What is the HVLA for a Anterior Fibular Head?
- Pt is supine with doc ipsilateral to dysf.
- Thenar eminence of most lateral hand on anterolateral fibular head
- Grasp foot with most medial hand, invert, IR, plantarflex the foot
- Closepack the knee then slightly flex; thrust rapid knee extension with downward and medial thrust THROUGH fibular head
What is the HVLA for a Posterior Fibular Head; technique 1 (supine)?
- Pt supine w/ doc contralateral to dysf.
- Index finger of thrusting hand monitors fibular head with MCP
- Opposite hand flexes hip and knee to 90° then everts, dorsiflexes and ER at the ankle
- Thrust is anterior on fibular head while rapidly flexing the knee
What is the HVLA for a Posterior Fibular Head; technique 2 (prone)?
- Pt is prone w/ knee flexed to 90° and doc contralateral to dysf.
- MCP of cephalad index finger on posterior aspect of fibular head w/ hypothenar eminence on hamstrings (creates a "wedge")
- Externally rotate tib-fib complex
- Thrust further flexion of knee
What is the HVLA for an ankle inversion and eversion?
- Pt supine w/ doc at foot of table
- One hand on calcaneus, other on dorsum of foot
- Thrust for inversion SD: caudad traction with hypereversion of the ankle
- Thrust for eversion SD: caudad traction with hyperinversion of the ankle
What is the HVLA for a plantarflexed talus?
- Pt is supine w/ doc at foot of table
- Fingrs interlace on the dorsum of the foot, thumbs on the ball of the foot
- Traction with dorsiflexion
- Thurst = tractional with increased dorsiflexion
What is the HVLA for Metatarsal Dysfunction?
- Pt is supine w/ doc ipsilateral to dysfunction
- Thumbs placed over the distal end of the metatarsal and proximal end of the first phalanx
- Thurst downward through the thumb (separates the joint)
What is the "Hiss Whip" technique for cuboid, navicular dysfunctions?
- Pt prone with hip and knee of affected leg at edge of table, doc at the foot of table
- Both thumbs over plantar surface of affected structure with fingers on dorsum of foot
- Slightly abduct patients LE off the table and flex the knee
- Thrust downward through thumbs with a "whip-like" motion ankle and knee
What is the HVLA for a transtarsal dysfunction (both plantar cuboid and plantar navicular SD)?
- Pt supine with knee flexed, abducted, and ER. Doc ipsilateral to dysf
- Cephalad thenar eminence over calcaneus and caudad hand over 1st metatarsal and talus
- Thrust: rotational with caudad hand and simultaneosuly downward THROUGH the calcaneus
- For plantar cuboid SD ---> Invert forefoot
- For plantar navicular SD ---> Evert forefoot
What is the BLT for a Posterior Fibular Head?
- Pt supine with doc ipsilateral to dysf.
- Thumb of cephalad hand on the superolateral aspect of the fibular head
- Caudad hand inferior to the distal fibula
- Thumb on fibular head applies pressure straight towards the foot while caudad hand inverts the foot to point of BLT
What is the BLT for Femorotibial (knee) dysf (cruciate ligaments)?
- Pt supine w/ doc ipsilateral to dysf.
- Cephalad palm over anterior femur w/ caudad palm over tibial tuberosity
- Lean onto the pt's leg w/ posterior force and approximate femur and tibia with a compressive force
- Induce internal or external rotation to obtain BLT
What is the "Boot-Jack" technique?
- Pt supine w/ knee under physicians axilla. Doc ipsilateral to dysf.
- Medial hand holds calcaneus w/ thumb and index finger
- Fingers of lateral hand wrap around the medial foot
- Elbow on medial aspect of knee creates a fulcrum with proximal pressure
- Doc leans back inducing further flexion of hip and knee while distracting the calcaneus from the talus
- Induce slight plantar flexion to obtain BLT
What is the Cuneiform and Metatarsal BLT?
- Pt supine w/ doc at foot of table
- Thumbs on dorsum of distal metatarsal and fingers on plantar aspect of foot
- Press thumbs down toward the metatarsals until reaching BLT