Measurement Of Dorsiflexion Research Articles

Validation of Fixed Ultrasonography for Achilles Tendon Assessment: A Reliability Study

Background: It is important to highlight the advantages of ultrasound in assessing muscular and tendinous behavior due to its non-invasive nature and capacity for dynamic studies. However, evaluating tendons via ultrasound can be challenging given the complexity of anisotropic phenomena related to collagen fiber arrangement. This study aims to validate the reliability of fixed ultrasound compared to manual acquisition in measuring Achilles tendon thickness. Method: Twenty participants, six men and fourteen women, were recruited. Ultrasound was used to measure the Achilles tendon’s thickness at two specific points (4 and 6 cm from the calcaneal insertion of the Achilles tendon). The measurements were conducted by two examiners, one with previous experience and another without. Results: The measurements at 6 cm from the calcaneal insertion showed α = 0.996, α = 0.998 for measurements at 4 cm using manual acquisition, and α = 0.997 for measurements with fixed ultrasound at rest. For the weight-bearing and ankle dorsiflexion measurements, the reliability was excellent (α = 0.999 and α = 1.000). Conclusions: The findings demonstrated excellent reliability in the ultrasound measurements of the Achilles tendon’s thickness, even when performed by different evaluators and under load-bearing conditions. This study suggests the clinical utility of assessing anatomical structures under load, enhancing ultrasound’s applicability beyond the examination table. It is concluded that fixed ultrasound acquisition exhibits excellent reliability in measuring the Achilles tendon’s thickness, offering potential benefits for precise diagnosis of pathologies, planning surgical interventions, and reducing possible errors related to operator variability.

Association of clinically-measured and dynamic ankle dorsiflexion assessed by markerless motion capture during the drop-jump task on landing biomechanics and risk of ankle injury in military personnel undergoing 10 weeks of physical training.

Determine the influence of clinically-measured maximum dorsiflexion, dynamic peak dorsiflexion and percent of clinically-measured maximum dorsiflexion used during a drop-jump task on landing biomechanics and risk of ankle injury in military personnel. Prospective cohort study. 672 participants (122 women) enrolled. The weightbearing lunge test assessed clinically-measured maximum dorsiflexion averaged across limbs (degrees). Markerless motion capture and force plates collected lower extremity kinematic and kinetic data during a drop-jump task. Percent of clinically-measured maximum dorsiflexion used during landing was calculated as dynamic peak dorsiflexion divided by clinically-measured value, multiplied by 100 (%). De-identified injury data was derived from military physical therapists. Simple linear regression analysis determined the association between dorsiflexion measures and landing biomechanics. Simple binary logistic regression analyses identified predictors of ankle injuries. Statistical significance was set at α = 0.05. Eighteen participants sustained a traumatic ankle injury from a landing. All measures of dorsiflexion were associated with movement patterns that countered the stiff-legged landing strategy with dynamic measures showing a higher predictive value. Protective factors against ankle injury included height (odds ratio: 0.818, p = 0.006) and weight (odds ratio: 0.824, p = 0.023) for women. Relative braking impulse was a risk factor for men (odds ratio: 1.890, p = 0.001). Greater clinically-measured and dynamic measures of dorsiflexion were associated with movement patterns that countered the stiff-legged landing strategy but neither measure of dorsiflexion predicted ankle injury risk. Resultant biomechanics and anthropometrics influenced ankle injury risk to warrant recognition for injury prevention initiatives.

Radiographic Changes in Tibiotalar Motion Following Achilles Tendon Lengthening and Gastrocnemius Recession in Total Ankle Arthroplasty: A Comparative Cohort Study

