The ‘neutral position’ is one in which the longitudinal axis of the lower leg is perpendicular to the plane of the sole of the foot and the axis though the second metatarsal bone is perpendicular to the frontal plane [Figure 94].
Ask the patient to perform the active movements on both sides at the same time.
Figure 94
Procedure
- The patient sits on the examination table with the legs hanging down.
- Inspect the movements on the ventral side and assess:
- The course of the movement.
- The maximum range of motion.
- The occurrence of pain.
- The occurrence of crepitations.
Talocrural Joint
- Dorsal flexion [Figure 95].
- Plantar flexion [Figure 96].
Figure 95
Figure 96
Subtalar Joint
- Inversion [Figure 97].
- Eversion [Figure 98].
Figure 97
Figure 98
Active inversion and eversion of the foot: In general, patients tend to rotate the hips during this movement. In order to prevent this, the examiner can stabilise both knees beforehand, so that the inversion/eversion can be examined without any interfering effects.
MTP, PIP and DIP Joints and IP Joint of Digit 1
- Flexion [Figure 99].
- Extension [Figure 100].
Figure 99
Figure 100
Active flexion and extension of the MTP, PIP and DIP joints and the IP joint of digit 1. The calcaneus and mid-foot should be stabilised by the examiner in the ‘neutral position’ to prevent the other joints from moving as well.