Dorsiflexion Range Research Articles

Ankle contractures and functional motor decline in Duchenne muscular dystrophy

IntroductionThis prospective, correlational pilot study investigated the relationship between ankle plantar flexion contractures and motor function in boys with Duchenne muscular dystrophy in British Columbia (BC), Canada. ParticipantsAmbulatory boys with Duchenne muscular dystrophy were recruited from BC Children’s Hospital, which follows everyone with Duchenne muscular dystrophy in BC ≤ 18 years of age (n = 14). MethodsSpearman and Pearson correlation coefficients were estimated to examine the association between the degree of ankle dorsiflexion range of motion and North Star Ambulatory Assessment scores and the degree of ankle dorsiflexion range and six-minute walk test distances. ResultsOur analysis showed a moderate correlation between the degree of ankle dorsiflexion range and North Star Ambulatory Assessment scores [rho (14) = 0.50; p = 0.070] and a weak correlation between ankle dorsiflexion range of motion and six-minute walk test distances [rho (13) = 0.08; p = 0.747], however neither result was statistically significant. DiscussionAlthough a significant relationship between ankle dorsiflexion range of motion and motor function was not found, the variability of ankle dorsiflexion range suggests challenges with preventing ankle contracture. This reinforces the importance of assessing ankle range of motion in boys with Duchenne muscular dystrophy with sufficient frequency to identify a need for additional interventions.

Reliability of the weight-bearing ankle dorsiflexion range of motion measurement using a smartphone goniometer application.

BackgroundWeight-bearing ankle dorsiflexion range of motion measurement (weight-bearing lunge test) is gaining in popularity because it mimics lower extremity function in daily physical activities. The purpose of the study is to assess the intra-rater and the inter-rater reliability of the weight-bearing ankle dorsiflexion range of motion measurement with a flexed knee using a smartphone application Spirit Level Plus installed on an Android smartphone.MethodsThirty-two young, healthy subjects participated in the study and were measured in four sessions by two examiners. One measurement was taken on each ankle in every session. Eight measurements were taken from each participant. A total of 256 were taken from all the participants. The measurements for the individual subject were repeated no sooner than 24 hours after the first session. In order to assess the reliability, intraclass correlation coefficients (ICC), standard error measurements (SEM) and minimal detectable change (MDC) at the 95% confidence interval were calculated.ResultsStatistical data analysis revealed moderate intra-rater reliability for the right ankle (ICC = 0.72, 95% CI [0.49–0.85]) and good intra-rater reliability for the left ankle (ICC = 0.82, 95% CI [0.66–0.91]). Inter-rater reliability is moderate for the right (ICC = 0.73, 95% CI [0.52–0.86]) and the left ankle (ICC = 0.65, 95% CI [0.39–0.81]).ConclusionThe observed method is moderately reliable and appropriate when the main objective is to assess ankle dorsiflexion mobility in weight-bearing when weight-bearing is not contraindicated. The concurrent validity of the Spirit Level Plus application is excellent.

Effects of Self-Myofascial Release Using a Foam Roller on the Stiffness of the Gastrocnemius-Achilles Tendon Complex and Ankle Dorsiflexion Range of Motion.

Increased muscle stiffness can contribute to reduced range of motion (ROM) and impaired function. Reduced ankle dorsiflexion ROM has been associated with increased injury risk in the ankle. Self-myofascial release (SMR) has been widely used in clinical and sports settings, but the effects of SMR on gastrocnemius and Achilles tendon (AT) stiffness are unclear. Therefore, we investigated the effects of self-myofascial release using a foam roller (FR) on the stiffness of the gastrocnemius–AT complex and ankle dorsiflexion ROM. Fifty healthy, untrained, and non-sedentary participants (age=22.5±2.6years) were randomly divided into an intervention group (FR group) and a control group. The subjects in the intervention group received a single foam roller intervention (three sets of 1min), while the subjects in the control group performed a 5-min sedentary rest. Stiffness of the gastrocnemius–AT complex was evaluated using MyotonPRO and the ankle dorsiflexion ROM was assessed using the weight-bearing lunge test. For the foam roller and control groups, the between-group analysis revealed a statistically significant difference in gastrocnemius stiffness and ankle dorsiflexion ROM after intervention (p<0.05). Within-group analysis revealed a significant increase in ROM and a significant decrease in medial and lateral gastrocnemius (LG) stiffness for the foam roller group after the intervention (p<0.05). In addition, further analysis of the preintervention data revealed a significant negative correlation between ankle dorsiflexion ROM and AT stiffness (r=−0.378 and p=0.007). These results suggest that self-myofascial release using a foam roller on the calf is an effective method for decreasing the stiffness of the gastrocnemius and increasing ankle dorsiflexion ROM.

