The patient lies on the affected side and the operator fixes the dorsiflexed foot against his inner thigh. Hold it firmly against the table with the fixing hand and rock the calcaneum into inversion and eversion. Dysfunctional areas of the sub-talar joint are reached by varying the angles of movement.
Tips: This technique will only gap the medial aspect of the joint. Extra considerations: If the pressure on the table is uncomfortable, try interposing a pillow between foot and table.
33.15 • (bottom left) Articulation to sub-talar joint sidelying In this operator viewpoint photograph the patient is lying on the unaffected side and the operator is gripping medially on the distal part of the calcaneum. Place your thumbs just under the lateral maleolus. Maintain a firm grip and lean forward until tension is felt to build in the joint. The medial side of the joint is being stretched.
Tips: Try varying the angle of dorsiflexion to reach different surfaces of the joint.
33.16 • (see next page, top left) Thrust to subtalar joint sidelying The patient lies on the affected side with the knee flexed. Fix the foot into dorsiflexion to stabilize the ankle. Fix the calca-neum to the table, and with your other hand invert the foot by fixing on the navicula and pushing up along the long axis of the tibia. Tension should accumulate in the sub-talar joint. Rock the foot between the hands until the optimum barrier is sensed. Maintain the pressure and thrust the whole foot toward the table thereby applying a gapping force to the target joint.
Tips: If the tension is correct the foot will rock back and forth like a saucer rocking from edge to edge. According to whether the anterior or posterior of the joint is dysfunctional, the tension will be felt better with the proximal or the distal hand. Extra considerations: If this position is very painful, try working from the lateral side of the foot as in next technique illustration.
33.17 and 33.18 • Thrust to sub-talar joint side-lying The patient lies on the unaffected side. Pull the medial side of the dorsiflexed foot into inversion with your distal hand. Maintain pressure toward the table with your other hand cupping the lateral maleolus. The calcaneum is, therefore, a fulcrum. This has the effect of putting a stress on the subtalar joint on the medial aspect of the foot. Vary the degree of abduction with your distal hand until a suitable barrier is felt, and then apply a thrust with your proximal hand to gap the joint.
Tips: This may be useful when the opposite sidelying position is a problem. Note that the second photograph shows the distal hand in the final position. The wrist is now straight and the foot inverted and abducted. Firm compression is necessary if the force is not to be dissipated in the tissues generally. The sub-talar joint is extremely strong, and if the compression is not firm enough, the technique will be ineffective.
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