Weight-bearing Ankle Dorsiflexion Research Articles

Comprehensive corrective exercise program improves ankle function in female athletes with limited weight-bearing ankle dorsiflexion: A randomized controlled trial.

Limited ankle dorsiflexion range of motion is one of the most important risk factors for lower limb injury, which changes the biomechanics and the neuromuscular control of the lower limb muscles. This study aims to test the effectiveness of a comprehensive corrective exercise program (CCEP) on the range of motion, proprioception, dynamic balance, and muscle activation in female athletes with limited weight-bearing lunge ankle dorsiflexion range of motion. 30 female athletes aged 15 to 25 years with dorsiflexion under 34° were randomized to two groups. The intervention group (n = 15) received eight weeks of CCEP including soft tissue mobilization, joint mobilization, stretching, and strengthening, and the control (n = 15) group did not receive any intervention. range of motion, proprioception, dynamic balance, and muscle activation were assessed before and after the intervention. The training group showed clinically acceptable and statistically significant changes in ankle dorsiflexion range of motion (ES = 0.714), balance (ES = 0.423), and proprioception (ES = 0.253; P < 0.05). There were significant changes in the activity of the tibialis anterior and soleus muscles in the dynamic overhead squat test (descending and ascending phases) and the activity of the medial gastrocnemius in the descending phase decreased significantly (P < 0.05). No significant change was observed in the activity of the peroneus longus muscle (P > 0.05). The findings show that CCEP appears to be beneficial in increasing dorsiflexion range of motion, proprioception, balance, and decreasing ankle muscle activity among individuals with limited ankle dorsiflexion. Improving the dorsiflexion range of motion may be promising for reducing ankle sprain injury.

Establishing a Reference Database for Select Clinical Measures in National Basketball Association Players.

Musculoskeletal injuries are prevalent in the NBA and are associated with a significant number of games missed. There is a lack of reference data for clinical measures in NBA players, making it difficult for sports medicine professionals to set goals and develop programs. Values for clinical measures in NBA players will differ from those of the general population but will not differ between dominant (D) and nondominant (ND) limbs. Descriptive laboratory study. Level 3. Clinical measures were taken on 325 players invited to NBA training camp (2008-2022). Measures included range of motion for great toe extension, hip rotation, weightbearing ankle dorsiflexion, flexibility, arch height (AH) indices, and tibial varum. Clinical values for NBA players differ from reference norms of the general population. Results for NBA players include great toe extension (D, 40.4°; ND, 39.3°), 90/90 hamstring (D, 41.5°; ND, 40.9°), hip internal rotation (D, 29.0°; ND, 28.8°), hip external rotation (D, 29.7°; ND, 30.9°), total hip rotation (D, 60.2°; ND, 60.4°), Ely (D, 109.9°; ND, 108.8°), AH difference (D, 0.5 mm; ND, 0.5 mm), AH index (D, 0.310; ND, 0.307), arch stiffness (D, 0.024; ND, 0.024), arch rigidity (D, 0.924; ND, 0.925), tibial varum (D, 4.6°; ND, 4.5°), and weightbearing ankle dorsiflexion (D, 35.4°; ND, 35.6°). Descriptive statistics are presented; 2-tailed paired t tests show that, whereas most measures demonstrated differences between sides, the results were not statistically significant. Clinical measures of NBA players differ from those reported for the general population and athletes of other sports although there were no statistically significant differences between D and ND limbs. Establishing a reference database may help clinicians develop more sensitive and more effective preseason and return-to-play screening processes, aiding the management of player orthopaedic care and reducing injury risk.

Immediate effects of TECAR therapy on lower limb to decrease hypertonia in chronic stroke survivors: a randomized controlled trial