The Effect of Therapeutic Low-Frequency Ultrasound applied to Myofascial Trigger Points: A Pilot Pre-Post Design Study

Ultrasound at a frequency of 1 or 3 MHz is frequently used to treat various musculoskeletal conditions, but research on ultrasound operating at 38-50 kHz frequencies (US-KHz) is lacking. Study aimed to evaluate the short-term effect of US-KHz on pain pressure threshold (PPT), ankle dorsiflexion range of motion (ROM), and motor performance (the Side Hop Test) in subjects with a myofascial trigger point (TrP) in the calf muscle. US-KHz was applied to the area of the palpable TrP in the calf muscle for 10 minutes (continuous pulse, transducer head size 19.6 cm2, power 0.75-1.25 w/cm2) in twenty volunteers (18-45 years old). Significant improvements (p&lt;0.001) were noted in the Side Hop Test 24 hours after the intervention. ROM improved significantly after 5 minutes with changes maintained 24 hours later. No change was found in the PPT. This pilot study presents preliminary evidence of the efficacy of US-KHz in treating TrPs. Doi: 10.28991/SciMedJ-2021-0303-5 Full Text: PDF

Effect of Ankle Joint Mobilization with Movement on Range of Motion, Balance and Gait Function in Chronic Stroke Survivors: Systematic Review of Randomized Controlled Trials.

BackgroundAnkle joint mobilization with movement has been speculated to be an important intervention for enhancing range of motion, balance, and gait functions in chronic stroke survivors. Nonetheless, there is a scarcity of recent conclusive evidence that evaluates its efficacy in chronic stroke patients. The purpose of this review was to synthesize existing evidence on the efficacy of mobilization with movement therapy on range of motion, balance, and gait performance in subjects after stroke.MethodsA comprehensive systematic search of literature was performed using the following databases: PubMed/Medline, CINAHL, AMED, PEDro, Cochrane Library, and Scopus. Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of included trials. The primary outcome measures of this review were dorsiflexion range of motion (DF-ROM), and Berg balance scale (BBS). This review was reported in accordance with PRISMA statement guidelines. Due to variations in relevant trials, meta-analysis was not carried out.Results and ConclusionsSeven randomized controlled trials with a total of 224 subjects were analyzed. Evidence of overall quality was graded from moderate to high. This review found that mobilization with movement therapy could be an alternative rehabilitative intervention for subjects with chronic stroke to increase range of motion, balance, and gait ability. However, the evidence remains preliminary due to the small number of participants. Large-scale RCTs in the future are warranted to investigate the efficacy of mobilization with movement in subgroups of chronic stroke subjects.

Comparison Between Foam Rolling With and Without Vibration on Passive and Active Plantar Flexor Muscle Properties.

