BRIEF PODIATRIC ASSESSMENT Non-weight-bearing assessment Hips n Sagittal plane motion: flexion 120–140°, extension 5–20° n Frontal plane motion: abduction 40°, adduction 25° n Transverse plane motion: internal and external rotation 45°. The hamstrings help in the extension of the hip during late swing and early stance. They also work to decelerate the tibia at the knee before contact. It is important, therefore, to test this muscle group as part of the hip assessment. The 90:90 test is used to test for tightness of the hamstrings: with the patient lying supine, the knee and hip is flexed; the knee is then extended. Normal values are between 75° and 90°.

Leg length Leg-length differences can be structural or functional. With the patient lying supine, with hips and knees extended, a slight pull on the leg should bring the knees and malleoli level. A difference indicates a discrepancy in either the femur or the tibia. A tape measure can be used from the anterior superior iliac spine (ASIS) to the medial malleolus to measure leg length.

Knees n Sagittal plane motion: flexion 135°, extension 0–10° – motion above 10° is known as genu recurvatum. No frontal plane or transverse

plane motion should be seen with the knee extended. A medial or lateral stress test can be used to assess the collateral ligaments. The drawer test is used to test the anterior and posterior cruciate ligaments. Apley’s compression test and McMurray’s test can be carried out to check for meniscal tears. The Q angle test is used to check for patella displacement. A line is drawn from the ASIS to a line bisecting the patella; a value over 15° is significant.

Ankle With the patient lying supine, the subtalar joint (STJ) is held in neutral with one hand while the other hand dorsiflexes the ankle. n Sagittal plane motion: plantarflexion 45°, dorsiflexion 10–20° – ankle equinus occurs when there is less than 10° of STJ dorsiflexion.

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Figure 1:

Movement at the subtalar joint:

(a) inversion; (b) eversion

Figure 2:

Movement at the midtarsal joint

Figure 3:

Movement at the first ray

Figure 4: (a) Relaxed

calcaneal stance position; (b)

foot held in the neutral position

to assess neutral calcaneal stance position

Limitation can be compensated with an early heel-lift or excessive pronation. The plantarflexors (soleus and gastrocnemius), the invertors (tibialis posterior and anterior), the dorsiflexors (long extensors and tibialis anterior) and the evertors (the peronei) can all be tested for muscle strength by asking the patient to act against resistance for each of the muscle groups.

Subtalar joint The STJ produces triplanar motion, supination and pronation. Supination consists of inversion, plantarflexion and adduction. Pronation consists of eversion, dorsiflexion and abduction. It is difficult to measure the motion attained in each plane, so the frontal plane motion of inversion and eversion is used as an indicator of STJ range of motion. This test is performed with the patient lying prone, with the foot and ankle over the edge of the couch. The foot is maximally inverted and everted (Fig. 1). The amount of inversion is usually twice that of eversion.

Midtarsal joint

The midtarsal joint (MTJ) is made up of the calcaneocuboid joint (CCJ) and the

talonavicular joint (TNJ). It has two axes: longitudinal and oblique. With the STJ in neutral, the foot is held distal to the CCJ and TNJ. The MTJ is then moved in all three planes (Fig. 2). Most of the motion should come from the sagittal and transverse planes.

Rearfoot With the STJ in neutral, the alignment of the rearfoot to the leg is determined. When the calcaneus is inverted relative to the tibia, it is known as rearfoot varus. Less commonly, rearfoot valgus is when the rearfoot is everted relative to the leg.

Forefoot With the STJ in neutral, the alignment of the forefoot to the rearfoot is determined. When the forefoot is inverted relative to the rearfoot, it is known as forefoot varus; when the forefoot is everted, it is known as forefoot valgus.

First ray With the STJ in neutral and the MTJ fully pronated, the first ray is dorsiflexed and plantarflexed 45° to the sagittal and frontal planes (Fig. 3). There should be equal motion in dorsiflexion with inversion and plantarflexion with eversion.

sportEX medicine 2009;42(Oct):20-23