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Identifying uncontrolled movement

29th August 2013

Uncontrolled  subtalar and midtarsal inversion can be associated with many foot and ankle pain presentations and pathologies

e.g. antero-lateral tibial pain, ankle sprains, plantar faciitis

This test can help to identify uncontrolled movement at this site and direction

 

Test:Low Lunge & Front Foot Heel Lift


Ideal pattern

In the low lunge position (4 foot lengths) with the trunk upright, and the rear thigh vertical in line with the trunk, the rear knee should be approximately 5 cm (2 inches) above the floor. The inside edge of the front foot should be in the sagittal plane with the second metatarsal aligned to the 10° neutral line of weight transfer. The knee of the front foot should be vertically above the toes with the line of the thigh also aligned to the tendering neutral line of weight transfer (matching the second metatarsal).
In this low lunge position, perform a maximum heel lift of the front foot into full plantarflexion. Hold this maximum heel lift for release five seconds.

 

Faults

Uncontrolled subtalar / midtarsal inversion is indicated if there is an inability to prevent the rear foot from rolling out into inversion during heel lift or of the weight shifting to the lateral metatarsal heads and the base of the first metatarsal lifts and loses weight-bearing support.

 

Correction

Start training in a short lunge (3 foot lengths) with only partial weight on the front foot. Hold onto a supporting service with the hands to maintain balance and lift the heel of the front foot only 1-2 cm. Keep the line of the femur aligned over the 2nd metatarsal and maintain weight-bearing pressure on the base of the first metatarsal.
Progress this retraining by slowly increasing the height of the heel lift, initially in a short lunge position. The final progression is into a maximum heel lift in the long, low lunge position.

 

 

Retraining strategy for subtalar and midtarsal inversion

 

An intersting read:

Br J Sports Med. 2011 Jun;45(8):660-72. doi: 10.1136/bjsm.2010.077404. 
Characteristics of people with recurrent ankle sprains: a systematic review with meta-analysis.
Hiller CE, Nightingale EJ, Lin CW, Coughlan GF, Caulfield B, Delahunt E.
Assessment of movement control in recurrent ankle sprains is sparse!

Keywords: Clinical Tips