Purpose To analyze immediate effects of TECAR therapy (TT) to reduce lower limb hypertonia and improve functionality in chronic post-stroke. Materials and methods It is a single-blind randomized controlled clinical trial. A total of 36 chronic stroke survivors were divided into two groups. The experimental group received a single 30-minute session of TT with functional massage (FM) on lower limb. The control group received a single 30-minute session sham treatment of TT plus FM. The primary outcome measure was hypertonia (Modified Ashworth Scale, MAS). Secondary outcomes were gait speed (4-Meter Walk-Test), standing knee-flexion (Fugl-Meyer Assessment Scale IV-item), change in weight bearing ankle dorsiflexion (Ankle Lunge Test, ALT), and functional lower limb strength (5-Times Sit-to-Stand Test). All measurements were performed at baseline, immediately and 30-minutes after treatment. Results There was a group–time interaction in MAS-knee (p = 0.044), MAS-ankle (p = 0.018) and ALT (p = 0.016) between T1 and T0 (p<.0001) and T2 and T0 (p<.0001) for the experimental group. There was a significant increase in ALT between T1 and T0 (p = 0.003) in the control group. Conclusions A single session of TT performed at the same time as FM immediately reduces plantar-flexors and knee-extensor muscle hypertonia and increases change in weight bearing ankle dorsiflexion in chronic stroke survivors.

Single-Leg Heel Raise Capacity is Lower, and Perceived Ankle Instability is Greater, in Dancers and Athletes With Posterior Ankle Impingement Syndrome.

To compare clinical assessment findings between elite athletic populations with and without a clinical diagnosis of posterior ankle impingement syndrome (PAIS). Cross-sectional case-control study. Elite ballet and sport. Ten male and female professional ballet dancers and athletes with a clinical diagnosis of PAIS and were matched for age, sex, and activity to 10 professional ballet dancers and athletes without PAIS. Posterior ankle pain on body chart and a positive ankle plantarflexion pain provocation test. Single-leg heel raise (SLHR) endurance test, range of motion testing for weight-bearing ankle dorsiflexion, passive ankle plantarflexion, and first metatarsophalangeal joint dorsiflexion, and Beighton score for generalized joint hypermobility. Participants also completed the Cumberland Ankle Instability Tool (CAIT) questionnaire. The group with PAIS achieved significantly fewer repetitions on SLHR capacity testing ( P = 0.02) and were more symptomatic for perceived ankle instability according to CAIT scores ( P = 0.004). Single-leg heel raise endurance capacity was lower, and perceived ankle instability was greater in participants with PAIS. The management of this presentation in elite dancers and athletes should include the assessment and management of functional deficits.

"Evaluation of Weight-bearing Ankle Dorsiflexion Range in Professional Soccer Players"

"Evaluation of Weight-bearing Ankle Dorsiflexion Range in Professional Soccer Players"

Dose-response of talus mobilizations in weight bearing ankle dorsiflexion ROM of the older adults with limited ankle mobility: A randomized clinical trial

BackgroundAlthough manual therapy is an effective technique for increasing ankle range of motion, the dose-response required is unclear. ObjectiveTo find out what number of sessions of talus mobilizations will induce a detectable change in weight bearing ankle dorsiflexion range of motion of older adults with limited ankle mobility. DesignFour-arm randomized clinical trial. SettingCommunity-dwelling. Methods62 older adults; aged over 60; with ankle dorsiflexion ROM below 35°. Four groups received from one to four treatment sessions. Each session consisted of 3 mobilizations of 30 s, with of the talus in anteroposterior glide, with a rest of 30 s. Grade IV mobilizations were applied to target the accessory movement of the ankle up to the resistance offered by periarticular tissues. The Lunge test was used to measure weight bearing ankle dorsiflexion. ResultsThe four groups increased their ankle mobility after one session, but two sessions were needed to overcome the established 4.7°’ threshold, regardless of group. Only those participants who received four sessions maintained the improvements for 8 weeks. ConclusionsTwo sessions of talus mobilizations are effective in improving weight bearing ankle dorsiflexion ROM. It will be necessary to deliver four sessions of treatment if these improvements are to be maintained for at least 8 weeks. Clinical trial registration numberNCT04563663.

Altered Ankle Muscle Activation at 2-Year Post Achilles Tendon Repair: An Age, Gender, and Activity Level-Matched Comparison With Healthy Subjects.

