Procedure
- The patient sits on the examination table with the lower legs dangling.
- Examine the muscles by having them contract isometrically.
- The examiner should provide resistance to the force produced by the patient.
- Ensure adequate stabilisation with your other hand (be aware of compensatory movements).
- Inquire about pain.
- If pain is indicated, then compare left/right.
- If necessary, palpate the muscles:
- To determine the muscle tone and the maximum point of pain.
- To differentiate between lipomas and muscle herniations.
- If an avulsion or muscle rupture is suspected.
- Initially, isometric testing of the different muscle groups is sufficient.
- If the patient indicates pain during this, after the left and right comparison, examine the various muscles of the group of muscles concerned separately if possible.
- Have the patient tense the muscles as selectively as possible:
- The dorsal flexors (extensors: in particular extensor digitorum longus muscle, extensor hallucis longus muscle, tibialis anterior muscle) [Figure 108].
Figure 108
- The plantar flexors (in particular triceps surae muscle, tibialis posterior muscle, peroneus longus and peroneus brevis muscles, flexor digitorum longus muscle, flexor hallucis longus muscle) [Figure 109].
Figure 109
- The eversion muscles (in particular peroneus longus and peroneus brevis muscles, tibialis anterior muscle) [Figure 110].
Figure 110
- The inversion muscles (in particular tibialis anterior muscle, tibialis posterior muscle, flexor digitorum longus muscle, flexor hallucis longus muscle) [Figure 111].
Figure 111
The following muscles may be tested more or less selectively:
- Extensor digitorum longus muscle (and peroneus tertius muscle) [Figure 112].
- Function: Dorsal flexion of the feet, extension of the MTP, PIP and DIP joints II to V (extension applies solely to the extensor digitorum longus muscle).
- Disorder: Compartment syndrome.
Figure 112
- Extensor hallucis longus muscle [Figure 113].
- Function: Dorsal flexion of the foot and extension of MTP I and IP I.
- Disorder: Compartment syndrome.
Figure 113
- Tibialis anterior muscle [Figure 114].
- Function: Dorsal flexion and inversion of the foot.
- Disorder: Compartment syndrome.
Selective muscle test of the tibialis anterior muscle. The examiner should bring the foot from the ‘neutral position’ into dorsal flexion and ask the patient to perform inversion from this position against the resistance provided by the examiner.
× = Tendon of tibialis anterior muscle.
- Tibialis posterior muscle [Figure 115].
- Function: Plantar flexion and inversion of the foot.
- Disorder: Rupture, shin splints, compartment syndrome.
Figure 115
Selective muscle test of tibialis posterior muscle. The examiner brings the foot from the ‘neutral position’ into plantar flexion and asks the patient to perform inversion from this position against the resistance provided by the examiner.
- Peroneus longus and peroneus brevis muscles [Figure 116].
- Function: Plantar flexion and eversion of the foot.
- Disorder: Avulsion fracture involving the peroneus brevis muscle, compartment syndrome.
Figure 116
Selective muscle test of the peroneus longus and peroneus brevis muscles. The examiner should bring the foot from the ‘neutral position’ into plantar flexion and ask the patient to perform eversion from this position against the resistance provided by the examiner.
- Gastrocnemius muscle [Figure 117].
- Function: Plantar flexion of the foot (examine with knee extended) and flexion of the knee.
- Disorder: ‘Whiplash’ (muscle rupture), rupture of the Achilles tendon, compartment syndrome.
Figure 117
- Flexor digitorum longus muscle [Figure 118].
- Function: Plantar flexion and inversion of the foot and flexion of the second to fifth MTP, PIP and DIP joints.
- Disorder: Shin splints, compartment syndrome.
Figure 118
- Flexor hallucis longus muscle [Figure 119].
- Function: Plantar flexion and inversion of the foot and flexion of MTP I and IP I.
- Disorder: Shin splints, compartment syndrome.
Figure 119