Lower Ankle Dorsiflexion Research Articles

Are static foot posture and ankle dorsiflexion range of motion associated with Achilles tendinopathy? A cross-sectional study

BackgroundSubtalar hyperpronation and ankle dorsiflexion restriction have been theoretically associated with Achilles tendinopathy (AT). However, evidence to support these associations is lacking. ObjectivesTo compare foot alignment and ankle dorsiflexion range of motion (ROM) between the symptomatic and non-symptomatic limbs of individuals with unilateral AT. And to verify whether differences exist between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain, structure, and symptom severity. MethodsSixty-three participants with unilateral AT underwent a bilateral evaluation of pain during tendon palpation, symptom severity, tendon thickening, tendon neovascularization, ankle dorsiflexion ROM, and foot posture alignment [foot posture index (FPI), navicular drop, navicular drift, and longitudinal arch angle (LAA)]. Side and group comparisons were made using t-tests and correlations were evaluated using the Pearson test. ResultsThere were no differences between the symptomatic and non-symptomatic limbs regarding foot posture alignment. Specifically, non-significant negligible differences were observed between limbs regarding FPI [mean difference (MD)=-0.23; 95% confidence interval (CI)=-0.70, 0.25), navicular drop (MD=0.58 mm; 95%CI=-0.25, 1.43), navicular drift (MD=0.16 mm; 95%CI=-0.77, 1.09), and LAA (MD=0.30º; 95%CI=-1.74, 2.34). There was no difference between limbs regarding ankle dorsiflexion ROM. However, lower ankle dorsiflexion was associated with worse symptom severity (r = 0.223). Finally, no difference was observed between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain or structure. ConclusionsStatic foot alignment measures do not seem to be clinically relevant in patients with AT. Smaller ankle dorsiflexion ROM, however, was associated with greater symptom severity in this population.

Pain and Achilles tendon shortening in patients with idiopathic toe walking

Idiopathic toe walking (ITW) is a heterogeneous disorder, which is associated with muscle shortening in lower limbs, pain and neurodevelopmental disorders. We try to study the frequency of clinical features in patients with ITW. Out of 100 patients evaluated with toe walking in a pediatric rehabilitation clinic, 77 (24,7% women) patients were diagnosed with ITW by means of TWT questionnaire. Achilles' tendon shortening with Silfverskiold manoeuvre, pain and attention deficit hyperactivity disorder (ADHD) were studied. In the group of patients with pain (n = 30), we studied pain evolution by means of a telephonic interview which assessed intensity, location, school absenteeism and used therapies. Out of 77 patients, 44.2% had family history of toe walking. 37.7% and 9.1% showed Achilles' tendon shortening and Knee flexor shortening, respectively. Confirmed diagnosed of ADHD was present in 9.1% and was suspected in 20.8%. The older the patient was, the higher frequency of pain and the lower passive ankle dorsiflexion. Pain has a moderate-severe intensity, was related with school absenteeism in 42.3% of the patients with pain. Pain was located mainly on the calf, the ankle and the foot. It was treated with physiotherapy, oral pain relievers, orthosis and botulinum toxin type A (BTxA). Pain in ITW is frequent, have a moderate-severe intensity, interferes in normal life and is referred in older children with lower ankle dorsiflexion. We found a common association between ITW and ADHD which points out ITW as alarm sign of learning problems.

Postural Stability in Children with High Sacral Level Spina Bifida: Deviations from a Control Group

Objective: To assess static and dynamic postural stability changes in children with high sacral level spina bifida.Methods: Thirty-five children with high sacral level spina bifida and 35 age-matched healthy controls were enrolled. Their lower extremity muscle strengths and static and dynamic postural stability parameters were measured with the use of a dynamometer and the NeuroCom Balance Master® device, respectively. Functional gait and balance were evaluated using the five times sit-to-stand test (5STS) and the 6-minute walk test (6MWT). Spinal, hip, and ankle deformities of the patient group were measured by radiologic evaluation.Results: In comparison with controls, patients were found to have lower ankle dorsiflexion and plantar-flexion strength, increased 5STS duration, and decreased 6MWT distance while both static and dynamic postural stability parameters were significantly different. Bilateral ankle muscle strengths were found to be negatively correlated with postural stability parameters. The presence of hydrocephalus or meningomyelocele in the patient group was found to have negative effects on static postural stability.Conclusion: Static and dynamic postural stability is affected even in children with high sacral level spina bifida who are expected to have best condition in this patient population. The ankle muscle strength is the main factor influencing these changes.

