Heel raise test for posterior tibial dysfunction

NewsBot · Aug 4, 2009

Members do not see these Ads. Sign Up.
Foot Kinematics During a Bilateral Heel Rise Test in Participants With Stage II Posterior Tibial Tendon Dysfunction.
Houck JR, Neville C, Tome J, Flemister AS.
J Orthop Sports Phys Ther. 2009 Aug;39(8):593-603

STUDY DESIGN: Experimental laboratory study using a cross-sectional design.

OBJECTIVES: To compare foot kinematics, using 3-dimensional tracking methods, during a bilateral heel rise between participants with posterior tibial tendon dysfunction (PTTD) and participants with a normal medial longitudinal arch (MLA).

BACKGROUND: The bilateral heel rise test is commonly used to assess patients with PTTD; however, information about foot kinematics during the test is lacking.

METHODS: Forty-five individuals volunteered to participate, including 30 patients diagnosed with unilateral stage II PTTD (mean +/- SD age, 59.8 +/- 11.1 years; body mass index, 29.9 +/- 4.8 kg/m2) and 15 controls (mean +/- SD age, 56.5 +/- 7.7 years; body mass index, 30.6 +/- 3.6 kg/m2). Footkinematic data were collected during a bilateral heel rise task from the calcaneus (hindfoot), first metatarsal, and hallux, using an Optotrak motion analysis system and Motion Monitor software. A 2-way mixed-effects analysis of variance model, with normalized heel height as a covariate, was used to test for significant differences between the normal MLA and PTTD groups.

RESULTS: The patients in the PTTD group exhibited significantly greater ankle plantar flexion (mean difference between groups, 7.3 degrees ; 95% confidence interval [CI]: 5.1 degrees to 9.5 degrees ), greater first metatarsal dorsiflexion (mean difference between groups, 9.0 degrees ; 95% CI: 3.7 degrees to 14.4 degrees ), and less hallux dorsiflexion (mean difference, 6.7 degrees ; 95% CI: 1.7 degrees to 11.8 degrees ) compared to controls. At peak heel rise, hindfoot inversion was similar (P = .130) between the PTTD and control groups.

CONCLUSION: Except for hindfoot eversion/inversion, the differences in foot kinematics in participants with stage II PTTD, when compared to the control group, mainly occur as an offset, not an alteration in shape, of the kinematic patterns
Click to expand...

NewsBot · Aug 5, 2009

Related:
Other threads tagged with posterior tibial tendon dysfunction

NewsBot · Aug 5, 2009

What appears to be a different version of the above appeared in JFAR from i-FAB conference:

Comparison of the clinical heel rise test in subjects with Stage II PTTD and healthy controls
J Foot Ankle Res. 2008; 1(Suppl 1): O6.
Chris Neville, Jeff Houck, Sam Flemister

Introduction
The heel rise test is commonly used as a strength test for the triceps surea muscle group but has also become widely used as a functional task to aid in the diagnosis of Posterior Tibial Tendon Dysfunction (PTTD) [1,2]. Although failure to invert the hindfoot during the heel rise test is reported to be a sign of failure in the posterior tibial muscle, posterior tibialis function may also contribute to forefoot plantar flexion, assisting with raising the heel off the floor. Midfoot collapse associated with weakness of the posterior tibialis muscle may limit a PTTD subjects' ability to plantar flex the forefoot during the heel rise test. The purpose of this study was to compare sagittal plane ankle and midfoot kinematics as well as HF frontal plane kinematics in subjects with stage II PTTD and healthy controls during a bilateral heel rise test.

Methods
30 stage II PTTD subjects (age; 59.2 (11.3) years, BMI; 29.8 (4.8)) and 15 healthy controls (58.6 (7.7) years, BMI; 30.5 (3.6)) were included in this study. While subjects performed a bilateral heel rise task, kinematic data was collected (sampled at 60 Hz, filtered at 6 Hz) from the shank, calcaneus (HF), and first metatarsal (FF) using an Optotrak Motion Analysis System (Northern Digital Inc, CAN) and Motion Monitor Software (Innsport Training Inc, USA). Kinematic data were used to calculate Cardan angles (Z-X-Y sequence) including ankle plantar flexion/dorsiflexion (HF relative to the shank), ankle inversion/eversion (HF relative to the shank) and midfoot plantar flexion/dorsiflexion (FF relative to the HF). Statistical Analysis: To compare groups a mixed design ANOVA model with a repeated factor of phase (three levels: start position, peak heel rise position, and ending position) and a fixed factor of group (two levels: PTTD and healthy controls) was utilized.

