ROM Tarsal Inversion 0-35

Talocrural dorsiflexion 0-20

Patient: Place the individual sitting, with the knee flexed

Patient: Place the individual sitting, with the knee flexed
to 90 degrees. The foot should be in 0 degrees of
inversion and eversion.
PT: Stabilize the tibia and fibula to prevent knee motion
and hip rotation. Use one hand to move the foot into
dorsiflexion by pushing on the bottom of the foot.
End feel: firm
Fulcrum: over the lateral aspect of the lateral malleolus
Proximal arm: lateral midline of the fibula.
Distal arm: parallel to the lateral aspect of the fifth
metatarsal.
to 90 degrees. The foot should be in 0 degrees of
inversion and eversion.
PT: Stabilize the tibia and fibula to prevent knee motion
and hip rotation. Push the forefoot medially into
adduction and downward into plantar flexion, turning
the sole of the foot medially into supination.
End feel: firm
Fulcrum: over the anterior aspect of the ankle midway
between the malleoli.
Proximal arm: anterior midline of the lower leg,.
Distal arm: anterior midline of the second metatarsal.
Tarsal Eversion 0-15

Talocrural plantarflexion 0-50

Patient: Place the individual sitting, with the knee flexed

to 90 degrees. The foot should be in 0 degrees of
Patient: Place the individual sitting, with the knee flexed
inversion and eversion.
to 90 degrees. The foot should be in 0 degrees of
inversion and eversion. PT: Stabilize the tibia and fibula to prevent knee motion
and hip rotation. Pull the forefoot laterally into
PT: Stabilize the tibia and fibula to prevent knee motion
abduction and upward into dorsiflexion, turning the
and hip rotation. Push downward on the dorsum of the
forefoot into pronation
individual’s foot to produce plantar flexion
End feel: hard
End feel: firm
Fulcrum: over the anterior aspect of the ankle midway
Fulcrum: over the lateral aspect of the lateral malleolus
between the malleoli.
Proximal arm: lateral midline of the fibula.
Proximal arm: anterior midline of the lower leg.
Distal arm: parallel to the lateral aspect of the fifth
Distal arm: anterior midline of the second metatarsal.
metatarsal.
Subtalar Joint Inversion 0-5 Distal arm: posterior midline of the calcaneus.

Transverse Tarsal (Midtarsal) Joint: Inversion 30-37 not

established but less ROM values that include all tarsal
jts

Patient: Place the individual in the prone position, with

the hip in 0 degrees of flx, ext, abd, add, and rotation.
Position the knee in 0 degrees of flexion and extension.
Patient: Place the individual sitting, with the knee
PT: Stabilize the tibia and fibula to prevent lateral hip
flexed to 90 degrees and the lower leg over the edge of
and knee rotation and hip adduction. Hold the
the supporting surface. The hip is in 0 degrees of rot,
individual’s lower leg with one hand and use the other
add, and abd. The subtalar joint is placed and held in
hand to pull the calcaneus medially into adduction and
the 0 starting position.
to rotate it into supination. Avoid pushing on the
forefoot. PT: Stabilize the calcaneus and talus to prevent eversion
of the subtalar joint and plantarflexion of the ankle. Pull
End feel: firm
the forefoot laterally into abduction and slightly upward
Fulcrum: posterior aspect of the ankle midway between
into dorsiflexion. Turn the forefoot into pronation so
the malleoli
that the lateral side of the foot is higher than the medial
Proximal arm: posterior midline of the lower leg
side
Distal arm: posterior midline of the calcaneus.
End feel: firm
Subtalar Joint Eversion 0-5 Fulcrum: - anterior aspect of the ankle slightly distal to a
point midway between the malleoli.
Proximal arm: anterior midline of the lower leg (tibial
tuberosity for reference)

Distal arm: anterior midline of the second metatarsal.

Note: When doing range of motion in tarsal joint, there

is a plantarflexion component. While on the transverse
tarsal jt., it simply moving on a transverse plane.
Patient: Place the individual in the prone position, with
the hip in 0 degrees of flx, ext, abd, add, and rotation.
Position the knee in 0 degrees of flexion and extension. Transverse Tarsal (Midtarsal) Joint: Eversion 15 to 21
not established but less ROM values that include all
PT: Stabilize the tibia and fibula to prevent medial hip tarsal jts
and knee rotation and hip abduction. Pull the calcaneus
laterally into abduction and rotate it into pronation .