Category: Ankle; Hindfoot Introduction/Purpose: End-stage ankle osteoarthritis is a debilitating condition that often results in limited tibiotalar range of motion. Total ankle replacement (TAR) preserves ankle range of motion and improves the patient's functionality. Tendo-Achilles lengthening (TAL) and gastrocnemius recession (GR) are concomitant procedures often performed with TAR to improve tibiotalar dorsiflexion. The purpose of this study is to determine the effect of a TAL and GR during TAR on radiographic range of motion compared to a control group without a lengthening procedure. Methods: A retrospective review of a prospectively maintained TAR database was conducted from November 2015 - June 2020 at a single academic institution. All surgeries were performed by fellowship-trained foot and ankle surgeons. Inclusion criteria included greater than18 years of age and a minimum of one-year radiographic follow-up with both preoperative and postoperative weight-bearing, range of motion radiographs. Exclusion criteria included concomitant 1) calcaneal osteotomies, 2) hindfoot or midfoot arthrodesis, 3) prior ankle arthrodesis, or 4) revision total ankle arthroplasty. A total of seventy-five patients (TAL, n = 40; GR, n = 35) were included with a control group of seventy-five consecutive patients who underwent TAR without a lengthening procedure. Demographic and clinical data were extracted from the TAR database. Preoperative and postoperative radiographic assessment included a measurement of dorsiflexion and plantarflexion. All measurements were performed by two members of the research team. Results: A total of 150 patients were included in this study: TAL: n = 35, GR: n = 40, Control: n = 75. Dorsiflexion significantly improved by 3.4° (p=0.0053) and by 6.7° (p < 0.0001) in the TAL and GR cohorts respectively with no significant difference in the control group (+1.3°, p=0.0857). Plantarflexion was significantly decreased by 3.6° (p=0.0378) and by 6.6° (p=0.0002) in the TAL and GR cohorts respectively with no significant difference in the control group (+0.3°, p=0.7863). The total arc of motion did not change significantly for any of the three groups postoperative (control 1.63°, GR 0.05°, TAL -0.20°; all p>0.05). There were no significant between-group differences in the change in overall arc of motion between the groups (p=0.3913). Compared to TAL group, GR resulted in a greater increase in dorsiflexion (6.7° versus 3.4°; p=0.0459) with a reciprocal, albeit non-significant, greater decrease in plantarflexion (6.8° versus 3.6°; p=0.1598). Conclusion: Both TAL and GR significantly increased postoperative dorsiflexion; however, this was accompanied by a reciprocal significant loss in plantarflexion. GR resulted in double the improvement in dorsiflexion and loss in plantarflexion compared to TAL. The total arc of motion did not significantly change for the control, GR, or TAL cohorts. Patients should be counselled that their preoperative range of motion (ROM) will dictate their postoperative ROM, and that concomitant procedures performed to achieve an increase in dorsiflexion will do so at the expense of plantarflexion.

Порівняльний аналіз валідності гоніометричного, інклінометричного та рентгенологічного методів вимірювання розгинання у гомілковостопному суглобі

Актуальність. Пошук оптимального методу оцінки амплітуди розгинання в гомілковостопному суглобі (ГС) залишається актуальним предметом наукових дискусій. Мета роботи — провести порівняльний аналіз валідності гоніометричного та інклінометричного методів вимірювання обсягу розгинання у гомілково-стопному суглобі порівняно із рентгенологічними показниками. Матеріали та методи. У дослідження ввійшло 25 здорових, фізично активних осіб (50 гомілковостопних суглобів), серед яких чоловіків було 18, жінок— 7; середній вік обстежуваних становив 25,8 ± 5,2 року; середнє значення індексу маси тіла — 25,01 ± 5,01. Обсяг розгинання у ГС вимірювали при навантаженні за допомогою двоплощинного гоніометра та інклінометра і порівнювали їх з рентгенологічними показниками. Результати вимірювань оцінювали методами описової статистики. Результати. Cередні значення розгинання у ГС, виміряні за допомогою двоплощинного гоніометра, становили 37,62 ± 5,56°; інклінометра — 40,61 ± 5,15°; рентгенологічні показники — 23,69 ± 7,25°. Різниця між середніми була вірогідною (p < 0,001). Середнє значення коефіцієнта варіації для рентгенологічного методу становило 0,31 і значно переважало показники гоніометричного (0,15) та інклінометричного (0,13) методів вимірювання (p < 0,001). Рентгенографія ГС при навантаженні при максимальному розгинанні стопи призводить до збільшення показників тало-1-метатарзального кута. Висновки. Значення кутових параметрів розгинання у ГС при гоніометричному та інклінометричному методах вимірювання суттєво перевищують рентгенологічні показники. Більший коефіцієнт варіації для рентгенологічного дослідження вказує на кращу відтворюваність інклінометрії та гоніометрії при оцінці розгинання у ГС. Навантажувальна рентгенограма ГС в положенні максимального розгинання демонструє збільшення тало-1-метатарзального кута порівняно із нормативними значеннями, що потрібно враховувати при інтерпретації результатів рентгенологічної оцінки розгинання у ГС.

