ANKLE PLANTAR

FLEXION
Evaluation and Measurements

By Isabelle Devreux

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 Ankle Plantar Flexion: Gastrocnemius and Soleus
ROM: 0 to 40- 45
A. Soleus:
Origin:
Posterior of head of fibula and
proximal1/3 of its body.
Soleal line & middle 1/3 of medial
border of tibia.
Tendinous arch between tibia and
fibula.
Insertion: Posterior surface of the
calcaneum (w/ gastrocnemius).
Nerve: Tibial nerve: L5, S1, S2
Action: Plantar flexes the ankle joint.
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 Ankle Plantar Flexion: Gastrocnemius and Soleus
B. Gastrocnemius:
Origin:
Medial Head:
Proximal & posterior of part of medial
condyle of femur.
Capsule of knee joint.
Lateral Head:
Lateral condyle and post. surface of femur.
Capsule of knee joint.
Insertion: Middle part of posterior
surface of the calcaneum
Nerve: Tibial nerve: L5, S1, S2
Action: Plantar flexes the ankle joint +
assists in flexion of the knee joint.

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Ankle Plantar Flexion:
C. Plantaris muscle:
Origin:
Distal part of lateral supracondylar line of the femur +
popliteal surface.
Oblique popliteal ligament of
the knee joint.

Insertion: Posterior part of calcaneum.

Nerve: Tibial Nerve: L4,L5, S1

Action: Plantar flexes the ankle + assists in flexion of the

knee joint.
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Ankle Plantar Flexion:
ROM: +- 45 to 45
Limitation by:
Tension of talofibular ligament.
Tension of the dorsifexor ms.
Contact of posterior portion of talus bone on the tibia.
Accessory ms.:
Tibialis posterior
Forefoot &
Peroneus longus ankle joint
Peroneus Brevis plantar flexors

Flexor hallucis longus

Toe, forefoot
Flexor digitorum longus & ankle joint
plantar flexors
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 Weight bearing
Ankle Plantar Flexion: Grade 3, 4, 5 Or
Non Weight Bearing
Tests
Pt.: Standing on leg to be tested ,
knee straight.
Therapist stands beside the
patient.
Grade 3: Rise on your toes
clearing your heel off the floor---
relax (one time).
Grade 4 & 5: Same + repeat 4 to
5 times .
Needs sufficient stabilization to the
forefoot on the ground.
Good = if patient has difficulty to
complete the ROM or if he fatigues
easily.
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 Ankle Plantar Flexion: Grade 3
Non Weight Bearing:
Pt. is in prone with foot to be tested
over end of the table.

Ph.Th. stands beside foot.

Proximal hand is placed on the

L.L., proximal to the ankle to
stabilize.

Pull the heel upward and push

backwards with your toes---relax .
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 Ankle Plantar Flexion: Grade 4-5

Pt. Is in prone as in gr. 3.

Therapist applies resistance:
Proximal hand hods the
sides of the heel.
Distal hand is on plantar
surface of the foot.

Moderate ( gr. 4) and Maximal

+ hold ( gr. 5) push of
resistance simultaneously at
heel + forefoot through full
ROM.

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 Ankle Plantar Flexion: Grade 2 1 - 0

Pt. in sidelying position:with

lateral border of the foot to be
tested resting on the table.

Therapist is beside the foot,

proximal hand grasps the lower leg
just above the ankle joint to
stabilize it.
Push your foot down through full
ROM.
Grade 1: Palpation of the
contraction of the ms. fibers and on
tendon above calcaneum.
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 Ankle Plantar Flexion:
Effects of weakness:
Hyperextension of the knee.
Nonweightbearing position in standing.
Gastrocnemius limp: inability to rise
on toes and to transfer weight normally
forward.

Effects of contracture & shortness:

Equinus position( ankle joint plantar
flexed) of the foot and flexion of the knee.

Muscle shortness: restriction of the ankle

dorsiflex. when knee is extended & a
restriction of the knee extension when the
ankle is dorsiflexed.

