Normal values for joint range of motion can be found in Table 65-1. Start by evaluating the heel cord and gastrocsoleus complex (GSC) for excessive tightness. Passively dorsiflex the foot while the knee is flexed and note the motion. Then pas
Figure 65-7 Testing for gastrocsoleus complex tightness (knee extended). Note relative plantarflexion of the foot indicating a tight gastrocsoleus complex.
sively extend the knee while holding the foot dorsiflexed. Because the GSC crosses the knee and ankle joints, when tight, it will force the foot into relative plantarflexion as the knee extends (Figs. 65-6 and 65-7). A supple GSC is essential for prevention of multiple foot injuries including bunions, forefoot overload, and tendonitis. At least 10 degrees of ankle dorsiflex-ion is required during the support phase of running.3
The tibiotalar joint should then be checked for range of motion while the knee is flexed (to eliminate the GSC contribution). To evaluate the subtalar joint, first place the ankle in a plantigrade position, locking the talus in the ankle mortise. Then passively invert and evert the hindfoot. It is normal to have twice as much inversion. The subtalar joint is critical for accommodating uneven surfaces, and lack of motion here may indicate a tarsal coalition or fibrosed joint as may occur in late stages of posterior tibialis dysfunction. In the midfoot, examination for excessive plantar-dorsal motion (more than approximately 1 cm) of the first tarsometatarsal joint is useful in making treatment decisions for bunions.4 Similarly, the first MTP should be checked to ensure motion, particularly full, painless dorsiflexion that may be limited by hallux rigidus or turf toe.
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Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.