The agreement and repeatability of measurements of ankle joint dorsiflexion and poplietal angle in healthy adolescents

BackgroundThe intra-rater repeatability and inter-rater agreement of orthopaedics measurements are important for estimating injury risk and appropriate treatment. In clinical practice, it is often unavoidable to trust the measurements of other health professionals.MethodsThis study tested the agreement and repeatability of measurements of the dorsiflexion of the foot, dorsiflexion with 90-degrees knee flexion, and popliteal angle test in healthy adolescents performed twice by three raters differing in clinical experience. Three raters, i.e., an orthopaedics specialist (16 years of experience), a resident medical doctor in orthopaedics (4 years of experience), and a physiotherapy student (1 year of experience) measured the ankle joint dorsiflexion and the popliteal angle in 142 healthy adolescent subjects.ResultsThe student outperformed more experienced raters by displaying good repeatability for all the evaluated parameters. The orthopaedics specialist failed to replicate the measurements of the left ankle joint passive dorsiflexion and the left popliteal angle. The medical resident in orthopaedics displayed a lack of repeatability in evaluating the right ankle joint dorsiflexion with the knee joint bent. Kendall’s W value for all parameters ranged 0.66–0.78, indicating a good inter-rater agreement.ConclusionsThe study highlights that measurements of the ankle joint dorsiflexion and popliteal angle test by different health professionals can generally be trusted. It indicates that novice health professionals could potentially evaluate such parameters in healthy subjects without a quality loss.

The Zadek calcaneal osteotomy in Haglund’s syndrome of the heel: Its effects on the dorsiflexion of the ankle and correlations to clinical and functional scores

The Zadek osteotomy is a therapeutic option in Haglund’ syndrome for patients with a X/Y ratio measurement of the calcaneus under 2.5. We hypothesized that Zadek osteotomy would lead to improvement in ankle dorsiflexion and functional scores.Twenty-two patients (mean age: 48.5 years) with Haglund’s syndrome underwent a Zadek osteotomy and were enrolled in a prospective study investigating the proposed hypothesis. Radiological measurements included the X/Y ratio and the pitch angle. Measurements of the dorsiflexion of the ankle, using a hand-made frame, were performed twice by 2 independent observers. Inter and intra classes correlations were calculated. Functional results were assessed using AOFAS, EFAS and EFAS sport. Correlation between ankle dorsiflexion and functional scores were determined using linear regression curves.Our hypothesis was validated with a mean improvement of dorsiflexion of 7.27° (54.98% improvement from pre-operative measurement) (p < 0.0001). Ankle dorsiflexion measurements were highly reproducible with an interclass correlation coefficient(ICC)> 0.95 (0.98–0.99). All mean values of functional scores were significantly improved(p < 0.05) [AOFAS (61.95–94), EFAS (14–21.82), EFAS sport (7.68–13.69)] and were strongly correlated to the dorsiflexion values with a coefficient of determination of 0.82 for AOFAS and EFAS and of 0.86 for EFAS sport, respectively. The mean values of X/Y ratio and pitch angle improved from pre to postoperative conditions, 2.18–2.75 and 28.95–19.77° (p < 0.05), respectively.The angle correction obtained from modifiying the shape of the calcaneus, due to the Zadek osteotomy, confirms it as a safe and reliable treatment, with improvements of both ankle dorsiflexion and functional scores.

The Ankle Lunge Test for measurement of dorsiflexion in individuals following stroke; reliability, validity and evaluation of change following intervention for spasticity of the lower limb.