Results
There was no significant difference (p = 0.11) in sagittal plane ankle motion between subjects with PTTD and healthy controls across all phases of the heel rise test. Interestingly, although subject with PTTD began the heel rise test with greater eversion compared to controls (5 degrees difference p < 0.001) they achieved a position of inversion equal to controls at peak heel rise (1.7 degrees difference p = 0.15). A significant difference between groups in sagittal plane midfoot motion was found to be dependent on phase of the heel rise task (interaction p = 0.05). Pairwise comparisons between groups at each phase revealed a significant (p = 0.03) decrease in midfoot plantar flexion in subjects with PTTD (6.5 degrees) compared to healthy controls (12.1 degrees) at the peak heel rise position.

Conclusion
Raising the heel off the floor during the heel rise test is accomplished with both ankle plantar flexion and midfoot plantar flexion. Significantly reduced midfoot plantar flexion (midfoot collapse) was observed in PTTD subjects compared to healthy controls despite normal HF inversion. Hindfoot inversion may provide some stability to the midtarsal joint limiting midfoot collapse but this relationship is only partially able to protect secondary ligaments. Summary: In this first investigation of the heel rise test failure to plantar flex the midfoot while completing the heel rise test was more common in subjects with stage II PTTD than failure to invert the hindfoot. The ability to stabilize the midfoot with muscle control or joint stability is compromised in subjects with stage II PTTD placing increased demand on support ligaments.
Click to expand...

NewsBot · Feb 27, 2014

Adult-Acquired Flatfoot Deformity and Age-related Differences in Foot and Ankle Kinematics During the Single Limb Heel Rise Test.
Chimenti RL, Tome J, Hillin CD, Flemister AS, Houck J.
J Orthop Sports Phys Ther. 2014 Feb 25

Study Design Cross-sectional, laboratory study. Objective To compare single limb heel rise performance and foot/ankle kinematics between persons with stage II Adult-Acquired Flatfoot Deformity (AAFD) and healthy controls.

Background The inability to perform a single limb heel rise is considered a functional diagnostic test for AAFD. However, it is unknown what foot motions contribute to poor performance of this task.

Methods Fifty individuals participated in this study (20 with stage II AAFD, age=57.6±11.3 years; 15 older controls, age=56.8±5.3 years; 15 younger controls, age=22.2±2.4 years). Forefoot (sagittal plane) and rearfoot (sagittal and frontal plane) kinematics were collected using a three dimensional motion analysis system. Heel rise performance (heel height) and kinematics (joint angles, excursions) were evaluated. One-way and two-way ANOVA's were used to examine differences in heel rise performance and kinematics between groups.

Results Individuals with AAFD and older controls demonstrated lower heel rise height than the comparison group (P<0.001). Persons with AAFD demonstrated higher degrees of first metatarsal dorsiflexion (P<0.001), lower ankle plantar flexion (P<0.001) and higher subtalar eversion (P=0.027) than older controls. Persons with AAFD demonstrated lower ankle (P<0.001) and first metatarsal (P<0.001) excursions than older controls, but no difference in subtalar excursion (P=0.771).

Conclusions Persons with stage II AAFD did not achieve sufficient heel height during a single leg heel rise. Both forefoot and rearfoot kinematics in the sagittal plane, not frontal plane, contributed to the lower heel height in participants with stage II AAFD. Older controls demonstrated lower heel rise height than younger controls indicating that clinical expectations of heel rise performance may need to be adjusted accordingly for age
Click to expand...

NewsBot · Sep 12, 2014

Effect of Tibialis Posterior Tendon Dysfunction on Unipedal Standing Balance Test
Kornelia Kulig et al
Foot & Ankle International September 11, 2014