The study purpose was to compare the ankle muscle activation and dynamic ankle joint stability of subjects who underwent endoscopy-assisted Achilles tendon repair (ATR; at ≥ 2y postsurgery) with age, gender, and activity level-matched healthy control group subjects. Prospective, cross-sectional study. All functional tests were performed on the involved ankle of the ATR group, and at the matched side of healthy age, gender, and activity-level control group subjects. Fifteen men in each group were evaluated for medial and lateral gastrocnemius, soleus, tibialis anterior, and peroneus longus muscle activation during modified star excursion balance test and heel-rise test performance. The weight-bearing lunge test (ankle dorsiflexion) and heel-rise test distance (ankle plantar flexion) also determined weight-bearing, active ankle mobility magnitudes. The Achilles Tendon Total Rupture Score and Foot and Ankle Outcome Score provided patient-reported outcome perceptions specific to Achilles tendon rupture and comprehensive foot and ankle symptoms and function, respectively. Medial (P = .005) and lateral (P = .012) gastrocnemius displayed greater activation amplitudes in the ATR group during the star excursion balance test, and peroneus longus displayed greater activation amplitudes during the heel-rise test (P = .006). The star excursion balance test reach distance was comparable between groups. Active weight-bearing ankle plantar flexion (heel-rise test) and dorsiflexion (weight-bearing lunge test) mobility magnitudes were lower in the ATR group. Subjects who underwent endoscopy-assisted percutaneous ATR had reduced active weight-bearing ankle dorsiflexion and plantar flexion mobility magnitudes and greater gastrocnemius and peroneus longus neuromuscular activation when performing the same tasks as healthy control group subjects. As surgical approaches evolve to less invasive, soft tissue preserving methods with less tissue morbidity and faster healing, rehabilitation approaches may likewise need to evolve. Level III.

Association of Proximal and Distal Factors With Lower Limb Kinematics During a Classical Ballet Jump

Excessive dynamic lower limb misalignment may predispose ballet dancers to jump-related injuries. However, it is unknown whether proximal and distal factors influence this movement pattern. The aim of this study was to investigate whether hip abduction strength, foot alignment, and ankle dorsiflexion range of motion (ROM) are associated with peak angles of hip adduction and internal rotation and knee abduction during the preparation and landing phases of a classical ballet jump. Cross-sectional study. Forty-one healthy amateur ballet dancers were included. Hip abduction strength was evaluated isometrically using a handheld dynamometer, foot alignment was determined by the shank-forefoot alignment, and weight-bearing ankle dorsiflexion ROM was measured by performing the lunge test. Peak hip and knee angles were analyzed 3-dimensionally during the preparation and landing phases of a single-leg jump. A Pearson correlation matrix was used to investigate the association of hip abduction strength, shank-forefoot alignment, and ankle dorsiflexion ROM with peak angles of hip adduction and internal rotation and knee abduction during the preparation and landing phases of the jump. Greater hip abduction strength was associated with greater peak hip internal rotation angle (r = .43, P < .05), but not with peak hip adduction and knee abduction angles during the preparation phase of the jump. There were no associations of shank-forefoot alignment and ankle dorsiflexion ROM with peak hip and knee angles during the preparation (r = -.23 to .36, P > .05) and landing (r = -.20 to .24, P > .05) phases of the jump. There was no association of hip abduction strength with peak hip and knee angles during the landing phase of the jump (r = -.28 to .16, P > .05). Hip abductors strengthening, correction of foot misalignments, and increasing ankle dorsiflexion ROM may not prevent excessive hip and knee movements during a classical ballet single-leg jump in amateur dancers.

THE LEVEL OF DORSIFLEXION IN YOUNG GYMNASTS COMPARED TO YOUNG ATHLETES - PILOT STUDY

Gymnastic training develops strength, flexibility, concentration, balance, precision, and speed. The purpose of the study is to determine if gymnastic preparation leads to an increase in weight-bearing ankle dorsiflexion range of motion in a closed kinematic chain in young artistic gymnasts compared to a different type of sport. The weight-bearing lunge was chosen to measure the dorsiflexion range of motion in the ankle joint in the closed kinematic chain. The first group consists of members of the Slovak national youth team in artistic gymnastics (n-26). The second group consists of members of the Slovak national team in rhythmic gymnastics (n-13). The control group consists of young athletes (n-22). The mean dorsiflexion range of motion in artistic gymnasts was 47.32 ° in the right ankle joint and 44.75 ° in the left ankle joint. The mean dorsiflexion range of motion in rhythmic gymnasts was 44.32 ° in the right ankle joint and 43.41 ° in the left ankle joint. The mean dorsiflexion range of motion in young athletes was 44.27 ° in the right ankle joint and 42.32 ° in the left ankle joint. Results indicate a statistically significant difference in favor of artistic gymnasts compared to rhythmic gymnasts at the right ankle joint (p-0.04). In the left ankle, the two groups did not differ significantly from each other (p-0.38). There was no significant difference between artistic gymnasts and athletes in the right ankle joint (p-0.09) and the left ankle joint (p-0.19). There was no significant difference between rhythmic gymnasts and athletes at the right ankle joint (p-0.38) and the left ankle joint (p-0.24). A greater dorsiflexion range of motion in a closed kinematic chain in the ankle joint was detected in young gymnasts compared to rhythmic gymnasts. There was no significant difference between artistic gymnasts and athletes.

