Transcript (Flexor Hallucis Brevis) Test For Grades 5, 4, 3, 2, 1

Ankle & Foot
(3)
Flexion:
Metatarsophalangeal
Joint
 Range of motion
Great Toe : 0° – 45 °
Lateral Four Toes : 0° – 40 °
Testing position
Supine or sitting, ankle & foot in 0° of dorsiflexion, plantar
flexion, inversion, eversion. MTP in 0° abduction & adduction.
IP 0° of flexion & extension
Stabilization
Stabilize metatarsal to prevent plantar flexion of ankle &
inversion or eversion of foot. Do not hold MTP of other toes in
extension, because tension in transverse metatarsal ligament
will restrict the motion
 Goniometer Alignment
Fulcrum
Dorsal aspect of MTP joint
Proximal Arm
Dorsal midline of metatarsal
Distal Arm
Dorsal midline of proximal phalanx
 Alternative Goniometer Alignment For First
Metatarsophalangeal Joint
Fulcrum
Medial aspect of the first MTP joint
Proximal Arm
Medial midline of the first metatarsal
Distal Arm
Medial midline of the proximal phalanx the first toe
 Patient Instruction
Ask the patient to Bend
their toe.
 Normal End Feel
Firm, because of tension in:
 Dorsal Joint capsule
 Collateral ligaments
 Extensor digitorum brevis
Hallux & Toe Metatarsophalangeal
Flexion Muscles
Lumbricales
Flexor Hallucis Brevis
Lumbricales
Origin:
Tendons of Flexor digitorum longus + 1st lumbricale +
2nd-4th lumbricales
Insertion:
Toes 2-5 (proximal phalanges & dorsal expansions of tendons of Extensor digitorum
longus)
Innervation:
Medial Planter Nerve (L5-S1)  1st lumbricale
Lateral Planter Nerve (S2-S3)  2nd 3rd 4th lumbricales
Flexor Hallucis Brevis
Origin:
Lateral head: cuboid bone + lateral cuneiform bone
Medial head: medial intermascular septum + tendon of Tibialis
posterior
Insertion:
Lateral & Medial heads : Hallux ( proximal phalanx on both sides of base) + blend
with abductor hallucis
Intervention:
Medial Planter Nerve (S1-S2)
1- Hallux MP Flexion (Flexor Hallucis Brevis)
Test For Grades 5, 4, 3, 2, 1 and 0
 Patient Position
The patient is short sitting with legs
hanging over the edge of the table.
The ankle is in a neutral position
 Therapist and Patient Instructions
The therapist is seated on a stool in front of the patient. The
test foot rests on the examiner's lap. The therapist stabilizes
the dorsum of the foot just below the ankle with one hand,
and uses the index finger of the other hand to resist
beneath the proximal phalanx of the great toe. Ask the
patient to, “Bend your big toe over my finger. Hold it.
Don’t let me straighten it.”
Test For Grades 5, 4, 3, 2, 1 and 0
Grade 5 (Normal): completes full range of motion and holds against maximal
resistance.
Grade 4 (Good): completes available range of motion and holds against strong
to moderate resistance.
Grade 3 (Fair): patient completes available range of MP flexion of great toe but
unable to hold against any resistance
Grade 2 (Poor): completes only partial range of motion.
Grade 1 (Trace): therapist my note contractile activity but no toe motion
Grade 0 (Zero): no contractile activity
2- Toe MP Flexion (Lumbricales)
Test For Grades 5, 4, 3, 2, 1 and 0
 Patient Position
The patient is short sitting with legs
hanging over the edge of the table.
The ankle is in a neutral position
 Therapist and Patient Instructions
The therapist is seated on a stool in front of the patient. The
test foot rests on the examiner's lap. The therapist stabilizes
the dorsum of the foot just below the ankle with one hand,
and uses the index finger of the other hand to resist
beneath the MP joints of the four lesser toes. Then patient
actively flexes the toes at the MP joints, keeping the IP
joints neutral. Ask the patient to, “Bend your toes over my
finger.”
Test For Grades 5, 4, 3, 2, 1 and 0
Grade 5 (Normal): completes full range of motion and holds against maximal
resistance.
Grade 4 (Good): completes available range of motion and holds against strong
to moderate resistance.
Grade 3 (Fair): patient completes available range of MP flexion of toes but
unable to hold against any resistance
Grade 2 (Poor): completes only partial range of motion.
