Limited Ankle Research Articles

Altered knee and ankle kinematics during squatting in those with limited weight-bearing-lunge ankle-dorsiflexion range of motion.

Ankle-dorsiflexion (DF) range of motion (ROM) may influence movement variables that are known to affect anterior cruciate ligament loading, such as knee valgus and knee flexion. To our knowledge, researchers have not studied individuals with limited or normal ankle DF-ROM to investigate the relationship between those factors and the lower extremity movement patterns associated with anterior cruciate ligament injury. To determine, using 2 different measurement techniques, whether knee- and ankle-joint kinematics differ between participants with limited and normal ankle DF-ROM. Cross-sectional study. Sports medicine research laboratory. Forty physically active adults (20 with limited ankle DF-ROM, 20 with normal ankle DF-ROM). Ankle DF-ROM was assessed using 2 techniques: (1) nonweight-bearing ankle DF-ROM with the knee straight, and (2) weight-bearing lunge (WBL). Knee flexion, knee valgus-varus, knee internal-external rotation, and ankle DF displacements were assessed during the overhead-squat, single-legged squat, and jump-landing tasks. Separate 1-way analyses of variance were performed to determine whether differences in knee- and ankle-joint kinematics existed between the normal and limited groups for each assessment. We observed no differences between the normal and limited groups when classifying groups based on nonweight-bearing passive-ankle DF-ROM. However, individuals with greater ankle DF-ROM during the WBL displayed greater knee-flexion and ankle-DF displacement and peak knee flexion during the overhead-squat and single-legged squat tasks. In addition, those individuals also demonstrated greater knee-varus displacement during the single-legged squat. Greater ankle DF-ROM assessed during the WBL was associated with greater knee-flexion and ankle-DF displacement during both squatting tasks as well as greater knee-varus displacement during the single-legged squat. Assessment of ankle DF-ROM using the WBL provided important insight into compensatory movement patterns during squatting, whereas nonweight-bearing passive ankle DF-ROM did not. Improving ankle DF-ROM during the WBL may be an important intervention for altering high-risk movement patterns commonly associated with noncontact anterior cruciate ligament injury.

Three-dimensional analysis of foot motion after uphill walking with mobilization with movement using tape applied to the talocrural joint in women with limited ankle dorsiflexion.

Previous studies that investigated mobilization with movement (MWM) treatment assessed only improvements in passive range of motion (ROM). No information is currently available regarding the efficacy of modified MWM by application of tape. Therefore, we investigated the effect of uphill walking with modified MWM using tape applied to the talocrural joint (uphill walking with MWM taping) in women with limited ankle dorsiflexion. Twelve feet of 12 women with ankle dorsiflexion < 8 degrees were studied. Passive ROM measured using a goniometer was used to select participants. Participants walked on a level walkway under 3 conditions: before exercise, after uphill walking, and after uphill walking with MWM taping. The Oxford Foot Model using 3D motion analysis system was used to examine dynamic foot kinematics, and statistical significance was determined by 1-way repeated-measures analysis of variance. After uphill walking with MWM taping, peak hindfoot dorsiflexion relative to the tibia was significantly greater than that before exercise and after uphill walking. Furthermore, peak forefoot plantarflexion relative to the hindfoot, peak hindfoot plantarflexion relative to the tibia, and backward tilt of the tibia were greater than those before exercise. Uphill walking with MWM taping resulted in an immediate alteration in foot motion during walking, increasing hindfoot dorsiflexion in particular. Further studies are needed to investigate the long-term effects of uphill walking with MWM taping and its potential use in rehabilitation training.

Changes in Kinetic, Kinematic, and Temporal Parameters of Walking in People With Limited Ankle Dorsiflexion: Pre-Post Application of Modified Mobilization With Movement Using Talus Glide Taping

