Conclusiones

The dorsal interossei are bipennate muscles, each with two heads. Their action occurs relative to the midline of the foot (second digit). Although the majority of the intrinsic lumbrical muscles lie on the plantar aspect of the foot, they may be indirectly palpated along with the dorsal interossei as a group between the metatarsal bones.

Origin: Metatarsal bones (1-4)

Insertion: First: Medial surface of the second proximal phalange and extensor digitorum tendons

Second to fourth: Proximal phalanges and extensor digito-rum tendons

Action: Toe abduction and metatarsophalangeal (MP) joint extension Innervation: S2-S3 (lateral plantar nerve)

Dorsal interossei

E6296/Speicher/Fig. 04.01/532003/JG/R2

Palpation Procedure

• Place the foot in a relaxed position.

• Stabilize the plantar aspect of the forefoot with one hand.

• With the other hand, apply moderate pressure between the metatarsals with the fingers.

• Palpate the entire length of the dorsal interossei along the metatarsal shaft.

• Note the location of any tender points or fas-ciculatory response along the muscle.

• Once you have determined the most dominant tender point or fasciculation (or both), maintain light pressure with the pad(s) of the finger(s) at the location throughout the PRT treatment procedure until reassessment has occurred.

PRT Clinician Procedure

• The patient is prone with the knee flexed to 90°

and the shin supported with either your thigh or a bolster.

• With the ulnar aspect of your far hand or fore-arm, apply downward compression over the forefoot, moving the ankle into dorsiflexion.

• Use the fingers of your near hand to assess and monitor the treatment position and fasciculatory response.

• Apply eversion and inversion of the forefoot with your far hand or forearm (a greater amount of inversion for the first through third meta-tarsals and eversion for the fourth and fifth metatarsals).

• Alternate: Grasp the lateral forefoot with your far hand for positioning and force application.

• Corollary tissues treated: Metatarsals

See video 4.1 for the dorsal interossei PRT procedure.

Dorsal interossei palpation procedure.

Dorsal interossei PRT clinician procedure.

Cuneiforms

Three cuneiforms comprise the midfoot. Each lies behind its respective metatarsal (the first cuneiform behind the first metatarsal, and so on), and all communicate with the navicular bone.

The first cuneiform serves as an attachment site for the tibialis anterior and tibialis posterior muscles. The cuneiforms are a common site of midfoot ligament sprains.

Palpation Procedure

• Place the foot in slight dorsiflexion to relax the extensor structures of the dorsal foot.

• Palpate the shaft of the first metatarsal up to its proximal base.

• Glide your fingers just over the joint space or valley between the first metatarsal proximal base and the first cuneiform.

• Moving medially onto the second, or middle, cuneiform, you will feel a distinct rise as you gain the ridge of the second cuneiform.

• Continue to slide your fingers laterally off the ridge of the middle cuneiform and into the next valley, where you will find the third, or lateral, cuneiform behind the third metatarsal.

• Note the location of any tender points or fasciculatory response between and over the cuneiforms.

• Once you have determined the most dominant tender point or fasciculation (or both), maintain light pressure with the pad(s) of the finger(s) at the location throughout the PRT treatment procedure until reassessment has occurred.

PRT Clinician Procedure

• The patient is prone with the knee flexed to 90°

and the shin supported with either your thigh or a bolster.

• With your far hand or forearm, apply downward compression over the midfoot, moving the ankle into dorsiflexion.

• Apply eversion and inversion of the midfoot with your far hand or forearm (greater inversion for the first and second cuneiforms, less for the third) for fine-tuning.

• Alternate: Grasp the midfoot with your far hand for positioning.

• Corollary tissues treated: Cuneiform interosse-ous ligaments and talus

Tuberosity

Navicular Calcaneus Talus

Superior Cuneiforms

E6296/Speicher/Fig. 04.02/532006/JG/R2

Cuneiform palpation procedure.

Cuneiform PRT clinician procedure.

Talus

The talus is a cube-shaped bone with a body, neck, and head configuration. The posterior portion of the talus is narrower than the front, and when the ankle is dorsiflexed, a wedge is formed within the talocrural joint. This moves the ankle into a closed-pack position, increasing the stability of the ankle and limiting inversion and eversion.

Cuneiforms Navicular

Talus

Calcaneus Medial

Sesamoid Sustentaculum tali

E6296/Speicher/Fig. 04.03/532009/JG/R1

Palpation Procedure

• Place the ankle in a relaxed open-pack position (plantar flexion).

• Place your fingers at the center of the ankle joint at the level of the malleoli between the extensor tendons. This location is over the anterior dome of the talus.

• While palpating on the bony surface of the talus, move the ankle through dorsiflexion and plantar flexion to feel the roll of the anterior dome.

• The medial and lateral heads of the talus can be palpated by sliding the fingers in either direc-tion from its anterior dome. To expose each head more fully, invert the foot to expose the lateral head and apply eversion to expose the medial head. Also, the medial head is located just proximal to the navicular tubercle.

• Note the location of any tender points or fas-ciculatory response over the talus.

• Once you have determined the most dominant tender point or fasciculation (or both), maintain light pressure with the pad(s) of the finger(s) at the location throughout the PRT treatment procedure until reassessment has occurred.

PRT Clinician Procedure

• The patient is prone with the knee flexed between 60 and 90° and the shin supported with either your thigh or a bolster.

• Grasp the calcaneus with your far hand and apply compression downward while moving the ankle into dorsiflexion.

• Apply inversion, eversion, and rotation with your far hand to fine-tune the treatment location.

• Corollary tissues treated: Extensor digitorum tendons

Talus palpation procedure.

Talus PRT clinician procedure.