Grade 1 (Trace): therapist my note contractile activity but no toe motion
Grade 0 (Zero): no contractile activity
Extension:
Metatarsophalangeal
Joint
 Range of motion
0° to 50°-70 °
Testing position
Supine or sitting, ankle & foot in 0° of dorsiflexion,
plantar flexion, inversion, eversion. MTP in 0°
abduction & adduction. IP 0° of flexion & extension
Stabilization
Stabilize metatarsal to prevent dorsiflexion of ankle &
inversion or eversion of foot. Do not hold MTP of
other toes in flexion, because tension in transverse
metatarsal ligament will restrict the motion
 Goniometer Alignment
Fulcrum
Dorsal aspect of MTP joint
Proximal Arm
Dorsal midline of metatarsal
Distal Arm
Dorsal midline of proximal phalanx
 Alternative Goniometer Alignment For First
Metatarsophalangeal Joint
Fulcrum
Medial aspect of the first MTP joint
Proximal Arm
Medial midline of the first metatarsal
Distal Arm
Medial midline of the proximal phalanx the first toe
 Patient Instruction
Instruct the patient to
extend their toe.
 Normal End Feel
Firm, because of tension in:





Planter Joint capsule
Planter pad
Flexor hallucis brevis
Flexor digitorum brevis
Flexor digiti minimi
Hallux & Toe MP & IP Extension Muscles
Extensor Digitorum Longus
Extensor Digitorum Brevis
Extensor Hallucis Longus
Extensor Digitorum Longus
Origin:
Lateral condyle of tibia + shaft of fibula + fascia
cruris + interosseous membrabe + intermascular septum
Insertion:
Toes 2-5 (to each middle & each distal phalanx, dorsal surface)
Innervation:
Deep Peroneal Nerve (L5-S1)
Extensor Digitorum Brevis
Origin:
Calcaneus + lateral talocalcaneal ligament +
extensor retinaculum
Insertion:
Ends in four tendons: Hallux ( proximal phalanx, dorsal surface) + toes 2-4: join
tendons of extensor digitorum longus
Innervation:
Deep Peroneal Nerve (L5-S1)
Extensor Hallucis Longus
Origin:
Shaft of fibula + interosseous membrane
Insertion:
Hallux (distal phalanx, dorsal aspect of base) + expansion to proximal
phalanx
Innervation:
Deep Peroneal Nerve (L5)
1- Hallux
Test For Grades 5, 4, 3, 2, 1 and 0
 Patient Position
The patient is short sitting or supine.
Ankle is neutral
 Therapist and Patient Instructions
The therapist stabilizes the metatarsal area by contouring hand
around the plantar surface of the foot with the thumb
curving around the base of the great toe. The other hand
stabilizes the foot at heel. For resistance, place the thumb
over the MP or IP joint. Ask the patient to, “straighten you
big toe, hold it.”
2- Toes
Test For Grades 5, 4, 3, 2, 1 and 0
 Patient Position
The patient is short sitting or supine.
Ankle is neutral
 Therapist and Patient Instructions
The therapist uses both hands to stabilize the metatarsals with
the fingers on the plantar surface and the thumbs on the
dorsum of the foot. The other hand is used to give
resistance with the thumb placed over the dorsal surface of
the proximal phalanges of the toes. Ask the patient,
“straighten you toes, hold it.”
Test For Grades 5, 4, 3, 2, 1 and 0
Grade 5 (Normal) & Grade 4 (Good): : patient can extend the toes fully
against variable resistance (which may be small)
Grade 3 (Fair) & Grade 2 (Poor): patient can complete range of motion
with no resistance (Grade 3), or can complete partial range of
motion (Grade 2).
Grade 1 (Trace): tendons of the Extensor digitorum longus can be
palpated or observed over dorsum of metatarsals. Tendon of the
Extensor digitorum brevis often can be palpated on the lateral side
of the dorsum of the foot just in front of the malleolus
Grade 0 (Zero): no contractile activity
Abduction:
Metatarsophalangeal
Joint
Testing position
Supine or sitting, foot in 0° of inversion & eversion. MTP
& IP 0° of flexion & extension
Stabilization
Stabilize metatarsal to prevent inversion or eversion of
foot.
