clasp either the calcaneum or the cuboid to apply traction and adduction with different degrees of dorsiflexion and plantarflexion. Fix the foot against your abdomen to help block movement in the rest of the foot.
Tips: Most useful in very mobile feet where it may be difficult to isolate the cuboid.
33.44 and 33.45 Thrust to cuboid supine Pull up on the fourth and fifth metatarsals with your fingertips. Apply the pad of the other thumb under the medial border of the cuboid. The thumb becomes a fulcrum over which you can plantarflex, invert and slightly adduct the foot. As tension accumulates you can amplify these components and add a compression force toward the table. The thumb forming the fulcrum should remain in as little abduction as possible to avoid straining it. Although the thumb applies a slight increase of force the thrust comes principally from the other hand. At the end of the thrust both elbows should be close to the operator's sides.
Tips: Least useful where operator thumb strength may be suspect. The technique could be modified so that the thenar or hypothenar eminences could be substituted. Extra considerations: If it proves impossible to build a suitable barrier, try lifting the whole leg off the table then bring it down sharply and, as the heel hits the table, execute the thrust. The momentum component may allow the barrier to be accessed more effectively.
33.46 • Thrust to cuboid prone Pull the foot into dorsiflexion with the distal hand and fix the other thumb toward the table on the medial border of the cuboid. Keep the arm close to the side, shrug the shoulder of the distal hand to produce an inversion of the lateral border of the foot with the heel of your hand.
Tips: Least useful where thumb strength is a problem but try substituting the thenar or hypo-thenar eminences. Extra considerations: Try cir-cumducting the operator's body and the patient's lower extremity until the optimum thrust point is sensed.
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