Background: Foot pain and diminished functional capacity are characteristics of tibialis posterior tendon dysfunction (TPTD). This study tested the hypotheses that women with TPTD would have impaired performance of a unipedal standing balance test (USBT) and that balance performance would be related to the number of single limb heel raises (SLHR).
Methods: Thirty-nine middle-aged women, 19 with early stage TPTD (stage I and II), were instructed to perform 2 tasks; a USBT and repeated SLHR. Balance success was defined as a 10-second stance. For those who were successful, center of pressure (COP) data in anterior-posterior (AP) and medial-lateral (ML) directions were recorded as a measure of postural sway. SLHR performance was divided into 3 bins (≤2; 3-9 and > 10 repetitions). The between-balance success on performing the SLHR test was analyzed using the Fisher’s exact test (2 × 3). Independent t tests were used to compare between-group differences in postural sway. Relationship of postural sway to the number of heel raises was assessed using Spearman’s rho.
Results: The success rate of the USBT was significantly lower in women with TPTD than the controls (47% vs 85%, P = .041). In addition, women with TPTD who completed the USBT exhibited increased AP COP displacement (14.0 ± 7.4 vs 8.4 ± 1.3 mm, P = .008), and a strong trend of increased ML COP displacement (8.3 ± 4.5 vs 6.1 ± 1.2 mm, P = .050). The success rate of USBT was correlated with the number of SLHR (P = .01). The AP and ML COP displacement were correlated with SLHR (r = −.538 and .495), respectively.
Conclusions: Women with TPTD have difficulty in performing the USBT. Performance of the USBT and SLHR are highly correlated and predictive of each other.
Clinical Relevance: A unipedal balance test may be used as a proxy TPTD assessment tool to the heel raising test when pain prevents performance.
Click to expand...

NewsBot · Jul 8, 2015

Posterior Tibial Tendon Dysfunction: What does the single heel raise test mean in assessment?
Beverley Durrant, Nachiappan Chockalingam, Paula J Richards, Christopher Morriss-Roberts
The Foot and Ankle Online Journal 8 (2): 6

This paper aims to review the literature pertaining to single heel raise test, which is used for the assessment of PTTD. Whilst there is little published information relating to the origins of this test, there is also a clear paucity of information pertaining to the interpretation of the test findings. Understanding why clinicians utilize this test in the assessment of this debilitating pathology and how the result is interpreted is important in helping to bridge the remaining knowledge gap surrounding this condition. This review will contribute to the body of knowledge that is helping to explain why PTTD is an under recognized and underdiagnosed condition. Databases that were searched include PubMed, MEDLINE 1990-present, SportDiscus, AMED 1990-present, CINAHL 1990-present, BMJ Clinical Evidence, Cochrane Library, ISI Web of Knowledge (science) 1990 to present, Ingentaconnect, Science Citation Index, Science Direct and Wiley Interscience. Until recently there has been very little work isolating the tibialis posterior muscle activity in dysfunction. There has been even less work surrounding the individual elements of the assessment this condition such as the single heel rise test. Areas covered within the review are the history of the test, validity and reliability of the test, kinematic changes associated with the test in the presence of PTTD and the biomechanical changes in the presence of PTTD and how this may impact of the execution and interpretation of the test findings. The results from this review are inclusive in relating the single heel raise test to the assessment and diagnosis of PTTD. There is variable use of this test in clinical practice in addition to the clinical setting and patient groups where it is utilized. Further work is indicated surrounding validity and interpretation of the test findings.
Click to expand...

NewsBot · Nov 29, 2017

Reference values for the bilateral heel-rise test.
Monteiro DP et al
Braz J Phys Ther. 2017 Sep - Oct;21(5):344-349. doi: 10.1016/j.bjpt.2017.06.002.

BACKGROUND:
The bilateral heel-rise test is an instrument that evaluates the performance of the triceps surae. Normative parameters need to be established for the use of the heel-rise test in clinical practice.
OBJECTIVE:
To determine the reference values for the bilateral heel-rise test.
METHODS:
This cross-sectional study assessed healthy subjects using the bilateral heel-rise test. We analyzed the number of repetitions, time (in seconds), and repetition rate (repetitions/second) during execution of the heel-rise test, until the point of voluntary fatigue. The estimates were stratified by age and gender. Multiple linear regression was performed to define the reference equation for the bilateral heel-rise test.
RESULTS:
A total of 147 individuals were included. The median age was 37 years (IQR 28-46). It was observed that the number of repetitions decreases with age, with a higher number of repetitions in male participants compared to female participants. Gender, body mass index, and maximum activity scores predict 14% of the number of plantar flexions performed in the bilateral heel-rise test. Age and adjusted activity scores predict 18% of the repetition rate in the bilateral heel-rise test.
CONCLUSION:
The bilateral heel-rise test reference values for an adult population were defined as scores above the 25th percentile for number of repetitions, time, and repetition rate. The number of heel-rise test repetitions that corresponds to the 25th percentile, according to age and gender, is as follows: age 20-29, 65 repetitions for men and 45.5 for women; age 30-39, 62.75 men and 41.5 women; age 40-49, 67.25 men and 45 women; and age 50-59, 54 men and 39.25 women.
Click to expand...

