Manual Muscle Testing

Abductor Hallucis

Origin: Medial process of tuberosity of calcaneus, flexor retinaculum, plantar aponeurosis and adjacent intermuscular septum
Insertion: Medial side of base of proximal phalanx of great toe. Some fibers are attached to the medial sesmoid bone
Action: Abducts and assists in flexion of the metatarsophalangeal joint of the great toe
Nerve: Tibial, L4–5 & S1
Patient: Sitting or supine
Fixation: Grasps heel firmly
Test: Abduction of great toe from axial line of foot
Pressure: Against medial side of the first metatarsal and proximal phalanx
See Test

Flexor Digitorum Brevis

Origin: Medial process of the calcaneal tuberosity, central part of plantar aponeurosis and adjacent intermuscular septa
Insertion: Middle phalanx of digits two through five
Action: Flexes the proximal interphalangeal joints and assists in flexion of the metatarsophalangeal joints of second through fifth digits
Nerve: Tibial, L4–5 & S1
Patient: Sitting or supine
Fixation: Stabilization of proximal phalanges with foot and ankle in neutral position
Test: Flexion of the proximal interphalangeal joints of the second through fifth digits
Pressure: Against the plantar surface of the middle phalanx of digits two through five in direction of extension
See Test

Flexor Hallucis Longus

Origin: Posterior surface of distal two thirds of fibula, interosseus membrane and adjacent intermuscular septa and fascia
Insertion: Base of distal phalanx of great toe on plantar surface
Action: Flexes the interphalangeal joint of the great toe and assists in flexion of the metatarsophalangeal joint, plantar flexion of the ankle and inversion of the foot
Nerve: Tibial, L5 & S1–2
Patient: Sitting or supine
Fixation: Stabilization of metatarsophalangeal joint with foot and ankle in neutral position
Test: Flexion of the interphalangeal joint of the great toe
Pressure: Against the plantar surface of the distal phalanx in direction of extension
See Test

Flexor Digitorum Longus

Origin: Middle three fifths of the posterior surface of the tibia from the fascia covering the tibialis posterior
Insertion: Bases of the distal phalanges of digits two through five
Action: Flexes the proximal and distal interphalangeal joints and metatarsophalangeal joints of second through fifth digits and assists in plantar flexion of the ankle and inversion of the foot
Nerve: Tibial, L5 & S1–2
Patient: Sitting or supine, knee flexed if gastrocnemius is tight
Fixation: Stabilization of metatarsals with foot and ankle in neutral position
Test: Flexion of the distal interphalangeal joints of the second through fifth digits the flexor digitorum is assisted by the quadratus plantae
Pressure: Against the plantar surface of the distal phalanx of digits two through five in direction of extension
See Test

Extensor Digitorum Longus

Origin: Lateral condyle of the fibula, proximal three fourths of the anterior surface of the body of the fibula, proximal part of the interosseous membrane, adjacent intermuscular septa and deep fascia
Insertion: Bbases of the middle and distal phalanges of digits two through five
Action: Extends the metatarsophalangeal joints and assists in extension of the interphalangeal joints of second through fifth digits and assists in dorsiflexion of the ankle and eversion of the foot
Nerve: Peroneal, L4–5 & S1
Patient: Sitting or supine
Fixation: Stabilization of foot in slight plantarflexion
Test: Extension of all joints of the second through fifth digits
Pressure: Sgainst the dorsal surface of the toes in direction of flexion
See Test

Extensor Digitorum Brevis

Origin: Distal portion of superiolateral portion of the calcaneus, lateral talocalcaneal ligament and apex of the inferior extensor retinaculum
Insertion: On the proximal phalanx of the great toe and the distal phalanges of toes two through four
Action: Extends the metatarsophalangeal joints and assists in extension of the interphalangeal joints of first through fourth digits and assists in extending the interphalangeal joints of toes two through four
Nerve: Deep Peroneal, L4–5 & S1
Patient: Sitting or supine
Fixation: Stabilization of foot in slight plantarflexion
Test: Extension of all joints of the second through fifth digits
Pressure: Sgainst the dorsal surface of the toes in direction of flexion
See Test

Extensor Hallucis Longus & Brevis

Origin of Longus: Middle half of anterior surface of the fibula and adjacent interosseous membrane
Origin of Brevis: Distal part of superior and lateral surfaces of the calcaneus, lateral talocalcaneal ligament and apex of the inferior extensor retinaculum
Insertion: Dorsal surface of base of proximal phalanx of great toe
Action: Extends the metatarsophalangeal joint of the great toe
Nerve: Deep Peroneal, L4–5 & S1
Patient: Sitting or supine
Fixation: Stabilization of foot in slight plantar flexion
Test: Extension of the metatarsophalangeal and interphalangeal joints of the great toe
Pressure: Against the dorsal surface of the distal and proximal phalanges in direction of flexion
See Test

