Malleolar position:
Indicated if in-toe or out-toe gait is present to determine cause.
Technique:
• patient supine
• first place foot in its defined STJ neutral position and dorsiflex foot to resistance (assumed to be a repeatable position to mark skin due to skin movement in other positions)
• bisect both malleoli at there widest part
• palpate both femoral condyle posteriorly and place them in the same frontal plane by externally and internally rotating the hip
• use gravity goniometer attached to callipers to measure or place self distally to the foot and observe the angle between the two malleoli
• should normally be about 13 – 18 externally rotated (0 degrees in the newborn)
This is not a measure of tibial torsion, which can not be clinically measured (but is thought to be about 5-7 degrees less that malleolar torsion)
Reliability
Sources of error:
• incorrect bisections of malleoli
• femoral condyles not in the frontal plane
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