Ankle and Foot Mobilisations
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Introduction
This page discusses the Maitland technique of mobilisation.
Joint mobilization refers to manual therapy techniques that are used to modulate pain and treat joint dysfunctions that limit the range of motion (ROM) by specifically addressing the altered mechanics of the joint. The altered joint mechanics may be due to pain and muscle guarding, joint effusion, contractures or adhesions in the joint capsules or supporting ligaments, or malalignment or subluxation of the bony surfaces.[1]
Ankle Joint Maitland Glides includes : talocrural joint distraction, Posterior and Anterior glide.
Ankle and foot mobilization also includes subtalar joint mobilisation. It includes subtalar joint distraction and the glides includes lateral and medial glide which helps in improving inversion and eversion movements.
Indications
1.Ankle pain(Grade 1 and 2 of Mobilisation)
2. Reduced Range Of Motion of the ankle.(Grade 3 and 4 of Mobilization)
3. Post Operative fracture of the talus /calcaneum or any tarsal bones.
4. Distraction at the ankle joint(talocrural dictraction) is indicated during initial assessment and pain relief.
Leg and ankle joints
Tibiofibular Joint
Ventral glide at proximal tibiofibular joint
Indications
To increase the movement at the head of fibula.
To correct the positional fault of the subluxed head.
Position of the patient
Side lying and the trunk and hips are rotated a bit towards prone lying.
The leg which is on the top is flexed forward so that it rests on the table or on the pillow.
Therapist position and hand placement
The therapist stand behind the patient, places one hand under the tibia to stabilize it.
The other hand is placed posterior to the head of the fibula, fingers will wrap anteriorly.
Mobilizing force
The force is applied via the heel of the hand in an anterolateral direction.
Anterior and posterior glide at distal tibiofibular joint
Indication
To increase mobility when the ankle joint motion is restricted.
Talocrural Joint
Resting position/Loose pack position
10 degrees of plantar flexion
Talocrural distraction
Indications
Assessment, initial treatment, Reduction of pain, general mobility.
Position of the patient
Supine lying
Position of the therapist and hand placement
The therapist stands at the end of the couch and wraps the fingers of both hands over the dorsum of the foot keeping the thumbs on the plantar aspect. The joint has to be in the resting position. Legs are stabilized using the belt.
Mobilisation
The foot is pulled in the long axis. It is held for a few seconds.
Anterior(Ventral) Glide
Indication
The ventral glide is indicated to increase plantarflexion
Patient Position
Prone lying with the foot at the edge of the table.
Position of the therapist and hand placement
One hand is placed on the dorsum of the foot and grade I distraction is applied.
The Webspace of the other hand is placed on the posterior aspect of the talus and calcaneus.
Mobilizing force
Calcaneus is pushed in the anterior direction in order to glide the talus anteriorly.
Posterior (Dorsal) Glide
Indication
To increase dorsiflexion
Patient position
Supine lying with the heel at the edge of the couch
Position of the therapist with hand placement
The therapist is at the side of the patient and the leg is stabilized by the belt or the cranial hand.
The palmar aspect of the webspace of the other hand is placed over the talus, just distal to the ankle joint.
The foot is maintained in the resting position and grade I distraction is applied in the inferior direction.
Mobilisation
Glide is given on the talus bone in the posterior direction with respect to the tibia.
.
Subtalar (Talocalcaneal) Joint
This joint is formed between the calcaneus and the talus. The calcaneus is convex which articulates with concave talus.
Resting position
Midway between inversion and eversion
Subtalar Distraction
Indication
Pain control, general mobility for improving inversion and eversion
Position of the patient and placement of therapist's hand
Supine lying and the leg is supported on the table and heel over the edge.
The limb is in external rotation and the ankle joint is stabilized in dorsiflexion with pressure from of thigh on the plantar surface of the patient's foot.
The calcaneus is grasped and the talus is fixed against the table.
Mobilizing force
The calcaneus is pulled distally with respect to the long axis of the leg.
Subtalar Medial Glide or Lateral Glide
Indication
Medial glide to increase eversion; lateral glide to increase inversion.
Position of the patient and hand placement
The patient is side-lying or prone, with the leg supported on the table or with a towel roll. The Therapists aligns the shoulder and the arm parallel to the bottom of the foot,
Then the talus is stabilized with the proximal hand and the base of the distal hand is placed on the side of the calcaneus medially to cause a lateral glide and laterally to cause medial glide.
Mobilizing Force
Fingers are wrapped around the plantar surface and grade I distraction force is applied in a caudal direction, then the calcaneus is moved either medially or laterally .[3]
Intertarsal and Tarsometatarsal Plantar glide
Indication:
To increase the accessory motion of plantar flexion necessary for supination
Position of the patient and hand placement
Supine lying with flexion of hip and knee joint. An alternative position is high sitting with feet supported on the therapist's lap.
Position of the therapist and hand placement
The proximal bone is fixed with the index finger on the plantar surface of the bone.
The therapist is positioned at the lateral side of the foot to mobilize the foot on the medial aspect.
The proximal hand is placed over the dorsal aspect of the foot with fingers on the medial side.
The mobilisation is provided by the distal hand using the thenar aspect wrapping around the plantar aspect.
Mobilisation
The distal bone is pushed in the plantar direction from the dorsum of the foot.
Intertarsal and Tarsometatarsal Dorsal Glide
Indications
To improve the component of dorsal gliding while performing pronation.
Patient's position
Prone lying with knee flexion of 90 degrees.
Position of the therapist with hand placement
If the lateral part (lateral tarsal joint like cuboid) is to be mobilised the therapist has to stand on the medial side and the fingers are wrapped around the lateral side. The therapist places the second metacarpal joint against the bone to be mobilised.
Mobilisation
The force is given in the dorsal direction from the plantar surface.
References
- ↑ Kisner C, Colby LA, Borstad J. Therapeutic exercise: Foundations and techniques. Fa Davis; 2017 Oct 18.)
- ↑ Daryl Lawson. Distal Tibula Fibular Joint Mobilization Available from: https://www.youtube.com/watch?v=mw-B9E7Hxcw[last accessed 30/09/21]
- ↑ Ghafoor I, Hassan D, Rasul A, Shahid HA. Effectiveness of manual physical therapy in treatment of plantar fasciopathy. Age (y). 2016 Jul 1;45(10.81):47-14.