Measuring Ankle Dorsiflexion Research Articles

Acute Effects of Gastrocnemius/Soleus Self-Myofascial Release Versus Dynamic Stretching on Closed-Chain Dorsiflexion.

Limited ankle dorsiflexion (DF) range of motion has been correlated with decreased flexibility of the gastrocnemius/soleus complex. Decreased ankle DF range of motion can lead to an increase in lower-extremity injuries, for example, acute ankle sprains, Achilles tendinopathy. The purpose of this study was to determine whether a single application of the intervention to the gastrocnemius/soleus complex via multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques acutely improved ankle DF. Subjects were assigned to groups via random card selection. Investigators provided verbal cues as needed to yield correct performance of interventions. Both interventions were performed twice for 1 minute using a dynamic walking rest of 30.48 m at a self-selected pace between interventions. Statistical analyses were completed using a 1-way analysis of variance, at α level ≤ .05. A convenience sample study. A total of 42 asymptomatic physical therapy students (18 females and 24 males) with mean age of 26.12 (4.03) years volunteered to participate. Multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques. Weight-bearing right ankle DF measurements were recorded in centimeters using a forward lunge technique (intraclass correlation coefficient = .98, .97, and .96). Data analysis revealed no significant difference between the 3 groups in all pre-post measurements (P = .82). Mean (SD) measurements from pretest to posttest for myofascial release, dynamic stretching, and combination interventions were 0.479 (0.7)cm, 0.700 (0.7)cm, and 0.907 (1.4)cm, respectively. Until further studies are conducted, the selection of technique to increase ankle DF range of motion should be based on each individual patient's ability, preference, and response to treatment.

The Reliability of a Smartphone Goniometer Application Compared With a Traditional Goniometer for Measuring Ankle Joint Range of Motion.

Evaluation of range of motion (ROM) is integral to assessment of the musculoskeletal system, is required in health fitness and pathologic conditions, and is used as an objective outcome measure. Several methods are described to check ROM, each with advantages and disadvantages. Hence, this study introduces a new device using a smartphone goniometer to measure ankle joint ROM. To test the reliability of smartphone goniometry in the ankle joint by comparing it with the universal goniometer (UG) and to assess interrater and intrarater reliability for the smartphone goniometer record (SGR) application. Fifty-eight healthy volunteers (29 men and 29 women aged 18-30 years) underwent SGR and UG measurement of ankle joint dorsiflexion and plantarflexion. Two examiners measured ankle joint ROM. Descriptive statistics were calculated for descriptive and anthropometric variables, as were intraclass correlation coefficients (ICCs). There were 58 usable data sets. For measuring ankle dorsiflexion ROM, both instruments showed excellent interrater reliability: UG (ICC = 0.87) and SGR (ICC = 0.89). Intrarater reliability was excellent in both instruments in ankle dorsiflexion: UG and SGR (mean ICC = 0.91). For measuring ankle plantarflexion, both instruments showed excellent interrater reliability: UG (ICC = 0.76) and SGR (ICC = 0.82). Intrarater reliability was excellent in both instruments in ankle plantarflexion: UG (mean ICC = 0.85) and SGR (mean ICC = 0.82). Smartphone-based goniometers can be used to assess active ROM of the ankle joint because they can achieve a high degree of intrarater and interrater reliability.

The iPhone Measure app level function as a measuring device for the weight bearing lunge test in adults: a reliability study

BackgroundAnkle joint range of motion is a frequently assessed measure used by health care clinicians who manage lower limb pathologies to identify ankle equinus and/or other joint motion concerns that may negatively impact on function. The purpose of this study was to assess a new iPhone application (the level function of the ‘Measure application’), for measuring the weightbearing ankle lunge test in a healthy adult population (reliability) and measuring known angles (validity) when compared to a digital inclinometer.MethodsTo determine intra-rater reliability, inter-rater reliability and concurrent validity, 168 measures were conducted on 21 participants. Participants were preconditioned prior to assessment, and two experienced raters measured ankle dorsiflexion range of motion in the knee extended and knee flexed positions of the weight bearing lunge test, using an iPhone level function (of the Measure application) and a digital inclinometer in a randomised order, over two timepoints. Concurrent validity was also determined by comparison of measures of the two devices at known surface angles (0 and 15 degrees) in multiple planes. Reliability and validity were determined with intraclass correlation coefficients, concurrent validity was explored with the Bland Altman plot and an intraclass correlation coefficient. The Standard Error of the Mean and the minimal detectable change were also explored.ResultsThe intra-rater reliability using the iPhone and inter-rater reliability using the digital inclinometer, in the knee extended position, were ICC 0.85 respectively, indicating good reliability. All other intra-rater reliability and inter-rater reliability for both devices and both leg positions were over ICC 0.90, indicating excellent reliability. Concurrent validity between the two devices on a flat and known angle surface were ICC 1.0 (Limits of Agreement − 1.0 to 0.61), indicating excellent validity, with good validity demonstrated by a Bland Altman plot of all measures in all positions (ICC of 0.84 (Limits of agreement = − 4.51 to 6.49)).ConclusionThe use of the iPhone level measure, within the Measurement App has demonstrated to be an easy and reliable measurement tool to determine ankle joint dorsiflexion during the weightbearing lunge test in healthy adults.

