Original paperA weightbearing technique for the measurement of ankle joint dorsiflexion with the knee extended is reliable
Introduction
Ankle joint dorsiflexion is important to allow the body to progress forward over the weightbearing foot during gait and absorb impact force during ballistic activities such as jumping.1, 2 Limited ankle joint dorsiflexion is commonly caused by tightness of soleus and gastrocnemius muscles,3, 4 and has been shown to be a risk factor for and/or associated with several musculoskeletal pathologies of the foot including forefoot pain,3 plantar fasciitis5 and navicular stress fractures.6 Patella7 and Achilles tendinopathy,8 ankle sprains9 and lower limb overuse injuries in football players10 have also been shown to be caused by, or associated with limited ankle joint dorsiflexion. It is therefore important that clinicians who manage musculoskeletal pathology of the foot and lower limb are able to reliably assess ankle joint dorsiflexion range of motion. This would allow the practitioner to identify those at risk of developing foot and lower limb injuries, accurately measure the level of dysfunction post-injury and determine the effectiveness of an intervention aimed at improving ankle joint dorsiflexion range of motion.
The measurement of ankle joint dorsiflexion has traditionally occurred with the patient in a non-weightbearing position.4 However, the reliability of this measurement technique is questionable (intra-rater reliability ICCs ranging from 0.64 to 0.99 and inter-rater ICCs ranging from 0.29 to 0.81).11 In light of the questionable reliability of non-weightbearing measurements of ankle joint dorsiflexion, an alternative weightbearing ‘lunge’ technique has been described.12 This measurement technique has been shown to be reliable (high intra- and inter-rater reliability).12, 13 However, a major limitation of this measurement technique is that it primarily assesses the role of the soleus muscle and joint capsule structures of the ankle joint as it is performed with a flexed knee.4 This measurement technique is unable to determine if tightness of the gastrocnemius muscle is a contributing factor to limited ankle joint dorsiflexion.4 One way to overcome this limitation would be to perform the measurement of ankle joint dorsiflexion range of motion in a weightbearing position with the knee extended.
Only one study has investigated the reliability of the measurement of ankle joint dorsiflexion in a weightbearing position with the knee extended.14 Although the results showed high intra-rater reliability (coefficient of variation of 2.5%), the inter-rater reliability was not reported. Furthermore, only experienced clinicians were used, so it is unknown if this measurement technique is reliable when inexperienced raters perform this measurement.
Therefore, the aim of this study was to determine both the intra- and inter-rater reliability of the measurement of ankle dorsiflexion in a weightbearing position with the knee extended, using both experienced and inexperienced raters.
Section snippets
Participants
Participants were recruited from a student population at a University. Thirty individuals (10 male, 20 female), aged 19–42 years (mean ± S.D., 22.1 ± 5.6), height (mean ± S.D.) 171.8 ± 8.9 cm, BMI (mean ± S.D.) 22.8 ± 3.3 were recruited. Participants were excluded if they had any acute or chronic lower limb pathology in the previous 12 months, previous history of surgery to the lower limbs or any neurological or balance deficits. Institutional ethics approval was granted prior to the study and all
Ankle joint dorsiflexion measured with a digital inclinometer
The mean (range) values for each rater at the test and retest sessions are shown in Supplementary File 3. The main effect of session was not significant (F1 = 2.992, p = 0.09). Similarly, the main effect of rater was not significant (F3 = 2.470, p = 0.07). Clinically, these results suggest error associated with measurement between raters and between sessions was random and not a result of systematic differences.
Intra- and inter-rater reliability of the measurement of ankle joint dorsiflexion in a
Discussion
This study has demonstrated that measurement of ankle joint dorsiflexion in a weightbearing position with the knee extended can be performed reliably by experienced and inexperienced raters using both the digital inclinometer and the clear acrylic plate apparatus. These results are comparable to the findings from the study by Ekstrand et al.14 However, our study adds to the work of Ekstrand et al.14 as they assessed intra-rater reliability only and used experienced raters only.
An issue to
Practical implications
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Measurements of ankle joint dorsiflexion with participants in a weightbearing position with the knee extended are reliable when performed by the same rater or by different raters.
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The reliability of measurements of ankle joint dorsiflexion are not strongly affected by the experience of the rater or the equipment used.
References (25)
- et al.
Tendon action of two-joint muscles: transfer of mechanical energy between joints during jumping, landing, and running
J Biomech
(1994) - et al.
Reduced ankle dorsiflexion range may increase the risk of patella tendon injury among volleyball players
J Sci Med Sport
(2006) - et al.
Effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on injury risk in Army recruits
Aust J Physiother
(1998) Two feet, or one person? Problems associated with statistical analysis of paired data in foot and ankle medicine
Foot
(2004)- et al.
Effects of an eight-week stretching program on the passive-elastic properties and function of the calf muscles of older women
Clin Biomech
(2005) - et al.
Weightbearing ankle dorsiflexion range of motion in idiopathic pes cavus compared to normal and pes cavus feet
Foot
(2005) - et al.
Kinematics of normal human walking
- et al.
Isolated gastrocnemius tightness
J Bone Joint Surg
(2002) - et al.
Motion at the joints of the foot. Normal and abnormal function of the foot
(1977) - et al.
Risk factors for plantar fasciitis: a matched case-control study
J Bone Joint Surg Am
(2003)