Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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PASSIVE TESTS OF THE ANKLE JOINT-Passive plantar flexion

Positioning.

The subject lies supine with the leg on the couch and the ankle in neutral position. The examiner is distal to the foot. One hand supports the heel, the other is at the dorsum of the foot.

Procedure.

A simultaneous movement of both hands pulls and pushes the ankle into plantar
flexion.

Common mistakes.

None.

Normal functional anatomy:

• Rallge:

the dorsal aspect of the foot falls into line with the tibia

• Elld-feel: hard ligamentous
• Limiti”g structures:

– the engagement of the heel via the Achilles tendon against the back of the tibia
– anterior tibiotalar ligament.

Common pathological situations:

• Limitation of plantar flexion is usually caused by an articular lesion.
• Anterior pain in combination with a normal end-feel indicates stretching of anterior structures (capsule, tendons of dorsi flexors, anterior tibiotalar and anterior talofibular ligaments).
• Posterior pain is elicited when a pathological structure is painfully squeezed between tibia and calcaneus (bursa, insertion of Achilles tendon, periostitis).

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