Download Test For Grades 5, 4, 3 and 2

Ankle & Foot
(2)
Inversion:
Tarsal Joints
 Range of motion
0° – 35 °
Testing position
Short sitting with knee flexed to 90° & the lower leg
over the edge of the supporting surface
Stabilization
Stabilize the tibia and fibula to prevent:
Medial rotation & extension of knee + lateral rotation &
abduction of hip
 Goniometer Alignment
Fulcrum
Anterior aspect of the ankle midway between the malleoli
Proximal Arm
Anterior midline of the lower leg, using the tibial tuberosity
for reference
Distal Arm
Anterior midline of the second metatarsal
 Patient Instruction
Ask the patient to turn
their foot in.
 Normal End Feel
Firm, because of tension in:
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Joint capsule
Anterior & posterior talofibular ligaments
Calcaneofibular ligament
Anterior, posterior & interosseous talocalcaneal ligament
Dorsal calcaneal ligaments
Dorsal calcaneocuboid ligament
Dorsal talonavicular ligament
Lateral band of bifurcate ligament
Transverse metatarsal ligament
Dorsal, planter, interosseous cuboidonavicular,
cuneonavicular, intercuneiform, cuneocuboid, TMT, &
intermetatarsal joints
Peroneus longus & brevis muscles
Inversion Muscle
Tibialis posterior
Tibialis Posterior
Origin:
Shaft of tibia + interosseous membrane + shaft of fibula + deep transverse
fascia + intermascualr septum
Insertion:
Navicular tuberosity + cuneiform bones + suntestaculum tail + 2-4 metatarsal
Innervation:
Tibial Nerve (L4-L5, & sometimes S1)
Test For Grades 5, 4, 3, 2, 1 and 0
 Patient Position
Short sitting with ankle in slight planter
flexion
 Therapist and Patient Instructions
Sitting next to test limb place the resistance hand over the
dorsum and medial side of the foot at the metatarsal
heads. The stabilizing hand is placed around the posterior
ankle just above the malleoli. Resistance is given in the
direction of eversion and toward slight dorsiflexion, almost
as if pulling up and around laterally. Ask the patient to,
“turn your foot down and in, toward your other foot, don’t
let me push it out.”
Test For Grades 5, 4, 3, 2, 1 and 0
Grade 5 (Normal): completes full range of motion and holds against maximal
resistance.
Grade 4 (Good): completes available range of motion and holds against strong
to moderate resistance.
Grade 3 (Fair): the patient will be able to invert the foot through full available
range of motion.
Grade 2 (Poor): completes only partial range of motion.
Grade 1 (Trace): palpate tendon of tibialis posterior between the medial
malleolus & navicular bone, or above the malleolu. If palpable activity
occurs with no movement, the grade is 1.
Grade 0 (Zero): no palpable contraction
 Substitution 
 Substitution by the Flexors of the toes should remain
relaxed to prevent substitution by the Flexor
digitorum longus & Flexor hallucis longus
Eversion:
Tarsal Joints
 Range of motion
0° – 25 °
Testing position
Short sitting with knee flexed to 90° & the lower leg
over the edge of the supporting surface
Stabilization
Stabilize the tibia and fibula to prevent:
Lateral rotation & flexion of knee + Medial rotation &
abduction of hip
 Goniometer Alignment
Fulcrum
Anterior aspect of the ankle midway between the malleoli
Proximal Arm
Anterior midline of the lower leg, using the tibial tuberosity
for reference
Distal Arm
Anterior midline of the second metatarsal
 Patient Instruction
Ask the patient to turn
their foot out.
