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Dorsiflexion should be greater than 10° past neutral or “L” shape, but also it is better if it’s more than 10°. After tenotomy at least 20° is expected, while studies show that the average post tenotomy is 28°-38°.
10° is the minimum criteria for determine IF a tenotomy is necessary. Some doctors prefer to see 15°, and that’s ok as well. Dorsiflexion is an essential part of having a fully functional foot for a lifetime. All feet loose 5-10° of dorsiflexion by the age of 6, so it’s really best to have far more than 10° to start out with in life.
Checking dorsiflexion
Bend the knee at least 90°, push with one hand on the knee and then use your whole palm on the entire sole of the foot and push toes up as far as possible. You can use a book to keep the foot flat if you like. Dr Ponseti used to ask parents to use a book for this kind of photo.
If you’re sending anyone a picture to show dorsiflexion, make sure to lift your thumb or the edge of your hand so that it doesn’t wrap the foot and the plane of the sole can be easily seen in relation to the angle of the leg.
You can easily check dorsiflexion yourself. Here's how:.
Checking and Recording Dorsiflexion Alone with Video or Photo
if you are alone and have no one to snap the photo for you, try this. Prop your phone up to the side and start a video. You can take a screenshot of the most dorsiflexion you were able to get when you review the video.
Then do some tickles and distraction and use your whole palm on the entire sole, and press the toes up as far as you can, while bending the knee at least 90°.
Don’t be shy and don’t worry about being gentle, you really want to push the toes as far as you can to see the true range of flexibility.
Keep your palm flat on the sole and your other hand pushing on the knee. Raise your thumb or fingers/hand. It may take a few tries so after you are finished, look through the video and find the very best time showing how far that the foot can flex and then take a screenshot of that.
The image should look kinda like this:
Checking A Clubfoot's Dorsiflexion - This shows 25°-30°
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