lunge Test The angle made by anterior tibia/shin to vertical
<35-38 degrees is considered restricted, making the patient more prone to injuries.

39. Gait Analysis HEAD - straight or tilted SHOULDER - are they level
PELVIC TILT - any tilting one side to the other
KNEE - any internal or external position
REARFOOT - where is the rearfoot at heel strike and at midstance?
ARM SWING - are they even both sides
HEEL STRIKE
MIDSTANCE
PROPULSION: is there an abductory twist?