End feel: hard

Fulcrum: posterior aspect of the ankle midway between
the malleoli
Proximal arm: posterior midline of the lower leg

Patient: Place the individual sitting, with the knee
flexed to 90 degrees and the lower leg over the edge of
the supporting surface. The hip is in 0 degrees of rot,
add, and abd. The subtalar joint is placed and held in
the 0 starting position.
PT: Stabilize the calcaneus to prevent inversion of the
subtalar joint and dorsiflexion of the ankle. Grasp the
metatarsals and push the forefoot medially into
adduction and slightly into plantarflexion. Turn the sole
of the foot medially into supination, being careful not to
dorsiflex the ankle
End feel: firm
Fulcrum: - anterior aspect of the ankle slightly distal to a
point midway between the malleoli.
Proximal arm: anterior midline of the lower leg (tibial
tuberosity for reference)
MMT
Ankle plantarflexion Gastrocnemius and soleus
Patient: Patient stands on limb to be tested with knee
extended, facing a wall. Patient is likely to need external
support; thus, fingers can be placed on the wall, above
shoulder height. Alternatively, no more than one or two
fingers should be used on a table or wall (Gr3-5)
PT: Demonstrate heel rise to patient. Then stand with a
lateral view of test limb to ascertain height of heel rise.
Ask patient to lift heel while keeping knee straight
(GR3). If patient can clear the floor by 2 inches, ask the
patient to continue lifting the heel until the patient can
no longer achieve 1 inch of rise.“Stand on one leg. Lift
your heel. Now down. Repeat this as many times as
possible, lifting your heel as high as you can.”(Gr4-5)
Patient: Prone with feet off end of table (GR2)
PT: Stand at foot of patient. Ask patient to flex and
extend ankle to assure sufficient range is present. Hand
giving resistance is placed against the plantar surface at
the level of the metatarsal heads with foot in 80deg of
dorsiflexion. (Gr2)
Patient: Prone with feet off end of table. (gr1-0)
PT: Stand at end of table in front of foot to be tested.
One hand palpates gastrocnemius-soleus activity by
monitoring tension in the Achilles tendon just above the
calcaneus. “Point your toes down, like a ballet dancer.”
(gr1-0)
Grade5- Patient successfully completes 25 heel rises
through full range of motion without a rest between
rises
Grade4- patient completes between 2 and 24 heel rises
of at least 50% of initial heel raise height at a consistent
rate of one rise every 2 seconds using correct form in all
repetitions.
Grade3- Patient is able to hold body weight once in a
heel up position, but unable to raise body weight from
neutral more than one time.
Grade 1: Therapist will be able to detect some
contractile activity in the muscle, or the tendon will
“stand out.”
Grade 0: No discernable palpable contraction.
Foot Inversion Tibialis posterior

Grade2- Holds test position against maximal manual

resistance.

Grade1- Patient is able to move through partial range.

Contractile activity may be palpated in muscle bellies.

Grade0- no contractile activity

Patient: Short sitting with ankle in slight plantar flexion.
Foot Dorsiflexion and inversion Tibialis anterior
Patient inverts foot through available range of motion.
(Gr2-5)

PT:Sitting on low stool in front of patient or on side of

test limb. Therapist may need to demonstrate motion.
One hand is used to stabilize the ankle just above the
malleoli. Hand providing resistance is contoured over
the dorsum and medial side of the foot at the level of
the metatarsal heads. Resistance is directed toward
eversion and slight dorsiflexion. "Turn your foot down
Patient: Supine (GR0-5)
and in. Hold it." (Gr2-5)
PT: Stand at foot of patient with patient's heel resting
on table. Ask patient to bring the foot up and in,
towards the body (Gr3). Place hand providing resistance
on the medial aspect of the foot over the first ray.
Resistance is provided down and out . This is a strong
muscle, so applying resistance with the hand and flexed
forearm can help provide enough resistance for a valid
test. “Bring your foot up and in. Hold it! Don't let me
pull it down.” (GR4-5)