The Ankle Lunge Test (ALT) is a reliable method of measuring weight bearing ankle dorsiflexion range, a key component of gait, in healthy ankles and a range of musculoskeletal conditions. The aim of this study is to evaluate the reliability and concurrent validity of the ALT in people with stroke and investigate whether change in ALT is observed following treatment of spasticity with Botulinum Toxin. Repeated Measure Design: Forty stroke survivors were recruited for reliability testing. Twenty three stroke survivors were evaluated with the ALT before and after treatment of the lower limb with Botulinum Toxin. Measurement with the ALT was performed for all participants. For the reliability group, two physiotherapists evaluated the ALT on Day 1 and one therapist re-evaluated the ALT one to 5days later. For the change evaluation group, the ALT was tested prior to and six to eight weeks after intervention. Other measures evaluated were velocity, the Functional Ambulation Category, Timed Up and Go and the Modified Tardieu Scale. Intra-rater, inter-rater and test-retest reliability yielded intra-class correlation coefficients at or above 0.92. Moderate correlations were found between the ALT and velocity r=0.605 (p<0.01), the Timed Up and Go r=-0.598 (p<0.01) and the Functional Ambulation Category r=0.380 (p<0.05). Following intervention with Botulinum Toxin, there was significant (p<0.02) improvement in the ALT; pre-median 20mm (IQR -25 to 35) to post-median 21mm (IQR 0 to 40) and the Timed Up and Go; pre-median 21.40s (IQR 13.43 to 28.82) to post-median 20.08s (IQR 14.06 to 28.47). The ALT is a reliable and valid measure which may be applied in clinical practice to evaluate change in weight bearing ankle dorsiflexion in people with stroke.

Comparison of Reliability of Two Weight-Bearing Ankle Dorsiflexion Measurements

<h3>Research Objectives</h3> Passive range of motion in the weight bearing position is important for functional mobility. An easy to administer weight bearing method that is reliable and valid, using a standard, non-digital goniometer (rulongmeter), is not fully established. Our study examined performing an ankle goniometric measurement in a standing lunge position, to identify and compare the inter-rater reliability with the subject's lower extremity elevated on a step versus on the floor. <h3>Design</h3> Methodological study, systematic random assignment. <h3>Setting</h3> Academic. <h3>Participants</h3> A convenience sample of thirty-six college students was recruited with flyers and postings. Subjects with ankle fusions, ankle surgery, or an ankle sprain within the past 6 months were excluded. <h3>Interventions</h3> Subjects were tested using a rulongmeter. All measurements were taken on the right ankle with subjects barefoot in a single session. Measurements were taken by 4 different testers. Standardized instructions for assuming the lunge position with the subject's foot on the floor or on the 12 inch step were provided by first tester. The subjects were systematically randomized to start on the step or the floor and the testers rotated their order of testing. The subjects were allowed to return to a resting position between testers keeping their foot stationary. <h3>Main Outcome Measures</h3> Reliability of goniometric weight-bearing dorsiflexion measurement. <h3>Results</h3> Thirty-six test subjects, 20 male and 16 female. Although the subjects varied in age from 20 to 42 years, 77.8% were between 20-29 years of age. In both positions the intra-class correlation was very high (floor ICC = 0.987; step ICC = 0.983). However, the dorsiflexion on the step was consistently lower by an average of 2 degrees than dorsiflexion on the floor (p = 0.0001). <h3>Conclusions</h3> This study examined the validity and reliability of 2 weight bearing methods of ankle dorsiflexion measurement. The reliability of both methods was high, however, between the two testing positions, the measurements were different. Consistency of the method of measurement is most important to have accurate comparisons of range of motion over time. <h3>Author(s) Disclosures</h3> No conflicts of interest with the study.

Association of Ankle Dorsiflexion With Plantar Fasciitis

This study aimed to compare the mean ankle dorsiflexion range between individuals with and without plantar fasciitis using passive ankle dorsiflexion with consistent pressure, and to identify the prevalence of an isolated gastrocnemius and gastrocnemius soleus complex contracture in 2 groups. 91 participants were prospectively classified into the plantar fasciitis group (45 subjects) and the control group (46 subjects). Ankle dorsiflexion was measured with the knee extended and with the knee flexed 90° using a standard orthopedic goniometer while a consistent force of 2 kg was applied under the plantar surface of the forefoot using a custom-made scale. Intraclass correlation coefficients (ICC) were calculated to determine the interobserver and intraobserver reliability of the current ankle dorsiflexion measurement. The current ankle dorsiflexion measurement revealed excellent interobserver and intraobserver reliability. The mean ankle dorsiflexion in the knee extended was -9.6° ± 8.1° and -11.2° ± 8.2° in the study and control groups, respectively (p = .353). The mean ankle dorsiflexion in the knee flexed was 7.8° ± 6.5° and 5.1° ± 7.4° in the study and control groups, respectively (p = .068). In the study and control groups, 68.9% and 65.2%, respectively, had an isolated gastrocnemius contracture and 24.4% and 30.4%, respectively, had a gastrocnemius-soleus complex contracture (p = .768). The present study demonstrated that there were no significant differences in passive ankle dorsiflexion and in the prevalence of an isolated gastrocnemius or gastrocnemius soleus complex contracture between individuals with and without plantar fasciitis.

