Measurement Of Dorsiflexion Research Articles

Confiabilidade e aplicabilidade de dois métodos de avaliação da amplitude de movimento de dorsiflexão do tornozelo

Introdução: A limitação da amplitude de movimento de dorsiflexão é o parâmetro mais utilizado na avaliação e evolução da abordagem fisioterapêutica. Objetivos: Avaliar a confiabilidade e aplicabilidade da goniometria e do teste Weight-Bearing para a mensuração de dorsiflexão do tornozelo. Método: Participaram 25 voluntários, do sexo masculino, com idade média de 38,81 (± 6,26), distribuídos em dois grupos: G1 (n=13 Não-atleta) e G2 (n=12 Atletas). A medida da dorsiflexão do tornozelo foi realizada com goniômetro universal adaptado com haste metálica de 45 cm e por meio do teste Weigth-Bearing. Os dois métodos foram aplicados nos participantes por três examinadores, cada um efetuando a mensuração seis vezes. Com o ICC, verificou-se a confiabilidade dos testes. Resultados: Obtiveram-se ICC de 0,98 na goniometria, para o G1, e 0,97, para o G2. Já para o Weight-Bearing, obteve-se ICC de 0,98 para o G1 e o mesmo para o G2. Todas essas medidas foram consideradas muito elevadas. Conclusão: Ambos os métodos são de alta confiabilidade para aplicação clínica nessas condições experimentais.

Clinical Assessment of Ankle Joint Dorsiflexion

Ankle dorsiflexion measurement is important for clinical and research use. With so much evidence on the unreliability of goniometric measurements, a systematic review was performed to investigate various alternative techniques for measuring ankle dorsiflexion in the nonneurologic patient. All of the major databases were queried electronically to identify studies that used any method of ankle dorsiflexion measurement in the nonneurologic subject. Keywords included ankle dorsiflexion NOT cerebral palsy NOT stroke, the latter to exclude neurologic conditions. In 755 studies that used some form of ankle joint dorsiflexion measurement, ten different techniques were identified that included various apparatuses designed specifically for this purpose. Reliability testing of these techniques involved test-retest trials with small student populations as subjects, which returned high intraclass correlation coefficient scores. However, their methodological quality would have benefitted from the use of an actual patient population and comparison with a reference standard. When validating ankle dorsiflexion measurement techniques, actual patient populations should be used, otherwise papers would score poorly on methodological quality assessment. Standardizing patient position, foot posture, amount of moment applied, and reference landmarks will ensure that various trial results can be compared directly.

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Risk factors for chronic ulceration in patients with varicose veins: A case control study

Identifying which patients with varicose veins are at risk of progressing to more severe forms of chronic venous disease could help in assigning clinical priorities and targeting appropriate treatments. The aim of this study was to determine, in subjects with varicose veins, the characteristics of venous disease and other factors associated with an increased risk of ulceration. One hundred twenty subjects with varicose veins and an open or healed venous leg ulcer were compared with 120 controls with varicose veins and no history of venous ulcer on this case control study. Subjects were recruited from hospital settings and primary care. Each subject completed a questionnaire on lifestyle and medical history and underwent an examination comprising of clinical classification of venous disease (CEAP), duplex scanning, quantitative digital photoplethysmography, and measurement of dorsiflexion. Multiple logistic regression analyses and calculation of receiver operating characteristic (ROC) curves were performed to identify the combination of factors which most accurately predicted which patients with varicose veins will develop leg ulcers. An increased risk of ulceration was associated with the severity of clinical venous disease, especially with the presence of skin changes (P < .0001). Other significant risk factors included history of deep vein thrombosis (DVT) (P = .001), higher body mass index (BMI) (P = .006), smoking (P = .009), and reflux in the deep veins (P = .0001). Ulceration was associated with reduced volume of blood displaced as reflected by photoplethysmography and a limited range of ankle movement (not wholly due to the effects of an active ulcer) (both P < .05). Multivariate analyses showed that skin changes including lipodermatosclerosis (odds ratio [OR] 8.90, 95% confidence interval [CI] 1.44-54.8), corona phlebectatica (OR 4.52, 95% CI 1.81-11.3) and eczema (OR 2.87, 95% CI 1.12-7.07), higher BMI (OR 1.08, 95% CI 1.01-1.15), and popliteal vein reflux (OR 2.82, 95% CI 1.03-7.75) remained independently associated with increased risk of ulceration while good dorsiflexion of the ankle (OR 0.88, 95% CI 0.81-0.97) and an effective calf muscle pump (OR 0.96, 95% CI 0.92-0.99) remained protective factors. ROC curve analyses indicated that a model based on clinical observation of skin changes, duplex scanning for popliteal reflux, and calf muscle pump tests would be the most accurate in determining which patients with varicose veins develop leg ulcers. The results of this study confirm that, in patients with varicose veins, those with skin changes of chronic venous insufficiency and deep vein incompetence are at greatly increased risk of ulceration. However, the risks may also be increased in those who smoke, are obese, and have restricted ankle movement and reduced calf muscle pump power.