Grade 5: Holds test position against maximal resistance.
Grade 4: Holds test position against strong to moderate
resistance.
Grade 3: Completes available range of motion without
resistance
Grade 2: Completes only a partial range of motion.
Patient: Short sitting or supine. (GR1-0)
PT: Sitting on low stool or standing in front of patient.
Palpate tendon of the tibialis posterior between the
medial malleolus and the navicular bone. Alternatively,
palpate tendon above the malleolus. "Try to turn your
foot down and in." (Gr1-0)
Grade 5: The patient completes the full range and holds
against maximal resistance.
Grade 4: The patient completes availablerange against
strong to moderate resistance.
Grade 3: The patient will be able to invert the foot
through the full available range of motion.
Grade 2: The patient will be able to complete only a
partial range of motion.
Grade 1: Some contractile activity in the muscle, or the
tendon will “stand out.” There is no joint movement.
Grade 0: No palpable contraction.
Foot Eversion With Plantarflexion Peroneus longus and
peroneus brevis
of the fibula. The belly of the peroneus brevis can be
palpated on the lateral surface of the distal leg over the
fibula. (Gr1-0)
Grade 5: The patient completes the full range and holds
against maximal resistance.
Grade 4: The patient completes availablerange against
strong to moderate resistance.
Grade 3: The patient will be able to invert the foot
through the full available range of motion.
Grade 2: The patient will be able to complete only a
partial range of motion.
Grade 1: Some contractile activity in the muscle, or the
tendon will “stand out.” There is no joint movement.

Grade 0: No palpable contraction.

Patient: Short sitting with ankle in neutral position

(midway between dorsiflexion and plantar flexion). ST
Patient everts foot with depression of first metatarsal
Talar Tilt
head and some plantar flexion. (Gr2-5)

PT:Sitting on low stool in front of patient or standing at

end of table if patient is supine. One hand grips the
ankle just above the malleoli for stabilization. Hand
giving resistance is contoured around the dorsum and
lateral border of the forefoot. Resistance is directed
toward inv and slight df. "Turn your foot down and out.
Hold it! Don’t let me move it in."(Gr2-5)
Patient: lies in the supine or side lying position with the
foot relaxed

PT: Knee is flexed. The foot is held in the anatomical

(90°) position, which brings the calcaneofibular ligament
perpendicular to the long axis of the talus. The talus is
then tilted from side to side into inversion and eversion

Inversion tests the calcaneofibular ligament and, to

some degree, the anterior talofibular ligament by
Patient: Short sitting or supine. (GR1-0)
increasing the stress on the ligament.
PT: Sitting on low stool or standing in front of patient.
To palpate the peroneus longus, place fingers on the
lateral leg over the upper one third just below the head
 Eversion stresses the deltoid ligament, primarily the
tibionavicular, tibiocalcaneal, and posterior tibiotalar
ligaments.

(+) ligamentous instability = laxity or excessive

movement

Eversion stress test

Patient: lies prone with the feet extending over the end
of the examining table.

PT: With one hand, the examiner pushes the heel

steadily forward
Patient: lies in the supine or side lying position with the
(+) ligamentous instability = Excessive anterior
foot relaxed.
movement and a sucking in of the skin on both sides of
PT: flex the knee of the px with the foot in anatomical the Achilles tendon
position (90 deg). Grasp the talus while stabilizing the
distal tibia with other hand and apply eversion stress.
Tibial torsion (prone)
(+)deltoid ligament instability – excessive movement or
pain

Anterior drawer test of the ankle

Patient: lies prone with the knee flexed to 90°.

PT: The examiner views from above the angle formed by

the foot and thigh.
Patient: lies supine with the foot relaxed Out-toeing = tibial torsion is more than 18 deg
In-toeing = tibial torsion is less than 13 deg
PT: examiner stabilizes the tibia and fibula, holds the
patient’s foot in 20° of plantar flexion, and draws the Tibial torsion (Sitting)
talus forward in the ankle mortise. By adding inversion,
which gives an anterolateral stress, the examiner can
increase the stress on the anterior talofibular ligament
and the calcaneofibular ligament.