Nakamura, M, Sato, S, Kiyono, R, Yoshida, R, Yasaka, K, Yahata, K, and Konrad, A. Comparison between foam rolling with and without vibration on passive and active plantar flexor muscle properties. J Strength Cond Res XX(X): 000-000, 2021-Although foam rolling interventions with and without vibration have been used to increase flexibility in the field of sports, their effects on passive and active properties remain unclear. Hence, this study aimed to investigate the effects of foam rolling interventions on range of motion (ROM), shear elastic modulus, plantar flexor muscle strength, and jump performance. This randomized, controlled, crossover study included 16 healthy male subjects who visited the laboratory 3 times (control condition, foam rolling condition, and vibration foam rolling condition), each with an interval of >72 hours. In both foam rolling and vibration foam rolling conditions, subjects were instructed to perform 60-second bouts of intervention for 3 sets, with 30-second rest between each set. In the vibration foam rolling condition, the intensity of vibration was set at a frequency of 48 Hz. Dorsiflexion (DF) ROM, shear elastic modulus, plantar flexor muscle strength, and drop jump height were determined before and after the rolling intervention. Our results showed a similar increase in dorsiflexion range of motion (p < 0.01, d = 0.51; p < 0.01, d = 0.65, respectively) and passive torque at dorsiflexion range of motion (p = 0.02, d = 0.51 and p < 0.01, d = 0.65, respectively) after foam rolling and vibration foam rolling. Medial gastrocnemius shear elastic modulus decreased only after vibration foam rolling (p < 0.01, d = 0.44). No significant main effects of time were observed in maximal voluntary isometric contraction torque (F = 2.0, p = 0.15, = 0.119) and drop jump height (F = 1.5, p = 0.24, = 0.091) after both interventions. Maximal voluntary concentric contraction torque showed a significant main effect of time (F = 7.59, p = 0.02, = 0.336). However, only after foam rolling, the maximal voluntary concentric contraction torque significantly decreased (p = 0.01, d = 0.39). Our results suggest that vibration foam rolling effectively alters passive muscle properties without decreasing muscle strength and performance.

Effects of Dry Needling of Latent Trigger Points on Viscoelastic and Muscular Contractile Properties: Preliminary Results of a Randomized Within-Participant Clinical Trial

This study aimed to evaluate changes in neuromuscular function and pain perception in latent trigger points (TrPs) in the gastrocnemius muscle after a single session of dry needling. A randomized within-participant clinical trial was conducted. Fifty volunteers with latent TrPs in the gastrocnemius muscles were explored. Each extremity was randomly assigned to a control or experimental (dry needling) group. Viscoelastic parameters and contractile properties were analyzed by tensiomyography. Ankle dorsiflexion range of motion was assessed with the lunge test. Pressure pain thresholds (PPT) and pain perceived were also analyzed. The results observed that three viscoelastic proprieties (myotonometry) showed significant differences in favor of the experimental extremity in the lateral gastrocnemius: stiffness (p = 0.02), relaxation (p = 0.045), and creep (p = 0.03), but not in the medial gastrocnemius. No changes in tensiomyography outcomes were found. The control extremity showed a higher increase in PPTs (i.e., decrease in pressure pain sensitivity) than the experimental extremity (p = 0.03). No significant effects for range of motion or strength were observed. In general, gender did not influence the effects of dry needling over latent TrPs in the gastrocnemius muscle. In conclusion, a single session of dry needling was able to change some parameters of neuromuscular function, such as muscle tone, relaxation, pressure pain sensitivity, and creep in the lateral (but not medial) gastrocnemius but did not improve strength or range of motion.

Effects of global postural reeducation on postural control, dynamic balance, and ankle range of motion in patients with hallux abducto valgus. A randomized controlled trial.

Hallux abducto valgus (HAV) is a common musculoskeletal disorder that has been addressed surgically. Nevertheless, the manual therapy approach may play an important role in the management of this condition. The present study aimed to determine the effectiveness of global postural reeducation (GPR) in subjects with symptomatic mild to moderate HAV in static postural control, dynamic stability, and ankle dorsiflexion range of motion (DFROM). A total of 80 patients with mild to moderate symptomatic HAV were allocated to the intervention group (GPR) or control group (CG) (no treatment) for 8 weeks. Outcome measures were assessed at baseline at 4 and 8 weeks including static postural control (Romberg test), dynamic balance (Star Excursion Balance Test [SEBT]), and ankle DFROM (Weight-Bearing Lunge Test [WBLT]). No improvements were observed at 4 weeks, but there were improvements at 8 weeks in: static postural control mediolateral displacement (X) of center of pressure (CoP) in both eyes open (EO) and eyes closed (EC): XEO (t(36) = 2.892, p = .006, d = 0.67); XEC (t(68) = 2.280, p = .026, d = 054); and velocity (V) of CoP displacement: VEO (t(68) = 2.380, p = .020, d = 0.57); VEC (t(36) = 2.057, p = .047, d = 0.37). It were also improvements in: WBLT (t(36) = -2.869, p = .007, d = 0.54) and SEBT at three directions (anterior, ANT; posteromedial, PM; and posterolateral, PL): SEBT.ANT (t(36) = -2.292, p = .028, d = 0.23); SEBT.PM (t(36) = -4.075, p < .001, d = 0.43); SEBT.PL (t(62) = -3.506, p = .001, d = 0.34). The present study showed that GPR compared to the CG might be effective in enhancing ankle function including postural control, dynamic balance, and DFROM.