Ankle Joint Dorsiflexion Measurement Using the Deep Squatting Posture

[Purpose] The purpose of this study was to clarify the intrinsic factors influencing the deep squatting posture and to investigate the utility of ankle joint dorsiflexion measurement using this posture. [Subjects] The study subjects were 71 healthy male individuals. [Methods] The subjects were asked to squatted with their heels down and then were divided into 2 groups: possible squatting and impossible squatting. The anthropometric characteristics of the subjects were assessed, and the flexibility and movement range of the lower extremities were tested. To identify the intrinsic factors influencing the deep squatting posture, a dediscriminant analysis was performed by a stepwise procedure. The sensitivity, specificity, and cutoff values for the factors were evaluated by receiver operating characteristic curve analysis. [Results] Of the 71 participants, 55 were assigned to the possible squatting group and the remaining to the impossible squatting group. Analysis revealed that body weight and ankle dorsiflexion flexibility were significantly associated with ability to assume the deep squatting posture. In particular, ankle dorsiflexion flexibility was strongly associated with the ability to assume this posture. [Conclusion] The impossible squatting group showed reduced ankle dorsiflexion. Thus, the deep squatting posture is useful for easy and objective method for measuring ankle joint dorsiflexion flexibility.

Ankle Flexors Produce Peak Torque at Longer Muscle Lengths after Whole-Body Vibration

Whole-body vibration (WBV) has become a popular training method in recent years. This study investigated the effect of WBV on the length-tension relationship of the ankle dorsi- and plantarflexors as measured by a Biodex dynamometer (Biodex Medical Systems Inc, Shirley, NY). Twenty healthy young adult males participated in this study and were exposed to two treatments. The first treatment (nonvibration) involved passive stretching of the plantarflexors at end range of motion (ROM) for five 1-min bouts. The second treatment involved the same passive stretch with superimposed WBV (frequency = 26 Hz) for five 1-min bouts on a rotary vibration plate (Galileo 900; Novotec, Pforzheim, Germany). Voluntary ROM, peak torque, and corresponding joint angle of the plantar- and dorsiflexors were recorded pre- and posttreatment. Within-treatment (before and after) and between-treatment (WBV and nonvibration) outcomes were assessed by repeated-measures MANOVA. No significant changes in the measures of ankle dorsiflexion were found within or between treatments. No significant changes in the measures of ankle plantarflexion were found after the nonvibration treatment. After WBV, however, there was a significant 7.1 degree shift in the angle (P = 0.001) of peak plantarflexor torque production corresponding to a longer muscle length. This study shows that stretched human ankle plantarflexors respond to WBV by generating peak voluntary torque at longer muscle lengths. This has possible benefits for the rehabilitation of patients with neuromuscular disorders (e.g., stroke) who experience short ankle flexor resting lengths.