Implementing a Protocol of Ankle ROM Goniometry Measurement in the Neuroscience ICU

Background/Purpose: Prolonged intensive care unit (ICU) admission and symptoms of neurologic injury may increase the risk for joint contracture, negatively affecting function. Clear recommendations for assessing, monitoring, and providing interventions for contractures are limited. The purpose of our study was to determine the effect of implementing an ankle dorsiflexion (DF) measurement protocol in a patient population at risk for ankle contractures. We examined the effect of the measurement protocol on the frequency of measurement, ankle DF range of motion (ROM) from physical therapy (PT) evaluation to hospital discharge, and interventions provided. Methods: A measurement protocol of ankle DF ROM was implemented for patients admitted to the neuroscience ICU. A retrospective analysis was conducted of all patients who met eligibility criteria with a total hospital length of stay of more than 15 days and revealed 2 groups. A measurement group (MG) was evaluated by a physical therapist within 72 hours and included in the measurement protocol. A comparison group (CG) was not successfully evaluated per the measurement protocol and not included in the measurement protocol. Results: A total of 58 patients were analyzed. The MG (n = 27) received more measurements per week (P &lt; .001) and more total sessions with measurements (P &lt; .001); the CG (n = 31) received more estimated measurements (P = .005). More MG patients were assessed for the need for ROM intervention (P = .02). The CG received more interventions (mean [SD] = 0.94 [2.02]) than the MG (mean [SD] = 0.67 (1.00)], though not statistically significant. A subset of each group had analyzable ROM measurements. The MG subgroup (MGs) ROM change was positive (mean [SD] = 2.88°[8.55°]). The CG subgroup (CGs) was negative (mean [SD] = 4.50° [16.58°]); no significant difference was found. Discussion/Conclusion: The protocol increased the number of measurements performed. Ankle DF ROM was more frequently estimated in the CG. More MG patients were assessed for the need for ROM interventions; however, the number of interventions provided did not differ between groups. Ankle DF ROM goniometric measurements taken at a consistent frequency may affect the number of interventions provided. We were unable to determine the effect of the protocol on ROM measurements due to inconsistent measurement frequency and small sample size. Further studies are needed to assess barriers to consistent ROM measurement, assess the effects of increased measurement on ROM and functional outcomes, and the effect on the provision of intervention and allotment of resources.

Relationship Between Deep Squat And Joint Range Of Ankle Motion In Young Female Hockey Players

BACKGROUND: The "Deep Squat" (DS) is a qualitative functional test that integrates muscle strength, neuromuscular control, mobility and joint stability. This test has been frequently used to identify risk of musculoskeletal injury in varied populations. The active joint range of motion (AROM) is the arc of mobility that an individual performs during a voluntary movement, measured objectively by goniometer. PURPOSE: Identify the relationship between the DS and the AROM of the ankle measured by goniometer in young female hockey players who belong to Gimnasia Esgrima Rosario Club. METHODS: Twenty young and healthy female hockey players (age: 16.12 ± 1.16 years; Weight: 57.40 ± 6.32 Kg; Height: 161.42 ± 6.14 cm), participated in this study. Asymptomatic subjects were included, with no history of lumbar spine, hip, knee or ankle injuries. The functional DS test was measured by goniometer in angular degrees of movement for knee flexion, and three bilateral tests for the AROM of dorsiflexion of the ankle (a- Bipedal position with partial load; b- Seated with knee flexed at 90°; and c- Seated with knee at 0° of flexion). The Intraclass Correlation Coefficient (ICC: 0,832-0,993) and the Standard Error of Measurement (SEM: 0,803-0,971) were established by analysis of variance one way for each variable measured. We have applied matched t-test differences to determine statistical differences (SD) between dominant and non-dominant leg at p<0.05. Correlations were calculated through Pearson coefficient (r) between DS and right and left AROM mean values. RESULTS: No significant differences (ns) were found for dominant and non-dominant leg. Low correlation was found for dorsiflexion in bipedal position with partial load (r = 0.48; p <0.05) and seated with knee flexed at 90° (r = 0.39; p = 0.09 ns). However, a moderate correlation was found between the goniometric measurement of DS and dorsiflexion in the seat with 0° knee flexion (r = 0.61; p <0.01). CONCLUSION: Based on the results, we conclude that the DS measured objectively by goniometer has a moderate r with dorsiflexion seated with knee at 0° of flexion (gastrocnemius muscle length test). Therefore, in this sample, the DS test could be influenced by other determinants factors different from mobility, as they are the muscle strength, neuromuscular control and joint stability.

