At the conclusion of this chapter, the reader will be able to:
Identify the key anatomical and biomechanical features of the ankle and foot and their impact on examination and intervention.
List and perform key procedures used in the orthopaedic manual physical therapy (OMPT) examination of the ankle and foot.
Demonstrate sound clinical decision-making in evaluating the results of the OMPT examination.
Use pertinent examination findings to reach a differential diagnosis and prognosis.
Discuss issues related to the safe performance of OMPT interventions for the ankle and foot.
Demonstrate basic competence in the performance of an essential skill set of joint mobilization techniques for the ankle and foot.
FUNCTIONAL ANATOMY AND KINEMATICS
The ankle-foot complex performs a unique and complex role in bipedal gait and function. Throughout a typical gait pattern, this multijoint complex is responsible for performing two dichotomous roles. First, it serves as a mobile adapter upon initial heel strike and weight acceptance. Secondly, it functions as a rigid lever that facilitates forward propulsion. In addition to the challenge of accommodating the entire weight of the body to the underlying terrain, the ankle-foot complex is responsible for performing these roles efficiently, effectively, and reciprocally. The articulations that comprise the foot and ankle complex, each with its own axis of motion, provide triplanar mobility that is sufficient to allow normal function under a variety of conditions. The interdependence of this structure with proximal articulations renders it not only the source of accommodation but, as a result of both structural and functional impairments, a region that often demands compensatory strategies from its more proximal counterparts. As the most distal segment of the lower kinetic chain, the demands placed on it, coupled with its inherent complexity, render these structures a common locus of impairment and disability often requiring the specialized skills of the manual physical therapist.
The Distal Tibiofibular Joint
The distal tibiofibular (TF) joint has an interdependent relationship with its proximal counterpart, the proximal tibiofibular (TF) joint, and the impact of these articulations on ankle joint function is profound. This syndesmotic joint consists of a concave tibial joint surface that articulates with the convex fibula interposed with an interosseous membrane (Fig. 27–1). Although limited, motion within this joint is necessary for normal talocrural mobility. By virtue of its larger fibular facet on the talus, the distal fibula migrates through a greater arc of motion during dorsiflexion (DF) and plantar flexion (PF), which requires motion at both proximal and distal TF joints.
The distal tibiofibular joint.
The ankle joint proper is often referred to as the mortise, or talocrural (TC) joint. The TC joint is considered to be a synovial, hinge-type joint...