Side View L R
Heel lifting on stance foot
Heel lifting on placing foot
Poor control of tibia on placing foot
Poor control of tibia on stance foot
Excessive flexion of trunk
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Lower Body L R
Foot & ankle Toe - Out
complex Toe - In
Pronation
Flat Feet
High Arch
Upper Body L R
Spine Scoliosis
Scapula Deviation
Shoulder Deviation
Head Tilt
Rotation
Comments __________________________________________
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Lateral View
Tick where seen & refer to
Movement Management Plan
Lower Body L R
Ankle Dorsiflexion
Plantarflexion
Knee Flexed
Hyperextended
Pelvis Anterior translation
Y N
Is the deviation symmetrical?
Tilt: Anterior
Posterior
Upper Body Y N
Lumbar spine Lordosis
Flat
Thorac spine Kyphosis
Flat
Trunk Rotation (Symmetry)
Comments __________________________________________
Shoulders Forward
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Head position Forward
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