Ankle Dorsiflexion Range of Motion (ROM) Tests

 

In the previous blog it was observed that the client OHS and SLS, ankle dysfunctions such us eversion. However, the OHS assessment provided limited results therefore to further investigate it was decided to use a goniometer to assess the clients talocrural dorsiflexion mobility ad reduced ROM are related to ankle fractures and sprains (Hancock  et al., 2005; Collins et al., 2005).

There are several methods to measure ROM ankle dorsiflexion, in both weight-bearing (WB) and non-weight-bearing position. Research has reported that weight-bearing tests are more reliable than non-weight-bearing (NWB) assessment (ICC=0.93-0.96 vs  0.32-0.72) (Venturini et al., 2006). Disparities could be caused due to ROM values can be affected by the testing position (knee flexion or extension, WB, NWB position (Norkin and White, 2016). Norkin and White (2016), reported that dorsiflexion is usually lower with the knee extended because of shortened gastrocnemius limit ankle dorsiflexion and during NWB. Therefore, two different tests have been carried out to test client ankle ROM dorsiflexion.

 

1. Weight-Bearing wall lunge

Firstly, Weight-Bearing lunge (WBLT), is a very simple an inexpensive test. The client faces a wall was performed in a standing position with calcaneus in contact to the floor (Figure 6, video 1). Client was instructed to place his big toe 10 cm away and perform a lung until knee touched the wall. Client right ankle dorsiflexed 13 cm, and 14cm on the left, resulting in a 1 cm difference. Additionally, goniometer was used on both legs resulting in R-ankle= 18°; L-ankle=15°. Konor et al., (2012), investigated different methods to measure ankle dorsiflexion ROM on twenty subjects, and found intra-rater reliability of tape measure (right 0.98, left 0.99), digital inclinometer (right 0.96; left 0.97), and goniometer (right 0.85; left 0.96).  According to Ressinka (2015), the client results are classified as optimal dorsiflexion range  12.55 cm.

     Figure 6. Client performing the weight-bearing dorsiflexion wall lunge (left). On the right, measuring dorsiflexion with a goniometer tool.

         Video 1. ROM ankle dorsiflexion measured in non-weight-bearing position with knee extended.

2. Talocrural joint: Dorsiflexion Goniometer Test

The client underwent further testing to measure ankle-dorsiflexion ROM on an extended using a goniometer non-weight-bearing position (DF-goniometer test) and to compare to compare values between WB and NWB (video 2). Normal dorsiflexion ROM values for adults with the knee extended in NWB positions vary from about 10 to 20 degrees (Norkin and White 2016). The client results obtained were R-ankle 12° and L-ankle 5°,  normal range of ankle dorsiflexion ROM on the right ankle but  not on the left . However, there was a disparity in the results of the WBLT and DF-goniometer test both tests, which could demonstrate poor intra-rate reliability .

Research has shown that NWB measures have varying reports of intra-rater reliability with ICC values ranging from (0.649-0.97) (Munteanu et al., 2009), whirlst for WB ankle-dorsiflexion measurement ROM have uniformly high reports of both intra-inter rate reliability (ICC=0.90-0.99)(Venturini et al., 2006; Bennell et al., 1998).

         

Video 2. ROM ankle dorsiflexion measured in non-weight-bearing position with knee extended.

 

References:

Bennell, K.L., Talbot, R.C., Wajswelner, H., Techovanich, W., Kelly, D.H., and  Hall, A.J. (1998) ‘Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Australian Journal Physiotherapy, 44(3), pp. 175-180.

Brookbush, B. (n.d.) Overhead squat assessment. Brookbush Institute. [Online] [Accessed on April 27, 2023]https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment.

Collins, N., Teys, P., and Vicenzino, B. (2004) ‘The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains.’ Manual Therapy, 9(2) pp. 77–82.

Hancock, M.J., Herbert, R.D., Stewart, M. (2005) ‘Prediction of outcome after ankle fracture.’ Journal Orthopaedic Sports Physiology Therapy, 35(12), pp. 786–92.

Konor, M.M., Morton, S., Eckerson, J.M., and  Grindstaff, T.L (2012) ‘Reliability of three measures of ankle dorsiflexion range of motion.’ International Journal Sports Physical Therapy, 7(3), pp. 279-87.

McPoil, T.G., and Cornwall, M.W. (1996) ‘The relationship between static lower extremity measurements and rearfoot motion during walking.’ Journal Orthopaedic Sports Physiology Therapy, 24, pp.309.

Munteanu, S.E., Strawhorn, A.B., Landorf, K.B., Bird, A.R., and Murley, G.S. (2009) ‘A weightbearing technique for the measurement of ankle joint dorsiflexion with the knee extended is reliable.’ Journal Science Medicine Sport, 12(1), pp. 54-59.

Norkin, C.C., and White, D.J. Measurement of Joint Motion: A Guide to Goniometry. Philadelphia: FA Davis Company; 1995.

Stastny, P., Tufano, J. J., Lehnert, M., Golas, A., Zaatar, A., Xaverova, Z. and Maszczyk, A. (2015) ‘Hip abductors and thigh muscles strength ratios and their relation to electromyography amplitude during split squat and walking lunge exercises.’ Acta Gymnica, 45(2,) pp. 51–59.

 Venturini, C., Ituassú, N. T., Teixeira, L. M. and Deus, C. V. O. (2006) ‘Confiabilidade Intra E Interexaminadores de Dois Métodos de Medida da amplitude ativa de dorsiflexão do Tornozelo em indivíduos saudáveis.’  Revista Brasileira de Fisioterapia, 10(4) pp. 407–411.