Ankle and Foot Mobilisations

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Introduction

Joint mobilization refers to manual therapy techniques that are used to modulate pain and treat joint dysfunctions that limit range of motion (ROM) by specifically addressing the altered mechanics of the joint. The altered joint mechanics may be due to pain and muscle guarding, joint effusion,contractures or adhesions in the joint capsules or supporting ligaments, or malalignment or subluxation of the bonysurfaces.[1]

Tibiofibular Joint

  • Distal tibiofibular distraction

.The convex talus articulates with the concave mortise made up of the tibia and fibula. 10 degree plantarflexion is the resting position.Patient lies supine,with the lower extremity extended. The mobilization begins with the ankle in resting position and progress to the end of the avail- able range of dorsiflexion or plantarflexion.

Therapist stands at the end of the table, wrap the fingers of both hands over the dorsum of the patient’s foot and pull the foot away from the long axis of the leg in a distal direction by leaning backward. https://www.youtube.com/watch?v=mw-B9E7Hxcw

Talocrural Joint

  • Anterior(Ventral) Glide

The ventral glide is indicated to increase plantarflexion

Patient lies prone, with the foot over the edge of the table. Working from the end of the table, Therapist stand and place his lateral hand across the dorsum of the foot to apply a grade I distraction.Place the web space of the other hand just distal to the mortise on the posterior aspect of the talus and calcaneus. He pushes against the calcaneus in an anterior direction (with respect to the tibia); this glides the talus anteriorly.

  • Posterior (Dorsal) Glide

This mainly to increase dorsiflexion. Patient lies supine with the leg supported on the table and the heel over the edge. Therapist stands to the side of the patient, stabilize the leg with his cranial hand or use a belt to secure the leg to the table.he then places the palmar aspect of the web space of his other hand over the talus just distal to the mortise.Wrap his fingers and thumb around the foot to main- tain the ankle in resting position. Grade I distraction force is applied in a caudal direction and the talus is glided posteriorly with respect to the tibia by pushing against the talus.

Subtalar (Talocalcaneal) Joint

  • Subtalar Distraction 

This mobilization is indicated in pain control, general mobility for inversion/eversion.

The patient is placed in a supine position, with the leg supported on the table and heel over the edge.The hip is externally rotated so the talocrural joint can be stabilized in dorsiflexion with pressure from the therapist thigh against the plantar surface of the patient’s forefoot.

The distal hand grasps around the calcaneus from the pos terior aspect of the foot. The other hand fixes the talus and malleoli against the table and the calcaneus is pulled distally with respect to the long axis of the leg.

  • Subtalar Medial Glide or Lateral Glide 

Medial glide to increase eversion; lateral glide to increase inversion.

The patient is side-lying or prone, with the leg supported on the table or with a towel roll. The Therapists aligns shoulder and arm parallel to the bottom of the foot,

stabilizes the talus with the proximal hand and places the base of the distal hand on the side of the calcaneus medially to cause a lateral glide and laterally to cause

a medial glide. Wraps the fingers around the plantar surface and apply a grade I distraction force in a caudal direction, then pushes with the base of the hand against the side of the calcaneus parallel to the planter surface of the heel.

Intertarsal and TarsometatarsalPlantar Glide 

Indication: To increase plantarflexion accessory motions (necessary for supination)

The patient is supine with hip and knee flexed, or sitting, with knee flexed over the edge of the table and heel resting on the Therapist lap. Therapist stabilizes the joint by fixating the more proximal bone with the index finger on the plantar surface of the bone.

To mobilize the tarsal joints along the medial aspect of the foot, Therapist positions himself on the lateral side of the foot and places the proximal hand on the dorsum of the foot with the fingers pointing medially so the index finger can be wrapped around and placed under the bone to be stabilized.

He then places his thenar eminence of the distal hand over the dorsal surface of the bone to be moved and wrap the fingers around the plantar surface.

To mobilize the lateral tarsal joints,he positions himself on the medial side of the foot, point his fingers laterally and position his hands around the bones as just

described.

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References

  1. Kisner C, Colby LA, Borstad J. Therapeutic exercise: Foundations and techniques. Fa Davis; 2017 Oct 18.)