Effects of Injection‐Drug Injury on Ankle Mobility and Chronic Venous Disorders

To identify potential confounders and test a causal model of injection-site risk, chronic venous disorders (CVD), and ankle mobility. The reliability and validity of goniometry measurements of ankle mobility were also of interest because they are seldom performed in people with a history of injection-drug use. The study was a test-retest design, consisting of 104 participants from a methadone maintenance treatment center. Each participant provided demographic information, health and drug histories, and underwent bilateral ankle goniometric measures of dorsiflexion, plantar flexion, inversion, and eversion. The clinical portion of the Clinical-Etiology-Anatomy-Pathophysiology (CEAP)was used to classify CVD severity. Reliability of goniometry measurements ranged from .70 to .90. Causal modeling supported hypotheses of increased risk from leg injection and reciprocal effects involving ankle mobility and disease progression. Ankle inversion mobility was the strongest indicator of ankle mobility. Injury to the lower extremities from IDU affected CVD and mobility. Further research should include assessment of comorbidity and other potential confounders. Ankle inversion should remain part of the goniometry assessment.

Use of a Dynamic Foot Pressure Index to Monitor the Effects of Treatment for Equinus Gait in Children With Cerebral Palsy

The purpose of this study is to introduce and describe a newly developed index using foot pressure analysis to quantify the degree of equinus gait in children with cerebral palsy before and after injection with botulinum toxin. Data were captured preinjection and 12 weeks postinjection. Ten children aged 2(1/2) to 6(1/2) years took part (5 boys and 5 girls). Three of them had a diagnosis of spastic diplegia and 7 of congenital hemiplegia. In total, 13 limbs were analyzed. After orientation and segmentation of raw pedobarographic data, we determined a dynamic foot pressure index graded 0 to 100 that quantified the relative degree of heel and forefoot contact during stance. These data were correlated (Pearson correlation) with clinical measurements of dorsiflexion at the ankle (on a slow and fast stretch) and video observation (using the Observational Gait Scale). Pedobarograph data were strongly correlated with both the Observational Gait Scale scores (R = 0.79, P < 0.005) and clinical measurements of dorsiflexion on a fast stretch, which is reflective of spasticity (R = 0.70, P < 0.005). We demonstrated the index's sensitivity in detecting changes in spasticity and good correlation with video observations seems to indicate this technique's potential validity. When manipulated and segmented appropriately, and with the development of a simple ordinal index, we found that foot pressure data provided a useful tool in tracking changes in patients with spastic equinus.

Achilles Tendon Torsion Has No Effect on Percutaneous Triple-Cut Tenotomy Results

Achilles tendon lengthening is an important part of the operative management of numerous foot and ankle disorders. The most commonly used percutaneous technique involves three hemitenotomies: medial, lateral, and medial. The discovery that Achilles tendon fibers may undergo external torsion created concern that improper consideration of this feature could result in fiber division insufficient to allow adequate percutaneous lengthening. Varying degrees of torsion have been reported since it was originally described. We hypothesized that torsion of the Achilles tendon does not decrease the effectiveness of a percutaneous lengthening procedure. This hypothesis was tested by comparing the medial-lateral-medial tenotomy pattern to a lateral-medial-lateral pattern. If tendon torsion affects fiber division, then asymmetrical tenotomy patterns should yield different results. Mechanical testing was performed using 22 human fresh tissue lower extremities. Specimens were divided into two groups (11 in each group): "MLM" which underwent testing using a medial-lateral-medial pattern and "LML" which underwent a lateral-medial-lateral pattern. Dorsiflexion load was applied evenly across the forefoot and measured with a force transducer. Dorsiflexion measurements were made from reproducible reference marks. After testing, specimens were dissected to examine tenotomy gap widths and other tissue effects. All specimens lengthened successfully. None of the following parameters were statistically different: pre-tenotomy or post-tenotomy dorsiflexion, force to lengthen, total tissue lengthening, and individual gap widths. In no specimen was there complete disruption of the Achilles tendon, and in 18 of 22 specimens (81.8%) the paratenon sleeve was intact except for the tenotomy puncture. In one LML specimen, the sural nerve was partially cut at the distal tenotomy site. Regardless of pattern, percutaneous triple-cut Achilles tendon lengthening was effective in achieving additional dorsiflexion at roughly one-third degree per millimeter of tissue lengthening. The pattern of the Achilles tendon lengthening used and, by inference, Achilles tendon torsion had no effect on achievable dorsiflexion. One explanation is that both patterns cut all tendon fibers at least once. We concluded that a properly designed triple-cut tenotomy would be successful regardless of Achilles torsion. Percutaneous Achilles tendon lengthening also appears to be a safe procedure if care is taken to avoid the sural nerve.