(+)anterior talofibular ligament injury = abnormal

anterior translation

Prone Anterior Drawer Test


Patient: sit with the knees flexed to 90° over the edge of
the examining table
PT: The examiner places the thumb of one hand over
the apex of one malleolus and the index finger of the
same hand over the apex of the other malleolus. Next,
the examiner visualizes the axes of the knee and of the
ankle. The lines are not normally parallel but instead
form an angle of 12° to 18° owing to lateral rotation of
the tibia
Out-toeing = tibial torsion is more than 18 deg
In-toeing = tibial torsion is less than 13 deg
Tibial Torsion (Supine)
Patient: supine
PT: The examiner ensures that the femoral condyle lies
in the frontal plane (patella facing straight up). The
examiner palpates the apex of both malleoli with one
hand and draws a line on the heel representing a line
joining the two apices. A second line is drawn on the
heel parallel to the floor. The angle formed by the
intersection of the two lines indicates the amount of
lateral tibial torsion
Out-toeing = tibial torsion is more than 18 deg
In-toeing = tibial torsion is less than 13 deg
Too many toes sign
Patient: stands in a normal relaxed position
PT: examiner views the patient from behind.
If the heel is in valgus, the forefoot abducted, or the
tibia laterally rotated more than normal. The examiner
can see more toes on the affected side than on the
normal side. If the talus is positioned in neutral and the
calcaneus is in neutral, the “too many toes” sign means
the forefoot is adducted on the rearfoot and may be
seen with excessive pronation (hyperpronation).
Hyperpronation is often associated with metatarsalgia,
plantar fasciitis, hallux valgus, and posterior tibial
tendon pathology.
(+)hyperpronation = PT can see too many toes
Thompson’s (Simmonds’) Test (Sign for Achilles Tendon
Rupture)
Patient: lies prone or kneels on a chair with the feet
over the edge of the table or chair
PT: examiner squeezes the calf muscles.
(+) ruptured Achilles tendon = absence of plantar flexion
when mm is squeezed.
Windlass Test
Patient: stands on a stool or chair with the foot
positioned so that the metatarsal heads rest on the
edge of the stool while the patient maintains weight
through the leg.
PT: The examiner then passively dorsiflexes the big toe
(+)Plantar Fasciitis = pain at the insertion of the plantar
fascia
(+)hallux rigidus = Lack of extension
Patient: seated with the leg hanging over the examining
table with the knee at 90°.
PT: stabilizes the leg with one hand. With the other
hand, the examiner holds the foot in plantigrade (90°)
and applies a passive lateral rotation stress to the foot
and ankle.

(+)syndesmosis (“high ankle”) injury = pain is produced

Navicular drop test
over the anterior or posterior tibiofibular ligaments and
the interosseous membrane

Squeeze Test

Patient: stands with the feet in a relaxed standing

position so that the base width and Fick angle are
normal for the patient.

PT: Using a small rigid ruler, the examiner first measures

the height of the navicular from the floor in the neutral Patient: lies supine
talus position using the most prominent part of the
PT: examiner grasps the lower leg at midcalf and
navicular tuberosity and then measures the height of
squeezes the tibia and fibula together. The examiner
the navicular in normal relaxed standing. The difference
then applies the same load at more distal locations
is called the navicular drop and indicates the amount of
moving toward the ankle.
foot pronation or flattening of the medial longitudinal
arch during standing (+)Syndesmosis injury = pain in the lower leg

Any measurement greater than 10 mm is considered Cotton Test

abnormal.

External (Lateral) Rotation Stress Test (Kleiger Test).

PT: supine or long sitting

PT: Stabilize the tibia and fibula with one hand then
apply lateral translation force with the other hand.

(+)Syndesmosis = any lateral translation of more than 3-

5mm o a clunk is felt or heard

Tinel sign at the ankle Patient: supine. Ask patient to passively extend the
knee

PT: Once the knee is extended the examiner raises the

patient’s straight leg to 10 degrees, then passively and
abruptly dorsiflexes the foot and squeezes the calf with
the other hand.

(+) Presence of DVT = Deep calf pain and tenderness

Patient: supine or long sitting
Hoffa’s Test
PT: palpate the medial malleolus, then assess the tibial
branch of the deep peroneal nerve by tapping the area
anterior to the medial malleolus. Assess the posterior
tibial nerve by tapping behind the medial malleolus

(+)Peripheral nerve injury = tingling and paresthesia is

felt distally

Fibular Translation Test

Patient: prone with the feet extended over the edge of

the examining table.

PT: palpate the Achilles tendon while the patient

plantar flexes and dorsiflexes the foot.

(+) Calcaneal Fracture = If one Achilles tendon (the

Patient: sidelying
PT: stabilizes the tibia with one hand and translates the
fibular malleolus anteriorly and posteriorly with the
other hand.
injured one) feels less taut than the other one. Passive
dorsiflexion on the affected side is also greater.
Morton’s Test

(+) Syndesmosis injury = pain during translation or if the

movement is greater on the affected side.

