Blecks

Met/forefoot adductus
Forefoot to rearfoot relationships Hallux ROM STJ ROM

Bisect the heel plantarly Bisect the heel Place tractograph against the heads of the metatarsals Put STJ into neutral and MTJ maximally pronated Place pt in their angle and base of gait. Df hallux With functional hallux limitus, increased motion in STJ neutral Place knee in frontal plane Longitudinal axis inversion/eversion Oblique axis df and abd, pf and add Put STJ in neutral lock by holding the heeldo NOT pronate Tight with knee extended and flexed= tight soleus or bony block

Through 2nd toe Lines should be perpendicular FF valgus: 1st lower than 4th and 5th 15-20 df 20 inversion 10 eversion Young: 3:1 or 4:1 Normal Coalition: 0:0 0-3 yr: df 75, pf 50 10 yr: df 15, pf 50 15-adult: df 5-10w/ knee extended df ~15 w/ knee flexed

Ankle ROM

Malleolar position

Bisect the medial and lateral malleoli Put the knee in the frontal plane Put STJ in neutral

pf 40-70 0-1 yr: 0-5 + 2-3 / yr Adult: 13-18 external High malleolar position associated with out-toe

Tibial Torsion

For of tibial torsion, +5 to malleolar position With pt kneeling, if foot if lateral to thigh= external tibial torsion

Infant: 0-5 external 18 mth: 9 external 3 yrs: 12 external 6 yrs: 18-23 external Valgus: benign Varus or parallel- Blounts

Cover Up Test

Cover foot in order to tell the difference between Blounts disease and physiologic bowing Bisect thigh Bisect upper leg Compare the level of one medial malleolus to the other or flex both hips and compare knee height Structural (ASIS Med malleolus), Functional (Umbilicus med malleolus) Assess all three planes pelvis must stay in the frontal plane and level External : internal rotation

Limb length Apparent True Hip ROM

Internal should NEVER be greater than external

Think of a clock: 1 hr = 30 If: < lateral rotation with hip extended = tight hip lig If: < lateral rotation with hip flexed = tight medial hamstring If: < medial rotation with hip flexed= tight lateral hamstring If: < medial rotation with hip extended = tight iliopsoas Flexion of the hip with knee extended then flexed (If bring the leg to the table while one is flexed = hip tightness Hip abduction and adduction Ryders Femoral torsion/version Hamstring flexibility Flex the pts hop and knee and rotate until the greater trochanter is in the frontal plane Pt supine, hip and knee are extended Leg is raised to resistance Also a test for Sciatica if it causes the pt pain

External: Internal 0-1yr: 3:1 1-3 yr: 2:1 3- Adult: 1:1 (45)

Extended: >70 Flexed:> 100 Ab: 45 Ad:20

0-1 yr: 30 1-3 yr: 20 3-6 yr: 8-12 70flexion

Popliteal Angle

With hip 90, fully extend knee If very close to 90 (very tight_ suspect pathology of nerve roots (spondylolesthesis, tumor, diskitis, syrinx) Holding above the knee and assess transverse, sagittal and frontal position Flexion: measure with hip extended and knee flexed, then with both flexed

Birth- 2 yrs: 0-6 5yrs- adult: 0-25 Flexion: 140-160 w/ hip flexed 120 w/ hip extended Extension: 160w/ hip flexed 189 w/ hip extended

Knee motion

Tibial varum STJ neutral

Place STJ in neutral Compare lower leg bisection to an imaginary perpendicular line to the ground Bisect the heel (not lower 1/3) Bisect the lower 1/3 of the leg (not Achilles tendon) Put STJ into neutral and load ankle to 90 Compare the two lines OFF WB

Birth: 5-10 4 yrs: 0-2

Calcaneal stance position Neutral Relaxed

Neutral: Put pt into STJ neutral and bisect the calcaneus compared to floor Relaxed: Pt standing in angle and base of gait bisect calcaneus, arm of tractograph against floor Calcaneal eversion (Valmassay method): Calcaneal inversion (Hubshiner maneuver): have pt go on tippy toes

If varum from STJ neutral on WB (calcaneal neutral) then tibial varum 7 - age of child = eversion Calcaneus goes into varus= NORMAL change = flatfoot or tarsal coatilition 0-1 : genu varum 1 -3: straight 3-6: genu valgum 6-12: straight 0= 1= trace 2= active w/o gravity 3= active w/ gravity 4= acive w/ gravity and some resistance 5= NORMAL 0= absent 1= hyporeflexive 2= NORMAL 3= hyperreflexic, brisk 4= clonus 5= abN with sustained clonus

Genu valgus/ varum Muscle power

Have pt stand with ankles as close as possible

Df, pf, inversion, eversion

Reflexes

Patellar- L3-L4 (femoral nerve) Achilles: S1-S2 (tibial nerve) Plantar: L5-S2 (done with Babinski) Sharp sensation- lateral spinothalamic tract Vibratory and position sense- posterior column