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276 Chapter 7_Lower Leg, Foot, and Ankle

Extension is most likely to be restricted by the physical abutment of dorsal osteophytes. Loss of extcnsion is par-ticularly disabling because it interferes with the heel rise necessary for normal gait.

Passive motion of the interphalangeal joint of the great toe is measured in a similar manner. In this case, the examiner grasps the proximal phalanx with one hand and manipulates the distal phalanx with the other hand. Passive flexion of the interphalangeal joint of the great toe is normally about 9(T (Fig. 7-AAA). Passive extension is usually limited to neutral (0°) (Fig. 7-AAB). Limitation of motion in this joint may be the sequela of an intraar-ticular fracture. Loss of motion in the interphalangeal joint of the great toe is not as disabling as loss of motion in the metatarsophalangeal joint.

Lesser Toes

Because the lesser toes each have three phalanges, they also each havc three joints: the metatarsophalangeal joint, the proximal interphalangeal joint, and the distal interphalangeal joint. As in the case of the great toe, active motion at these joints is usually assessed simultancously by asking the patient to maximally extend (Fig. 7-45) then to maximally flex, or curl, the toes (Fig. 7-46). It is not normally possiblc for an indi-vidual to isolate movement of any one of these toes from the others.

Passive motion of each of these joints may be assessed in a manner analogous to that used in the great toe. Normal passive extension of the metatarsophalangeal joints of the lesser toes is about 40° (Fig. 7-47A). Normal passive flexion is also about 40° (Fig. 7-A7B). In the proximal interphalangeal joints, normal passive extension is neutral and normal passive flexion is 35°. In the distal interphalangeal joints, normal passive exten-sion is 30* (Fig. 7-48A), and normal passive flexion is 60° (Fig. 7-48B). These motions vary considerably among individuals. In the smaller toes, the middle phalanx is quitc short, making it difficult to distinguish distal interphalangeal joint motion from proximal interphalangeal

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