Inter and Intra Rater Reliability of Different Measurement Techniques of Weight Bearing Ankle Dorsiflexion Range of Motion

Background: Measurement of range of motion is a crucial parameter in the physiotherapeutic evaluation and follow up. Ankle dorsiflexion is important for functional activities like running, jogging, waking, stair climbing. Restricted ankle dorsiflexion is seen in various lower limb injuries. Therefore, assessment of dorsiflexion is important to assess function. Goniometer, tape measure, mobile goniometer, inclinometer is used to measure ankle dorsiflexion range of motion in weight bearing and non-weight bearing positions. Weight bearing dorsiflexion has reported higher intra and inter-rater reliability as compared to non-weight bearing ankle dorsiflexion. All these measures may be taken by the same and by different therapists in the management of one patient. Therefore, it is necessary to determine if the measurements used are reliable both within and between the therapists. Material and Methods: 50 healthy subjects were recruited and their role was explained in the study. Written consent was taken from all the subjects. Weight bearing lunge was done in which the subject was asked to stand with the heel in contact with the ground and the great toe 10 cm away from the wall and the knee touching the wall. Inclinometer, standard goniometer, mobile goniometer and tape measure were administered to check for ankle dorsifexion range of motion. Results: ICC for inter rater reliability was almost perfect for tape measure and goniometer (0.968 and 0.837 respectively) and it was substantial for inclinometer and mobile goniometer (0.746 and 0.796 respectively). ICC for intra rater reliability was almost perfect for tape measure, inclinometer and goniometer (0.965,0.894 and 0.837 respectively) and it was substantial for mobile goniometer (0.802). Conclusion: The inter-rater reliability of tape measure, goniometer is almost perfect and for mobile goniometer, inclinometer is substantial. The intra rater reliability of tape measure, inclinometer, goniometer is almost perfect and mobile goniometer is substantial. KEY WORDS: Dorsiflexion, Mobile goniometer, Tape measure, Goniometer, Inclinometer, Reliability.

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.

Reliability of the weight-bearing ankle dorsiflexion range of motion measurement using a smartphone goniometer application.

BackgroundWeight-bearing ankle dorsiflexion range of motion measurement (weight-bearing lunge test) is gaining in popularity because it mimics lower extremity function in daily physical activities. The purpose of the study is to assess the intra-rater and the inter-rater reliability of the weight-bearing ankle dorsiflexion range of motion measurement with a flexed knee using a smartphone application Spirit Level Plus installed on an Android smartphone.MethodsThirty-two young, healthy subjects participated in the study and were measured in four sessions by two examiners. One measurement was taken on each ankle in every session. Eight measurements were taken from each participant. A total of 256 were taken from all the participants. The measurements for the individual subject were repeated no sooner than 24 hours after the first session. In order to assess the reliability, intraclass correlation coefficients (ICC), standard error measurements (SEM) and minimal detectable change (MDC) at the 95% confidence interval were calculated.ResultsStatistical data analysis revealed moderate intra-rater reliability for the right ankle (ICC = 0.72, 95% CI [0.49–0.85]) and good intra-rater reliability for the left ankle (ICC = 0.82, 95% CI [0.66–0.91]). Inter-rater reliability is moderate for the right (ICC = 0.73, 95% CI [0.52–0.86]) and the left ankle (ICC = 0.65, 95% CI [0.39–0.81]).ConclusionThe observed method is moderately reliable and appropriate when the main objective is to assess ankle dorsiflexion mobility in weight-bearing when weight-bearing is not contraindicated. The concurrent validity of the Spirit Level Plus application is excellent.