 Goniometer Alignment
Fulcrum
Dorsal aspect of MTP joint
Proximal Arm
Dorsal midline of metatarsal
Distal Arm
Dorsal midline of proximal phalanx
 Normal End Feel
Firm, because of tension in:





Joint capsule
Collateral ligaments
Fascia of the web space between toes
Addactor hallucis
Planter interosseus muscles
Adduction:
Metatarsophalangeal
Joint
Adduction is the return from abduction to
the 0 starting position, it is not usually
measured
Flexion: IP Joint of First
Toe & PIP Joints of
Four Lesser Toes
 Range of motion
Great Toe : 0° to 30 ° – 90 °
Lateral Four Toes : 0° to 35 ° – 65 °
Testing position
Supine or sitting, ankle & foot in neutral
Stabilization
Stabilize metatarsal & proximal to prevent dorsiflexion
or planterflexion of ankle & inversion & eversion of
foot. Avoid flexion & extension of the MTP joint
 Goniometer Alignment
Fulcrum
Dorsal aspect of IP joint being tested
Proximal Arm
Dorsal midline of proximal phalanx
Distal Arm
Dorsal midline of the phalanx distal to the joint being
tested
 Normal End Feel
May be soft:
 because of compression of soft tissues
between the planter surfaces of the
phalanges
Sometimes it might be firm, because of tension
in:
 Dorsal Joint capsule
 Collateral ligaments
Flexion: DIP Joints of The
Four Lesser Toes
 Range of motion
0° to 30 °
Testing position
Supine or sitting, ankle & foot in neutral
Stabilization
Stabilize metatarsal ,proximal and middle phalanx to
prevent dorsiflexion or planterflexion of ankle &
inversion & eversion of foot. Avoid flexion &
extension of the MTP & PIP joints of the toe being
tested
 Goniometer Alignment
Fulcrum
Dorsal aspect of DIP joint being tested
Proximal Arm
Dorsal midline of middle phalanx
Distal Arm
Dorsal midline of the distal phlanx
 Normal End Feel
Firm, because of tension in:
 Dorsal Joint capsule
 Collateral ligaments
 Oblique retinacular ligament
Hallux & Toe DIP & PIP Flexion Muscles
Flexor Digitorum Longus
Flexor Digitorum Brevis
Flexor Hallucis Longus
Flexor Digitorum Longus
Origin:
Shaft of tibia + fascia over tibialis posterior
Insertion:
Toes 2-5 (distal phalanges, planter surfaces & bases)
Innervation:
Tibial Nerve (L5-S2)
Flexor Digitorum Brevis
Origin:
Calcaneus + plantar aponeurosis + intermascular septum
Insertion:
Toes 2-5 (by four tendons to middle phalanges, both sides)
Innervation:
Medial Plantar Nerve (S1-S2)
Flexor Hallucis Longus
Origin:
Shaft of fibula + interosseous membrane + intermascular
septum + fascia over tibialis posterior
Insertion:
Slip of tendon to Flexor digitorum longus + hallux
Innervation:
Tibial Nerve (L5-S2)
Test For Grades 5, 4, 3, 2, 1 and 0
 Patient Position
The patient is short sitting with foot on examiner's lap,
or supine.
 Therapist and Patient Instructions
The therapist is seated on a stool in front of the patient. One
hand grasps the anterior foot with fingers placed across
the dorsum of the foot & the thumb under the (PIP) or
(DIP) or under the IP of the hallux for stabilizaion . The
other hand applies resistance using the examiner’s four
fingers or thumb under the middle phalanges (for the
IP test); under the distal phalanges (for the DIP test); &
with the index finger under the distal phalanx of the
hallux Ask the patient, “Curl your toes . Hold it. Curl
your big toe . Hold it.”
Test For Grades 5, 4, 3, 2, 1 and 0
Grade 5 (Normal) & Grade 4 (Good): : patient complets range of
motion of toes & then hallux; resistance in bothe tests may be
minimal
Grade 3 (Fair) & Grade 2 (Poor): patient can complete range of
motion with no resistance (Grade 3), or can complete partial
range of motion (Grade 2).
Grade 1 (Trace) & Grade 0 (Zero): minimal to no palpable
contractile activity occurs. Tendon of the Flexor hallucis longus
may be palpated on the planter surface of the proximal
phalanx of the great toe
 Good Luck To You All 