Biomechanical evaluation should be included in the evaluation of any athlete with an overuse injury of the lower extremity. Note that measurements are not usually made, as clinical measurements are notoriously inaccurate.
Described below is one example of a routine for biomechanical evaluation.
Remember that there are three main biomechanical abnormalities of the lower limb
Excessive pronation
Excessive supination
Abnormal pelvic movement.
Patient in front view
Assess level of pelis at anterior superior pelvic spines. Watch for leg length descrepancy.
Assess knee orientation. Watch for valgus or varus deformity.
Assess angle of stance
Assess medial longitudinal arch
Assess limb alignment
Patient in rear view
Assess shoulder height
Assess alignment of spine
Assess level of posterior superior iliac spines
Assess angle of tibia. Watch for tibial varum (lateral bowing) as this leads to foot inversion and compensatory pronation.
Assess rear-foot position
Inspect for ankle bulging
Measure resting calcaneal stance position
Measure neutral calcaneal stance position
Measure tibial angulation
Patient in side view
Assess lumbar lordosis or kyphosis
Assess pelvic tilt: Watch for excessive anterior tilt.
Assess hyperextension of the knees
Patient Walking
Assess pelvic tilt: watch for excessive lateral tilt.
Assess foot position at heel strike
Assess foot postion at midstance
Assess foot position at toe-off
Patient Seated
Assess pelvic symmetry
Measure hip joint: Internal and external rotation
Patient Supine
Assess pelvic symmetry
Assess lower limb alignment
Assess for genu recurvatum by fully extending the knee
Assess tibial torsion, may use a goniometer on the malleoli with the knee in the frontal plane.
Assess midtarsal joint; With the subtalar joint in neutral, the foot is held just distal to the talonavicular and calcaneoucuboid joints. Assess the oblique and long axis.
Movement of hip: Assess flexion/extension/rotation
Movement of knee: Look for hamstring flexibility with hip at 90degrees and extending the knee
Movement of midtarsal joint:
Movement of first metatarsophalyngeal joint
Patient Prone
Measure quadriceps flexibility with knees fully flexed.
Measure ankle range of motion with the knee extended. (angle between the bisection of the lateral leg and fifth metatarsal). Watch for ankle equinus.
Measure ankle range of motion with knee flexed (this helps determine the soft tissue influence on ankle flexibility)
Assess forefoot/rearfoot position. With the subtalar joint in neutral and the midtarsal joint pronated, the alignment of the bisection of the calcaneous to the bisection at the leg is determined. The position of the forefoot on the rearfoot is als determined. Watch for forefoot varus and rearfoot varus.
Assess first ray range of motion. Watch for plantarflexed first ray.
Others
Note that it may be helpful to examine the athletes shoes for some indication of biomechanical abnormality.