Dr. Kevin Yip

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

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SPECIFIC TESTS

Combined plantar flexion-inversion

Significance.

This movement brings all the lateral structures of ankle and foot under stretch and is therefore an extremely important test in sprained ankles.

Positioning.

The heel rests on the couch, the knee is slightly flexed and the ankle is in neutral position. The examiner is distal to the foot. His ipsilateral hand fixes the leg at the distal and medial side, The contralateral hand is placed on the midfoot, so that the heel of the hand rests at the fifth metacarpal bone and the fingers encircle the medial border.

Procedure.

Stabilize the leg with the ipsilateral hand. Press the foot downwards and inwards
with the heel of the contralateral hand. Meanwhile perform a supination movement by an upwards pulling of the fingers,

Common mistakes:

• The lower leg is not sufficiently stabilized.
• Plantar flexion is lost.
• Supination is not conducted to the end,
• Painful pinching of the forefoot occurs.

Normal functional anatomy:

• Ral/ge: 6G-120° angle between forefoot and lower leg
• Elld-fee/: soft ligamentous
• Limiting structures:

– anterior talofibular ligament
– lateral and dorsal calcaneocuboid ligaments
– capsule of the cuboid-fifth metatarsal joint
– peronei longus and brevis tendons
– extensor digitorum longus tendons.

Common pathological situations:

• This movement is extremely painful in ankle sprains.
• Excessive range is noted in total rupture of the anterior talofibular ligament.
• In chronic ankle sprains with ligamentous adhesions there is slight limitation with a tougher end-feel.
• Marked limitation with a spasti

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