Homans Sign

Patient: supine.
PT: grasps the foot around the metatarsal heads and be restored and the veins to fill and become prominent
squeezes the heads together. (part 2).

(+) Stress Fracture or Neuroma = pain Forced Dorsiflexion Test

Duchenne Test

Patient: sits on the edge of the table.

Patient: supine with the legs straight. PT: stabilizes the patient’s leg with one hand and with
the other hand passively and forcefully dorsiflexes the
PT: pushes up on the head of the first metatarsal
foot by holding onto the heel and using the forearm to
through the sole, pushing the foot into dorsiflexion.
dorsiflex the foot.
(+) lesion of the superficial peroneal nerve or a lesion of
(+) Syndesmosis injury = pain on forced dorsiflexion
L4, L5, or S1 nerve root = when the patient is asked to
plantar flex the foot, the medial border dorsiflexes and Heel Thump Test
offers no resistance while the lateral border plantar
flexes.

Buerger’s Test

Patient: supine while the examiner elevates the

patient’s leg to 45° for at least 3 minutes.(part 1)
Patient: sitting or lying.

PT: holds the patient’s leg with one hand and with the
other hand applies a gentle but firm thump on the heel
with the fist.

(+) Syndesmosis injury = pain in the area of ankle

Patient: The examiner then asks the patient to sit with (+) Stress Fracture = pain along the shaft of the tibia
the legs dangling over the edge of the bed. (part 2)

(+) poor arterial blood circulation = If the foot blanches

Matles Test
or the prominent veins collapse shortly after elevation
(part 1). If it takes 1 to 2 minutes for the limb color to

Patient: prone with the foot over the end of the
examining table while the clinician stands near the end
of the table.
PT: The patient is asked to actively flex the knee to 90°.
During the motion, the examiner watches the foot.
Normally, it will be slightly plantar flexed.
(+) 3° strain (rupture) of the Achilles tendon = If the
foot falls into neutral or slight dorsiflexion
Feiss Line
A. Feiss line in non–weight-bearing. Navicular is in
normal position. B. Feiss line in weight-bearing.
Navicular is slightly below line (within normal limits).
PT: The examiner marks the apex ofthe medial
malleolus and the plantar aspect ofthe first
metatarsophalangeal joint while the patient is not
bearing weight. The examiner then palpates the
navicular tuberosity on the medial aspect ofthe foot,
noting where it lies relative to a line joining the two
previously made points. The patient then stands with
the feet 8 to 15 cm (3 to 6 inches) apart. The two points
are checked to ensure that they still represent the apex
of the medial malleolus and the plantar aspect ofthe
metatarsophalangeal joint. The navicular tubercle is
again palpated . The navicular tubercle normally lies on
or close to the line joining the two points.
(+) first-degree flatfoot = If the tubercle falls one third
of the distance to the floor
(+) second-degree flatfoot = if it falls two thirds of the
distance
(+) third-degree flatfoot = if it rests on the floor, it
represents a third-degree flatfoot
Figure-Eight Ankle Measurement for Swelling or Figure
of 8
Patient: long sitting with the ankle and lower leg beyong
the end of the examining table with the ankle in
plantigrade (90°) °and the ankle in 20° plantarflexion
(called figure-of-eight-20).
PT: Using a 6 mm (1 4-inch) wide plastic tape measure,
the examiner places the end of the tape measure on the
tibialis anterior tendon, drawing the tape medially
across the instep just distal to the navicular tuberosity.
The tape is then pulled across the arch of the foot just
proximal to the base of the fifth metatarsal, across the
tibialis anterior tendon, and then around the ankle joint
just distal to the tip of the medial malleolus, across the
Achilles tendon, and just distal to the lateral malleolus,
returning to the starting position . The measurement is
repeated three times and an average taken.
Patla Tibialis Posterior Length Test
Patient: prone lying with the knee flexed to 90° and the
calcaneus held in eversion and the ankle in dorsiflexion
with one hand.

PT: With the other hand, the examiner’s thumb contacts

the plantar surface of the bases of the second, third,
and fourth metatarsals while the index and middle
fingers contact the plantar surface of the navicular. The
examiner then determines the end feel by pushing
dorsally on the navicular and metatarsal heads. The end
feel is compared with the normal side.

(+) heel pain/ankle pain that may be due to pre-stage 1

posterior tibial dysfunction - reproduction of symptoms