Sagittal Plane Range of Motion of the Pediatric Ankle Joint

Measurement of ankle dorsiflexion is a routine part of the podiatric examination of children, yet the reliability of this measure is largely unknown in healthy individuals. This study assessed the intrarater and interrater reliability of the first and second resistance levels of sagittal ankle range of motion in 4- to 6-year-old children. The results show that measures of ankle dorsiflexion in children are highly variable among examiners, and, in general, gastrocnemius range of motion is more reliable than soleal range of motion.

Effects of dorsiflexor endurance exercises on foot drop secondary to multiple sclerosis: A pilot study

This is a pilot study to determine if endurance exercises for dorsiflexors will improve walking for people with foot drop secondary to MS, and if improvement in muscle endurance for persons with MS can be predicted based on the amount of central fatigue (CF) in the muscle. Five individuals with foot drop secondary to MS and five age-matched controls. The intervention was 4 sets of 10 isometric contractions, at 60% of MVC, 3X/week, 8 weeks. Pretests-posttests included a dorsiflexor endurance test with superimposed electrical stimulation to measure CF, and a gait assessment including measurement of dorsiflexion at initial contact. Two of 5 subjects with MS had significant improvement in muscle endurance in both legs and in dorsiflexor control during walking. Correlation between CF and improved endurance was not significant (r=-0.07). One of the subjects with significant improvement in endurance had a significant decrease in central activation failure. For individuals with foot drop secondary to MS, endurance exercises for the dorsiflexors can result in improved walking. CF may not be useful in predicting whether a muscle will improve in endurance with exercise. Improvement may result from either a peripheral training effect, a central learning effect, or both.

A Mechanical Equinometer to Measure the Range of Motion of the Ankle Joint: Interobserver and Intraobserver Reliability

Clinical measurement of passive dorsiflexion of the ankle joint is essential for the diagnosis of various pathologic conditions of the foot and ankle but is of unreliable precision with high interobserver variability in nonweightbearing tests. This work was designed to develop and test a precise, standardized, and reliable technique for measurement of passive and active ankle range of motion. The proposed measurement tool is composed of two mobile parallelograms, one attached to the tibia, the second one to the plantar surface of the foot. The parallelograms are connected with a hinge with an angular scale to measure the angle between the foot and tibia. Interobserver correlation between clinical measurements for maximal passive foot dorsiflexion were 0.03 with knee extension and 0.38 with knee flexion, while for measurements with the proposed tool they reached 0.89 and 0.97, respectively, with a mean measurement error of 0.9 degrees. Intraobserver correlations reached values of r = 0.98 and 0.99. The proposed tool allows measurement of the ankle range of motion with very high precision and reproducibility far superior to clinical measurements. Precise measurement of ankle range of motion is clinically challenging. With the use of the proposed tool, measurement precision and reliability are decisively improved.

Investigation into the relationship between the passive flexibility and active stiffness of the ankle plantar-flexor muscles

Objective. The purpose of the study was to investigate the relationship between measurements of passive flexibility and active stiffness of the ankle plantar-flexor muscles. Design. The study was a correlation design. Background. Flexibility has passive and active components. Little information is available regarding the relationship of these measurements in terms of the information that they yield on the state of the muscle–tendon unit. Methods. Free oscillation data representing active stiffness was obtained using applied masses equivalent to 30%, 60% and 90% of the subject’s maximal voluntary contraction. The angle of dorsiflexion, representing passive flexibility, was measured in standing using computer digitisation to obtain the angle. Results. Mean active stiffness values were 14280 N/m (30% maximal voluntary contraction), 22260 N/m (60% maximal voluntary contraction) and 28010 N/m (90% maximal voluntary contraction). Dorsiflexion measurement gave a mean of 34.3 degrees (S.D. 4.8). Correlation’s obtained for the association between range of motion and active stiffness were r=0.01 (30% maximal voluntary contraction), r=0.09 (60% maximal voluntary contraction) and r=0.04 (90% maximal voluntary contraction). Moderate reliability coefficients of 0.71 (30% maximal voluntary contraction), 0.78 (60% maximal voluntary contraction) and 0.68 (90% maximal voluntary contraction) were obtained. Conclusions. The results imply that measurements of passive flexibility and active stiffness of the lower leg musculature are independent measures of components of muscle–tendon unit flexibility. Relevance Flexibility is a construct with different components of measurement. Etiological studies typically relate static flexibility measurements to injury with conflicting outcomes. This study suggests that static and active flexibility measures yield different information about the muscle tendon unit of the ankle plantar flexors, and that researchers should consider this point in the design of etiological studies.

