Foot pronation affects the spine. It can lead to problems such as short leg syndrome, which can lead to scoliosis, or a curvature of the spine. When your feet pronate, the arches drop and the pelvis and sacrum lower, which laterally flexes the lumbar spine and causes compensatory scoliosis. Functional orthotics are designed to prevent this from happening by controlling the foot as it unfolds during natural gait—heel strike, stance phase, toe off—which in turn prevents the wearer from developing short leg, scoliosis and unhappiness.
The Foot’s Range of Motion |
|
| Range | Degree |
| Dorsiflexion | 20 |
| Plantar flexion | 50 |
| Inversion and eversion | 5 |
| Forefoot adduction | 20 |
| Forefoot abduction | 10 |
In ligamentous testing, the following standard tests should be conducted in order:
- The Eversion Test to evaluate the deltoid ligaments
- The Inversion Test to observe the integrity of the anterior tibiofibular ligament; perform by stabilizing the tibia and fibula and then trying to move the talus side-to-side
- The Anterior Drawer Test to evaluate the anterior talofibular ligament; perform by translating the heel forward
- The Talar Tilt Test to evaluate the previous ligament as well as the calcaneofibular ligament
Other tests include:
- The lateral squeeze test in which pressure on an inflamed nerve, as in neuroma, will demonstrate pain.
- Plantar fascia palpation at the medial aspect of the calcaneus where the fascia inserts is diagnostic for plantar fasciitis.
- The Simmonds–Thompson Test involves squeezing the calf and should produce a plantar flexion of the foot. If there isn’t a response in the foot, it could indicate an Achilles tendon disruption. If they experience calf pain during foot dorsiflexion in a non-traumatic situation may indicate thrombophlebitis.
Test Details
Eversion (Talar Tilt) Test
Procedure
Patient seated with legs over the edge of the table. Doctor grasps the calcaneus with one hand and stabilizes the lower leg with the other hand. Doctor induces an eversion stress rolling the calcaneus outward while the ankle is neutral.
Positive Test
Talus tilts or gaps excessively; pain
Positive Test Indicates
Deltoid ligament sprain
Inversion (Talar Tilt) Test
Procedure
Patient is sitting with legs over the edge of the table. Doctor grasps the calcaneus with one hand and stabilizes the lower leg with the other hand. Doctor induces inversion stress rolling the calcaneus inward while the ankle is in neutral. Doctor then repeats the test inducing an inversion stress by rolling the calcaneus inward while the ankle is in the plantar flexion.
Positive Test
Talus tilts or gaps excessively; pain
Positive Test Indicates
Involvement of anterior talo-fibular ligament (ATF) when in plantar flexed position, the calcaneo-fibular ligament (CF) when in neutral position.
Anterior Drawer Test
Procedure
Patient is sitting over the edge of the table with the knee bent. Doctor stabilizes the lower leg with one hand and cups the calcaneus with the forearm supporting the foot in slight plantar flextion (approximately 20°) and slight inversion (10–15°) Doctor then draws the calcaneus and talus anteriorly and slightly medially.
Positive Test
Pain, anterior translation, dimple/sulcus and/or “click”
Positive Test Indicates
Anterior talo-fibular ligament (ATF) sprain/capsular sprain
Simmond’s – Thompson’s Test
Procedure
Patient is prone with feet hanging over edge of table. The doctor squeezes the calf muscles just below the widest portion of the leg.
Positive Test
Foot does not plantarflex.
Positive Test Indicates
Achilles tendon rupture.
Plantar Fasciitis/Heel Spur Test
Procedure
Patient seated. Doctor applies pressure with thumb tip on the plantar surface on the foot, slightly medial to the midline, where the plantar fascia attaches to the calcaneous
Positive Test
Pain at point of pressure.
Positive Test Indicates
Plantar fasciitis and possible heel spur.
Squeeze Test – Lateral Squeeze Test
Procedure
Patient is supine. The doctor squeezes the metatarsal heads together.
Positive Test
Pain upon squeezing.
Positive Test Indicates
Morton’s neuroma, hairline fracture.
Mulder’s Sign
Pain as well as a click , can be produced by squeezing the two metatarsal heads together with one hand, while putting pressure on the interdigital space with the other hand.