ObjectiveThe purpose of this study was to investigate the changes in passive ankle dorsiflexion range of motion (ROM), maximum plantar force, force-time integral, and time to heel off during walking between pre- and postapplication of modified mobilization with movement (MWM) using talus glide taping in people with limited ankle dorsiflexion. MethodsEighteen feet with limited ankle dorsiflexion in 13 people were examined. Participants performed 3 different walking tasks in the following order: walking before and immediately after applying the modified MWM using talus glide taping and walking after 5-minute walking with the modified MWM using talus glide taping. A floor-mat pressure measurement system (HR-mat) was used to measure maximum plantar force, force-time integral, and time to heel off; and passive ankle dorsiflexion ROM was measured using a standard goniometer. The significance of differences was assessed using repeated one-way analysis of variance. ResultsPassive ankle dorsiflexion ROM and time to heel off were significantly increased after 5-minute walking with the modified MWM using talus glide taping compared with walking before and immediately after applying the tape. Significantly increased maximum plantar force and force-time integral on the hindfoot and significantly decreased force-time integral on the forefoot during walking after 5-minute walking were observed with the modified MWM using talus glide taping compared with before applying the tape. No significant difference between before and immediately after applying the tape was observed in any variable. ConclusionsOur results suggest that walking an additional 5-minute with the modified MWM using talus glide taping increased passive ankle dorsiflexion ROM and time to heel off and improved dynamic plantar loading during walking.

Anterior ankle impingement: diagnosis and treatment.

Anterior ankle impingement is a common clinical condition characterized by chronic anterior ankle pain that is exacerbated on dorsiflexion. Additional symptoms include instability; limited ankle motion; and pain with squatting, sprinting, stair climbing, and hill climbing. Diagnosis is typically confirmed with plain radiographs. Nonsurgical management includes physical therapy, strengthening exercises, activity modification, bracing, and anti-inflammatory medication. Although arthroscopic treatment is sufficient in some patients, most require an open approach to address related pathology. We advocate aggressive range of motion as well as weight bearing postoperatively. Further study is needed to confirm current understanding of anterior ankle impingement and to better define treatment options and prevention strategies.

Limited ankle dorsiflexion increases the risk for mid-portion Achilles tendinopathy in infantry recruits: a prospective cohort study.

BackgroundAchilles tendinopathy (AT) is a prevalent condition among runners and military personnel. Although ankle dorsiflexion (DF) range of motion (ROM) as measured with the knee bent has not been previously associated with AT, the literature concerning its role is limited. In addition, the role of lower extremity movement pattern in the pathogenesis of AT has not been studied prospectively.The purpose of this study was to further explore the role of ankle DF ROM as measured with the knee bent and that of lower extremity movement pattern as risk factors for mid-portion AT.MethodsSeventy healthy male military recruits (mean ± SD age, height and body mass of 19.6 ± 1.0 years, 176.0 ± 10.0 cm, and 71.5 ± 7.4 kg) participated in this study. Ankle DF ROM as measured with the knee bent in weight-bearing (WB) and non-weight-bearing (NWB), as well as lower extremity quality of movement during a lateral step down (LSD) test were measured at baseline. Participants were then followed for a 6-month period of army basic training with recording of the development of AT.ResultsFive participants developed AT during training. Participants that developed AT had a more limited NWB ankle DF ROM (27.40 versus 21.10, p = 0.025). The quality of lower extremity movement did not differ between injured and uninjured participants (p = 0.361).ConclusionsA more limited ankle DF ROM as measured in NWB with the knee bent increases the risk of developing AT among military recruits taking part in intensive physical training.

Lower Extremity Fibro-Adipose Vascular Anomaly (FAVA): A New Case of a Newly Delineated Disorder

The acronym FAVA (Fibro-Adipose Vascular Anomaly) has been recently given to a distinct vascular entity that is characterized by fibrofatty infiltration of muscle, unusual phlebectasia with pain, and contracture of the affected extremity. We report a new case of FAVA in a 10-year-old girl with pain in her right lower leg and equinus contracture. As in our case, FAVA typically presents in young females with calf involvement and limited ankle dorsiflexion with local pain. FAVA should be considered as a differential diagnosis when evaluating vascular anomalies in the lower extremities.