RELATIONSHIP OF PSYCHOLOGICAL, ANATOMICAL AND ACHIEVEMENT MOTIVATION GOALS TO INJURY CONDITIONS IN PROFESSIONAL SOCCER PLAYERS

196 The purpose of this study was to assess the relationship of personality, anatomical variables and achievement motivation goal variables to injury conditions in professional soccer players. Fourteen professional soccer players were participants in the study. Data were collected on each player for demographic variables, anatomical measures, flexibility measures, achievement motivation goals and personality variables. All interclass correlations for test-retest were above r=.90. Data were analyzed using Pearson correlations. Results indicated the following relationships: high positive correlations existed between injury occurrence with active hamstring flexibility on the right side, and all left and right side measures of flexibility except for moderate correlations on measures of plantar and dorsiflexion when the knee was extended. Moderate positive correlations existed between the following variables: ego with anxiety, days trained per week with personality, and injury occurrence with active hamstring flexibility on the left side. Inverse relationships existed between the following variables: personality with how much one weight trained per week, age with anxiety, and years of participation with anxiety. The results suggest that greater active hamstring flexibility may indicate a tendency for injury occurrence. Players who tend to be a more type A personality weight train less, but in general spend more days per week practicing. Level of anxiety is reduced as age and number of years of participation increase. However, level of anxiety seems to increase the greater the ego of the player. The players who are more task oriented appear to practice more hours per week.

20.1 Long-term clinical follow-up of venous thrombolysis

Identifying which patients with varicose veins are at risk of progressing to more severe forms of chronic venous disease could help in assigning clinical priorities and targeting appropriate treatments. The aim of this study was to determine, in subjects with varicose veins, the characteristics of venous disease and other factors associated with an increased risk of ulceration.One hundred twenty subjects with varicose veins and an open or healed venous leg ulcer were compared with 120 controls with varicose veins and no history of venous ulcer on this case control study. Subjects were recruited from hospital settings and primary care. Each subject completed a questionnaire on lifestyle and medical history and underwent an examination comprising of clinical classification of venous disease (CEAP), duplex scanning, quantitative digital photoplethysmography, and measurement of dorsiflexion. Multiple logistic regression analyses and calculation of receiver operating characteristic (ROC) curves were performed to identify the combination of factors which most accurately predicted which patients with varicose veins will develop leg ulcers.An increased risk of ulceration was associated with the severity of clinical venous disease, especially with the presence of skin changes (P < .0001). Other significant risk factors included history of deep vein thrombosis (DVT) (P = .001), higher body mass index (BMI) (P = .006), smoking (P = .009), and reflux in the deep veins (P = .0001). Ulceration was associated with reduced volume of blood displaced as reflected by photoplethysmography and a limited range of ankle movement (not wholly due to the effects of an active ulcer) (both P < .05). Multivariate analyses showed that skin changes including lipodermatosclerosis (odds ratio [OR] 8.90, 95% confidence interval [CI] 1.44-54.8), corona phlebectatica (OR 4.52, 95% CI 1.81-11.3) and eczema (OR 2.87, 95% CI 1.12-7.07), higher BMI (OR 1.08, 95% CI 1.01-1.15), and popliteal vein reflux (OR 2.82, 95% CI 1.03-7.75) remained independently associated with increased risk of ulceration while good dorsiflexion of the ankle (OR 0.88, 95% CI 0.81-0.97) and an effective calf muscle pump (OR 0.96, 95% CI 0.92-0.99) remained protective factors. ROC curve analyses indicated that a model based on clinical observation of skin changes, duplex scanning for popliteal reflux, and calf muscle pump tests would be the most accurate in determining which patients with varicose veins develop leg ulcers.The results of this study confirm that, in patients with varicose veins, those with skin changes of chronic venous insufficiency and deep vein incompetence are at greatly increased risk of ulceration. However, the risks may also be increased in those who smoke, are obese, and have restricted ankle movement and reduced calf muscle pump power.