Application of channel-assisted minimally invasive repair system in Myerson types Ⅰand Ⅱ chronic Achilles tendon rupture

To investigate the effectiveness of channel-assisted minimally invasive repair system (CAMIR) in treatment of the Myerson types Ⅰ and Ⅱchronic Achilles tendon rupture. Between May 2016 and August 2017, 19 patients with Myerson types Ⅰ and Ⅱchronic Achilles tendon ruptures were treated with CAMIR. There were 14 males and 5 females, aged from 21 to 48 years, with an average age of 34.5 years. The disease duration was 5-9 weeks (mean, 7.5 weeks). The preoperative Thompson tests of affected ankles showed positive. There were 11 cases of Myerson type Ⅰwith the gaps of Achilles tendon defect of 1-2 cm (mean, 1.58 cm), and 8 cases of Myerson type Ⅱwith the gaps of Achilles tendon defect of 2.5-4.0 cm (mean, 3.16 cm). The ankle dorsiflexion and plantarflexion range of motion were measured before and after operation; the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was used to assess the patients' ankle joint function. No major blood vessels, nerves, and other tissue structures were damaged during the operation; 3 cases of Myerson type Ⅰ were converted to Myerson type Ⅱ according to the gaps of the defect after the scar tissue was removed during the operation. After operation, the depressed part of the Achilles tendon disappeared, the continuity of the tendon was restored, and the Thompson tests were negative. All 19 patients were followed up 12-25 months, with an average of 14 months. All incisions healed by first intention, and no infection and skin necrosis occurred; all the pre-injury activities and exercise were restored at 6 months after operation. During the follow-up period, no heel pain or re-rupture occurred. At last follow-up, except that there was no significant difference in ankle dorsiflexion range of motion of Myerson type Ⅰ patients ( t=2.118, P=0.071), the AOFAS ankle and hindfoot score, ankle plantarflexion range of motion of Myerson types Ⅰ and Ⅱ patients, and ankle dorsiflexion range of motion of Myerson type Ⅱ patients were significantly improved when compared with preoperative values ( P<0.05). According to AOFAS ankle and hindfoot function score, the ankle joint function of type Ⅰ patients was excellent in 7 cases and good in 1 case, and of type Ⅱ patients were excellent in 8 cases, good in 2 cases, and fair in 1 case. CAMIR is safe and effective in the treatment of Myerson types Ⅰ and Ⅱ chronic Achilles tendon rupture with fewer complications and better functional recovery of ankle joint.

Increased Ankle Range of Motion Reduces Knee Loads During Landing in Healthy Adults.

Decreased dorsiflexion range of motion (DROM) can be modified using static stretching and joint mobilizations and may attenuate known knee anterior cruciate ligament injury risk factors. It is not known how these interventions compare to each other and how they improve knee landing mechanics. This study's purpose was to determine the immediate effects of static stretching and joint mobilization interventions on DROM measurement changes and right-leg drop jump knee landing mechanics. Eighteen females and 7 males, all recreationally active, completed 2 study sessions. Active and passive DROM, the weight-bearing lunge test, the anterior reach portion of the Star Excursion Balance Test, and a right-leg drop jump landing task were completed before and after the intervention. Change in DROM (ΔDROM) was calculated for DROM assessments between preintervention and postintervention. Pairwise dependent t tests determined no differences in ΔDROM between interventions, and statistical parametric mapping determined increased knee flexion (P = .004) and decreased anterior shear force (P = .015) during landing after both interventions. Increased DROM improves sagittal plane displacement and loading at the knee. Stretching may be a more feasible option in a healthy population for those wanting to maintain range of motion and decrease knee injury risk without physical therapist involvement.

Serial Within-Session Improvements in Ankle Dorsiflexion During Clinical Interventions Including Mobilization-With-Movement and A Novel Manipulation Intervention - A Case Series.

