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

doi:10.1016/j.fas.2016.01.008

Foot and Ankle Surgery

Volume 22, Issue 4, December 2016, Pages 274-277

https://doi.org/10.1016/j.fas.2016.01.008 Get rights and content

Highlights

•
Weight bearing measurement of ankle dorsiflexion is critical in quantifying physical impairment in patients following ankle fractures.
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A lunge ankle dorsiflexion measurement device (LAD), has been devised.
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Assessment of ankle dorsal flexion using the novel LAD shows a high inter- and intra-tester reliability in patients following a fracture of the ankle joint.

Abstract

Background

Assessment of ankle joint movement in a weight bearing position has important clinical implications. The lunge ankle dorsiflexion measurement device (LAD) has been developed with the aim of facilitating ease of and standardisation of the measurement of ankle joint movement. The literature lacks studies evaluating the reliability of weight bearing measurements of the ankle joint in study groups with ankle disabilities. The objective of this study was to examine the intra- and inter-tester reliability of ankle dorsiflexion measured with the novel LAD in patients following a fracture of the ankle.

Method

This study was a randomized intra- and inter-tester reliability study with blinding of testers and participants. All participants were tested twice by each tester, with the order of testers randomized. The intra- and inter-tester reliability was assessed by the calculation of interclass correlation coefficients (ICC).

Results

The study sample consisted of 24 patients: 15 females and nine males post-immobilisation following surgery for ankle fractures. The mean age was 51.0 years, ranging from 22 to 92 years. All patients had sustained an AO classification 44- fracture of the ankle. The mean follow-up time was 9.3 months (16.2 SD) after the time of fracture. The inter-tester reliability was high, with an ICC of 0.984 (95%CI: 0.963–0.993) and SE_meas of 0.14 cm. The ICC for Tester A was 0.989 (95%CI: 0.974–0.995) and SE_meas 0.10 cm. The ICC for Tester B was 0.990 (95%CI: 0.977–0.996) and SE_meas 0.09 cm.

Conclusion

This study shows a high inter- and intra-tester reliability for measuring ankle dorsiflexion with the LAD following a fracture of the ankle.

Section snippets

Background

Measurement of ankle dorsiflexion is critical in quantifying physical impairment and guiding treatment [1]. Ideally it should be measured in a weight bearing position, as that is where it impacts function most [2]. Ankle dorsiflexion in weight bearing has been measured with a highly reliable weight bearing lunge test against a wall [3], which is the horizontal linear distance between the front of the knee touching a wall (the datum) and the tip of the longest toe. Whilst this is reliable, from

Method

This study was a randomized intra- and inter-tester reliability study with blinding of testers and participants. The study was conducted in agreement with the principles of the Declaration of Helsinki and approved by the local ethics committee in North Denmark Region and the Danish Data Protection Agency J.Nr.: 2008-58-0028. All patients provided signed informed consent forms prior to their participation. The study was conducted in November 2014 at the Department of Occupational Therapy and

Statistical analysis

The assumption of a normal distribution in variables was checked visually by QQ-plots. Continuous data were expressed as means and standard deviations (SD). Categorical data were expressed as frequencies. The intra- and inter-tester reliability was assessed by the calculation of interclass correlation coefficients (ICC), and 95%CI is given. ICC values were interpreted as: 0.0–0.3 low; 0.30–0.70 moderate; 0.70–1.0 high [17]. The standard error of the measurements was calculated using the ICC as

Results

Twenty-nine patients were included in the study sample. Five patients were excluded due to the exclusion criteria; two patients were excluded due to pain, one patient due to age, one patient due to lack of co-operation and one patient due to no ankle movement. All besides the patient excluded due to age were excluded during the test procedure. Thus, the study sample consisted of 24 patients: 15 females and nine males. The mean age was 51.0 (range, 22–92) years. The mean height was 171 cm (SD

Discussion

This study shows that measurement of the ankle dorsiflexion with the LAD following an ankle fracture, can be reliably performed by the same tester as well as different testers, indicated by high ICC levels for both intra- and intertester reliability and low SE_meas indicating minimal random and systematic errors were found. The intra- and interrater reliability in this study shows ICC levels in line with or better than other studies measuring dorsiflexion of the ankle [3], [18], [19].

A number of

Conclusion

Assessment of ankle dorsal flexion using the novel LAD shows a high inter- and intra-tester reliability in patients following a fracture of the ankle joint, even in the hands of raters with very limited clinical experience.

Competing interests

The authors declare that they have no competing interests.

Conflicts of interest

The authors have no conflicts of interest to report. The authors did not receive benefits or grants in any form from a commercial part related directly or indirectly to the subject of this article.

Acknowledgments

The Department of Orthopaedic surgery and the Department of Occupational and Physiotherapy Aalborg University Hospital Denmark were acknowledged for proving unrestricted grants.

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This method was selected instead of a passive ROM measurement because it allows a more functional assessment of the ankle dorsiflexion flexibility, which seems to be more related to lower limb compensatory movement patterns caused by a reduced ankle dorsiflexion ROM during functional activities such as squatting tasks [25]. In addition, this method has shown very high reliability (CCI > 0.9) [25,26]. WBL was performed with the patient facing a wall.
Ankle fractures are among the most common traumatic fractures and have a great socio-economic impact. Consequences of an ankle fracture requiring surgical treatment (e.g. pain, reduced ankle range of motion (ROM), muscle weakness, etc.) lead to balance deterioration, which has a profound impact on activities of daily living. However, to the best of the authors' knowledge, no reliable clinical tests are available to monitor balance in patients after ankle surgery.
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Dorsiflexion range of motion (ROM) was measured using the weight bearing lunge test, as it has been shown to effect anterior balance in the YBT.22 Participants were instructed to lunge the knee forward as far as possible without lifting the heel.23 Intra-rater reliability of dorsiflexion range of motion testing was high (ICC 0.984).
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Knee and hip flexor and extensor, and hip adductor and abductor muscle torque was less in individuals with CAI compared to controls (standardised mean difference (SMD) >1.2). Hip and knee flexor and extensor muscle torque was less in CAI participants than copers (SMD: 0.69–1.1). Hip external and internal rotator torque did not differ between groups. There was no difference in hip or knee muscle torque between controls and copers (SMD: 0.01–0. 54). Balance was impaired in CAI participants compared to copers and controls in all directions. There was a strong positive correlation between posterolateral Y-balance test performance and torque of the hip adductors (r = 0.53), flexors (r = 0.52) and extensors (r = 0.50).
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Passive ankle plantarflexion-inversion range of motion, weight-bearing dorsiflexion range of motion, anteroposterior translation, inversion-eversion tilt, and perceived ankle stability and confidence during hopping were assessed before and immediately after the application of fibular repositioning tape and after 15 min of exercise in 14 individuals with chronic ankle instability.
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Fibular repositioning tape was associated with a restriction of ankle total inversion-eversion tilt and improved perceived ankle stability and confidence both immediately after application of tape and after participating in exercise. This data provides grounds for exploring mechanical and psychological mechanisms underpinning any clinical efficacy of fibular repositioning tape.
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View full text

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

Highlights

Abstract

Background

Method

Results

Conclusion

Section snippets

Background

Method

Statistical analysis

Results

Discussion

Conclusion

Competing interests

Conflicts of interest

Acknowledgments

Aust J Physiother

Aust J Physiother

Injury

Injury

J Sci Med Sport

Aust J Physiother

Man Ther

Clinical outcomes following ankle fracture: a cross-sectional observational study

J Foot Ankle Res

Epidemiology of ankle fractures in Rochester, Minnesota

Acta Orthop Scand