Ankle dorsiflexion: what is normal?

NewsBot · Jul 16, 2016

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Ankle dorsiflexion: what is normal? Development of a decision pathway for diagnosing impaired ankle dorsiflexion and M. gastrocnemius tightness.
Baumbach SF, Braunstein M, Seeliger F, Borgmann L, B?cker W, Polzer H
Arch Orthop Trauma Surg. 2016 Jul 14

INTRODUCTION:
Impaired ankle dorsiflexion (ADF) is known to increase forefoot pressure, which is associated to various pathologies affecting the foot and ankle. M. gastrocnemius tightness (MGT) is its most common cause. Up to date we are missing a standardized examination procedure, norm values, and a valid decision pathway to diagnose impaired ADF and MGT. The aim of this study was to define norm values for ADF using a standardized examination procedure. These were used to define a decision pathway to diagnose impaired ADF and MGT.
MATERIALS AND METHODS:
64 young, asymptomatic subjects were examined. Based on a standardized examination procedure, bilateral ADF, both with the knee extended and flexed, non-weight bearing and weight bearing, was assessed by three investigators. Inter-rater test reliability and norm values for ADF were calculated. Side differences were analyzed. ADF differences between the knee extended and flexed were calculated.
RESULTS:
The standardized examination procedure revealed high ICC values (0.876-0.915). ADF values with the knee extended for the left/right limb were 22.7? ? 5.9? [95 % CI 21.2?-24.3?]/23.4? ? 6.5? [95 % CI 21.7?-25.1?] non-weight bearing and 33.3? ? 5.5? [95 % CI 31.9?-34.7?]/33.6? ? 5.6? [95 % CI 32.1?-35.0?] weight bearing. Physiological side differences with the knee extended were <6? (95 % CI). Knee flexion resulted in an approximate ADF increase of 10?.
CONCLUSIONS:
Based on an extensive systematic approach, physiological values for ADF were assessed in a large asymptomatic population. This allowed the definition of a decision pathway to diagnose impaired ADF and MGT. Patients presenting with pathologies associated with impaired ADF should be examined according to the herein presented examination protocol. This systematic approach provides a consistent definition of impaired ADF and MGT, which is the prerequisite to study the effectiveness of treatment strategies for MGT.
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Admin2 · Jul 16, 2016

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NewsBot · Aug 10, 2016

Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination.
Baumbach SF et al
J Vis Exp. 2016 Jul 7;(113). doi: 10.3791/53446.

Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described to assess MGT. Still, a standardized examination procedure is missing. Literature argues for weightbearing examination but the degree of knee flexion needed to eliminate the restraining effect of the M. gastrocnemius on ankle dorsiflexion (ADF) is unknown. This manuscript investigates the effect of knee flexion on ankle dorsiflexion and provides a detailed description of a standardized examination protocol. Examination on 20 healthy individuals revealed, that 20? of knee flexion is sufficient to fully eliminate the influence of the M. gastrocnemius on ADF. This builds the prerequisite for a standardized examination for MGT. Non-weightbearing and weightbearing examination of ADF has to be conducted with the knee fully extended and at least 20? flexed. Two investigators should conduct non-weightbearing testing with the subject in supine position. In order to obtain reliable results, the axis of the fibula should be marked. One examiner can conduct weightbearing examination with the subject in lunge stance. Isolated MGT is present if ADF is impaired with the knee fully extended and knee flexion results in a significant ADF increase. The herein presented standardized examination is the prerequisite for future studies aiming at establishing norm values.
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NewsBot · Dec 15, 2016

The relationship of weight-bearing and non-weight bearing ankle dorsiflexion to balance and gait performance in young and older adults
Elizabeth Norris et al
Physical Therapy and Rehabilitation; in press

Background: Limitations in ankle dorsiflexion have been associated with balance dysfunction and the development of altered gait patterns. Methods to assess ankle dorsiflexion include non-weight bearing and weight-bearing positions. While the non-weight bearing position is the traditional method for the assessment of ankle dorsiflexion range of motion, the mobility requirements for ankle DF during gait and balance are primarily weight-bearing related. The purpose of this study is to investigate the relationship of ankle dorsiflexion, measured in non-weight bearing and weight bearing positions, to balance and gait performance in healthy young and older adults.

