anterior fibular head somatic dysfunction
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Anterior Fibular Head Somatic Dysfunction: Diagnostics and Questions

If you are anything like me, you were kind of lost that first day in OMM lab, especially when they started discussing things like anterior fibular head somatic dysfunctions??!!

OMM was one of those things I was super nervous about, well that and the USMLE and COMLEX, but OMM was so difficult to study.

What do you need to know, what was important? What is clinically relevant?

These are all questions I had, and ones that I eventually was able to answer on my way to a 4.0 GPA and >97th percentile board scores.

These questions are why comprepmed.com was created, and especially why this OMM tips series of articles exists. To help you answer those questions and destroy Osteopathic Medical School, and get the highest scores possible!

Introduction

Somatic dysfunctions are the reason OMM exists. One of the most common somatic dysfunctions you will see in the clinical world, as well as on those lovely exams you have to take to become a DO, is the anterior fibular head.

This is not a very intuitive diagnosis to make. We don’t always think of the fibula as having motion, and even more important is we don’t think that it can cause such pain and problems when it is dysfunctional.

This article will cover how to diagnose, treat, and ultimately get questions on tests right that have to do with anterior fibular head somatic dysfunctions.

Lets get to it.

Keys to diagnosing an Anterior Fibular Head Somatic Dysfunction

The first part to diagnosing an anterior fibular head is to understand the motion that the fibular head goes through with foot movement.

  • As you dorsiflex and pronate the foot, the fibular head moves anterior.
  • As you plantarflex and supinate the foot the fibular head moves posterior.

Knowing that, then you can say, if a patient has an anterior fibular head somatic dysfunction then their fibular head is stuck anterior, which means they are going to be restricted in supination and plantar flexion of the foot.

Now, that you know those basics, lets get to treatment positions.

To treat the fibular head, you move the foot into the barrier, or the opposite direction of the diagnosis.

So, if someone has an anterior fibular head, then you move the foot towards the barrier (or the direction that takes the fibular head more posterior).

If the fibular head is anterior, then you move the foot into supination and plantarflexion in order to move the fibular head more posterior.

Why this is tough

Alright, so a lot of people struggle with the fibular head and its dysfunctions or mechanics.

Besides cranial, this is one of the toughest topics in OMM for most students.

  • Combining the motion of the foot, ankle, and distal fibula and comparing it to the fibular head can be confusing.
  • Test writers know this, and so they go after this a lot, so it becomes important to know it so you can score well on this material.

This is one of the biggest reasons I made CPM OMM, to help you own topics like this one that are notoriously difficult.

How Anterior fibular heads present in questions

This is the real reason you ssearched this term on google right?

You want to get more questions right.

Lets go through a sample question now.

A 45 year old triathelete comes to your clinic with complaints of right knee pain. She was previously in a walking boot for a fracture of her metatatrsals from frequent running. She just came out of the boot, and is not complaining of pain in the knee on the same leg her boot was on.

You decide to do an osteopathic structural exam and find the following:

Her right foot resists going into supination, but gos into pronation easily.

You note that the right fibular head also resists going posterior and seems to have a hard end feel when you try and press it posterior.

What is the diagnosis?

  1. Posterior fibular head
  2. Tibial torsion
  3. Anterior fibular head
  4. Anterior distal fibula

The correct answer is c: Anterior fibular head

The key points that help you make that decision are:

  • The fibular head resists posterior motion. If it is stuck anterior, then it won’t move posterior very easily or at all.
  • Also, the fact that the foot goes into pronation much easier than supination also tells you that it is anterior because to move the fibular head anterior you pronate the foot.

This is complicated, go back through it a few times.



Summary points

When it comes to diagnosing and anterior fibular head you need to know:

What direction the foot wants to go

If there is resistance to motion in the anterior fibular head

If you know those basic points then you are well on your way to understanding the fibular head mechanics/somatic dysfunctions and you will definitely get more points on test day.

Conclusion

This article is designed to help you get more points on test day, just like this entire website and all the products.

Diagnosing the fibular head is tough, follow the outline above and you will be good.

Thanks for reading,

I hope it was helpful

Sean Kiesel, DO, MBA

Related FAQ’s

What is fibular head motion?

This is the movement that is inherent in the fibular head. The head of the fibula is located about 1 inch inferior to the lateral knee.

The fibular has minor movement that helps with ankle movement and overall gait function.

The fibular head can move anterior or it can move posterior, there is little to no medial/lateral movement of the fibular head.

How do you do Posterior Fibular Head HVLA?

To perform posterior fibular head HVLA you will completely flex the knee. Place your hand behind the fibular head, turn the foot out and into dorsiflexion, then you will engage the barrier and like any other HVLA, perform low amplitude high velocity thrust through the fibular head barrier.

How do you do muscle energy to a posterior Fibular Head?

The patient can be seated for this. You turn the foot as far as it will go into pronation and dorsiflexion, resist the patient movement into plantar flexion and supination, as you apply anterior force on the posterior fibular head.

This is a topic that I go over in great depth in CPM OMM.

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