The Effect of Subtalar Joint Position on Dorsiflexion of the Ankle/Rearfoot Versus Midfoot/Forefoot During Gastrocnemius Stretching

Limited ankle joint dorsiflexion passive range of motion (PROM) has been associated with common chronic lower extremity conditions, and clinicians often instruct patients in stretching exercises to increase dorsiflexion. However, little is known about how subtalar joint (STJ) position affects dorsiflexion at the midfoot/forefoot versus ankle/rearfoot during gastrocnemius stretching. The purpose of this study was to determine if more dorsiflexion occurs at the ankle/rearfoot and less at the midfoot/forefoot during gastrocnemius stretching with the STJ positioned in supination versus pronation. In this repeated measures design, 27 participants (23 females, 4 males; mean age = 31.3 years, SD = 10.7) with current or recent history of lower extremity chronic conditions and less than 10 degrees ankle dorsiflexion measured with the knee in extension on the involved side(s) performed five 30-second gastrocnemius stretching trials in pronation and supination on each side in a randomly determined sequence. A 7-camera Vicon Motion Analysis System and an AMTI force plate were used to measure midfoot/forefoot dorsiflexion, ankle/rearfoot dorsiflexion, knee extension, and normalized vertical ground reaction force. Two-way repeated measures ANOVA revealed a significant increase in midfoot/forefoot dorsiflexion when stretching in pronation compared to supination (P < .001). ANOVAs also demonstrated significantly more extension of the knee when stretching in supination compared to pronation (P < .001), and increased normalized vertical ground reaction force when stretching in supination compared to pronation (P = .032). With the numbers available, no significant difference in ankle/rearfoot dorsiflexion when stretching in supination compared to pronation could be detected (P > .05). Gastrocnemius stretching in pronation resulted in more dorsiflexion at the midfoot/forefoot than stretching in supination. Clinicians may want to consider STJ position during gastrocnemius stretching to either facilitate or limit recruitment of dorsiflexion motion at the midfoot/forefoot.

Amputation versus functional reconstruction in the management of complex hind foot injuries caused by land-mine explosions: a long-term retrospective comparison

The purpose of this study is to compare the long-term clinical outcomes of patients who were treated with either hind foot reconstruction or amputation in complex hind foot injuries accompanied with bone and soft tissue loss due to land-mine explosions. Between 1994 and 2004, all patients with hind foot complex injuries due to land-mine explosion, who were operated in our clinic, were enrolled to the study. All patients were evaluated with Short-Form 36 (SF-36), Foot and Ankle Disability Index (FADI) and Body Image Quality of Life Inventory (BIQLI) after a mean of 15.1 ± 2.2 (range 9-19) years of follow-up. Demographic characteristics, number of operations, necessity of psychiatric treatment and all complications were compared between groups. There were a total of 42 patients [21 in reconstruction group (Gr I) and 21 in amputation group (Gr II)]. The mean age at the time of final follow-up was 38.4 ± 3.04 years in Gr I and 38.2 ± 4.24 years in Gr II (p = 0.732). The mean follow-up duration was 15.7 ± 2.07 years in Gr I and 14.57 ± 2.29 years in Gr II (p = 0.081). The number of operations was significantly higher in Gr I (8.66 ± 10.2 times vs. 4.42 ± 7.7 times, respectively, p = 0.001). The mean FADI score at the final follow-up was 64.3 ± 18.1 in Gr I. In amputation group, more patients needed psychotherapy due to major depression (12 patients vs. 4 patients, p = 0.012). Major complications in Gr I were musculocutaneous flap atrophy in calcaneal region (n = 8 patients), limited ankle motion (n = 11) and painful osteophytes on plantar region (n = 6). In Gr II, stump problems were dominating (pain and tenderness n = 10, ulcer n = 2, allergic skin lesions n = 7, painful neuroma n = 10, bony spur n = 5, paresthesia n = 1, excessive sweating n = 12). At the final visit, although SF-36 scores were similar between groups (p = 0.182), extremity reconstruction group had significantly higher BIQLI scores than the amputation group (p = 0.016). If the dorsalis pedis is intact and midfoot and forefoot is relatively protected, hind foot reconstruction should be attempted. Long-term outcomes of hind foot reconstruction are satisfactory with minor complications and better BIQLI.

Immediate effect of walking with talus-stabilizing taping on ankle kinematics in subjects with limited ankle dorsiflexion

ObjectiveTo determine the effects of walking with talus-stabilizing taping (TST) on ankle dorsiflexion (DF) and heel-off time in the stance phase of gait and ankle DF passive range of motion (PROM). DesignPre- and post-intervention study. SettingUniversity motion analysis laboratory. ParticipantsTen subjects participated in this study. Sixteen ankles with limited ankle DF PROM were tested. Main outcome measuresAnkle DF PROM was measured using a goniometer, and maximum ankle DF before heel-off and time to heel-off in the stance phase of gait were measured using a 3D motion analysis system before and after walking with TST. Data were analyzed using a paired t-test. ResultsAnkle maximum DF before heel-off (p = 0.001), time to heel-off during the stance phase of gait (p = 0.005), and ankle DF PROM (p < 0.001) were significantly increased post-intervention compared with pre-intervention. ConclusionsWalking with TST is an effective self-exercise for improving ankle kinematics during gait and increasing ankle DF PROM in individuals with limited ankle DF PROM.