Effects of timing parameter changes on the gait of functional electrical stimulation users with drop foot.

IntroductionFunctional electrical stimulation uses clinician-set parameters to modify stimulation. This study aimed to investigate whether timing parameters in the ODFS Pace functional electrical stimulation device have an effect on the gait of the general population of functional electrical stimulation users who have a foot drop.MethodsTwelve functional electrical stimulation users with foot drop resulting from upper motor neurone disorders were recruited from the functional electrical stimulation Service in Leeds, UK. A crossover trial design was used, comparing adjusted values of rising ramp, delay and extension. Instrumented gait analysis was carried out to measure ankle dorsiflexion during the swing phase of gait, foot clearance from the ground, and speed of ankle plantarflexion at initial contact. The effect of timing parameters on gait kinematics was studied.ResultsNo statistically significant effects on the measured parts of gait were found for any of the timing parameters. Trends were identified in average mid-swing ground clearance and dorsiflexion associated with the delay and rising ramp timing parameters.ConclusionsFurther work in this area should use larger numbers of participants. Based on these results, the effects of ramping and delay would be of particular interest for further study.

Concurrent validity and reliability of an iPhone app for the measurement of ankle dorsiflexion and inter-limb asymmetries

ABSTRACTThe purpose of this investigation was to analyze the validity and reliability of an iPhone app (named: Dorsiflex) for the measurement of weight-bearing ankle dorsiflexion. To do this, twelve healthy participants (age=28.6±2.3 years) performed a weight-bearing lunge test with each leg in five separate occasions, while dorsiflexion angle was simultaneously registered using a professional digital inclinometer and the Dorsiflex iPhone app, which was specifically developed for this study. A total of 120 angles measured both with the digital inclinometer and the app were then compared for validity, reliability and accuracy purposes using several statistical tests. There was an almost perfect correlation between the digital inclinometer and the Dorsiflex app for the measurement of ankle dorsiflexion (r=0.989, 95% CI=0.986-0.993, SEE=0.48º), with trivial, non-significant differences between devices (SMD=0.17, p=0.10). When analyzing the reliability of the app for the measurement of five different trials for each participant, similar coefficients of variation (CV) were observed in comparison with those obtained with the digital inclinometer (Dorsiflex app: CV=5.1±2.3 %; Digital inclinometer: CV=4.9±2.5 %). The results of the present study show that weight-bearing ankle dorsiflexion can be easily, accurately, and reliably evaluated using the Dorsiflex iPhone app.

Weight bearing versus non-weight bearing ankle dorsiflexion measurement in people with diabetes: a cross sectional study

BackgroundAccurate measurement of ankle dorsiflexion is important in both research and clinical practice as restricted motion has been associated with many foot pathologies and increased risk of ulcer in people with diabetes. This study aimed to determine the level of association between non-weight bearing versus weight bearing ankle dorsiflexion in adults with and without diabetes, and to evaluate the reliability of the measurement tools.MethodsOne hundred and thirty-six adults with diabetes and 30 adults without diabetes underwent ankle dorsiflexion measurement non-weight bearing, using a modified Lidcombe template, and weight bearing, using a Lunge test. Pearson product-moment correlation coefficients, intraclass correlation coefficients (ICCs) with 95% confidence intervals, standard error of measurement and minimal detectable change were determined.ResultsThere was a moderate correlation (r = 0.62–0.67) between weight and non-weight bearing tests in the non-diabetes group, and a negligible correlation in the diabetes group(r = 0.004–0.007). Intratester reliability was excellent in both groups for the modified Lidcombe template (ICC = 0.89–0.94) and a Lunge test (ICC = 0.83–0.89). Intertester reliability was also excellent in both groups for the Lidcombe template (ICC = 0.91) and a Lunge test (ICC = 0.88–0.93).ConclusionsWe found the modified Lidcombe template and a Lunge test to be reliable tests to measure non-weight bearing and weight bearing ankle dorsiflexion in adults with and without diabetes. While both methods are reliable, further definition of weight bearing ankle dorsiflexion normative ranges may be more relevant for clinical practice.