BackgroundPersisting reductions in ankle dorsiflexion range of motion are commonly encountered clinically and seen to be associated with adverse outcomes after ankle and other lower extremity injuries. Accordingly improving identified deficits is a common goal for rehabilitation; however, little data exists documenting any improvement related to interventions in these patients.PurposeTo document the change in dorsiflexion range of motion after stretching and mobilization-with-movement and exercise and a novel manipulation intervention in a population of injured athletes.DesignCase series in 38 consecutive injured athletes with persisting reductions in ankle dorsiflexion range of motion (42 “stiff” ankles, 34 uninjured) in an outpatient sports physiotherapy clinic.MethodDuring a single treatment session, two baseline measurements of weight-bearing dorsiflexion were taken at the start of the session to establish reliability and minimum detectable change, and then the same measures were performed after stretching and a mobilization-with-movement intervention, and again after clinical exercise and a novel manipulation which was applied on both ankles.ResultsExcellent reliability was demonstrated (ICC2,1>0.93, MDC=3.5°) for the dorsiflexion measure. Statistically significant (p<0.01), but clinically meaningless improvements were seen after stretching and the mobilization-with-movement intervention on the injured and uninjured legs (1.9° and 1.4° respectively) with greater improvements seen after exercise and the subsequent manipulation (6.9° and 4.7°).ConclusionsThe relatively simple clinical exercise and manipulation intervention program was associated improvement in dorsiflexion range of motion in this cohort with persisting ankle stiffness. The interventions described largely restored range of motion consistent with baseline levels of the uninjured ankles. Improvements were also seen in the uninjured ankles following intervention.

Restrictions in Ankle Dorsiflexion Range of Motion Alter Landing Kinematics But Not Movement Strategy When Fatigued.

Ankle dorsiflexion range of motion (DF ROM) has been associated with a number of kinematic and kinetic variables associated with landing performance that increase injury risk. However, whether exercise-induced fatigue exacerbates compensatory strategies has not yet been established. (1) Explore differences in landing performance between individuals with restricted and normal ankle DF ROM and (2)identify the effect of fatigue on compensations in landing strategies for individuals with restricted and normal ankle DF ROM. Cross-sectional. University research laboratory. Twelve recreational athletes with restricted ankle DF ROM (restricted group) and 12 recreational athletes with normal ankle DF ROM (normal group). The participants performed 5 bilateral drop-landings, before and following a fatiguing protocol. Normalized peak vertical ground reaction force, time to peak vertical ground reaction force, and loading rate were calculated, alongside sagittal plane initial contact angles, peak angles, and joint displacement for the ankle, knee, and hip. Frontal plane projection angles were also calculated. At the baseline, the restricted group landed with significantly less knee flexion (P = .005, effect size [ES] = 1.27) at initial contact and reduced peak ankle dorsiflexion (P < .001, ES = 1.67), knee flexion (P < .001, ES = 2.18), and hip-flexion (P = .033, ES = 0.93) angles. Sagittal plane joint displacement was also significantly less for the restricted group for the ankle (P < .001, ES = 1.78), knee (P < .001, ES = 1.78), and hip (P = .028, ES = 0.96) joints. These findings suggest that individuals with restricted ankle DF ROM should adopt different landing strategies than those with normal ankle DF ROM. This is exacerbated when fatigued, although the functional consequences of fatigue on landing mechanics in individuals with ankle DF ROM restriction are unclear.

Assessing Inter-Limb Asymmetries in Soccer Players: Magnitude, Direction and Association with Performance.

In this study, we aimed to analyze the magnitude and direction of inter-limb asymmetries in ankle dorsiflexion range of motion (ROM), power (using iso-inertial devices), and a neuromuscular skill (change of direction). Secondarily, we aimed to determine the relationship between inter-limb asymmetry scores for each test and also between these scores and the scores for the different performance tests. Sixteen semiprofessional male soccer players (age: 25.38 ± 6.08 years; body height: 1.78 ± 0.64 m; body mass: 79.5 ± 14.9 kg) participated in this study. We calculated inter-limb asymmetries using five tests: ankle dorsiflexion ROM, change of direction (COD 180º), and iso-inertial resistance tasks in the open (leg extension strength (LE), leg curl strength (LC)) and closed (crossover step (CRO)) kinetic chain. Our results showed that asymmetry magnitudes differed between all tests with highest inter-limb asymmetries displayed during iso-inertial overloading. In addition, we observed that the direction of asymmetries varied depending on the test-specificity, and that the CRO asymmetries had a negative association with LE and CRO performance. These findings highlight the independent nature of asymmetries and that CRO could be an appropriate test to detect asymmetries related with the performance of soccer-specific actions (such as changes of direction). Practitioners are encouraged to use multiple tests to detect existing inter-limb differences according to the specific characteristics of each sport.

