What should accompany fibular head HVLA to improve the likelihood of correction?

• A. Interosseous membrane soft tissue/MFR
• B. Only HVLA is necessary
• C. Long-term immobilization of the ankle
• D. Stretching the calf prior to HVLA

Answer: (A)

Addressing surrounding soft tissue, especially the interosseous membrane between the tibia and fibula, helps the fibular head move freely during HVLA. The interosseous membrane and the nearby fascia and muscles can become taut or adhered, creating a tether that resists correction. Soft tissue techniques or myofascial release targeting this area reduce fascial tension, normalize tissue texture, and lessen muscle hypertonicity, so the fibular head can reset more completely when HVLA is applied. Without this release, the correction may be incomplete or quickly recur because the restricting tissues still pull on the fibula.

Relying on HVLA alone ignores these soft tissue constraints, long-term immobilization is not a corrective strategy, and pre-stretching the calf isn’t necessary to improve the correction. The emphasis is on loosening the restrictive fascia around the interosseous membrane to enable a more effective, lasting adjustment.