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The latest issue of Dynamic Chiropractic has this article:
Treatment of the Distal Fibular for Lateral Ankle Sprains

Read full article here.

 

When doing a single leg stance knee flexion test on myself I found I could lower so far and then hit a problem. The sensation seemed to be a block of movement which, if I tried to push through, led to a sensation of the distal Fibula pushing my foot into further pronation. (at least that was the "feel" of the foot). The result was not an increase in knee flexion but a movement of the low limb medially and becoming unstable in single leg stance. All this "push" seemed to be focused at the distal fibula area.

Twenty seconds of mobilisations of the distal fibula saw a very good improvement in the amount of single leg stance knee flexion available.

I have found it interesting to see my pts achieve increased active foot inversion and eversion ability using simple mob's on the foot and ankle.

I have also seen persistent plantar lesions reduce considerably with a couple of sessions of mob' of the hip.

This does raise some thoughts for me:

1. In light of the above, if using the lunge test to check knee flexion and / or equinus, is it more useful and accurate to assess pre and post mobilisation of the ankle complex and knee?

2. If mobilisations enable a patient to achieve greater active inversion and eversion capability should they become a fundamental part of podiatric biomechanical assessment - including hip and knee mob's?

3. If the above have significant benefit upon a pts gait should they be done before any prescription for orthoses are given?

Of course, other issues arise such as how long do the benefits last etc but, over the years, mob's have become more impportant for me in assessment and treatment

Ian

 

Its easy to increase ankle joint motion with fibula mobs (assuming there is a dysfunction present) and its also easy to change the position of STJ neutral with STJ mobilisation in some people (I have no idea which is the true neutral - ie before or after the moblisation?) ...

 

I have seen that demonstrated. Dosen't it make a mockery of the whole concept of STJ neutral?

 

In the above paper, Mulligan states an "anterior distal fibular position" relative to the tibia. Hubbard cites previous papers as having demonstrated a "posterior distal fibular position" relative to the talus. Would this not suggest that there is also a significant anterior talar position, and if so, would talar manipulation not be as significant as fibular manipulation? Furthermore, if the talus is manipulated in an anterior to posterior fashion, would this not result in a posterior and lateral shift of the fibula by default?