Immediate Effects of Weight-Bearing Calf Stretching on Ankle Dorsiflexion Range of Motion and Plantar Pressure During Gait in Patients with Diabetes Mellitus.

High plantar pressure is a risk factor for diabetic foot ulcers, and it is known that restriction of ankle dorsiflexion range of motion (ROM) causes high plantar pressure. Stretching is a non-invasive and general means to improve ROM; however, the effect of stretching on the ROM and plantar pressure has not been clarified in patients with diabetes mellitus. We aimed to study the effects of intermittent weight-bearing stretching on ankle dorsiflexion ROM and plantar pressure during gait in patients with diabetes mellitus. Seven patients with diabetes mellitus participated, and their triceps surae was stretched using weight-bearing stretching with a stretch board. Five minutes of stretching was performed 4 times with a rest interval of 30 s. Ankle dorsiflexion ROM was measured with the knee flexed and extended. Peak pressure and pressure-time integral during gait were measured and calculated for the rearfoot, midfoot, forefoot, and total plantar surface before and after stretching. Ankle dorsiflexion ROM with the knee extended or bent increased significantly after stretching (P < .05). Peak pressure and the pressure-time integral decreased significantly, especially in the forefoot (P < .01), and these also decreased significantly in the total plantar surface (P < .05). The duration of foot-flat decreased after stretching (P < .05). Weight-bearing stretching improved ankle dorsiflexion ROM and reduced plantar pressure during gait. These results suggest that weight-bearing calf stretching may be an effective means to prevent and treat diabetic foot ulcers.

Can we predict the landing performance of simulated aerials in surfing?

ABSTRACT This study explored which technical and physical attributes could predict superior and/or safe landing performance when surfers performed variations of a simulated aerial task. Fourteen surfers (age 20.6 ± 5.7 years, height 178.1 ± 9.50 cm, mass 70.6 ± 10.8 kg) had their lower limb mobility, squat jump, countermovement jump, and drop-and-stick landing performance assessed. Performance of two aerial variations (Frontside Air (FA) and Frontside Air Reverse (FAR)) was also measured, with variables relating to technical performance (critical feature and subjective ratings) and potential injury risk (relative total peak landing force and loading rates) collected. Multiple linear regressions were used to predict performance of both aerial variations based on a subset of independent variables. Four models could predict performance. Predicted technical capability in the FAR was mostly influenced by lead limb hip extension and lead limb knee flexion range of motion. Potential injury risk when surfers perform an FA and FAR was predicted to be mitigated by increasing lead ankle dorsiflexion range of motion, as well as trail hip extensor mobility to reduce the relative total peak force experienced when landing the FA. These simple outcome measures could be routinely assessed to ensure successful and safe aerial landings in surfing.

A novel manual therapy technique is effective for short-term increases in tibial internal rotation range of motion.

The coupled motions of tibial internal rotation (T-IR) and ankle dorsiflexion (DF) are necessary for proper lower-limb function. Anecdotally, clinicians have been performing techniques to restore T-IR to improve ankle DF, however, no evidence exists to support their efficacy. Therefore, the two objectives were to: (a) determine the effectiveness of a manual therapy technique for improving T-IR range of motion (ROM) and (b) Examine the relationship between ankle DF and T-IR ROM. Twenty-four participants qualified to participate and were randomly allocated to either the control (n=12) or manual therapy (n=12) group. Closed-chain ankle DF and T-IR ROM were assessed at baseline and immediately posttreatment. Control group participants sat quietly for 5 minutes. The experimental group performed 3 sets of 15 repetitions of a manual therapy, mobilization with movement technique. With the patient in a kneeling lunge position, the examiner wrapped an elastic band around the tibia and fibula and was instructed to lunge forward while the examiner simultaneously manually internally rotated the lower leg. T-IR ROM significantly increased following the intervention for the manual therapy group when compared to the control group. There were no significant changes in standing or kneeling DF ROM. No significant correlation was found between T-IR and both standing and kneeling DF ROM. A single mobilization with movement treatment is effective for improving tibial IR ROM in the short-term compared to no treatment. However, active tibial IR and end-range dorsiflexion range of motion do not appear to be correlated based on these methods.