무용전공에 따른 남자무용수의 하지 가동범위, 기능적 움직임 및 근력 비교

The objective of this study was to assess and compare among the range of motion, functional movements, and muscular strength of knee joint of male dancers, depending on dance type(ballet, modern dance, and Korean dance). Twenty one male dancers(each of seven from the three dance types) were recruited from those who have had no surgery or medical history in the lower limbs within the last six months. Measurements were taken of their range of motion(ROM) of hip internal and external rotations. Additionally, goniometric measurement of plantar-flexion and dorsiflexion of the ankle were done using a goniometer. To assess functional movement, all subjects completed the seven Functional Movement Screen(FMS) tests. Isokinetic dynamometry was (Humac NORM CSMi U.S.A) use for isokinetic strengthe measures. The ballet dancers showed larger ROM(right side; 34.29±6.07, left side; 35.00±5.77) than those(right side; 25.71±6.27, left side; 24.29±3.45) of modern dancers(right side; p=.046, left side; p=.003). The Korean dancers also presented larger ROM(right side; 37.14±5.66, left side; 35.00±6.45) than those(right side; 25.71±6.27, left side; 24.29±3.45) of the modern dancers(right side; p=.007, left side; p=.003). In relation to functional movement among the dance types, the ballet dancers were found to have scored higher(18.43±1.27) than those(16.57±0.78) of the modern dancers in the FMS tests (p=.020). No significant differences were found in isokinetic knee flexion/extension strength. In summary, It appeared that hip external rotation of ballet dancers and korean dancers were greater than those of the modern dancers. Additionally, ballet dancers seemed to have higher functional levels among the three dance types.

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.

Progression of Ankle Plantarflexion Contractures and Functional Decline in Duchenne Muscular Dystrophy: Implications for Physical Therapy Management.

This study characterizes the progressive loss of ankle dorsiflexion range of motion in boys with Duchenne muscular dystrophy (DMD), the relationship to functional decline, and the implications for physical therapy management. Longitudinal data for 332 boys with DMD were extracted from medical records and analyzed. Summary statistics for age, number of visits, ankle dorsiflexion measures, and North Star Ambulatory Assessment (NSAA) scores were computed. Ankle dorsiflexion motion ranged from -32.5 to 25 degrees. Progression of ankle contractures is demonstrated by a trend line: slope -1.43 per year. NSAA score was estimated to decline approximately 0.23 points per 1 degree of ankle dorsiflexion lost. The results of this study describe the progression of ankle contractures and functional decline in DMD. The findings may help inform decisions regarding interventions to support participants with DMD and their families.

Validity and reliability of ankle dorsiflexion measures in children with cerebral palsy.

We compared a goniometer method in a non-weight-bearing position with a tape measure method in a weight-bearing position to determine which was more reliable for assessing dorsiflexion range of motion (ROM) in children with cerebral palsy (CP). Ankle dorsiflexion ROM was measured using goniometer and tape measure methods in non-weight- and weight-bearing positions, respectively. In the test-retest reliability of ankle dorsiflexion ROM using a universal goniometer, the intraclass correlation coefficient (ICC) varied from 0.75 to 0.96 and the overall ICC score was 0.91 (p< 0.001). In the test-retest reliability of ankle dorsiflexion ROM using a tape measure, ICC varied from 0.98 to 0.99 and the overall ICC score was 0.99 (p< 0.001). Ankle dorsiflexion ROM using a universal goniometer had a standard error of measurement (SEM) of 2.86 and a minimum detectable change (MDC) of 7.94. Ankle dorsiflexion ROM using a tape measure had an SEM of 1.01 and a MDC of 2.80. The tape measure method in a weight-bearing position was more reliable than using a universal goniometer in a non-weight-bearing position in children with CP.

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.

