Ankle MMT

 

 

 

 

Plantar Flexion

Gastrocnemius and soleus

Origin:

·        Gastrocnemius: medial head: medial condyle, popliteal surface of femur, lateral head: lateral condyle of the femur

·        Soleus: head and proximal 1/3 of the shaft of the fibula and the popliteal line of the tibia

Insertion:

·        Gastrocnemius: achilles tendon to the calcaneus

·        Soleus: achilles tendon to the calcaneus

Nerve Innervation:

·        Gastrocnemius: tibial

·        Soleus: tibial

Patient Position:

·        Patient stands on limb to be tested with knee extended, other leg raised off the floor.  The patient may place one or two fingers on the table for balance.

Therapist and Patient Instructions:

·        The patient should now perform twenty heel raises.  Tell the patient to, “rise up on your toes and down, do this twenty times.”

·        Scale:

Grade 5: Can complete minimum of 20 heel raises through full range of motion.

Grade 4: Can complete between 10 and 19 heel raises through full range of motion.

Grade 3: Can complete 1 and 9 heel raises through full range of motion.

Alternate test to isolate the soleus

·        The test is the same as above except the test limb is slightly flexed at the knee.

 

 

 

 

 

 

 

 

 

 

 

 

MMT for Grades 2,1 and 0

Patient Position:

·        Prone on the table with the foot hanging off the edge. 

Therapist and Patient Instructions:

·        Palpate the Achilles tendon and instruct the patient to point their toes down.

 

 

 

 

 

 

 

 

 

 

 

Dorsiflexion and Inversion

Tibialis anterior

Origin:

·        Tibialis anterior: lateral condyle, and proximal 2/3 of the shaft of the tibia

Insertion:

·        Tibialis anterior: first cuneiform and first metatarsal

Nerve Innervation:

·        Tibialis anterior: deep fibular (peroneal)

Patient Position:

·        Sitting, with the patient’s heel resting on the thigh of the therapist. Patient's foot should be dorsiflexed and inverted.

Therapist and Patient Instructions:

·        Therapist is sitting on stool beside the limb being tested.  The heel of the patient can be resting on the therapist’s thigh.  The resistance hand should be placed around the dorsum and medial aspect of the foot.  Resistance is given down and out toward eversion.  The stabilizing hand is around the posterior leg just above the ankle.  Have the patient, “turn your foot up and in, don’t let me push it down.”

 

 

MMT for Grades 2, 1, and 0

Patient Position:

·        Patient is sitting with the heel of their foot resting on the thigh of the therapist. Refer to starting position picture.

Therapist and Patient Instructions:

·        Palpate the tendon of tibialis anterior in-between the malleoli and with the other hand palpate the muscle just lateral to the tibia while asking the patient to try and turn their foot up and in.

 

Inversion

Tibialis posterior

Origin:

·        Tibialis posterior: proximal 2/3 of shaft and distal condyle of tibia, proximal 2/3 and posterior head of the fibula

Insertion:

·        Tibialis posterior: navicular, cuneiforms, cuboid, and second through fourth metatarsals

Nerve Innervation:

·        Tibialis posterior: tibial

Patient Position:

·        Sitting with ankle in slight plantar flexion.

Therapist and Patient Instructions:

·        Sitting next to test limb place the resistance hand over the dorsum and medial side of the foot at the metatarsal heads.  The stabilizing hand is placed around the posterior ankle just above the malleoli.  Resistance is given in the direction of eversion and toward slight dorsiflexion, almost as if pulling up and around laterally.  Ask the patient to, “turn your foot down and in toward your other foot, don’t let me push it out.”

MMT for Grades 2, 1, and 0

Patient Position:

·        Same as above, except the heel of the patient should be resting on the therapist’s thigh.  Refer to starting position picture for dorsiflexion and inversion.

Therapist and Patient Instructions:

·        Palpate the tibialis posterior tendon between the navicular bone and the medial malleolus and the belly of the muscle while the patient tries to invert their foot.

 

Eversion with Plantar Flexion

Peroneus longus and Peroneus brevis

Origin:

·        Peroneus longus: head and upper 2/3 of shaft of the fibula

·        Peroneus brevis: distal 2/3 of shaft of the fibula

Insertion:

·        Peroneus longus: first metatarsal and first cuneiform

·        Peroneus brevis: fifth metatarsal

Nerve Innervation:

·        Peroneus longus: superficial fibular (peroneal)

·        Peroneus brevis: superficial fibular (peroneal)

Patient Position:

·        Sitting with the ankle in a neutral position.

Therapist and Patient Instructions:

·        Sitting on stool beside the patient’s test limb, one hand stabilizes by gripping around the ankle.  Resistance is given around the dorsum and lateral border of the foot.  Resistance is in the direction of inversion and slight dorsiflexion, or in an up and medial direction.  Ask the patient to, “turn your foot down and out, don’t let me push it in.”  

 

 

 

 

 

 

 

Alternate Test to Isolate Peroneus Tertius

 

MMT for Grades 2, 1, and 0

Patient Position:

·        Same as above.

Therapist and Patient Instructions:

·        Palpate the tendon of peroneus longus posterior to the lateral malleolus and behind peroneus brevis.  The tendon of peroneus brevis can be palpated proximal to the base of the fifth metatarsal.  The belly of these muscles can also be palpated while the patient everts and plantar flexes.

 

 

 

 

Return to Homepage

 

return to MMT scale