Normal End Feel
Hard, because of tension in:
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Contact between the calcaneus & the floor of the sinus tarsi
Or
Firm, because of tension in:
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Joint capsule
Deltoid ligament
Medial talocalcaneal ligament
Planter calcaneonavicular ligament
Calcaneocuboid ligament
Dorsal talonavicular ligament
Medial band of bifurcate ligament
Transverse metatarsal ligament
Dorsal, planter, interosseous cuboidonavicular, cuneonavicular,
intercuneiform, cuneocuboid, TMT, & intermetatarsal joints
Tibialis posterior muscles
Foot Eversion
With Planter
Flexion
Foot Eversion With Planter Flexion
Muscles
Peroneus Longus
Peroneus brevis
Peroneus Longus
Origin:
Head & shaft of fibula + lateral condyle of tibia + fascia cruris +
intermascular septum
Insertion:
1st metatarsal + medial cuneiform + occasionally from other metatarsals
Innervation:
Superficial Peroneal Nerve (L5-S1)
Peroneus Brevis
Origin:
Shaft of fibula + crural intermascular septum
Insertion:
5th metatarsal
Innervation:
Superficial Peroneal Nerve (L5-S1)
Test For Grades 5, 4, 3 and 2
 Patient Position
Short sitting with ankle in neutral
position
 Therapist and Patient Instructions
Sitting on stool beside the patient’s test limb, one hand
stabilizes by gripping around the ankle. Resistance is given
around the dorsum and lateral border of the foot.
Resistance is in the direction of inversion and slight
dorsiflexion, or in an up and medial direction. Ask the
patient to, “turn your foot down and out, don’t let me
push it in.”
Grading
Grade 5 (Normal): completes full range of motion and holds
against maximal resistance.
Grade 4 (Good): completes available range of motion and
holds against strong to moderate resistance.
Grade 3 (Fair): the patient will be able to invert the foot
through full available range of motion but tolerate no
resistance.
Grade 2 (Poor): completes only partial range of eversion
motion.
Test For Grades 1 and 0
 Patient Position
Short sitting or supine
 Therapist and Patient Instructions
Sitting on stool beside the patient’s test limb, or standing at the end of table.
To palpate Peroneus longus, place fingers on the lateral leg over the
upper one-third just below the head of the fibula. The tendon of the
muscle can be felt posterior to the lateral malleolus behind the tendon
of the Peroneus brevis.
To palpate tendon of Peroneus brevis place the index finger over the
tendon as it comes forward from behind the lateral malleolus,
proximal to the base of 5th metatarsal. The belly of the muscle can be
palpated on the lateral surface of the distal leg over the fibula
Grading
Grade 1 (Trace): palpation will reveal contractile activity
in either or both muscles, which may cause the tendon
to stand out. No motion occurs
Grade 0 (Zero): no palpable contraction
 Notes 
 To Isolate Peroneus Longus give resistance against
the planter surface of the head of the 1st metatarsal
in a direction toward invesion & dorsiflexion.
 Foot Eversion With Dorsiflexion: if peroneus tertius is
present, it can be tested by asking the patient to
evert & dorsiflex the foot. In this motion, however,
Extensor digitorum longus participates. The tendon
of peroneus tertius can be palpated on the lateral
aspect of the dorsum of the foot, lateral to the
tendon of Extensor digitorum longus.
Inversion:
Subtalar Joint
(Rearfoot)
 Range of motion
0° –5 °
Testing position
Prone
Stabilization
Stabilize the tibia and fibula to prevent:
lateral rotation of knee + lateral rotation & abduction
of hip
 Goniometer Alignment
Fulcrum
Posterior aspect of the ankle midway between the malleoli
Proximal Arm
Posterior midline of the lower leg
Distal Arm
Posterior midline of the calcaneus
 Patient Instruction
Ask the patient to turn
their foot in.
 Normal End Feel
Firm, because of tension in:
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Lateral Joint capsule
Anterior & posterior talofibular ligaments
Calcaneofibular ligament
Anterior, posterior & interosseous
talocalcaneal ligament
Eversion:
Subtalar Joint
(Rearfoot)
 Range of motion
0° –5 °
Testing position
Prone
Stabilization
Stabilize the tibia and fibula to prevent:
Medial rotation flexion of knee + Medial rotation &
abduction of hip
 Goniometer Alignment
Fulcrum
Posterior aspect of the ankle midway between the malleoli
Proximal Arm
Posterior midline of the lower leg
Distal Arm
Posterior midline of the calcaneus
 Patient Instruction
Ask the patient to turn
their foot out.
Normal End Feel
Hard, because of tension in:
 Contact between the calcaneus & the floor of the
sinus tarsi
Or
Firm, because of tension in:
 Deltoid ligament
 Medial talocalcaneal ligament
 Tibialis posterior muscles
 Good Luck To You All 