This case study describes using ankle and foot joint mobilization techniques to rehabilitate a 28-year old male who suffered a talar body fracture that was surgically repaired with lag screws. The mobilization techniques targeted the talocrural, subtalar, midtarsal, and metatarsophalangeal joints to restore range of motion, address residual loss of motion from the intra-articular fracture, and improve muscle strength in the ankle and foot. Specific techniques included distraction, glides, inversion, eversion, and distraction maneuvers applied to the relevant joints.

1. Ankle/Foot Mobilization
Techniques
Case Study
Using ankle/foot joint mobilization
techniques in rehabilitation of a talar
fracture

2. Fracture of the Talar Body
• Patient is 28 year old male
• Mechanism of Injury
– Motor Vehicle -High Impact Injury
• Patient is six weeks post op.
• Cast remove one day ago.

3. Orthopedic Procedure
• Internal Fixation with lag screws across
the talar body facture to produce
anatomic reduction
• Fracture of the talar body must be stably
fixed to restore subtalar joint congruity

4. Rehabilitation Objectives
• Range of Motion • Muscle Strength
– Restore ROM to the • Tibialis posterior
ankle • Pernoneus longus &
brevis
Restore ROM to the • Tibialis anterior
subtalar joint • Extensor hallucis longus
• Restore ROM to the • Gastrocnemius
metatarsophalangel • Soleus
joints • Flexor digitorum

5. Important Consideration
Intraarticular fracture of the talar
body involving the subtalar joint
may have residual loss of range
motion.

6. Mobilization Techniques
Talocrural Subtalar Joint
Anterior glide of • Inversion of Calcaneus
Talus • Eversion of Calcaneus
Posterior glide of • Calcaneus Distraction

7. Ankle Joint
• Ankle Distraction
good start to restore
general motion at the
ankle.

8. Ankle
Anterior glide of talus
restore the component
motion for ankle
plantar flexion & STJ
supination

9. Ankle Joint
• Posterior glide of talus
• To restore component
motion for ankle dorsi
flexion & STJ
• pronation.
• Position similar to distraction
except you do posterior glide of
talus. See lab disc

10. Subtalar Joint
• Calcaneal distraction
– General technique to
restore all motion in
the STJ
.

11. Sub Talar Joint
Calcaneal inversion
subtalar joint
inversion
useful to help in
restoring push of the
foot

12. Subtalar Joint
Calcaneal eversion
subtalar joint
eversion
useful to help in storing
pronation at the foot.

13. Mobilization Techniques
• Mid- tarsal joints
– Plantar& Dorsal glides of • Metatarsophalangel
the cuboid & cuneiforms – Distraction
Dorsal & plantar glide of – Plantar glide-flexion
the navicular on talus – Dorsal glide-extension

14. Mid-tarsal Joint
• Plantar& Dorsal
glides of the cuboid
& cuneiforms
– Restore general
mobility of the mid
foot Plantar & Dorsal
glides of the cuboid
& cuneiforms

15. Mid-tarsal Joints
Dorsal & plantar glide
of the navicular on
talus.
Used to improve
ankle dorsi flexion
and general motion
at the mid foot.

16. Metatarsophalangel Joints
• Distraction of toes
restore joint play
• Good initial technique
for pain& movement.

17. Metatarsophalangel Joints
• Plantar glide of the
MTP, PIP and DIP
– To increase flexion of
the toes

18. Metatarsophalangel Joints
• Dorsal Glide of the
MTP, PIP and DIP
– Useful to increase toe
extension ( push off)
Plantar Glide of the
MTP, PIP and DIP
MTP Plantar glide
shown