A novel iPhone App for measuring ankle dorsiflexion range of motion

A novel iPhone App for measuring ankle dorsiflexion range of motion

Validation of a New Device for Measuring Isolated Gastrocnemius Contracture and Evaluation of the Reliability of the Silfverskiöld Test.

Important aspects on the diagnostics of isolated gastrocnemius contractures (IGCs) have been poorly described. This study was designed to validate a new ankle range of motion (ROM) measuring device for diagnosing an IGC. In addition, we wanted to investigate the reliability of the clinical Silfverskiöld test. Twelve health care personnel (24 feet) were examined by 4 testers on 3 different occasions for the reliability testing of the new ankle ROM measuring device. The same participants were examined using the Silfverskiöld test to examine the reliability of the clinical test. Eleven patients (15 feet) with IGC were examined before gastrocnemius recession, immediately after surgery, and 3 months after surgery to examine the validity and responsiveness of the ankle ROM device. An intraclass correlation coefficient (ICC) >0.85 was found for both inter- and intrarater reliability for the new ankle ROM device. The device confirmed an IGC in 13 of 15 feet before surgery and 3 of 13 feet at 3-month follow-up. At baseline, the measured ankle dorsiflexion was median 3 degrees with the knee in extension, which increased to 10 degrees ( P < .001) immediately after surgery and 12 degrees ( P = .003) at 3-month follow-up. ICC values of 0.230 to 0.791 were observed for the inter- and intrarater reliability testing of the clinical Silfverskiöld test. The new ankle ROM measuring device was reliable and responsive for detecting IGC. The Silfverskiöld test had poor inter- and intrarater reliability. Level of evidence Level II, prospective cohort study.

A randomised cross over study to evaluate the performance of a novel ankle dorsiflexion measurement device for novice users

BackgroundThe ankle joint is a common site of musculoskeletal pathology. Measurement of its functional range of motion is a primary indicator for rehabilitation outcomes in therapy settings. The present study was designed to assess reliability and validity of a new standardised method using a D-Flex device to assess ankle range of motion.MethodsA cohort of 20 healthy volunteers were recruited to measure the weight-bearing ankle range of motion using three assessment tools, namely, a goniometer, inclinometer and the D-Flex measurement devices. Repeated measures were performed both between and within observers for each device over a 48 h period. Performance evaluation of each device and their reliability was assessed using intra-class correlation coefficients and Bland and Altman plots.ResultsAlthough significant correlations (p < 0.05) were observed between devices, there were large mean differences in ankle range of motion values ranging from 4.3°-15.7°. The D-flex produced the highest inter- and intra-rater reliability (ICCs 0.76–0.95), compared to values of 0.55–0.85 and 0.32–0.71 for the goniometer and inclinometer, respectively. The Bland and Altman plots revealed a low mean observer difference for the D-Flex (mean difference = 0.7°), with the vast majority of data coincident within the 95% confidence intervals. For both the goniometer and inclinometer mean differences were higher, with values of 3.1° and 5.7° respectively.ConclusionThe results of the present study provide evidence to support the use of the D-Flex system as a valid, portable, and easy to use alternative to the weight-bearing lunge test when assessing ankle dorsiflexion ROM in healthy participants.

Validity of a Smartphone Application for Measuring Ankle Plantar Flexion.

