Ankle loose body manipulation?

How to perform manipulation for an ankle loose body?

The question is of course: where is the loose body (-bodies) or internal derangement?

•  In the ankle joint and/or the subtalar joint? 
• Which type of loose body?
  
  It is very important to find out whether the loose bodies are bony of nature or if they are cartilage fragments.
  Manipulation is only useful in case of non-bony loose bodies (check medical imaging).

Irregular twinges  on doing plantiflexion movements are a typical element in the history of the patient.

How to perform the technique

The patient holds on to the table or is stabilized by a belt. 

Therapist’s grip : for a right foot the left hand holds the calcaneus. The right hand grasps the forefoot ; a reserve of skin is given until the little finger has contact with the talus. 

The feet of the therapist lean against the couch and his toes point to the right. 

Execution : left hand on the patient’s heel, left foot against the leg of the couch, right hand on the forefoot, right foot against the couch, bend the knees, straighten the arms ; followed several deep knee flexions (e.g. three consecutive movements of sitting down and slightly coming up again).

 Make sure the foot remains on the table during the total procedure. Don’t do the manipulation when the patient’s leg is not relaxed.