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 Foot/ Ankle Deformities

Talipes calcaneus: Talipes equinus:

ankle joint dorsiflexed. ankle joint plantar flexed

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Inversion & Eversion

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 Foot/ Ankle Deformities
Talipes Valgus:

Foot is everted and

accompanied by
flattening of
the longitudinal arch.

Talipes Varus:
Foot is inverted &
accompanied by
an increase in the height
of the longitudinal arch.
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 ANKLE DORSI
FLEXION AND
INVERSION

Evaluation and Measurements

By Isabelle Devreux

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Foot Dorsiflexion and Inversion: Tibialis Anterior
Origin:
Lateral condyle & prox. of lateral
surf. of tibia.
Interosseus membrane, deep fascia
and intermucular sceptum.
Insertion:
Medial and plantar surface of medial
cuneiform bone.
Base of first metatarsal bone.

Nerve: Peroneal nerve: L4, L5, S1

Action: Dorsiflexes and assist in inversion
of the ankle foot.
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Foot Dorsiflexion and Inversion: Tibialis Anterior

ROM : 20
Limited ROM by:

Tension of the lateral

tarsal ligament
Tension of the peroneus
longus and peroneus
brevis ms.
Contact between tarsal
bones, medially.

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 Foot Dorsiflexion & Inversion: Tibialis Anterior -
Testing Gr. 3 and 2
Pt. sits with legs over the edge of
the table.

Therapist sits on a stool near the

affected leg. Proximal hand grasps
around the ankle to stabilize the
lower leg.

Pull your foot up and in; through

full ROM ----relax .
Grade 3: Full ROM.
Grade 2: Partial ROM
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 Foot Dorsiflexion & Inversion: Tibialis
Anterior - Testing Gr. 4 & 5
Pt. Position in sitting over the edge
of the table. His heel is supported on
the thigh of the therapist.
Therapist : Proximal hand supports
the lower leg above calcaneus,
distal hand grasps the medial border
if forefoot to give resistance.
Resistance: pushing down the
medial border of the foot.
Pt. Should keep big toe flexed to
avoid substitution by extensor
hallucis longus.
Pull your foot up and in through
full ROM.
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 Foot Dorsiflexion & Inversion: Tibialis
Anterior - Testing Gr. 1 & 0
Pt. In backlying, foot over the
edge of the table.

Therapist stands near the

edge, distal hand supports
the forefoot, the proximal
hand palpates the tibialis
anterior on its tendon on the
medial volar aspect of ankle.

Try to pul your foot up and

in----relax.
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 Foot Dorsiflexion & Inversion: Tibialis Anterior
Effects of weakness:
Decrease of the ability to
dorsiflex the ankle and allows
tendency towards the foot
eversion.
Substitution:
The extensor Hallucis Longus
which has the function of
assisting the dorsiflex. +
inversion may substitute to a
weak tibialis anterior muscle.
Pt should keep the toes
relaxed.
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Foot Inversion from
Plantar Flexion

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Foot Inversion from Plantar Flexion: Tibialis Posterior
Origin:
Most of interosseus membrane.
Lat. posrtion of posterior surface of
tibia. Prox. 2/3 of medial surface of
fibula.
Insertion:
Tuberosity of navicular bone.
By fibrous expansions to the
sustentaculum tali of calcaneus
three cuneiforms, cuboid and
bases of 2nd, 3rd, 4th metatarsal
bones.
Nerve: Tibial nerve ; L4, L5, S1.
Action: Inverts the foot and assists in
the plantar flexion of the ankle
joint.
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Foot Inversion from Plantar Flexion: Tibialis
Posterior
Accessory muscles:
Flexor digitorum longus.
Flexor Hallucis Longus.
Gastrocnemius medial head .

Range of Motion: 35
But may be limited by:
Tension of lateral tarsal ligaments.
Tension of peroneal muscle group.
Contact between tarsal bones medially.

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 Foot Inversion from Plantar Flexion: Tibialis
Posterior- Grade 3 Fair strength
Pt; is in sidelying, affected leg down,
foot in plantar flexion & resting on
lateral border.