Range of motion is a component of a physical examination used in the diagnostic and rehabilitative processes. Following ankle injury and/or during research, it is common to measure plantar flexion with a universal goniometer. The ease and availability of digital inclinometers created as applications for smartphones have led to an increase in using this method of range of motion assessment. Smartphone applications have been validated as alternatives to inclinometer measurements in the knee; however, this application has not been validated for plantar flexion in the ankle. The purpose of this study was (1)to assess the validity of the Clinometer Smartphone Application™ produced by Plaincode App Development for use in the ankle (ie, plantar flexion) and (2)to assess the validity of the inclinometer procedures used to measure ankle dorsiflexion for measuring ankle plantar flexion. Blinded repeated measures correlational design. University-based outpatient rehabilitative clinic. A convenience sample (N = 50) of participants (27 females and 23 males) who reported to the clinic (mean age = 30.48y). Patients were long seated on a plinth, with the knee in terminal extension. Three plantar flexion measurements were taken with a goniometer on each foot by the primary researcher. The primary researcher then conducted 3 blinded measurements with The Clinometer Smartphone Application™ following the same procedure. A second researcher, who was blinded to the goniometer measurements, recorded the inclinometer measurements. After data were collected, a Pearson's correlation was calculated to determine the validity of the clinometer app compared with goniometry. Degrees of motion for ankle plantar flexion. Measurements produced using the Clinometer Smartphone Application™ were highly correlated for right foot (r = .92, P < .001), left foot (r = .92, P < .001), and combined (r = .92, P < .001) with goniometer measurements using a plastic universal goniometer. The Clinometer Smartphone Application™ is a valid instrument for measuring plantar flexion of the ankle.

Assessment of the metrological qualities of the inertial FOX Hikob compared to the reference system for adaptive trigger functional electrical stimulation to correct dropfoot in poststroke hemiplegic patients

Eighty percent of poststroke patients are temporarily unable to walk without help, often with a dropfoot during the midswing phase. Functional electrical stimulation (FES) induces compensation of dropfoot by preprogrammed fixed stimulation, however they are not more effective than mechanical ankle foot orthesis. FES has the advantage of being able to provoke a physiological muscular contraction and respect the articular amplitude. Our objective is to evaluate the metrological quality of the inertial sensors for movement reconstruction in comparison to the gold standard motion analysis. The aim is to improve the SEF using adaptive triggers for dorsiflexion, in hemiplegic poststroke patients. Adults with supratentorial ischaemic or hemorrhagic stroke, presenting a foot-drop, able to walk 10 metres without human help, with or without a walking stick were included from May 2016 to June 2017. Patients with ankle dorsiflexion < 0° in knee extension were excluded. Synchronous gait analysis was performed using the VICON © system, the GAITRITE © walkway system and Fox Hikob inertial measurement unit (IMU). The main outcome is the measurement error for the dorsiflexion angle at the heel strike and midswing phase. Eleven patients included so far, 7 right sided hemiplegia, 8 male, mean age 56 years. To compare the IMU with the gold standard VICON, the measurement errors were estimated by Blant Altman analysis. Dorsiflexion angle measurements demonstrated a bias of 0.43° between the two techniques, with the limits of agreement [−13.46°; + 14.32°] during stance phases and a bias of 0.72° with agreement values [−16.19°; + 17.64°] during swing phases. The data treatment algorithms from IMU seem to be effective in measuring ankle dorsiflexion with small biases between techniques. The limits of agreement are too wide from a clinical perspective, probably due to a small sample size, but are narrow enough to warrant further technological research. Analysis of the full sample size will provide further information on the limits of agreement.

Figure 8 (Heel open) short leg cast

Category: Ankle, Trauma Introduction/Purpose: To report the results of applying heel open (figure 8) short leg cast on foot &amp; ankle trauma or disease patients requiring short leg casts. Methods: 380 patients who were confirmed and treated by diagnosed of foot &amp; ankle trauma or diseases were included between November 2014 and July 2016. Comprised of 222 males and 158 females, their mean age was 46 years old. The bottom of the figure 8 cast covered the metatarsal head to half portion of the medial longitudinal arch, while leg portion covering consisted from the prominence of the both malleolus to halfway of the lower leg, resulting in complete exposure of the heel and distal portion of the achilles tendon. After application of the figure 8 cast, changes in the ROM in active ankle dorsiflexion &amp; plantarflexion, passive foot inversion &amp; eversion, and foot internal &amp; external rotation were measured. Results: In all cases, measurements of active ankle dorsiflexion &amp; plantarflexion was less than 5 degrees, measurements of passive foot inversion &amp; eversion was less than 5 degrees, foot internal &amp; external rotation was less than 0 degrees, and were stably held without skin or soft tissue injury until cast removal. Notable were 22 cases of foot &amp; ankle fractures treated with conservative therapy with figure 8 short leg cast resulting in bone union and stabilization without surgery. VAS discomfort score was an average of 2.6 (0~5) and figure 8 short leg cast was selected in all cases requiring a short leg cast. Conclusion: The use of figure 8 short leg cast in patients of foot &amp; ankle trauma and diseases requiring short leg cast provides safety and prevention of skin necrosis and pressure sores from open heels while providing high patient satisfaction in daily life, such as heel touch. We believe that figure 8 short leg cast could replace the traditional short leg cast, if the safety of the figure 8 cast could be proven through long-term follow up study with various patient and cases.

