Mark, you wrote:
>With regard to the position of the foot. It is neither plantar grade or
dorsiflexed - it is what I would term as a neutral mid-stance position i.e.
at right angles with the lower leg. Passive movement allows slightly
greater dorsiflexion than plantarflexion - but only slightly. There is
severe resistance after the few degrees of movement is reached. In essence
the ankle joint feels 'locked'. If it is soft tissue contracture then it is
not demonstrating a great deal of elasticity.<
Are you certain that the limited sagittal plane motion that you can observe
clinically is actually occurring at the ankle joint, or is it possible that
the ankle might be immobile and that the sagittal plane motion you can
observe (foot to leg) might actually be occurring distally at the subtalar
and/or midtarsal joints? Any difference in ROM with the knee extended and
flexed? If you feel like the ankle is "locked", you might want to trust
your instincts and look at the ankle more closely. Perhaps an ultrasound
might help determine if there is any ankle joint motion or not. Out of
curiosity, when you move the STJ, what is the approximate frontal plane ROM
of the calcaneus (ie. roughly how much calcaneal inversion/eversion motion
can you observe)?
Respectfully,
Jeff Root
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