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Measuring standing hindfoot alignment: Reliability of goniometric and visual measurements

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Abstract

Haight HJ, Dahm DL, Smith J, Krause DA. Measuring standing hindfoot alignment: reliability of goniometric and visual measurements.

Objective

To examine the reliability of a functional weight-bearing measure of hindfoot alignment, the standing tibiocalcaneal angle (STCA), and to compare the relative reliabilities of goniometrically and visually estimated STCAs.

Design

Prospective blinded comparison.

Setting

Sports medicine center.

Participants

Eighteen asymptomatic volunteer subjects (10 men, 8 women; age range, 22–41y).

Interventions

Not applicable.

Main outcome measures

Two experienced examiners completed 2 blinded goniometric STCA and 2 blinded visual STCA measurements on each subject’s right and left ankles in random order.

Results

Quantitative visual and goniometric STCAs were similar (visual mean range, 5.61°–6.50° valgus vs goniometric mean range, 5.50°–6.94° valgus), and both measurements exhibited good to excellent intrarater reliabilities (intraclass correlation coefficient [ICC] range, .80–.94; 95% prediction limits, 1.51°–2.06°). Interrater ICCs were only fair for both measurement methods (.50–.75; 95% prediction limits, 2.2°–4.1°). In terms of relative reliability, the visual STCA and goniometric STCA exhibited good to excellent agreement (ICC range, .64–.95).

Conclusions

The STCA as described herein exhibited acceptable intrarater reliability for clinical use but may not be acceptably reliable between experienced examiners. The visual and goniometric STCA measurements were quantitatively similar and exhibited similar reliability. Using either method, changes of up to 2° over time may be attributable to measurement error. Clinicians may consider using either STCA measurement in evaluating patients with lower-limb injuries or during screening of high-risk populations.

Section snippets

Participants

Eighteen healthy subjects (10 men, 8 women) aged 22 to 41 years (mean, 24.8y) agreed to participate in the study. Subjects were recruited by advertisement through the medical and physical therapy schools at our institution. Exclusion criteria included (1) active symptoms of ankle injury or pathology; (2) history of lower-extremity injury or condition requiring medical evaluation, surgery, or treatment for which the subject sought professional care; (3) presence of grossly identifying marks

Results

The study population consisted of young, healthy, moderately active subjects. The mean subject age ± SD was 24.8±4.3 years (range, 22–41y) (table 1). Subjects had a mean body mass index of 22.6±3.3kg/m2 and participated in an average of 4.4±2.4 hours of regular physical activity each week (range, 0–9.5h/wk). Seventeen of 18 were right-foot dominant.

The quantitative STCA measurements for the visual and goniometric techniques are presented in table 2. Mean visual STCA measurements for each trial

Discussion

The primary purpose of our study was to examine the intrarater and interrater reliability of goniometrically measured standing hindfoot alignment measurements (ie, the STCA). Many studies have shown goniometric measures of joint angle and motion to be unreliable between raters.20, 23, 24 However, the techniques described in each of these investigations assess hindfoot angle in a non-weight-bearing position. For nearly all purposes of sport, exercise, or activities of daily living, the

Conclusions

The STCA exhibited acceptable intrarater reliability for clinical use, but the measurement may not be acceptably reliable between experienced examiners. Visual estimation and goniometric measurement of STCA exhibited equivalent intrarater reliability. For the experienced examiner, changes of up to 2° over time may be attributable to measurement error.

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    Supported by the Mayo Foundation.

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