Overtightening of the Syndesmosis Revisited and the Effect of Syndesmotic Malreduction on Ankle Dorsiflexion

Category: Ankle, Trauma Introduction/Purpose: Ankle syndesmotic injuries are a significant source of morbidity and require anatomic reduction to optimize outcomes. Although a previous study concluded that maximal dorsiflexion during syndesmotic fixation was not required, methodologic weaknesses existed and several studies have demonstrated improved ankle dorsiflexion after removal of syndesmotic screws. The purposes of the current investigation are: To assess the effect of syndesmotic screw fixation on ankle dorsiflexion utilizing a controlled load and instrumentation allowing for precise measurement of ankle dorsiflexion. To assess the effect of anterior &amp; posterior syndesmotic malreduction after syndesmotic screw fixation on ankle dorsiflexion. Methods: Fifteen cadaveric leg specimens were utilized for the study. Ankle dorsiflexion was measured utilizing a precise micro- sensor system after application of a consistent load in the intact state, after compression fixation with a syndesmotic screw and after anterior &amp; posterior malreduction of the syndesmosis. Results: Following screw compression of the nondisplaced syndesmosis, dorsiflexion ROM was 99.7±0.87% (mean ± standard error) of baseline ankle ROM. Anterior and posterior displacement of the syndesmosis resulted in dorsiflexion ROM that was 99.1±1.75% and 98.6±1.56% of baseline ankle ROM, respectively. One-way ANOVA was performed showing no statistical significance between groups (p-value =0.88). Two-way ANOVA comparing the groups with respect to both the reduction condition (intact, anatomic reduction, anterior displacement, posterior displacement) and the displacement order (anterior first, posterior first) did not demonstrate a statistically significant effect (p-value= 0.99). Conclusion: Maximal dorsiflexion of the ankle is not required prior to syndesmotic fixation. Anterior or posterior syndesmotic malreduction following syndesmotic screw fixation has no effect on ankle dorsiflexion thus poor patient outcomes after syndesmotic malreduction does not appear to be the result of loss of dorsiflexion due to mechanical block.

Psychometric Properties of a Clinical Strength Assessment Protocol in People with Multiple Sclerosis.

Strength training in people with multiple sclerosis (MS) is an important component of rehabilitation, but it can be challenging for clinicians to quantify strength accurately and reliably. This study investigated the psychometric properties of a clinical strength assessment protocol using handheld dynamometry and other objective, quantifiable tests for the lower extremities and trunk in people with MS. This study determined discriminant validity between 25 participants with MS and 25 controls and between participants with MS who had higher versus lower disability; test-retest reliability across 7 to 10 days; and response stability. The protocol included handheld dynamometry measurements of ankle dorsiflexion, knee flexion and extension; hip flexion, extension, abduction, and adduction; and trunk lateral flexion. Muscular endurance tests were used to measure trunk extension, trunk flexion, and ankle plantarflexion. The protocol discriminated between participants with MS and controls for all muscles tested (P < .001-.003). The protocol also discriminated between low- and moderate-disability groups (P = .001-.046) for 80% of the muscles tested. Test-retest reliability intraclass correlation coefficients were high (0.81-0.97). Minimal detectable change as a percentage of the mean was 13% to 36% for 85% of muscles tested. This study provides evidence for the discriminant validity, test-retest reliability, and response stability of a strength assessment protocol in people with MS. This protocol may be useful for tracking outcomes in people with MS for clinical investigations and practice.

