Ankle Planter Flexion: Test: Patient Raises Heel From Floor Consecutively Through Full Range of Plantar Flexion

Ankle Planter Flexion
• Position of Patient: Patient stands

on limb to be tested with knee
extended. Patient is likely to need
external support; no more than one
or two fingers should be used on a
table (or other surface) for balance
assist only
• Position of Therapist: Standing or
sitting with a lateral view of test
limb.
• Repeat this 25 times.
• Test: Patient raises heel from floor consecutively through full range of plantar flexion.
1
• Grade 5 (Normal): Patient successfully
completes a minimum of 25 heel rises
through full range of motion without a
rest between rises and without fatigue.
• Grade 4 (Good): A Grade 4 is conferred

when the patient completes any number
of correct heel rises between 24 and 10
with no rest between repetitions and
without fatigue.
• Grade 3 (Fair): Patient completes

between nine and one heel rises
correctly with no rest or fatigue.
2
Grade 2 (Poor)
•Position of Patient: Standing on limb
to be tested with knee extended, with
a two-finger balance assist.
•Position of Therapist: Standing or
sitting with a lateral view of test limb.
•Grade 2+ (Poor+): The patient can just
clear the heel from the floor and cannot
get up on the toes for the end test
position.
• Test: Patient attempts to raise heel from the floor through the full range of plantar
flexion 3
Grade 2 (Poor)
•Position of Patient: Prone with feet
off end of table.
•Position of Therapist: Standing at
end of table in front of foot to be
tested. One hand is contoured under
and around the test leg just above the
ankle.
•Heel and palm of hand giving
resistance are placed against the
plantar surface at the level of the
metatarsal heads.
• Test: Patient plantar flexes ankle through the available range of motion. Manual resistance
is down and forward toward dorsiflexion.
4
Grade 2 (Poor)
•Grade 2+ (Poor+): Completes plantar flexion
range and holds against maximal resistance.
•Grade 2 (Poor): Patient completes plantar

flexion range but tolerates no resistance.
•Grade 2- (Poor-): Patient completes only a

partial range of motion.
•Grade 1 (Trace): Tendon reflects some

contractile activity in muscle, but no joint
motion occurs.
•Grade 0 (Zero): No palpable contraction.
5
Foot Dorsiflexion & Inversion
• Position of Patient: Short sitting.
Alternatively, patient may be supine.
• Position of Therapist: Sitting on
stool in front of patient with
patient's heel resting on thigh. One
hand is contoured around the
posterior leg just above the malleoli.
The hand providing resistance for
the same grades is cupped over the
dorsomedial aspect of the foot.
• Test: Patient dorsiflexes ankle and inverts foot, keeping toes relaxed.
6
• Grade 5 (Normal): Completes
full range and holds against
maximal resistance.
• Grade 4 (Good): Completes

available range against strong to
moderate resistance.
• Grade 3 (Fair): Completes

available range against strong to
moderate resistance.
• Grade 2 (Poor): Completes only

a partial range of motion.
7
Grade 1 (Trace) and Grade 0 (Zero)
•Grade 1 (Trace): Therapist will be
able to detect some contractile
activity in the muscle, or the tendon
will "stand out." There is no joint
movement.
•Grade 0 (Zero): No palpable

contraction.
8
Foot Inversion
• Position of Patient: Short sitting with
ankle in slight plantar flexion.
• Position of Therapist: Sitting on low
stool in front of patient or on side of
test limb. One hand is used to stabilize
the ankle just above the malleoli.
• Hand providing resistance is contoured
over the dorsum and medial side of the
foot at the level of the metatarsal
heads. Resistance is directed toward
eversion and slight dorsiflexion.
• Test: Patient inverts foot through available range of motion.

9
Foot Inversion
• Grade 5 (Normal): The patient
completes the full range and holds
against maximal resistance.
• Grade 4 (Good): The patient
completes available range against
strong to moderate resistance.
• Grade 3 (Fair): The patient will be
able to invert the foot through the
full available range of motion.
• Grade 2 (Poor): The patient will be
able to complete only a partial
range of motion. 10
Foot Inversion
•Position of Patient: Short sitting or
supine.
•Position of Therapist: Sitting on low

stool or standing in front of patient.
Palpate tendon of the tibialis posterior
between the medial malleolus and the
navicular bone.
•Grade 1 (Trace): The tendon will stand

out if there is contractile activity in the
muscle.
•Grade 0 (Zero): No palpable

contraction. 11
Foot Eversion With Planter Flexion
• Position of Patient: Short sitting with
ankle in neutral position (midway
between dorsiflexion and plantar
flexion)
• Position of Therapist: Sitting on low
stool in front of patient or standing at
end of table if patient is supine.
• One hand grips the ankle just above the
malleoli for stabilization.
• Hand giving resistance is contoured
around the dorsum and lateral border of
the forefoot. Resistance is directed
toward inversion and slight dorsiflexion.
• Test: Patient everts foot with depression of first metatarsal head and
12
some plantar flexion.
• Grade 5 (Normal): The patient
completes the full range and holds
against maximal resistance.
• Grade 4 (Good): The patient
completes available range against
strong to moderate resistance.
• Grade 3 (Fair): The patient will be
able to invert the foot through the
full available range of motion.
• Grade 2 (Poor): The patient will be
able to complete only a partial
range of eversion motion. 13
•Position of Patient: Short sitting or
supine.
•Position of Therapist: Sitting on low
stool or standing at end of table. To
palpate the peroneus longus, place
fingers on the lateral leg over the upper
one third just below the lateral malleoli
of the fibula.
•Grade 1 (Trace): Palpation will reveal
contractile activity in either or both
muscles.
•Grade 0 (Zero): No palpable contraction.
14
The Ankle Goniometry
Landmarks for measuring ankle movements’ ROM
15
Talocrural Dorsiflexion (20 degrees)