Effect of Heel-First Strike Gait on Knee and Ankle Mechanics.

Background and Objectives: Acquiring knowledge about the magnitude and direction of induced joint forces during modifying gait strategies is critical for proper exercise prescription. The present study aimed to evaluate whether a heel-first strike pattern during gait can affect the biomechanical characteristics of ankle and knee joints among asymptomatic people. Materials and Methods: In this cross-sectional study performed in the biomechanics laboratory, 13 professional healthy male athletes walked on an instrumented walkway under two walking conditions. For the normal condition, subjects were instructed to walk as they normally would. For the heel-first strike condition, subjects were instructed to walk with heel-first strike pattern and increase heel contact duration as much as possible. Then, knee and ankle joint range of motions and moments, as well as vertical ground reaction force was measured by the Kistler force plate and Vicon motion analysis system. Results: Knee flexion angle at the initial contact and during stance phase was significantly lower when increasing the heel strike pattern. In addition, the mean values of the knee external rotation and adductor moments during heel strike condition were lower than those in normal walking. Further, the ankle dorsiflexion range of motion (ROM) during mid-stance increased significantly during heel-first strike pattern compared to the value in normal gait pattern. Conclusions: The modification of gait pattern including heel-first strike pattern can reduce the mechanical load applied to the knee, while improving the extensibility of gastro-soleus muscle complex.

Effects of wedge-shaped heel pad in the treatment of extremely severe burn patients with foot drop deformity

Objective: To explore the effects of wedge-shaped heel pad in the treatment of foot drop deformity in extremely severe burn patients. Methods: A retrospective cohort study method was conducted. From March 2015 to July 2016, 33 patients with foot drop deformity caused by extremely severe burn scar who met the inclusion criteria were admitted to the Department of Burn Rehabilitation of Kunshan Rehabilitation Hospital, including 18 males and 15 females, aged (38±9) years. Patients received comprehensive post-burn rehabilitation treatment after admission, and the wedge-shaped heel pad with appropriate height was placed under the patients' insole, according to the degree of the foot drop deformity in patients. Standing, squatting, and walking exercises were performed after putting on shoes with wedge-shaped heel pad. Before and immediately after the first treatment (hereinafter referred to as before and immediately after treatment), and in 1 month after treatment with wedge-shaped heel pad, the Simple Balance Scale was used to evaluate the standing balance ability of patients. In 1, 3, and 12 months after treatment, active ranges of motion (AROMs) of bilateral ankle joint dorsiflexion and knee joint flexion were measured with joint motion range measuring ruler, the shortest distance between buttocks of patients and the ground when squatting and walking distance in 1 min of patients were measured with measuring tape, and the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of activity of daily living (ADL) in patients were evaluated with modified Barthel index. Data were statistically analyzed with Friedman test, Wilcoxon rank sum test, unequal interval analysis of variance for repeated measurement, and Bonferroni correction. Results: Immediately after treatment, the standing balance ability of patients was 2.0 (1.0, 2.0) levels, which was significantly higher than 1.0 (0, 1.0) level before treatment (Z=-5.568, P<0.01); in 1 month after treatment, the standing balance ability of patients was 3.0 (2.5, 3.0) levels, which was significantly higher than that immediately after treatment (Z=-5.303, P<0.01). In 3 and 12 months after treatment, AROMs of the left and right ankle joint dorsiflexion and the left and right knee joint flexion in patients were significantly increased compared with those in 1 month after treatment (Z=-4.860, -4.836, -4.965, -4.909, -5.037, -5.025, -5.020, -4.942, P<0.01); in 12 months after treatment, AROMs of the left and right ankle joint dorsiflexion and knee joint flexion in patients were significantly increased compared with those in 3 months after treatment (Z=-5.062, -4.962, -5.017, -4.944, P<0.01). In 3 and 12 months after treatment, the shortest distances between buttocks of patients and the ground were (67±11) and (57±11) cm, which were significantly shorter than (72±11) cm in 1 month after treatment (P<0.01), respectively; in 12 months after treatment, the shortest distance between buttocks of patients and the ground was significantly shorter than that in 3 months after treatment (P<0.01). In 3 and 12 months after treatment, the walking distances within 1 min of patients were significantly longer than that in 1 month after treatment (Z=-5.043, -5.016, P<0.01); in 12 months after treatment, the walking distance within 1 min of patients was significantly longer than that in 3 months after treatment (Z=-5.025, P<0.01). In 3 and 12 months after treatment, the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of ADL in patients were significantly increased compared with those in 1 month after treatment (Z=-4.472, -4.025, -4.707, -4.565, -3.994, -4.777, P<0.01); in 12 months after treatment, the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of ADL in patients were significantly increased compared with those in 1 month after treatment (Z=-3.827, -3.358, -3.557, P<0.01). Conclusions: After using the wedge-shaped heel pad, the standing balance ability, ankle joint dorsiflexion range of motion, walking ability are significantly improved, and the independent levels of movement items in ADL are significantly increased in extremely severe burn patients with foot drop deformity.