Experimental Comparison of the Clinical Measurement of Ankle Joint Dorsiflexion and Radiographic Tibiotalar Position

Clinical measurement of ankle dorsiflexion is typically used to diagnose limited ankle range of motion. Controversy and a lack of clarity continue regarding the most accurate clinical method of measuring ankle joint dorsiflexion and the effect that the foot position (supinated, neutral, pronated) has on the true tibiotalar position. We investigated the effects of supinated, neutral and pronated foot positions on the clinical dorsiflexion measurements in 50 healthy subjects and compared these results to the radiographic measurement of tibiotalar joint position with the ankle maximally dorsiflexed in each of the 3 foot positions. Interrater reliability was confirmed to be adequate among the 3 clinicians of varied skill levels. Radiographic measurements of the tibiotalar position showed very little change in each of the 3 foot positions, with a total difference of 0.35° between supination and pronation. However, we found a mean difference of 14° of dorsiflexion in the clinical measurements between the pronated and supinated foot position, with a 9.08° difference between the neutral and supinated positions. Motion of the foot between the neutral and supinated positions introduced an additional source of potential error from the measurement technique when using the neutral position as the standard, which has been recommended in the past. We recommend a supinated foot position as a more reliable foot position for measuring the clinical ankle joint range of motion and propose it as a potential standard.

WEEKLY ANKLE LUNGE TEST SCREENING MIGHT HELP PREVENT ANKLE INJURIES

BackgroundResearch has shown that almost 80% of injuries in track and field athletes affect the lower limb. Therefore, it is important to regularly monitor the condition of athlete's musculoskeletal system...

The concurrent validity and reliability of the Leg Motion system for measuring ankle dorsiflexion range of motion in older adults.

BackgroundNew reliable devices for range of motion (ROM) measures in older adults are necessary to improve knowledge about the functional capability in this population. Dorsiflexion ROM limitation is associated with ankle injuries, foot pain, lower limb disorders, loss of balance, gait control disorders and fall risk in older adults. The aim of the present study was to assess the validity and reliability of the Leg Motion device for measuring ankle dorsiflexion ROM in older adults.MethodsAdescriptive repeated-measures study was designed to test the reliability of Leg Motion in thirty-three healthy elderly patients older than 65 years. The subjects had to meet the following inclusion and exclusion criteria in their medical records: older than 65 years; no lower extremity injury for at least one year prior to evaluation (meniscopathy, or fractures) and any chronic injuries (e.g., osteoarthritis); no previous hip, knee or ankle surgery; no neuropathic alterations and no cognitive conditions (e.g., Alzheimer’s disease or dementia). Participants were recruited through the person responsible for the physiotherapist area from a nursing center. The subjects were evaluated in two different sessions at the same time of day, and there was a break of two weeks between sessions. To test the validity of the Leg Motion system, the participants were measured in a weight-bearing lunge position using a classic goniometer with 1° increments, a smartphone with an inclinometer standard app (iPhone 5S®) with 1° increments and a measuring tape that could measure 0.1 cm. All testing was performed while the patients were barefoot. The researcher had ten years of experience as a physiotherapist using goniometer, tape measure and inclinometer devices.ResultsMean values and standard deviations were as follows: Leg Motion (right 5.15 ± 3.08; left 5.19 ± 2.98), tape measure (right 5.12 ± 3.08; left 5.12 ± 2.80), goniometer (right 45.87° ± 4.98; left 44.50° ± 5.54) and inclinometer app (right 46.53° ± 4.79; left 45.27° ± 5.19). The paired t-test showed no significant differences between the limbs or between the test and re-test values. The test re-test reliability results for Leg Motion were as follows: the standard error of the measurement ranged from 0.29 to 0.43 cm, the minimal detectable difference ranged from 0.79 to 1.19 cm, and the intraclass correlation coefficients (ICC) values ranged from 0.97 to 0.98.ConclusionsThe results of the present study indicated that the Leg Motion device is a valid, reliable, accessible and portable tool as an alternative to the classic weight-bearing lunge test for measuring ankle dorsiflexion ROM in older adults.

Functional Outcomes Of Primary Open Repair With Augmentation And Without Augmentation In Achilles Tendon Rupture

