Dear Editorial Staff, 6/24/2006 `

Ben Benjamin’s article in Massage today magazine " Eversion of the Foot" June 2006 gave us a good description of the anatomy & physiology of the foot everters peroneus longus and brevis. The article failed, however, to show in both illustration (Figures 2 & 3 in the article) and description, effective procedures for muscle testing. Muscle testing would help determine the relative involvement of the peroneus brevis/longus vs. ankle ligaments after a sprain. If the muscle test hurts, clients may have injured the peroneus brevis and longus (Tenosynovitis or worse). Muscle testing also helps determine whether a disc or facet joint problem in the low back is pressing on the motor nerves (L4-S2) or if there is other nerve impingement of the Superficial Peroneal Nerve supplying these muscles. Although the muscle test is not diagnostic of disc involvement or peripheral nerve impingement if muscles are weak it may be a sign of problems elsewhere. Since both these muscles are associated in applied kinesiology with the Bladder, muscle testing may also help determine the functioning of this organ and its associated channel (Eastern Medicine).

All of these outcomes depend on being able to effectively complete the muscle test. To do this you need to be able to see the tendons pop out when the muscle is tested. The illustration (Figures 2 & 3) in Dr Benjamin’s article shows us a distant photograph of the medial aspect of the foot. What was needed is a close up photograph of the lateral aspect of the foot to show how the tendons articulate (pop out) when tested. This gives immediate feedback of correct muscle testing. The muscle test as depicted in the photographs and then described is also faulty. The idea of the muscle test is to isolate just the muscles being tested from other muscles. That way if the test causes pain or weakness the source is clear. The other muscles, which evert the foot, are the Peroneus Tertius (also Dorsiflexes) and the Extensor Digitorum Longus (also Extends the lateral 4 toes & dorsiflexes). To avoid testing these muscles the foot must be fully plantar flexed during the test. Reason; these muscles (Peroneus Tertius & Extensor Digitorum Longus) both dorsiflex the foot. When the foot is plantar flexed they are weaker and less effectively recruited during testing. The photograph and description in the article suggest two muscle-testing positions one with the foot plantar flexed and one with the foot dorsiflexed to better isolate the peroneus brevis. Trouble with that approach is that when the foot is dorsiflexed the peroneus tertius and extensor digitorum assist the peroneus brevis in resisted eversion. Solution; Start with the client supine. Assume we are testing the left foot. Stand facing the medial aspect of the foot. Grab the leg just above the ankle with your left hand (not the calcaneus as in Dr Benjamin’s article as this is less stable). Grab the outside of the foot with the palm of your right hand just above the 5^th metatarsal. Have the client plantar flex (Sole downward & Posterior) and evert the foot (sole facing outward (laterally)) Watch the peroneus longus/brevis tendons articulate (pop out). The tendons should be clearly visible and in a relatively straight line. Have the client relax the toes. Use your right hand to rotate the sole inward (medially). The tendons should pop out more when you do this. Muscle testing is tricky. It’s like patting your belly and rubbing your head or learning to drive a clutch car. With practice it’s easy. The rewards are smarter and more effective treatment.

Sincerely

Ted Nissen M.A. M.T.

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