Biomechanical Examination

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

Internally Rotated Hips

Intoe Gait Causes Internally rotated hips Internal tibial torsion Metatarsus adductus

Tibial Torsion

Tibial Torsion

Tibial Torsion

Arch Height NWB High, normal, low?

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.

Subtalar Joint ROM Normal Inversion 35o Eversion 15

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.

Cast with STJ in Neutral position and MTJ locked

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.

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

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

Relaxed Calcaneal Stance Position Weight Bearing

Relaxed Calcaneal Stance Position

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

Forefoot Position: Valgus

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

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

Position of Digits

Claw Toes

Hammertoe

Mallet Toe

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

Hallux Dorsiflexion Normal Flexion 30o

Knee Position Genu varus Genu valgus Genu recurvatum

Genu varum Bow Legs

Genu valgum

Genu Recurvatum

Patellas pointing inward or outward due to femoral rotation

Leg Length Discrepancy Measure from ASIS to bisection of medial malleolus

Base of Gait narrow, normal or wide?

Angle of Gait straight, abducted or adducted

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.

Jack Test

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

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?