Methods: Subjects were divided into a young age group (n=22; age range 20-40; mean age 27.5±4.4 years old) and an older age group (n=15; age range 60-80; mean age 70.3±5.3 years old). Ankle dorsiflexion was measured under 3 conditions: non-weight bearing active range of motion, non-weight bearing passive range of motion and weight bearing dorsiflexion. Balance was assessed using the limits of stability test on the Neurocom Smart Balance Master. End point excursion and maximal excursion were used to quantify balance performance in the forward direction of the LOS. Gait performance was assessed using spatiotemporal gait parameters using the GAITRite electronic walkway. Gait speed, cadence, step length, stance time, and single support time were used to quantify gait performance. Two-way ANOVA compared each method of ankle dorsiflexion for each age group. Independent t-tests examined differences between each age group for balance and gait parameters. Pearson correlation coefficients assessed associations between each method of ankle dorsiflexion to gait and balance measures.

Results: There was a significant difference between all measures of ankle dorsiflexion (non-weight bearing active

Conclusion: The correlations between method of ankle dorsiflexion measurement and balance and gait performance differed between the young and older age groups. Ankle dorsiflexion measured with nonweight bearing methods resulted significant correlations for balance and gait in the young age group, while ankle dorsiflexion measured with weight bearing methods resulted in a significant correlations for balance in the older age group.
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NewsBot · Feb 7, 2017

A pilot investigation into the relationship between static diagnosis of ankle equinus and dynamic ankle and foot dorsiflexion during stance phase of gait: Time to revisit theory?
Alfred Gatt, Stephanie De Giorgio, Nachiappan Chockalingam, Cynthia Formosa
The Foot; Article in Press

Highlights
•Participants with a plantarflexed foot exhibit less than 10° of dorsiflexion during gait.
•Participants with limited dorsiflexion do not necessarily exhibit reduced dorsiflexion during gait.
•We recommend that patients with equinus should be assessed using instrumented gait analysis.
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Background
Although the clinical assessment of ankle dorsiflexion has traditionally been measured utilizing various goniometric means, the validity of this static examination has never been investigated. Since any impairment in ankle flexibility is likely to result in injuries, it is imperative that the correct examination technique is conducted.

Hypothesis/Purpose
To determine whether a clinical diagnosis of ankle equinus, or limited ankle dorsiflexion, correlates with a decreased dorsiflexion range of movement of the foot and ankle during gait.

Methods
Twenty participants with a clinical diagnosis of ankle equinus underwent optoelectronic motion capture utilizing the Rizzoli foot model. Participants were divided into two groups, Group A with <-5° of dorsiflexion and Group B with −5° to 0° of ankle dorsiflexion.

Results
Participants in Group B had a mean dynamic ankle dorsiflexion angle of 13.9°, while those in Group A had a mean dorsiflexion angle of 4.4°, resulting in a significant difference (p = 0.004) between the two groups. Likewise, foot mean dynamic dorsiflexion angle of Group B was 17.13° and Group A 8.6° (p = 0.006).

Conclusion
There is no relationship between a static diagnosis of ankle dorsiflexion at 0° with dorsiflexion during gait. On the other hand, those subjects with less than −5° of dorsiflexion during static examination did exhibit reduced ankle range of motion during gait.
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NewsBot · Mar 9, 2017

Relationship Between Weightbearing Ankle Dorsiflexion Passive Range of Motion and Ankle Kinematics During Gait.
Min-Hyeok Kang, PhD, Jae-Seop Oh, PhD
Journal of the American Podiatric Medical Association: January 2017, Vol. 107, No. 1, pp. 39-45.

Background: Measurement of weightbearing ankle dorsiflexion (DF) passive range of motion (PROM) has been suggested as a way to estimate ankle kinematics during gait; however, no previous study has demonstrated the relationship between ankle DF during gait and ankle DF PROM with knee extension. We examine the relationship between maximum ankle DF during gait and nonweightbearing and weightbearing ankle DF PROM with knee extension.