Ankle joint dorsiflexion measurement studies. A review of the literature.

A spectrum of techniques exists to measure ankle joint dorsiflexion range of motion. However, information pertaining to the objective assessment of ankle joint dorsiflexion is controversial. Different study designs make comparisons of studies difficult which leads to measurement error. These errors can be related to the examiner, the subject, or the procedure. This author reviews the sources of measurement inaccuracies within the clinical setting and describes effective interventions used to reduce measurement error.

Reliability of Passive Ankle Dorsiflexion Measurements in Children

The reliability of measurements of passive ankle dorsiflexion obtained in children using both the Universal Goniometer (UG) and an adapted Biplane Goniometer (BPG) was studied. Twenty-five children were measured from each of 3 diagnostic categories: juvenile rheumatoid arthritis (JRA), cerebral palsy (CP), and nondisabled (ND) (N = 75). Five pairs of raters each measured five children from each diagnostic category. Generalizability theory provided a framework to determine the standard error of measurement (SEM) associated with each goniometer under different situations. Results revealed that the amount of error associated with each goniometer was similar when both rater and time were random, and ranged from +6.50 for the CP group to +4.40 for the JRA group. Error was reduced by almost half in all diagnostic groups by fixing either occasion or rater, or by taking the average of one rater's two consecutive measurements. Clinically, the goniometers can be used interchangeably and averaging of measurements is recommended.

Reliability of Passive Ankle Dorsiflexion Measurements in Children

The reliability of measurements of passive ankle dorsiflexion obtained in children using both the Universal Goniometer (UG) and an adapted Biplane Goniometer (BPG) was studied. Twenty-five children were measured from each of 3 diagnostic categories: juvenile rheumatoid arthritis (JRA), cerebral palsy (CP), and nondisabled (ND) (N = 75). Five pairs of raters each measured five children from each diagnostic category. Generalizability theory provided a framework to determine the standard error of measurement (SEM) associated with each goniometer under different situations. Results revealed that the amount of error associated with each goniometer was similar when both rater and time were random, and ranged from +6.50 for the CP group to +4.40 for the JRA group. Error was reduced by almost half in all diagnostic groups by fixing either occasion or rater, or by taking the average of one rater's two consecutive measurements. Clinically, the goniometers can be used interchangeably and averaging of measurements is recommended.

Effect of Foot Position on Gastrocnemius/Soleus Stretching in Subjects With Normal Flexibility

Following injury to the ankle or lower extremity, stretching of the gastrocnemius/soleus complex is commonly prescribed. Many authors recommend stretching the gastrocnemius/soleus complex with the foot placed in a supinated position. No research is available, however, that supports the efficacy of stretching in the supinated vs. the pronated position. Therefore, the purpose of this study was to compare the effect of stretching the gastrocnemius/soleus complex in two foot positions: supinated and pronated. Eleven female and eight male subjects completed 10 stretching sessions with one foot supinated and the other foot pronated. Each stretching session consisted of four 20-second stretches. On pretest and posttest measurements, maximum dorsiflexion range of motion and stretching force exerted through the foot were recorded for each subject. Foot position for the testing procedures and the stretching phase was standardized with individually constructed footprint templates. A two-way analysis of variance (stretching position and time) was used to compare pretest and posttest ankle dorsiflexion measurements. Results indicated a significant increase in dorsiflexion (p = 0.01, pronation + 6.36%, supination + 6.24%) but no significant difference between stretching positions (p = 0.23). We concluded that gastrocnemius/soleus complex stretching in either foot position is effective for increasing dorsiflexion range of motion in healthy subjects with normal flexibility of the gastrocnemius/soleus complex.

The measurement of ankle movements—a new method

We describe a new goniometer ∗ ∗ Enquiries about availability to: G.R. Plant, Department of Medical Physics, Nottingham General Hospital, Park Row, Nottingham. for the measurement of dorsiflexion and plantarflexion of the ankle. It has been assessed for ease of use and reliability.