Goniometer Alignment
•Fulcrum of the goniometer is centered

over the lateral aspect of the lateral
malleolus.
•Proximal arm is aligned with the lateral

midline of the fibula, using the head of
the fibula for reference.
•Distal arm is aligned parallel to the

lateral aspect of the fifth metatarsal.
16
Talocrural Dorsiflexion (20 degrees)
17
Talocrural Planterflexion (40 – 50 degrees)


over the lateral aspect of the lateral
malleolus.
•Proximal arm is aligned with the lateral

midline of the fibula, using the head of
the fibula for reference.
•Distal arm is aligned parallel to the

lateral aspect of the fifth metatarsal.
18
Talocrural Planterflexion (40 – 50 degrees)
19
Landmarks for measuring Tarsal joints movements’ ROM
20
Tarsal Joints Inversion (30 – 35 degrees)


over the anterior aspect of the ankle
midway between the malleoli.
•Proximal arm is aligned with the anterior

midline of the lower leg, using the tibial
tuberosity for reference.
•Distal arm is aligned with the anterior

midline of the second metatarsal.
21
Tarsal Joints Inversion (30 – 35 degrees)
22
Tarsal Joints Eversion (11 – 12 degrees)


over the anterior aspect of the ankle
•Proximal arm is aligned with the anterior

midline of the lower leg, using the tibial
tuberosity for reference.
•Distal arm is aligned with the anterior

midline of the second metatarsal.
23
Tarsal Joints Eversion (11 – 12 degrees)
24
Landmarks for measuring subtalar joint movements’ ROM
25
Subtalar Joint Inversion (5 – 15 degrees)


over the posterior aspect of the ankle
•Proximal arm is aligned with the

posterior midline of the lower leg.
•Distal arm is aligned with the posterior

midline of the calcaneus.
26
Subtalar Joint Inversion (5 – 15 degrees)
27
Subtalar Joint Eversion (5 – 10 degrees)


over the posterior aspect of the ankle
•Proximal arm is aligned with the

posterior midline of the lower leg.
•Distal arm is aligned with the posterior

midline of the calcaneus.
28
Subtalar Joint Eversion (5 – 10 degrees)
29
Good Luck

Ankle Planter Flexion: Test: Patient Raises Heel From Floor Consecutively Through Full Range of Plantar Flexion

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Ankle Planter Flexion

• Position of Patient: Patient stands

• Grade 4 (Good): A Grade 4 is conferred

• Grade 3 (Fair): Patient completes

•Grade 2 (Poor): Patient completes plantar

•Grade 2- (Poor-): Patient completes only a

•Grade 1 (Trace): Tendon reflects some

•Grade 0 (Zero): No palpable contraction.

• Grade 4 (Good): Completes

• Grade 3 (Fair): Completes

• Grade 2 (Poor): Completes only

•Grade 0 (Zero): No palpable

• Test: Patient inverts foot through available range of motion.

•Position of Therapist: Sitting on low

•Grade 1 (Trace): The tendon will stand

•Grade 0 (Zero): No palpable

Landmarks for measuring ankle movements’ ROM

Talocrural Dorsiflexion (20 degrees)

•Fulcrum of the goniometer is centered

•Proximal arm is aligned with the lateral

•Distal arm is aligned parallel to the

Talocrural Dorsiflexion (20 degrees)

Talocrural Planterflexion (40 – 50 degrees)

•Fulcrum of the goniometer is centered

•Proximal arm is aligned with the lateral

•Distal arm is aligned parallel to the

Talocrural Planterflexion (40 – 50 degrees)

Landmarks for measuring Tarsal joints movements’ ROM

Tarsal Joints Inversion (30 – 35 degrees)

•Fulcrum of the goniometer is centered

•Proximal arm is aligned with the anterior

•Distal arm is aligned with the anterior

Tarsal Joints Inversion (30 – 35 degrees)

Tarsal Joints Eversion (11 – 12 degrees)

•Fulcrum of the goniometer is centered

•Proximal arm is aligned with the anterior

•Distal arm is aligned with the anterior

Tarsal Joints Eversion (11 – 12 degrees)

Landmarks for measuring subtalar joint movements’ ROM

Subtalar Joint Inversion (5 – 15 degrees)

•Fulcrum of the goniometer is centered

•Proximal arm is aligned with the

•Distal arm is aligned with the posterior

Subtalar Joint Inversion (5 – 15 degrees)

Subtalar Joint Eversion (5 – 10 degrees)

•Fulcrum of the goniometer is centered

•Proximal arm is aligned with the

•Distal arm is aligned with the posterior

Subtalar Joint Eversion (5 – 10 degrees)

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