Human standing: does the control strategy preprogram a rigid knee?

Human standing requires control of multisegmental configuration. Does the postural system normally allow flexible adjustment of configuration, or does it minimize degrees of freedom at the ankle, knee, and hip joints? Gentle, external, unpredictable, sagittal, mechanical perturbations (randomized force, 1-10 N; duration, 0.2-2 s; and leg) were applied to either knee of 24 healthy participants who stood symmetrically for 200 s. The translation of knee perturbation force to ankle, knee, and hip joint rotations in the perturbed and unperturbed legs was studied. We assessed whether consequent joint rotations indicated a stiff configuration-conserving or viscous energy-absorbing relationship to the knee perturbation. Two distinctive response patterns were observed. Twenty-two participants showed limited knee flexion and high ankle stiffness, whereas two participants showed substantial knee flexion, low ankle stiffness, measurable internal rotation of the unperturbed hip (0.4 ± 0.3 vs. 3.0 ± 1°, 5.7 ± 17 vs. 0.5 ± 0.3 N/°, 1.1 ± 0.4°, respectively; mean ± SD), and a viscous relationship between perturbation force and subsequent ankle flexion, knee flexion, and perturbed and unperturbed hip internal rotation. The size of knee-flexion response to knee perturbations was uncorrelated with the extent of unperturbed standing sway. Normal standing conceals a large interindividual range in leg control strategies, indicating adaptive potential to progress with development and skill acquisition and decline with age, disease, injury, and fear. Commonly, leg configuration was maintained stiffly. Less commonly, a bilateral, low-stiffness, energy-absorbing strategy utilizing the available degrees of freedom was shown. We propose that identification of individual coordination strategy has diagnostic and prognostic potential in relation to perceptual-posture-movement-fall interactions.

Effects of the heel-to-toe rocker sole on walking in able-bodied persons

The most commonly prescribed external shoe modification is the use of rocker soles. The aim of this study was to evaluate the effect of a heel-to-toe rocker sole profile on specific temporal-spatial parameters and the kinematics of walking when added to footwear. Seventeen healthy adult volunteers participated in this study. For each subject, gait analysis was performed under two conditions that were tested in a random order: walking with either a baseline shoe with a flat sole or a modified shoe adapted with a heel-to-toe rocker sole. Significant differences were observed between rocker sole conditions during initial double-limb support and second double-limb support during stance phase. In frontal plane movement, significant differences were observed between the rocker sole conditions but only during second double-limb support phase. This heel-to-toe rocker sole may be useful for patients with conditions such as ankle arthrodesis or for use with ankle-foot orthoses where limited ankle motion is required.

Plantarflexor and Dorsiflexor Activation during Inclined Walking with and without Modified Mobilization with Movement Using Tape in Women with Limited Ankle Dorsiflexion

[Purpose] This study compared the EMG activities of the plantarflexor and dorsiflexor muscles during inclined walking with and without modified mobilization with movement (modified MWM) using tape in women with limited ankle dorsiflexion. [Subjects] Fifteen women with limited dorsiflexion in their feet (22 feet in total) were recruited for this study. [Methods] The subjects walked with and without modified MWM using tape on a treadmill at 6 degrees with a speed of 1.25 m/s for 5 minutes. The EMG activities of the medial gastrocnemius (GCM) and tibialis anterior (TA) muscles were measured using a surface EMG system. [Results] During incline walking with modified MWM using tape, the mean EMG activity of the GCM significantly increased, and that of the TA decreased between heel strike and heel off. There was no difference between heel off and toe off in the two muscles. [Conclusions] Modified MWM using tape on the talus during incline walking could alter the muscle activities of the GCM and TA between heel strike and heel off in women with limited ankle dorsiflexion.

