Sidelying
Ask the patient to wear shorts or roll up long pants and remove shoes and socks.
Medial to the foot being examined.
Please lie on your side. May I touch the inside of your ankle and the bottom of your toes? (or point to the areas). Please bend and straighten your toes (or demonstrate).
Guide or ask the patient to lie on his/her side. With the patient relaxed and with permission, place your fingers on the posterior aspect of the medial ankle, posterior to the tibialis posterior tendon. Ask the patient to flex and extend the toes. This action allows the tensing of the flexor digitorum longus muscle and tendons.
If location of the tendon is difficult, guide the patient to invert the foot to locate the tibialis posterior tendon.
The distal tendons of this muscle are palpable as they insert onto the plantar aspect of the distal phalanges of toes 2-5. The tendons are tensed as the patient attempts to flex the toes. Palpation is enhanced with stabilization of the medial and lateral sides of the distal phalanx while flexion is attempted but full flexion is prevented. Prevention of full joint motion allows room for palpation of the tendon.
If location of the tendon is difficult, guide the patient to invert the foot to locate the tibialis posterior tendon.
The distal tendons of this muscle are palpable as they insert onto the plantar aspect of the distal phalanges of toes 2-5. The tendons are tensed as the patient attempts to flex the toes. Palpation is enhanced with stabilization of the medial and lateral sides of the distal phalanx while flexion is attempted but full flexion is prevented. Prevention of full joint motion allows room for palpation of the tendon.
VH - Leg and foot skeleton with Achilles tendon, gastrocnemius and soleus muscles and tendonñ add posterior tibialis, flexor digitorum longus, flexor hallucis longus and peroneus longus and brevis muscles and tendons on one side