Tibialis Anterior

Origin: Lateral condyle and proximal half of the lateral surface of the tibia, interosseous membrane, deep fascia & lateral intermuscular septum
Insertion: Medial and plantar surface of medial cuneiform bone, base of the first metatarsal bone
Action: Dorsiflexes the ankle joint & assists in inversion of the foot
Nerve: Deep peroneal, L4–5 & S1
Patient: Sitting or supine
Fixation: Examiner supports leg just above ankle
Test: Dorsiflexion of the ankle with inversion of the foot
Pressure: Against the medial side, dorsal surface of the foot, in direction of plantarflexion of the ankle & eversion of the foot
See Test

Tibialis Posterior

Origin: Most of the interosseous membrane, lateral portion of the posterior surface of the tibia, proximal 2/3 of the medial surface of the fibula, adjacent intermuscular septa & deep fascia
Insertion: Tuberosity of the navicular & by fiberous expansions to the sustentaculum tali, three cuneiforms, cuboid & bases of the second through fourth metatarsals
Action: Inversion of the foot & assists with plantarflexion of the ankle
Nerve: Tibial, L4–5 & S1
Patient: Sitting or supine with extremity in lateral rotation
Fixation: Examiner supports leg just above ankle
Test: Inversion of the foot with plantarflexion of the ankle
Pressure: Against the medial side & plantar surface of the foot, in direction of dorsiflexion of the ankle & eversion of the foot
See Test

Peroneus Longus

Origin: Lateral condyle of the tibia, head & proximal 2/3 of the lateral surface of the fibula, intermuscular septa & adjacent deep fascia
Insertion: Lateral side of the base of the first metatarsal
Action: Eversion of the foot, depresses the first metatarsal & assists with plantarflexion of the ankle
Nerve: Superficial peroneal, L4–5 & S1
Patient: Sitting or supine with extremity in medial rotation
Fixation: Examiner supports leg just above ankle
Test: Eversion of the foot with plantarflexion of the ankle
Pressure: Against the lateral border & plantar surface of the foot, in direction of inversion of the foot & dorsiflexion of the ankle
See Test

Peroneus Brevis

Origin: Distal 2/3 of the lateral surface of the fibula & adjacent intermuscular septa
Insertion: Lateral side of the base of the fifth metatarsal
Action: Eversion of the foot & assists with plantarflexion of the ankle
Nerve: Superficial peroneal, L4–5 & S1
Patient: Sitting or supine with extremity in medial rotation
Fixation: Examiner supports leg just above ankle
Test: Eversion of the foot with plantarflexion of the ankle
Pressure: Against the lateral border & plantar surface of the foot, in direction of inversion of the foot & dorsiflexion of the ankle
See Test

Soleus

Origin: posterior surfaces of the head of the fibula and proximal 1/3 of its body, soleal line and middle 1/3 of the medial border of the tibia & tendinous arch between the tiia and fibula
Insertion: With the tendon of the gastrocnemius (achilles tendon), into the posteior surface of the calcaneus
Action: Plantarflexion of the ankle
Nerve: Tibial, L5 & S1–2

Soleus 1

Patient: Prone with knee flexed to 90°
Fixation: Examiner supports leg just proximal to ankle
Test: Plantarflexion of the ankle
Pressure: Against the plantar surface of the foot, in direction of dorsiflexion of the ankle
See Test

Soleus 2

Patient: Prone with knee flexed to 90°
Fixation: None
Test: Plantarflexion of the ankle
Pressure: Against the plantar surface of the foot, in direction of dorsiflexion of the ankle & cupping the calcanues, providing resistance in the direction of dorsiflexion
See Test

Gastrocnemius

Origin of Medial Head: Proximal & posterior part of the medial epicondye and adjacent part of the femur, capsule of knee joint
Origin of Lateral Head: Lateral condyle and posterior surface of femur, capsule of knee joint
Insertion: Into the middle part of the posteior surface of the calcaneus
Action: Plantarflexion of the ankle
Nerve: Tibial, & S1–2

Gastrocnemius

Patient: Standing on two feet
Fixation: None
Test: Plantarflexion of the ankle bilaterally
Pressure: Body weight and gravity
See Test

Gastrocnemius 2

Patient: Standing on two feet
Fixation: None
Test: Plantarflexion of the ankle bilaterally
Pressure: Against shoulders bilaterally in the direction of dorsiflexion, body weight and gravity
See Test

Gastrocnemius 3

Patient: Single leg stance
Fixation: None
Test: Plantarflexion of the ankle
Pressure: Body weight and gravity
See Test