Influence of Walking with Talus Taping on the Ankle Dorsiflexion Passive Range of Motion

[Purpose] This study investigated the effects of walking with talus taping on the ankle dorsiflexion passive range of motion (DF PROM) in individuals with limited ankle DF PROM. [Subjects] Fifteen ankles with limited DF PROM were examined. [Methods] After rigid strapping tape was applied to the ankles from the talus to the calcaneus, progressing posteriorly and inferiorly, the subjects walked on a walkway for 10 min. Using a goniometer, the ankle DF PROM was measured with the knee extended before and after walking with talus taping. The difference in ankle DF PROM between before and after walking with talus taping was analyzed using the paired t-test. [Results] The ankle DF PROM was significantly increased after walking with talus taping. [Conclusion] Our findings indicate that walking with talus taping is effective for increasing the ankle DF PROM in individuals with limited ankle DF PROM.

Stair ascent kinematics and kinetics with a powered lower leg system following transtibial amputation

During stair ascent (STA) persons with transtibial amputation (TTA) typically adopt a hip strategy to compensate for the limited ankle motion and joint power that is characteristic of conventional energy storing and returning (ESR) prosthetic feet. The purpose of this investigation was to determine if providing ankle power via a powered prosthetic device (BiOM) normalized STA kinematics and kinetics. Eleven individuals with TTA participated in two STA gait analysis sessions: (1) using an ESR foot, and (2) using the BiOM. Eleven height and weight matched able-bodied controls (CONT) were also assessed. Lower extremity peak kinematic and kinetic values were calculated at a self-selected and controlled cadence (80steps/min). Increased prosthetic limb peak ankle plantarflexion and push-up power were observed while using the BiOM as compared to ESR. Peak ankle power was not significantly different between BiOM and CONT indicating normalization of ankle power generation. However, peak ankle plantarflexion was significantly lower than CONT. Limb asymmetries including greater prosthetic limb hip flexion and power during stance, and decreased prosthetic limb knee power during stance were observed in the BiOM and ESR conditions. The results suggest that the BiOM successfully increased ankle motion and restored ankle power during STA. These differences did not, however, reduce the use of a hip strategy while ascending stairs. Additional device specific training may be necessary to utilize the full benefits of the device.

The Effect of Goniometric Alignment on Passive Ankle Dorsiflexion Range of Motion among Patients Following Ankle Arthrodesis or Arthroplasty

Goniometric measurement is a standard method used to quantify limited ankle dorsiflexion (DF). However, compensatory motion at the subtalar and midtarsal joints might also contribute to the amount of ankle DF obtained by goniometric measurements. The purpose of this study was to examine the effect of goniometric alignment on DF range of motion measurement among patients following ankle arthrodesis or arthroplasty and age- and gender-matched controls. A total of 22 participants were recruited to participate in this observational cohort study, including 7 patients following total ankle arthroplasty (2 male, 5 female; mean age = 67.5 years, standard deviation [SD] = 9.6 years), 4 patients following ankle arthrodesis (2 male, 2 female; mean age = 70.5 years, SD = 5.2 years), and 11 age- and gender-matched controls (4 male, 7 female; mean age 67.5 years, SD = 9.0 years). Two investigators measured and recorded ankle DF passive range of motion (PROM) using a randomly determined sequence of 2 alignment methods: (1) the distal aspect of the lateral calcaneus, and (2) the fifth metatarsal. One-sample t tests were performed to assess differences in ankle DF between the 2 different alignment methods. Significantly greater degrees of DF were obtained when aligning with the fifth metatarsal versus the lateral calcaneus on the patients' uninvolved sides and the randomly selected side of matched controls (P < .05) but not on the patients' operative side (P > .05). This study found that more degrees of DF PROM are measured when aligning a goniometer with the fifth metatarsal versus the calcaneus on the uninvolved side of patients and matched controls. Diagnostic, Level IV.