NewsBot · Sep 7, 2021

The single-leg heel raise does not predict maximal plantar flexion strength in healthy males and females
Lauren K Sara et al
PLoS One. 2021 Aug 20;16(8):e0253276.

Introduction: The single-leg heel raise test (SLHR) is commonly used in clinical settings to approximate plantar flexor strength, yet this is neither validated nor supported physiologically. The purposes of this study were to: determine (1) associations between SLHR repetitions, maximal plantar flexor strength, and reductions in strength; and (2) whether sex differences exist in performance of the SLHR.

Methods: Twenty-eight young, healthy participants (14 males,14 females, 19-30 years) performed repeated single-leg heel raises to task failure. Pre- and post-task measures included maximal voluntary isometric contractions (MVIC), and voluntary activation and contractile properties of the plantar flexor muscles, assessed using peripheral electrical stimulation of the tibial nerve. Surface electromyography was recorded for the medial and lateral gastrocnemius, soleus, and anterior tibialis muscles.

Results: The SLHR resulted in 20.5% reductions in MVIC torque (p<0.001). However, the number of SLHR repetitions was not correlated with either the baseline MVIC (maximal strength; p = 0.979) or the reduction in MVIC following the SLHR (p = 0.23). There were no sex differences in either the number of SLHR repetitions (p = 0.14), baseline MVIC torque (p = 0.198), or the reduction of MVIC (p = 0.14). MVIC decline was positively associated with the reduction in voluntary activation (r = 0.841, p<0.001), but was not associated with the change in twitch amplitude (p = 0.597).

Conclusions: The SLHR was similar in young males and females yet was a poor predictor of maximal plantar flexor strength but evaluates performance fatigability of the lower extremity specific to dynamic contractions. The reduction in maximal strength at task failure was explained by reduced neural drive to the plantar flexor muscles in both males and females.

Impact statement: SLHR performance is not a clinical assessment of plantar flexor strength but assesses dynamic lower extremity fatigability that is similar in males and females. Alternate clinical measures for maximal plantar flexion strength need to be developed.
Click to expand...

NewsBot · Jul 5, 2022

The heel-raise test for ankle plantarflexor
strength: a scoping review and meta-analysis of
studies providing norms
Richard W Bohannon
J. Phys. Ther. Sci. 34: 528–531, 2022

Purpose] The heel-raise test (HRT) is sometimes used to quantify ankle plantarflexion strength. However, descriptions of the test vary and normative values are limited. This paper, therefore was generated to summarize procedures and provide normative values for the HRT in a younger and older age group of adults. [Methods]
Electronic and hand searches were conducted to identify relevant literature. Meta-analysis was used to provide
norms. [Results] Among 439 nonduplicative articles identified, 13 qualifying articles were ultimately included.
Procedures for the HRT described in the studies varied considerably. The mean number of HRT repetitions was 28.7
for adults with a mean age less than 40 years and 11.8 for adults with a mean age greater than 60 years. [Conclusion]
This study provides information on HRT performance and norms derived with them for younger and older adults.
Click to expand...

NewsBot · Oct 28, 2022

Reliability and reference norms of single heel-rise test among children: A cross-sectional study.
Rajnee Mishra, MPT et al
October 27, 2022

There is a lack of data regarding the single heel-rise test (SHRT) among children. Hence, we aimed to establish reliability and reference norms of SHRT among children aged 8-12 years. 500 healthy children were randomly selected from the recognized school and community settings. After demographic measurements, SHRT was conducted to evaluate the strength of each plantar flexors. SHRT repetitions were assessed by the same rater on two occasions for intra-rater (on the same day) and test-retest reliability (on different days) and by two raters for inter-rater reliability. Relative reliability was described in terms of the intraclass correlation coefficient (ICC) and Pearson correlation coefficient (r). Absolute reliability was indicated by the standard error of measurement (SEm), minimal detectable change (MDC), and Bland-Altman graph. The mean of the number of repetitions of SHRT was calculated to derive the reference norm of SHRT. The anthropometric parameters were correlated with SHRT for multiple regression analysis. Intra-rater, test-retest and inter-rater reliability of SHRT were, ICC=0.81, ICC=0.70 and ICC=0.57 respectively. The Bland-Altman graph confirmed limits of agreement for intra-rater, test-retest, and inter-rater reliability. The reference norm of SHRT is documented to be 20.6 ± 4.8. SEm and MDC are found to be 2 and 3, respectively. Multiple regression analysis predicted a correlation of age, weight, and calf muscle girth with SHRT. SHRT is moderate to good reliable in assessing the strength of plantar flexors. The reference norms of SHRT have been derived for healthy children aged 8 to 12 years.
Click to expand...

