Thrust to tibiotalar joint supine Fix the

calcaneum with your crossed thumbs, and grip firmly around the front of the ankle. This produces a dorsiflexion component and an antero-posterior component. As you lower the foot toward the table increase the firmness of the grip. You can then amplify the hold to apply a force in an antero-posterior direction to the tibia to separate the joint.

Tips: Least useful where the operator may have any weakness in the thumbs. It is also difficult in large feet to maintain the dorsiflexion necessary and to grip around the foot at the same time. Extra considerations: The thrust is performed by the operator adducting his arms at the same moment as the grip tightens.

33.6 • Thrust to tibio-talar joint prone Stand to the side of the prone patient facing toward the foot of the table. Grip round the front of the ankle as you push forward with your crossed thumbs behind the calcaneum. Rock the patient's leg forward and back. When tension accumulates emphasize the simultaneous pull and push to gap the joint.

Tips: The thumbs can also vary the dorsiflexion to focus the technique more accurately.

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