REIDER PART 228
288__Chaptf.r 7_Lower Leg, Foot, and Anklc
Figurę 7-59. Assessing ankle dorsiflexion strength.
The patient is asked to maintain the extended position of the toe while the examiner attempts to passively plantar flex it by pressing downward on the dorsum of the distal phalanx (Fig. 7-60). In a normal individual, the examiner should have difficulty overcoming the strength of the extensor hallucis longus. The extensor hallucis longus tendon should be quite visible on the dorsum of the foot and the toe during such resistance testing. The morę common causes of extcnsor hallucis longus weakness include lumbar radiculopathy and peroneal nerve palsy.
The extensor digitorum longus is tested in a manner similar to that used for the extensor hallucis longus. The four lesser tocs are usually tested together with the resistance provided by the fingertips or the side of the exam-iner’s hand. The examiner is able to overcome the strength of the extcnsor digitorum longus in most normal patients (Fig. 7-61). As with the extensor hallucis longus, the extensor digitorum longus tendons should be quite visible during this test. The morę common causes of extensor digitorum weakness include lumbar radiculopathy and peroneal nerve palsy.
Figurę 7-61. Assessing extensor digitorum longus strength.
Ankle Plantar Flexors and Toe Flexors To test the gastroesoleus complex, the examiner asks the patient to maximally plantar flex the ankle. The patient is instructed to maintain the position of plantar flexion while the examiner attempts to force the ankle back into dorsiflexion. The examiner stabilizes the patient’s leg with one hand while the palm of the other hand pushes upward against the plantar surface of the metatarsal heads (Fig. 7-62). In the normal patient, the examiner should be unable to overcome the strength of the patients gastroesoleus complex. The strength of this muscle group is so great that toe walking is usually a morę sensitive test because the force generated by the patients body weight is usually much greater than the resistance
Figurę 7-60. Assessing extensor hallucis longus strength.
Figurę 7-62. Assessing ankle plantar flexion strength.
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