Preseason weight-bearing ankle dorsiflexion in male professional football players with and without a history of severe ankle injury: A novel analysis in an English Premier League club

ObjectivesAnkle injuries are common in professional football and have profound player/team/club consequences. The weight-bearing lunge-test (WBLT) assesses ankle dorsiflexion range-of-motion in football primary/secondary injury prevention and performance contexts. Data for uninjured and previously ankle-injured players in the English Premier League (EPL) is not available. This study analysed WBLT measurements (cm) within and between uninjured and previously severe ankle-injured players (injured-stiff group, injured-lax group) in one EPL club. DesignCross-sectional. SettingPreseason. ParticipantsForty-nine players (age 22.9 ± 4.6 yr; height 181.6 ± 5.2 cm; mass 77.7 ± 7.6 kg). Main outcome measuresPrevalence (%) of previous unilateral severe ankle injury (USAI). Side-to-side (right/left, dominant/nondominant, injured/uninjured) WBLT comparisons at group-level (t-test [within-group]; Welch's ANOVA [between-group]; effect sizes [within-/between-group]) and individual-level (limb symmetry index [%]; absolute-asymmetry [%]). ResultsPrevalence of USAI was 38.7%. There were no statistically-significant side-to-side differences for within-/between-group comparisons. Effect sizes: just-below-large (injured-stiff) and extremely-large (injured-lax) for within-group injured-side/uninjured-side comparisons; just-below-medium (injured-lax) to just-above-medium (injured-stiff) for injured-side comparisons to uninjured players. Absolute-asymmetries: uninjured players, 15.4±13.2%; injured-stiff, 21.8±33.6%; injured-lax 20.4±13.6%. ConclusionsOver one-third of players had previous USAI. Effect sizes indicate substantial within-group side-to-side differences and less substantial between-group differences. Across groups, some players had absolute-asymmetries that may elicit concern in ankle primary/secondary injury prevention and performance contexts.

Static Ankle Dorsiflexion and Hip and Pelvis Kinematics During Forward Step-Down in Patients With Hip-Related Groin Pain.

The authors hypothesized that in people with hip-related groin pain, less static ankle dorsiflexion could lead to compensatory hip adduction and contralateral pelvic drop during step-down. Ankle dorsiflexion may be a modifiable factor to improve ability in those with hip-related groin pain to decrease hip/pelvic motion during functional tasks and improve function. To determine whether smaller static ankle dorsiflexion angles were associated with altered ankle, hip, and pelvis kinematics during step-down in people with hip-related groin pain. Cross-sectional Setting: Academic medical center. A total of 30 people with hip-related groin pain (12 males and 18 females; 28.7 [5.3]y) participated. None. Weight-bearing static ankle dorsiflexion with knee flexed and knee extended were measured via digital inclinometer. Pelvis, hip, and ankle kinematics during forward step-down were measured via 3D motion capture. Static ankle dorsiflexion and kinematics were compared with bivariate correlations. Smaller static ankle dorsiflexion angles were associated with smaller ankle dorsiflexion angles during the step-down for both the knee flexed and knee extended static measures. Among the total sample, smaller static ankle dorsiflexion angle with knee flexed was associated with greater anterior pelvic tilt and greater contralateral pelvic drop during the step-down. Among only those who did not require a lowered step for safety, smaller static ankle dorsiflexion angles with knee flexed and knee extended were associated with greater anterior pelvic tilt, greater contralateral pelvic drop, and greater hip flexion. Among those with hip-related groin pain, smaller static ankle dorsiflexion angles are associated with less ankle dorsiflexion motion and altered pelvis and hip kinematics during a step-down. Future research is needed to assess the effect of treating restricted ankle dorsiflexion on quality of motion and symptoms in patients with hip-related groin pain.

Association ankle function and balance in community-dwelling older adults.