Therapist stands at the foot of the

table, proximal holds ankle joint
proximally to stabilize the L.L.

Raise up the medial border of your

foot through full ROM.---relax.

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 Foot Inversion from Plantar Flexion: Tibialis
Posterior- Grade 4- 5
Pt. In sidelying, foot over the edge
of the table.

Therapist: Prox. hand supports

the L.L. proximal to ankle, distal
hand over the medial border of
the foot + resistance.

Gr.4: moderate resistance.

Gr.5: maximal resistance + hold.

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 Foot Inversion from Plantar Flexion: Tibialis
Posterior grade 2 1 - 0.
Pt. in backlying with foot in plantar
flexion over the edge of the table.

Therapist stands at end + prox.

hand grasps the leg posteriorly
just above the akle joint.

Move your foot medially----

relax .

Gr. 1: palpation at the tibialis

posterior between medial
malleolus and navicular bone;
above the medial malleolus. 26
 Foot Eversion from
Plantar Flexion
Evaluation and Measurements

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 Foot Eversion from plantar flexion: Peroneus
longus & brevis.
Peroneus Longus:

Origin: Lateral condyle of tibia, Head of

proxilmal 2/3 of lateral surface of fibula,
intermuscular septa.

Insertion: lateral side of base of 1st

metatarsal and medial ccuneiform bone.

Nerve : Peroneal nerve: L4, L5, S1.

Action: Everts foot and assists in plantar

flexion of the ankle joint.
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 Foot Eversion from plantar flexion: Peroneus
longus & brevis.
Peroneus Brevis:
Origin:
Distal 2/3 of lateral surface of tibia.
Adjacent intermuscular septa.

Insertion: Tuberosity at base of 5th

metatarsal bone, lateral side.

Nerve: Peroneal nerve: L4,L5,S1.

Action: everts the foot and assits in

plantar flexion of the ankle joint.

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 Foot Eversion from plantar flexion: Peroneus
longus & brevis.
Accessory muscles:
Extensor Digitorum Longus
Peroneus Tertius
(evert.+dorsiflexion)

ROM: 35

Limited ROM by:

Tension of medial tarsal ligaments
Tension of tibialis anterior and
tibialis posterior muscles
Contact of tarsal bones laterally.
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 Foot Eversion from plantar flexion: Peroneus
longus & brevis. Test gr.3.
Pt. In side lying , upper leg is the
affected leg, foot over the edge of
the bed and in plantar flexion; leg
is resting on its medial border.

Therapist: proximal hand supports

the lower leg proximal to the
ankle joint.

Pull your foot up through full

ROM---relax.

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 Foot Eversion from plantar flexion: Peroneus
longus & brevis:Grade 4- 5
Pt. Position as in gr.3.
Therapist grasps the forefoot to
give resistance.
Moderate (or maximal for gr.5)
resistance against plantar
surface of first (or all)
metatarsal head.
Extensor digitorum longus
should be relaxed.
Raise up the lateral border of
the foot through full ROM.

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 Foot Eversion from plantar flexion: Peroneus
longus & brevis:Grade 2,1,0.
Pt. In sidelying with affected foot
plantar flexed and resting on its
medial border.
Therapist stands at the foot of the
table and proximal hand stabilizes
the L.L.
For GR. 1: palpation on the
peroneus brevis at the joint
proximal to the 5th metatarsal
bone on the lateral border of foot.

For peroneus longus: palpation

under the head of the 1st
metatarsal bone.
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 Foot Eversion from plantar flexion: Peroneus
longus & brevis: EFFECTS
Effects of Weakness:
Weakness of
strength of eversion
of the foot and plantar
Peroneus longus /
flexion of the ankle brevis:
joint. =Talipes Equino Varus
Allows a varus position
of the foot.
the ability to rise on
the toes.
Decreases lateral
stability of the foot.

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Effects of Contracture:
Contracture of
peroneus longus &
brevis:

= Talipes Equino Valgus

=Everted or valgus
position of the foot.

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THANK YOU

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