People with patellofemoral osteoarthritis have greater foot pronation and mobility, and lower ankle dorsiflexion, compared to controls

People with patellofemoral osteoarthritis have greater foot pronation and mobility, and lower ankle dorsiflexion, compared to controls

Acute effects of barefoot running and running requirement on lower-limb kinematics in habitually shod endurance runners

The aim of this study was to analyse kinematic variables when running barefoot and when wearing conventional running shoes at comfortable and demanding running speeds. Sixty healthy recreational male runners (age=35.6±11.7 years old, body mass index=22.9±2.4kg/m2) performed trials in shod/barefoot running conditions on a treadmill at self-selected comfortable and demanding speeds. Photogrammetric techniques (2D) were employed. In barefoot conditions, contact time was shorter (p<0.001) at demanding speed, flight time was shorter at comfortable (p<0.05) and demanding (p<0.05) speeds, and there was greater stride frequency at both speeds (p<0.001). In addition, in barefoot conditions, runners landed with significantly greater knee flexion (p<0.05); lower ankle dorsiflexion (p<0.001); and lower knee flexion in take-off at demanding speed (p=0.002) compared with shod conditions. In conclusion, the current study has provided evidence to suggest that acute changes occur in the temporal variables and kinematics between shod/barefoot conditions at low and high speeds in habitually shod runners. Significant differences were found in spatial–temporal events between shod/barefoot conditions, with shorter times in barefoot conditions with greater knee flexion and ankle dorsiflexion. When speed was increased in barefoot conditions, duration of timing variables decreased significantly both comfortable and demanding speed (p<0.001). Because of this, stride and gait cycle was significantly faster and thus there was a higher stride frequency.

Effect of age and fall status on lower-extremity muscle activation and joint torque and power in physically active women

BACKGROUND: Lower-extremity strength and neuromuscular parameters that are more affected with age and in individuals more prone to fall still needs to be identified in healthy physically active adults. OBJECTIVE: To investigate the ability of joint torque and muscle activity parameters to differentiate between physically active women, young, older non-fallers and older fallers; and their correlation with the number of falls in older women. METHODS: Measures were taken from concentric contractions during isokinetic sagittal plane movements at 90 ◦ /s and 120 ◦ /s. EMG from the rectus femoris, vastus lateralis, biceps femoris, lateral gastrocnemius and tibialis anterior were recorded. RESULTS:Overall young women were stronger, more powerful and presented lower muscle activation than older women fallers and non-fallers (all p< 0.04). Older women fallers had lower knee flexion and extension peak torque ( p< 0.033) and power ( p< 0.045), lower ankle dorsiflexion power (p = 0.04) and higher rectus femoris activation (p = 0.033) at 90 ◦ /s than older women non-fallers; and all these variables were correlated with the number of falls (r = 0.32–0.49; p< 0.05). CONCLUSIONS: These findings may be useful for a better understanding of biomechanical risk factors for falls and for exercise-based fall prevention programs development.

Lower limb electromygraphy and kinematics of neuropathic diabetic patients during real‐life activities: Stair negotiation

In this study we investigate the influence of diabetic neuropathy (DN) on lower limb electromyography (EMG) and kinematics during stair negotiation. Forty-six adults (healthy and DN) performed stair ascent and descent tasks. Kinematic and EMG data were assessed unilaterally. DN patients had lower ankle dorsiflexion while ascending and plantarflexion while descending. This reduced dorsiflexion compromises proper ankle and knee positions necessary for an efficient lifting action by the vastus lateralis (VL). The mechanical disadvantage of VL at the beginning of the stance triggered prolonged VL activation at the end of stair ascent. In stair descent, DN patients showed lower tibialis anterior activity in the early phase that can potentially impair the mechanism of impact absorption when the forefoot contacts the step. Our results reveal an adaptive motor strategy in DN patients to overcome the challenge of stair ascent, which promoted more biomechanical deficits.

Biomechanical characteristics of elderly individuals walking on land and in water

In this study, we examined Spatial–temporal gait stride parameters, lower extremity joint angles, ground reaction forces (GRF) components, and electromyographic activation patterns of 10 healthy elderly individuals (70 ± 6 years) walking in water and on land and compared them to a reference group of 10 younger adults (29 ± 6 years). They all walked at self-selected comfortable speeds both on land and while immersed in water at the Xiphoid process level. Concerning the elderly individuals, the main significant differences observed were that they presented shorter stride length, slower speed, lower GRF values, higher horizontal impulses, smaller knee range of motion, lower ankle dorsiflexion, and more knee flexion at the stride’s initial contact in water than on land. Concerning the comparison between elderly individuals and adults, elderly individuals walked significantly slower on land than adults but both groups presented the same speed walking in water. In water, elderly individuals presented significantly shorter stride length, lower stride duration, and higher stance period duration than younger adults. That is, elderly individuals’ adaptations to walking in water differ from those in the younger age group. This fact should be considered when prescribing rehabilitation or fitness programs for these populations.