The Effect of Heel Lifts on Postural Stability in Individuals with Parkinson’s Disease

Our purpose was to investigate if accommodating plantar flexion contractures will improve postural alignment, patient perceived stability, and balance in individuals with Parkinson’s disease (PD), and the correlation of plantarflexion (PF) contractures and the Falls Efficacy scale (FES). This was a single session pretest posttest study with subject as their own control. We recruited a convenience sample of 32 participants with PD who could independently ambulate 20 feet without assistive devices. The Institutional Review Board approved the study, and informed consent was obtained from all participants prior to their participation. The outcome measures included: sagittal plane posture photo, verbal numeric rating of perceived stability, 1-minute recording of double leg stance on an interface pressure map, functional reach test (FRT) and the Falls Efficacy Scale (FES). The intervention was the use of bilateral Adjust-a-Lift heel lifts worn inside the participants’ shoe. Assigned heel lift thickness was based on PF contracture severity, determined via passive talocrural dorsiflexion measurement. Photographic posture analysis was completed with free image measurement software. Sway measurements were taken of center of gravity tracing with Tekscan software. Statistical analysis included Paired t-tests for outcome measures and Pearson product correlation between the FES and PF contracture data. We found significant changes (p<.05) in increase in height (mean 1.00 cm), an anterior translation of the pelvis (mean 2.3cm), a more upright trunk angle (mean 1.37 degrees) and a more upright head angle (mean 2.61 degrees). Perceived stability significantly increased (mean 0.75) and functional reach significantly decreased (mean 2.22cm). Significant correlations (r=0.36–0.50) were found between the degree of PF contracture and the total scale score as well as reported fear of falling for questions that required walking on the FES. This study showed accommodating PF contractures with heel lift intervention significantly improved postural alignment and perceived stability, but decreased participants’ functional reach.

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.

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.

Knee Recurvatum in Children With Spastic Diplegic Cerebral Palsy.

The purpose of this study is to determine which factors drive patients with diplegic cerebral palsy to walk without knee recurvatum despite hyperextension of the knee on physical examination. A retrospective review was conducted of all data collected in the Gait Analysis Laboratory between 1999 and 2014. Patients with spastic diplegic cerebral palsy and at least 5 degrees of knee extension on clinical examination were identified for the study. After IRB approval, a total of 60 children ranging in age from 4 to 17 were included in the study. There were 27 female patients. Gross Motor Function Classification System level was distributed in the population as follows: 34 patients at Gross Motor Function Classification System level I, 18 at level II, and 8 at level III. Patients were excluded from this study if they had extrapyramidal involvement, history of selective dorsal rhizotomy or lower extremity surgery. Patient who received botulinum toxin A injections within 1 year of the study were excluded as well. Patients were divided into 2 groups: children that walked with knee hyperextension (KH) and children that walked without knee hyperextension (KF, "knee flexion"). There were 15 subjects in the KH group and 45 subjects in the KF group. Motion Laboratory evaluation included a comprehensive examination, kinematics, and kinetic analysis with a VICOM system. All data were analyzed with unpaired t test to detect differences between the 2 groups. All statistical analysis was done only for the right legs (unless the right leg did not meet the exclusion then the left leg was analyzed) to meet the statistical requirement for independence. The Pearson correlation was applied to correlate the maximum knee extension in stance with maximum ankle dorsiflexion in stance. The static measurement of dorsiflexion with knee flexed showed statistically significant difference (P=0.004) with KH group having 2.3±11.6 degrees and KF group having 13.1±12.2 degrees. There was also a statistically significant difference in the static measurement of dorsiflexion with knee extended (P=0.0014) with KH group having -3.3±9.0 degrees and KF group having 5.8±9.1 degrees. Maximum dorsiflexion in stance phase also showed significant difference (P=0.0022) with the KH group having 0.1±14.0 degrees and KF group having 11.5±11.2 degrees. Maximum dorsiflexion in stance phase also showed significant difference (P<0.001) with the DH group having 0.1 (SD) 14.0 degrees and KF group having 11.5 (SD) 11.2 degrees. There were no significant differences in popliteal angle measurements or any strength measurement. Our study shows that the plantar flexion knee extension couple is the major contributing factor to cause patients with passive knee hyperextension to walk in a recurvatum pattern. This would have implications of further treatment of the knee hyperextension in stance. Level III-case-control study.