Ankle function declines with age. The objective of this study was to investigate the association between ankle function and balance in older adults, with a focus on range of motion (ROM) and strength. This was a cross-sectional study that included 88 healthy community-dwelling older adults. Ankle mobility was measured while bearing weight (lunge test) and not bearing weight. The plantar-flexor muscle strength was assessed using a hand-held dynamometer. Balance was measured in terms of dynamic balance and mobility (timed up and go test), monopodal and bipodal static balance with open and closed eyes (single-leg stand test and platform measures), and margins of stability (functional reach test). Linear correlation and multiple regression analyses were conducted with a 95% CI. Most participants had limited ankle mobility (n = 75, 86%). Weight-bearing ankle dorsiflexion ROM was the strongest predictor of dynamic balance and included general mobility and stability ([Formula: see text] = [0.34]; β = [-0.50]). In contrast, plantar-flexor muscle strength was a significant predictor of static standing balance with open eyes ([Formula: see text] = [0.16-0.2]; β = [0.29-0.34]). Overall, weight-bearing ankle dorsiflexion ROM was a more representative measure of balance and functional performance; however, a non-weight-bearing mobility assessment provides complementary information. Therefore, both measures can be used in clinical practice. This study supports the concept that ankle mobility contributes to the performance of dynamic tasks, while the plantar-flexor muscle strength helps to develop a standing static balance. Identification of alterations in ankle function is warranted and may assist in the design of tailored interventions. These interventions can be used in isolation or to augment conventional balance training in order to improve balance performance in community-dwelling older adults.

Clinical foot measurements as a proxy for plantar pressure testing in people with diabetes

BackgroundHigh plantar pressures are associated with increased foot ulcer risk in people with diabetes. Identification of high plantar pressures in people with diabetes is clinically challenging due to time and cost constraints of plantar pressure testing. Factors affecting foot biomechanics, including reduced joint range of motion and foot deformity, are implicated in the development of high plantar pressures and may provide a method to clinically identify those at risk of pressure related complications. The aim of this study was to investigate the contribution of joint range of motion and foot deformity measures on plantar pressures in a community dwelling group with diabetes.MethodsBarefoot (Tekscan HR Mat™) and in-shoe (Novel Pedar-X®) plantar pressure variables, weight bearing ankle dorsiflexion, hallux range of motion, lesser toe deformities and hallux abductus (HAV) scale were assessed in 136 adults with diabetes (52.2% male; mean age 68.4 years). Multivariate multiple linear regression was used to assess the effect of the four biomechanical factors plus neuropathy and body mass index on plantar pressure variables. Non-parametric bootstrapping was employed to determine the difference in plantar pressure variables for participants with two or more foot biomechanical pathologies compared to those with less than two pathologies.ResultsAlmost one third (32%) of the cohort had two or more foot biomechanical pathologies. Participants with two or more foot biomechanical pathologies displayed significant increases in all barefoot plantar pressure regions (except forefoot), compared to those with less than two pathologies. No significant changes were found for the in-shoe plantar pressure variables. The regression model explains between 9.9% (95%CI: 8.4 to 11.4%) and 29.6% (95% CI: 28.2 to 31%), and between 2.5% (1.0 to 4.0%) and 43.8% (95% CI: 42.5–44.9%), of the variance in the barefoot and in-shoe plantar pressure variables respectively.ConclusionsParticipants presenting with two or more factors affecting foot biomechanics displayed higher peak pressures and pressure time integrals in all foot regions compared to those with less than two factors. The tests used in this study could help clinicians detect elevated plantar pressures in people with diabetes and present an opportunity for early preventative interventions.

Lateral Ankle Sprains and Their Association with Physical Function in Young Soccer Players.