Methods: Forty physically active individuals (mean ± SD age, 21.63 ± 1.73 years) participated in this study. Ankle DF PROM with knee extension was measured in the nonweightbearing and weightbearing conditions; maximum ankle DF during gait was assessed using a three-dimensional motion analysis system. The relationship between each variable was calculated using the Pearson product moment correlation coefficient, and the difference in ankle DF PROM between the nonweightbearing and weightbearing conditions was analyzed using a paired t test.

Results: The weightbearing measurement (r = 0.521; P < .001) for ankle DF PROM showed a greater correlation with maximum ankle DF during gait than did the nonweightbearing measurement (r = 0.245; P = .029). Ankle DF PROM was significantly greater in the weightbearing than in the nonweightbearing condition (P < .001) despite a significant correlation between the two measurements (r = 0.402; P < .001).

Conclusions: These findings indicate that nonweightbearing and weightbearing measurements of ankle DF PROM with knee extension should not be used interchangeably and that weightbearing ankle DF PROM with the knee extended is more appropriate for estimating ankle DF during gait.
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NewsBot · Dec 7, 2020

Principal motion analysis of manual stretching techniques for the ankle joints
Naomi Yamada et al
J Phys Ther Sci. 2020 Sep; 32(9): 584–590.

[Purpose] Physical therapists frequently perform manual stretching of the ankle joints. Manual stretching procedures are challenging to define because they involve multidirectional joint motions and external forces. Therefore, in this paper, we propose a method for quantitatively and statistically analyzing the manual foot stretching techniques used by physical therapists. [Participants and Methods] The participants were four physical therapists, and three patients who have a spastic foot. We investigated the manual foot stretching techniques employed by the physical therapists using a three-dimensional analysis system and an instrumented brace with force sensors. Principal motion analysis was applied to the obtained data, and principal motions were determined. [Results] The first principal motion was the application of force for the dorsiflexion of the foot; second, the pushing/pulling of the heel; third, the eversion/inversion of the entire foot; and fourth, the eversion/inversion of the forefoot. Furthermore, the manual stretching techniques varied among the physical therapists, even for the same patient, and some techniques occurred only between particular pairs. [Conclusion] This study demonstrated the effectiveness of the principal motion analysis for the statistical assessment of manual stretching techniques and clarifying differences in stretching technique among physical therapists.
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NewsBot · Sep 4, 2021

Is Gastrocnemius Tightness a Normal Finding in Children?: A Cross-Sectional Study of 204 Norwegian Schoolchildren
Suki Liyanarachi et al
J Bone Joint Surg Am. 2021 Aug 25

Background: Isolated gastrocnemius tightness has been associated with several foot conditions. We do not know whether gastrocnemius tightness is a normal finding in the developing child or whether tightness is associated with foot symptoms. Recurrent foot and leg pain is common in children, and more knowledge of gastrocnemius tightness is of interest.

Methods: Passive ankle dorsiflexion was measured with the knee flexed and extended (Silfverskiöld test) in 204 Norwegian schoolchildren (408 feet). School classes from 4 different age groups were recruited (5 to 6 years, 8 to 9 years, 11 to 12 years, and 14 to 15 years). Footprints were also recorded in order to assess for any association between foot morphology and dorsiflexion results, specifically, gastrocnemius tightness.

Results: Ankle dorsiflexion decreased with increasing age. The thresholds for equinus contracture were set at either ≤5° or ≤0° of ankle dorsiflexion when measured with the knee extended, and the Silverskiold test was considered to be positive when ankle dorsiflexion was reduced by ≥10° from the flexed knee position to the extended knee position. The rate of gastrocnemius tightness was 54.9% if the threshold was set at ≤5° and only 3.7% if the threshold was set at ≤0°. The data did not provide evidence of an association between dorsiflexion and footprints.

Conclusions: Ankle dorsiflexion decreased with increasing age in this population of schoolchildren, highlighting the importance of age-matched norms. A majority had a tight gastrocnemius when the ankle dorsiflexion threshold was set at ≤5°, indicating that isolated gastrocnemius tightness should not be interpreted as a pathological finding.
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