Instructions:
1.
Position the patient's knee at about 45° flexion.
2.
Wrap one hand around the posterior apect of the calcaneus. ie. grab
the heel like you might pull it superiorly.
3.
Place your other hand under the foot (onto the dorsum) such that
you align your index finger part of the hand up against the head
of the talus.
4.
Although this might sound strange, then place the patient's plantar
aspect of their midfoot/forefoot against your upper thigh. Get the
patient to hold on to the end of the examination couch.
5.
The sequence of this manipulation is a little complicated, but it
basically involves two steps:
(a)
with your hands located as above, pull on the whole lower limb
until it becomes almost straight, and you are distracting the
STJ a little (superiorly-inferiorly).
(b)
then apply pressure to the plantar aspect of the foot (with your
thigh) to dorsiflex the foot an amount, whilst simultaneously
allowing the lower limb to return to a position that is more flexed.
You should feel the motion around the talus as it is mobilised.
You will need to grip the foot relatively firmly to make sure
the movement is occuring in the right area.
Repeat
the above sequence 3-4 times. It's almost a little like watching
the leg pedal in the air.
