Richard Ogden, DO, FACOFP,FAAFP

Kansas Association of Osteopathic

Medicine

Describe the osteology of the ankle and foot.

Describe the osteopathic physiologic motions
of each bone.
Identify restricted ranges of motions, i.e.
somatic dysfunctions
y
of the ankle and foot.
Apply osteopathic principles and perform
osetopathic manipulative techniques to correct
the somatic dysfunctions

Dorsal View
Foot and Ankle

Ph l
Phalanges
Metatarsals
Medial
Cuneiform

Lateral Cuneiform

Intermediate
Cuneiform
Cuboid
Navicular
Calcaneous
Talus

Plantar View Ankle

and Foot

The true ankle is the articulation of the talus

and the distal tibia and the medial and lateral
malleoli.
Major motions of this articulation are plantar
and dorsal flexion of the foot.
With plantar flexion of the foot anterior glide of
the talus occurs.
With dorsal flexion of the foot posterior glide
of the talus occurs.

Plantar flexion of the ankle allows loose

loose
packing of the articulation due to the more
narrow posterior aspect of the talus.
This accounts for most of the combined plantar
flexed, inverted and adducted injuries of the
ankle (rolled ankle)

Conversely, the anterior aspect of the talar

articular surface is wider as compared to the
posterior aspect.
With dorsal flexion, the wider anterior surface
causes a tight pack and stabilizing force to
the ankle.

Ph l
Phalanges
Metatarsals
Medial
Cuneiform

Lateral Cuneiform

Intermediate
Cuneiform
Cuboid
Navicular
Calcaneous
Talus

Symptoms of the acute somatic dysfunction of

the talus are ankle pain; a palpable posterior or
anterior talus; limited plantar or dorsal flexion;
and tissue bogginess. (TART)

Patient in the supine position, physician

standing at the side of the table.
The p
physician
y
moves the thumb from p
proximal
to distal along the surface of the tibia.
If a ridge
g is encountered off the end of the tibia,
this represents an anterior talus or a plantar
flexed somatic dysfunction.

Patient is supine and the physician is standing

at the end of the table facing the head of the
table.
The physician contacts the dorsum of the ankle
with the thumb and slides the thumb
proximally.
If the talus has moved posteriorly, the tibia will
f l more anterior
feel
i like
lik a shelf
h lf over the
h talus.
l
This is a talus posterior somatic dysfunction or
d
dorsal
l flexion
fl i somatic
ti d
dysfunction.
f
ti

Each ankle and foot is checked and compared

to the opposite side in both dorsal flexion and
plantar flexion; inversion and eversion; and
abduction and adduction of the forefoot.

g
Treatment: Indirect ligamentous
release
The patient is in the supine position with the heel of
the foot on the table surface and the physician is facing
th table.
the
t bl
The physician places the ulnar aspect of the caudal
hand on the anterior surface of the tibia and reinforces
the hold by placing the other hand on top of the first.
A tableward force is placed against the tibia and this is
b l
balanced
d against
i t th
the ti
tissue resistance.
i t
This position is maintained until a tissue release is
palapated. The articulation is then re
re-tested.
tested.

p
p
The p
patient is in the supine
position with the heel jjust
off the end of the table and the physician is standing at
the foot of the table, facing the head of the table.
Th physician
The
h i i encircles
i l the
th foot
f t with
ith both
b th hands
h d and
d
thumbs are contacting the dorsum of the foot.
The p
physician
y
slightly
g y flexes the foot and applies
pp
a
balanced pressure through the entire foot towards the
floor with the heel still slightly off the table surface.
Thi position
This
iti iis h
held
ld until
til a release
l
iis palpated,
l t d ffeeling
li
as if the foot has moved posterior on the talus.
The talus/ankle is then re
re-assessed.
assessed.

This condition is characterized by plantar

aspect burning and calcaneal discomfort which
worsens with weight bearing.
This can occur in the presence of absence of
radiographic finding (calcaneal osteophyte)

This technique is repeated with the patient

actively dorsal flexing the toes.

p , and the p
y
g on
The p
patient is supine,
physician
is standing
the treatment side with the bent elbow in the patients
popliteal fossa.
Th physician
The
h i i grasps th
the sub-talar
b t l area with
ith th
the
tableward hand grasps and slightly plantar flexes the
forefoot with the other hand.
The physician leans backward and simultaneously
induces a balanced ligamentous force across the subtalar joint.
joint
This force is held until a softening of the tissues occurs,
as if y
your contact hand jjust slides off the heel.

This is monitored for 90

seconds with the ankle
dorsiflexed; inverted;
and internally rotated

Monitored for 90
seconds with the ankle
significanty dorsiflexed.

Monitored for 90
seconds with the foot in
inversion.

Monitored for 90
seconds with the
navicular pushed into
inversion and slight
flexion.