PURPOSE: The aim of this study was to compare the functional outcomes between two surgical techniques for Achilles tendon rupture: primary open repair (POR) versus open repair augmented with flexor hallucis longus tendon transfer (POR_FHL). METHODS: Twenty six patients (Age:44.7±8.6 years, Body Mass:83.4±14.5 kg, Height:177.7±23.4 cm, BMI:27.6±4.2 kg/m2, time after surgery to experiment: 3.13±1.96 yrs) who were operated either with POR (Group 1, n=14) or POR_FHL (Group 2, n=12) for achilles tendon rupture were included in this study. For evaluating dynamic balance, Star Excursion Balance Test (SEBT) with anterior, posteromedial and posterolateral reach distances was used and for evaluating hop performance, One Leg Hop Test (OLHT) was used. To measure ankle dorsiflexion range of motion, Weight Bearing Lunge Test (WBLT) was performed and Functional Squat Test (FST) was used for evaluating lower extremity concentric and eccentric strength. Limb symmetry index was calculated for each test. Student t test was performed for statistical analysis. RESULTS: The physical characteristics of the patients were not different between groups (p>0.05). There were no differences between groups in SEBT anterior (p=0.46), posteromedial (p=0.28) and posterolateral reach distances (p=0.71), OLHT (p=0.77), WBLT (p=0.13) and FST for concentric (p=0.96) and eccentric (p=0.78) strength. CONCLUSION: The results of the study showed that primary open repair with and without augmentation techniques for achilles tendon repair had similar effect on dynamic balance, hop distance, ankle dorsiflexion motion and lower extremity strength in long term after surgery.

A novel tool for measuring ankle dorsiflexion: A study of its reliability in patients following ankle fractures.

Assessment of ankle joint movement in a weight bearing position has important clinical implications. The lunge ankle dorsiflexion measurement device (LAD) has been developed with the aim of facilitating ease of and standardisation of the measurement of ankle joint movement. The literature lacks studies evaluating the reliability of weight bearing measurements of the ankle joint in study groups with ankle disabilities. The objective of this study was to examine the intra- and inter-tester reliability of ankle dorsiflexion measured with the novel LAD in patients following a fracture of the ankle. This study was a randomized intra- and inter-tester reliability study with blinding of testers and participants. All participants were tested twice by each tester, with the order of testers randomized. The intra- and inter-tester reliability was assessed by the calculation of interclass correlation coefficients (ICC). The study sample consisted of 24 patients: 15 females and nine males post-immobilisation following surgery for ankle fractures. The mean age was 51.0 years, ranging from 22 to 92 years. All patients had sustained an AO classification 44- fracture of the ankle. The mean follow-up time was 9.3 months (16.2 SD) after the time of fracture. The inter-tester reliability was high, with an ICC of 0.984 (95%CI: 0.963-0.993) and SEmeas of 0.14cm. The ICC for Tester A was 0.989 (95%CI: 0.974-0.995) and SEmeas 0.10cm. The ICC for Tester B was 0.990 (95%CI: 0.977-0.996) and SEmeas 0.09cm. This study shows a high inter- and intra-tester reliability for measuring ankle dorsiflexion with the LAD following a fracture of the ankle.

Effectiveness of Mobile Learning on Athletic Training Psychomotor Skill Acquisition

Context Instruction of psychomotor skills is an important component of athletic training education. Accommodating the varied learning abilities and preferences of athletic training students can be challenging for an instructor initiating skill acquisition in a traditional face-to-face (F2F) environment. Video instruction available on mobile devices may offer an alternative teaching tool, allowing for student-initiated learning. Objective To compare outcomes of Quick Clips (QC) instruction with F2F instruction as measured by skill-examination scores. Design Quasi-experimental. Setting Five higher learning institutions with Commission on Accreditation of Athletic Training Education (CAATE) accredited athletic training education programs. Patients or Other Participants Seventy-four pre-athletic training students, average age 18.86 ± 1.0 years (49 women, 25 men), volunteered for this study. Participants were randomly assigned to 1 of 2 instructional groups (F2F or QC). Intervention(s) The principal investigator provided F2F instruction to 38 participants in 3 skills (knee valgus stress test, middle trapezius manual muscle test, and goniometric measurement of active ankle dorsiflexion). The remaining 36 participants watched 3 QC videos demonstrating the same skills. Main Outcome Measure(s) Three individual skill exam scores and the total score. Results A 1-way multivariate analysis of variance indicated a significant effect (P &amp;lt; .0001) of instructional method on exam scores. Follow-up univariate analysis of variance indicated knee valgus stress test exam scores were significantly higher after F2F instruction (P &amp;lt; .0001). Neither manual muscle test nor goniometric measurement exam scores were affected by instructional method. Conclusions The findings support the use of QC as an alternative to F2F instruction for 2 of the 3 skills. This finding is similar to studies reported in the nursing literature on computer-assisted learning, which found inconclusive evidence to support the superiority of one method over another. Mobile video instruction is an effective teaching strategy. It may be best utilized to supplement traditional F2F instruction.