Deficits 10-Years after Achilles Tendon Repair

The purpose of this study was to determine the long-term impact of surgical repair and subsequent 6-week immobilization of an Achilles tendon rupture on muscle strength, muscle strength endurance and muscle activity. 63 patients participated in this study on average 10.8 ± 3.4 years after surgically repaired Achilles tendon rupture and short-term immobilization. Clinical function was assessed and muscle strength, strength endurance and muscle activity were measured using a dynamometer and electromyography. Ankle ROM, heel height during heel-raise tests and calf circumference were smaller on the injured than on the contralateral side. Ankle torques during the concentric dorsiflexion tasks at 60 °/sec and 180 °/sec and ankle torques during the eccentric plantarflexion task and during the concentric plantarflexion task at 60 °/sec for the injured leg were significantly lower than those for the contralateral leg. The total work during a plantarflexion exercise at 180 °/sec was 14.9% lower in the injured compared to the contralateral leg (p < 0.001). Muscle activity for the gastrocnemius muscle during dorsiflexion tasks was significantly higher in the injured than in the contralateral limb. Limited ankle joint ROM and increased muscle activity in the injured leg suggest compensatory mechanisms to account for differences in muscle morphology and physiology caused by the injury.

Exploración de la flexión dorsal del tobillo: Una revisión

The ankle joint is an important part of the musculoskeletal system necessary for normal ambulation. Reduced range of movement at this joint has been termed as gastrocnemius contracture, limited ankle dorsiflexion and ankle equinus . This condition has been related to various functional lower extremity musculoskeletal conditions. This paper explores and provides an overview of ankle equinus, its effect on the lower extremities and someof the issues involved in the clinical measurement of ankle dorsiflexion.

Fall incidence and risk factors in patients after total knee arthroplasty

To prospectively investigate the relationship between physical function and falls among elderly patients who underwent total knee arthroplasty (TKA) and to determine the incidence of falls as well as their risk factors. A total of 108 patients (17 male, 91 female) over 60 years of age who underwent TKA were enrolled and who were living independently in community. 75 patients fulfilled our inclusion criteria and 74 (8 male, 66 female) of them agreed to participate. Baseline assessment (physical examination, physical performance tests, and self-administered questionnaire) were conducted between 6 and 12 months after the last arthroplasty and the follow-up assessment was performed 6 months after the baseline assessment. Monthly pre-stamped postcards were sent to assess the incidence of falls. Of the 74 patients enrolled, 70 (94.6%) completed a 6-month prospective observation. 23 of 70 patients (32.9%) fell during the observational period. Postoperative range of knee flexion, ranges of knee flexion and extension and ankle plantar flexion were significantly lower in fallers than in non-fallers (P = 0.016, P = 0.037, P = 0.014, respectively). In the multivariate analysis, postoperative range of knee flexion (OR 0.277, 95%CI 0.088-0.869, P = 0.028) and ankle plantar flexion (OR 0.594, 95%CI 0.374-0.945, P = 0.028) were determined to be significant risk factors. Elderly people who underwent TKA are considered more likely to fall compared with healthy elderly people. For patients with limited knee flexion and ankle plantar flexion, improvement of ROM by exercise therapy and patient education regarding the prevention of falls and fractures are considered necessary.

Does limited ankle dorsi-flexion increase forefoot loading during running in military recruits?

Stress fractures are common in Royal Marine (RM) recruits during training, with the 3rd metatarsal most frequently affected (Ross and Allsopp 2002). Limited passive ankle dorsi-flexion has been ass...

Gait-Related Strategies for the Prevention of Plantar Ulcer Development in the High Risk Foot

High plantar pressures lead to ulceration in the diabetic foot, particularly in the forefoot region around the metatarsal heads. High plantar pressures persist during gait due to factors such as peripheral neuropathy, foot deformities, limited ankle dorsi flexion range of motion and reduced plantar tissue thickness. Strategies impinging upon gait such as the use of appropriate therapeutic footwear, custom-moulded insoles and injectable silicone can help to reduce plantar pressures and attenuate the risk for ulceration. Shoes adapted with external rocker profiles facilitate plantar flexion and restrict sagittal plane motion of the metatarsophalangeal joint, reducing pressures in the region of the metatarsal heads. Insoles custom-moulded to patient's feet help to reduce plantar pressures and minimise the risk of ulceration in the forefoot region. The loss of subcutaneous fat tissue in the diabetic foot enhances bony prominences and predisposes the foot to high-pressure areas. Silicone is a biocompatible material that can be safely injected into plantar soft tissue to augment tissue thickness and prevent the development of ulceration. This enhancement to the subcutaneous layer is remarkably well retained and is a generally well-adopted procedure in the clinical setting.