Physiotherapy for limitation of ankle dorsiflexion - New concept of classification and improvement strategies

This article describes the intervention for improvement of the limitation of range of ankle dorsiflexion. The limitation of range of ankle dorsiflexion has close relation to an ankle motion axis displacement. And its displacement is related to a shortening of the soft tissue around ankle joint at typical parts. These parts were identified as the D-point. A normalizing of the ankle axis is an important strategy in physiotherapy for the limitation of the range of ankle dorsal flexion. A compression and a stretching to the D-point normalize an ankle motion axis displacement.

Ankle Dorsiflexion Affects Hip and Knee Biomechanics During Landing.

Restricted ankle dorsiflexion range of motion (DFROM) has been linked to lower extremity biomechanics that place an athlete at higher risk for injury. Whether reduced DFROM during dynamic movements is due to restrictions in joint motion or underutilization of available ankle DFROM motion is unclear. We hypothesized that both lesser total ankle DFROM and underutilization of available motion would lead to high-risk biomechanics (ie, greater knee abduction, reduced knee flexion). Cross-sectional study. Level 3. Nineteen active female athletes (age, 20.0 ± 1.3 years; height, 1.61 ± 0.06 m; mass, 67.0 ± 10.7 kg) participated. Maximal ankle DFROM (clinical measure of ankle DFROM [DF-CLIN]) was measured in a weightbearing position with the knee flexed. Lower extremity biomechanics were measured during a drop vertical jump with 3-dimensional motion and force plate analysis. The percent of available DFROM used during landing (DF-%USED) was calculated as the peak DFROM observed during landing divided by DF-CLIN. Univariate linear regressions were performed to identify whether DF-CLIN or DF-%USED predicted knee and hip biomechanics commonly associated with injury risk. For every 1.0° less of DF-CLIN, there was a 1.0° decrease in hip flexion excursion (r2 = 0.21, P = 0.05), 1.2° decrease in peak knee flexion angles (r2 = 0.37, P = 0.01), 0.9° decrease in knee flexion excursion (r2 = 0.40, P = 0.004), 0.002 N·m·N-1·cm-1 decrease in hip extensor work (r2 = 0.28, P = 0.02), and 0.001 N·m·N-1·cm-1 decrease in knee extensor work (r2 = 0.21, P = 0.05). For every 10% less of DF-%USED, there was a 3.2° increase in peak knee abduction angles (r2 = 0.26, P = 0.03) and 0.01 N·m·N-1·cm-1 lesser knee extensor work (r2 = 0.25, P = 0.03). Lower levels of both ankle DFROM and DF-%USED are associated with biomechanics that are considered to be associated with a higher risk of sustaining injury. While total ankle DFROM can predict some aberrant movement patterns, underutilization of available ankle DFROM can also lead to higher risk movement strategies. In addition to joint specific mobility training, clinicians should incorporate biomechanical interventions and technique feedback to promote the utilization of available motion.