NewsBot · Sep 8, 2023

Using a Standing Heel-Rise Test as a Predictor of Ankle Muscle Strength in the Elderly
Weerasak Tapanya et al
Sports (Basel). 2023 Aug 2;11(8):146

The senior population is at increased risk of falling due to a reduction in ankle muscle strength. Evaluating the strength of the ankle muscles in older adults is of paramount importance. The purpose of this study was to formulate an equation to estimate ankle muscle strength by utilizing the basic physical characteristics of the subject and the variables related to their ability to perform the standing heel-rise test (SHRT). One hundred and thirty-two healthy elderly participants (mean age 67.30 ± 7.60) completed the SHRT and provided demographic information. Ankle plantar flexor (PF) muscle strength was evaluated using a push-pull dynamometer. Multiple regression analysis was utilized to develop a prediction equation for ankle PF muscle strength. The study revealed that the ankle PF strength equation was derived from variables including the power index of the SHRT, gender, age, calf circumference, and single-leg standing balance test. The equation exhibited a strong correlation (r = 0.816) and had a predictive power of 65.3%. The equation is represented as follows: ankle PF strength = 24.31 - 0.20(A) + 8.14(G) + 0.49(CC) + 0.07(SSEO) + 0.20(BW/t-SHRT). The equation had an estimation error of 5.51 kg. The strength of ankle PFs in elderly individuals can be estimated by considering demographic variables, including gender, age, calf circumference, single-leg standing balance test, and the power index of the SHRT. These factors were identified as significant determinants of ankle PF strength in this population.
Click to expand...

NewsBot · Dec 11, 2023

The Single Leg Heel Rise Test-A Helpful Tool for Dance Science?: A Systematic Review
Anna Schrefl, Daniel Erlacher, Andrea Schärli
Med Probl Perform Art. 2023 Dec;38(4):234-248

Background: Foot and ankle injuries are the most prevalent injuries in dance. The single leg heel-rise (SLHR) test is a simple tool to assess muscular endurance of the plantar flexors of the foot and is an increasingly popular manual muscle test in various areas of dance. Although the SLHR test has shown high reliability and validity in the medical field, no uniform description of this test exists in dance.

Objective: This systematic review aimed to identify parameters, outcome measures, purposes, and existing normative values of the SLHR test in the dance field.

Methods: Following the PRISMA guidelines, the electronic databases Scopus, PubMed, SPORTDiscus, EMBASE, CINAHL, and Cochrane were searched using a predefined search strategy up to June 2022. Studies were included if they reported screening, testing, or evaluation of either muscular endurance or strength of the calf muscle-tendon unit (MUT) in dancers using the SLHR test. The methodological quality of the studies was evaluated using a modified version of the Downs and Black Quality Index.

Results: A total of 180 studies were identified. Twelve studies comprising a total of 427 dancers met the inclusion criteria. Key testing parameters of the SLHR test varied widely or were not reported. The average quality rating of the reviewed studies was 12.9 (range 8 to 17) out of a possible 20 points.

Discussion: Although commonly used in test batteries, there are no standardized parameters of the SLHR test used in the dance field. Therefore, no generally applicable normative values could be established.

Conclusion: Key parameters such as the precise execution of the heel rises should be reported in testing protocols. For the SLHR test to be a useful tool in dance, further research on the influence of dance style, age, and injuries to the calf MTU on this test is needed.
Click to expand...

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Heel raise test in pediatric planovalgus feet

Heel raise test for assessment of function in peripheral vascular disease

Use of a heel raise for plantar fasciitis

Heel raises for plantar fasciitis

Optimised Heel Raise to Minimize Plantar Pressures

Single Heel Raise

Cannot do one foot heel raise but no other symptoms of posterior tibial tendon dysfunction

Share This Page