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					Special Test Foot and Ankle Anterior Draw Test        Patient supine with talocrural joint in 20 degrees plantar flexion. Therapist stabilizes distal tibia and fibula while applying an anterior directed force to talus and calcaneus. Alternatively, patient in hooklying with talocrural joint in 20 degrees plantar flexion. Stabilize talus and calcaneus while applying a posterior directed force on tibia. Assesses for integrity of the anterior talofibular ligament (ATF). Positive findings include pain and/or hypermobility. Bilateral comparison.

Posterior Draw Test        Patient supine with talocrural joint in 20 degrees plantar flexion. Therapist stabilizes distal tibia and fibula while applying a posterior directed force to talus and calcaneus. Alternatively, patient in hooklying with talocrural joint in 20 degrees plantar flexion. Stabilize talus and calcaneus while applying an anterior directed force on tibia. Assesses for integrity of the posterior talofibular ligament (PTF). Positive findings include pain and/or hypermobility. Bilateral comparison.

Talar Rock Test        Patient sidelying with therapist behind patient providing stabilization of the patient's posterior thigh to the therapist back. Therapist takes a purchase on the talus anterior and posterior. Therapist distracts along the long axis of the lower leg. With distraction maintained, the therapist plantar flexes and dorsi flexes the talocrural joint. Joint play assessment test in which a "clunk" may be noted which is normal. Positive findings include pain and/or hypermobility. Bilateral comparison.

Talar Tilt Test   Patient sidelying with therapist behind patient providing stabilization of the patient's posterior thigh to the therapist back. Therapist takes a purchase on the talus anterior and posterior.

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Therapist positions talocrural joint in 20 degrees plantar flexion while providing an inversion (varus) and eversion (valgus) directed force to the ankle. Assess the integrity of the calcaneal fibular ligament with inversion (varus) and the deltoid ligament with eversion (valgus). Positive findings include pain and/or hypermobility. Bilateral comparison.

Thompson Test (Simmonds' Test)     Patient in either supine, quadruped or tall kneel position. Therapist applies a quick stretch to the triceps surae. Negative finding includes plantar flexion of the ankle suggesting intact achilles tendon. Positive finding includes absent or diminished ankle plantar flexion in bilateral comparison suggesting achilles tendon tear or rupture.

Homan's Sign       Patient supine with bilateral knees extended. Therapist passively dorsi flexes ankle and notes if patient has pain/discomfort during the maneuver at the site of the involved calf. Therapist can asses for temperature changes and/or color changes to the posterior lower leg. Therapist may apply a gentle compressive force to the triceps surae and note pain reproduction. Positive test may indicate thrombophlebitis which is a red flag requiring consultation with the physician. Bilateral comparison.

Tinnel Test * Patient short sit with ankle in slight plantar flexion and inversion (varus). * Therapist taps with the second and third digits over the tarsal tunnel. * Positive findings include pain/paresthesias distal to the tarsal tunnel. * Implicates compression of the posterior tibial nerve at the tarsal tunnel. * Bilateral comparison. Compression Test/Morton's Test     Patient supine. Therapist applies compression of the metatarsal heads along the dorsum of the foot. Positive findings may include pain/discomfort and/or paresthesias. Assesses for metatarsal stress fracture and/or Morton's (digital) neuroma.

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Bilateral comparison.

Neurodynamic Examination of Peripheral Nerves         Patient supine. Therapist performs a Straight Leg Raise Test (SLR) void of hip internal rotation* and adduction (see Lumbopelvic Special Tests) with the following nerve biases: Tibial Nerve Bias: passively dorsi flex the talocrural joint and evert the calcaneus. Sural Nerve Bias: passively dorsi flex the talocrural joint and invert the calcaneus. Common Peroneal Nerve Bias: passively plantar flex the talocrural joint and invert the calcaneus along with hip internal rotation*. Positive findings include pain and/or paresthesias in the leg, foot (along specific peripheral nerve distribution), and/or low back region. Sensitize appropriately to distinguish adverse neural tension (ANT) vs. soft tissue tightness. Bilateral comparison.


				
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