In a retrospective study, if the plantar fasciitis patients had all been stretching their gastroc-soleus muscles before the study in an attempt to rid themselves of the plantar fasciitis, then it makes sense that they would have greater ankle joint dorsiflexion than the controls.

 

Kevin;

They used the lunge test to evaluate the AJ Rom in Hylton's paper. That means, as the picture in the paper shows, that the knee is flexed when the maximum AJ rom is taken.

They did not need to stretch the gastroc for the lunge test, only the Soleus!

Regardless, the use of a test such as that will not correlate with functional walking AJ ROM.

The point is, we all see severe limitations in AJ ROM in this PF patient population. Until this is addressed openly in publications people will continue to believe that AJ DFion is actually increased with Plantar Fascitis patients when that is rarely if ever the case.

Bruce

 

Bruce:

I believe Ron (Atlas), myself and a few others had quite a lengthy discussion on the problems associated with using the knee flexed lunge test for predicting walking injuries here on Podiatry Arena about a year or so ago.

However, I am sure, that if you took a group of subjects that had plantar fasciitis and had been stretching their calf muscles to treat it on their own and then the researchers did not control for whether the calf muscle had been stretched over the previous weeks or months in their groups before the retrospective research study began, then those with plantar fasciitis would have increased ankle joint dorsiflexion, whether that ankle joint dorsiflexion was evaulated with the knee extended or with the knee flexed. That is a good example of why prospective studies are always preferred in injury studies.:drinks

 

Bruce and Kevin,

The lunge test certainly has its limitations (as all clinical measurements do) which have been discussed at length previously, and were acknowledged in the paper, eg:

"...it is possible that tightness in the gastrocnemius muscle may have gone undetected in the case group"​

In our paper, the lunge test measurement was not retained in the multivariate analysis, indicating that the other two key variables - obesity and pronated foot type (using the FPI) - were more important in identifying the PF group. Hence, our key conclusion from this study was that obesity and pronated foot type may be associated with PF.

There's lots of potential explanations for the slightly higher lunge test scores in the PF group, although I think the suggestion that all the cases had been busily stretching their gastroc-soleal muscles before the study commenced is unlikely.

Our systematic review (link) found 5 studies that had examined ankle ROM (4 case-control and 1 case series). Four studies found no difference (or neglible differences) between the groups, and only one (Riddle et al) reported a significant decrease in the PF group. This review was conducted before our case-control study and that of Pohl et al.

The very limited evidence available is therefore somewhat inconclusive regarding the role of ankle ROM in PF. Ideally, to adequately answer this question you would need to undertake a large, prospective risk factor study in the general population with a long period of follow-up, but this would be logistically very difficult (not to mention expensive).

, Sep 18, 2009

#9

Hylton;

thank you for your response, I was hoping for more from you than you initially served up... and you delivered! ;-)

I agree that my clinical findings may be proven correct or incorrect over time and study. I would definitely be skeptical of a study that proved me wrong... but old habits die hard!

My ultimate point still is that those who study foot and lower extremity related disorders continue to treat the foot with motion only at the Aknle joint, Heel/STJ, and at times the 1st mpj.

Chris Nester's work is showing more and more the importance of the dorsiflexion of the 1st and 5th metatarsals as compensation as opposed to the MTJ. I think it is time for those in academia to start to address this more valiantly in their future studies, or to at least address the potential failures of their conclusions if they do not.

There is too much going on in between the ankle and forefoot that is being regularly ignored. Future studies need to find an effective way to address this issue, or to at least mention the fact that there studies may be at a significant loss in reliability for not doing so.

thanks again sincerely;
Bruce