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Lower Limb Biomechanical

Examination
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Patient Name:
Chief Complaint:
History of problem:
Nature of discomfort/pain
Location (anatomic)
Duration
Onset
Course
Aggravating and/or alleviating factors
Treatments and response
Left

Stance Evaluation:
Angle of gait:
Base of gait:
Foot appearance
Tibial influence
Relaxed calcaneal stance position (RCSP)
Neutral calcaneal stance position (NCSP)
Non-Weight Bearing Evaluation:
Limb length:
Hip sagittal planeKnee extended
Knee flexed
Hip transverse planeKnee extended
Knee flexed
Hip frontal plane
Knee sagittal plane
Knee recurvatum
Ankle sagittal planeKnee extended
Knee flexed
Subtalar jointInversion
Eversion

Right

Normative values:

0-2 varus or valgus


0
0
Equal
Flexion 120/extension 20-30
Flexion 45-60/extension 20-30
45 each direction
45 each direction
45 each direction
Flexion 120/extension 0-10
Absent
Dorsiflexion 10/plantarflexion 40-70
Dorsiflexion 10/plantarflexion 40-70
20
10

Subtalar joint axis location


Midtarsal joint
1st ray range of motion
1st MTPJ range of motion
Lesser MTPJ's
Other comments:
Muscle testing (extrinsics):
Invertors
Evertors
Dorsiflexors
Plantarflexors
Neurological testing:
Romberg
Patellar reflex
Achilles reflex
Babinski
Clonus
Protective sensation
Gait Evaluation Gait pattern

0
Dorsal & plantar excursion 5mm
Dorsal 65 or >unloaded/20-40 loaded

5/5:
5/5:
5/5:
5/5:

normal
normal
normal
normal

strength
strength
strength
strength

Balance intact
2+ normal
2+ normal
No hallux extension
Absent
Present

Comment on head/shoulders, spine, pelvis,


sagittal/transverse/frontal plane, postural, etc.

Footgear (size/width, wear pattern(s))


Existing orthoses/type
Weight
Height
Biomechanical assessment:
Treatment plan:
Enter resident name

Enter date of exam

Signature of resident

Signature of program director

Abducted
Apropulsive
Adducted
Ataxic
Charcot
Circumduction
Equinovarus Other (See column A )
High arch
Propulsive
Low arch
Scissor
Normal arch Shuffling
Other (See col Steppage
Rectus
Trendelenberg
Waddling

Balance intact
Balance not intact
Other (See column A )

Absent
Present

Medial
Central
Lateral

Hallux extension

Present

No Hallux extension

Absent see column A

Ankle foot orthosis (AFO)


Arizona brace
Charcot restraint walker (CROW)
Custom footwear
Extra-depth footwear
Foot orthoses (FO)
Gait assistive device
Knee ankle foot orthosis (KAFO)
Other (See column C )
Physical therapy
Surgery

Accomodative
Ankle foot orthosis (AFO)
Arizona brace
Bilaminate
Charcot restraint walker (CROW)
Functional
Leather
Other (enter in column A )
Plastizote
Trilaminate

0 Absent
1+ Diminished
2+ "Normal"
3+ Hyperactive without clonus

4+ Hyperactive with clonus

0/5: no contraction
1/5: muscle flicker, but no movement
2/5: movement possible, but not against gravity (testing in the horizontal plane)
3/5: movement possible against gravity, but not against resistance by the examiner
4/5: movement possible against some resistance by the examiner
5/5: normal strength