PurposeLateral ankle sprain (LAS) in childhood can result in lateral malleolus avulsion fractures; additionally, bone nonunion may occur. Physical maturity relates to the development of bone morphology and physical functionality. It is unknown how changes in physical functionality attributable to physical maturity affect young soccer players with abnormal lateral malleolus (ALM) morphology. Hence, the present study aimed to investigate the bone morphology of the lateral malleolus in young soccer players and to examine its relationship with physical functionality at different maturity levels.Subjects and MethodsTwo hundred and ninety young soccer players aged 6–15 years were included. The presence of ALM was assessed using ultrasonography. The subjects were allocated to three groups based on physical maturity (Pre-, Mid-, and Post-peak height velocity age [PHVA]). The prevalence of ALM and the relationship between ALM and physical maturity were examined for body composition, foot pressure distribution, foot alignment, ankle mobility, and single-leg balance.ResultsThe prevalence of ALM was 17.6%. For physical maturity, the post-PHVA group showed a decrease in ankle dorsiflexion and eversion and an increase in one-leg hop distance compared to the Pre-PHVA group (P < 0.05). In the ALM group, the center of pressure during heel raising was distributed laterally in the Post-PHVA (P < 0.01), and the weight-bearing dorsiflexion angle was decreased in the Mid- and Post-PHVA (P < 0.05).ConclusionIn the Post-PHVA young soccer players, decreased ankle dorsiflexion and eversion and increased one-leg hop distance were observed. The ALM group exhibited lateral loading during heel raising in the Post-PHVA group and decreased weight-bearing ankle dorsiflexion angle in the Mid- and Post-PHVA groups. The findings indicate the importance of secondary prevention of LAS and ultrasonography. Prospective studies of LAS in young athletes are required in the future.

A Randomized Controlled Trial Assessing the Evolution of the Weight-Bearing Ankle Dorsiflexion Range of Motion Over 6 Sessions of Talus Mobilizations in Older Adults.

Ankle range of motion declines with age, affecting mobility and postural control. The objective of this study was to investigate the effects of a talus mobilization-based intervention among healthy community-dwelling older adults presenting with limited weight-bearing ankle dorsiflexion range of motion and determine how ankle mobility evolved over the treatment. This was a randomized clinical trial. This study was conducted in an outpatient clinic. Community-dwelling, older adults over 60 years of age who had limited ankle mobility participated in this study. The experimental intervention consisted of 6 sessions of manual therapy applied in the ankle joint. The control group received the same volume of sham treatment. The primary outcome was the weight-bearing ankle dorsiflexion range of motion as measured using the lunge test. Data were collected at 9 time points: baseline, after each session, and follow-up. A total of 36 participants were analyzed. A single session of mobilization increased ankle range of motion by 8 degrees (95% confidence interval = 6 to 11). At the end of the sixth session, this effect had increased slightly to 11 degrees (95% confidence interval = 9 to 13). Significant between-group differences were found throughout the intervention. Optimal dose and effects from follow-up evaluations for treatment volumes of fewer than 6 sessions remain unknown. Six sessions of a talus mobilization-based intervention in healthy community-dwelling older adults found that the greatest mobility gain in terms of the weight-bearing ankle dorsiflexion range of motion is produced after the first session. Additional sessions produce smaller improvements with a slight upward trend. Importantly, the restoration of joint mobility is enhanced over time after the end of the intervention.

Validity and Reliability of an Inertial Device for Measuring Dynamic Weight-Bearing Ankle Dorsiflexion.

A decrease in ankle dorsiflexion causes changes in biomechanics, and different instruments have been used for ankle dorsiflexion testing under static conditions. Consequently, the industry of inertial sensors has developed easy-to-use devices, which measure dynamic ankle dorsiflexion and provide additional parameters such as velocity, acceleration, or movement deviation. Therefore, the aims of this study were to analyze the concurrent validity and test-retest reliability of an inertial device for measuring dynamic weight-bearing ankle dorsiflexion. Sixteen participants were tested using an inertial device (WIMU) and a digital inclinometer. Ankle dorsiflexion from left and right ankle repetitions was used for validity analysis, whereas test-retest reliability was analyzed by comparing measurements from the first and second days. The standard error of the measurement (SEM) between the instruments was very low for both ankle measurements (SEM < 0.6°). No significant differences between instruments were found for the left ankle measurement (p > 0.05) even though a significant systematic bias (~1.77°) was found for the right ankle (d = 0.79). R2 was very close to 1 in the left and right ankles (R2 = 0.85–0.89) as well as the intraclass correlation coefficient (ICC > 0.95). Test-retest reliability analysis showed that systematic bias was below 1° for both instruments, even though a systematic bias (~1.50°) with small effect size was found in the right ankle (d = 0.49) with WIMU. The ICC was very close to 1 and the coefficient of variation (CV) was lower than 4% in both instruments. Thus, WIMU is a valid and reliable inertial device for measuring dynamic weight-bearing ankle dorsiflexion.