Abstract
Clinical measurement of ankle dorsiflexion is typically used to diagnose limited ankle
range of motion. Controversy and a lack of clarity continue regarding the most accurate
clinical method of measuring ankle joint dorsiflexion and the effect that the foot
position (supinated, neutral, pronated) has on the true tibiotalar position. We investigated
the effects of supinated, neutral and pronated foot positions on the clinical dorsiflexion
measurements in 50 healthy subjects and compared these results to the radiographic
measurement of tibiotalar joint position with the ankle maximally dorsiflexed in each
of the 3 foot positions. Interrater reliability was confirmed to be adequate among
the 3 clinicians of varied skill levels. Radiographic measurements of the tibiotalar
position showed very little change in each of the 3 foot positions, with a total difference
of 0.35° between supination and pronation. However, we found a mean difference of
14° of dorsiflexion in the clinical measurements between the pronated and supinated
foot position, with a 9.08° difference between the neutral and supinated positions.
Motion of the foot between the neutral and supinated positions introduced an additional
source of potential error from the measurement technique when using the neutral position
as the standard, which has been recommended in the past. We recommend a supinated
foot position as a more reliable foot position for measuring the clinical ankle joint
range of motion and propose it as a potential standard.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Equinus: identification and clinical significance.Arch Podiatr Med Foot Surg. 1977; 4: 7-16
- Assessment of subtalar joint neutral position: a cadaveric study.Chin Med J. 2008; 121: 735-739
- Goniometric reliability in a clinical setting: subtalar and ankle joint measurements.Phys Ther. 1988; 68: 672-677
- Motion measured from the forefoot and hindfoot landmarks during passive ankle dorsiflexion range of motion.J Orthop Sports Phys Ther. 1991; 13: 20-22
- Accurate measurement of ankle range of motion after total ankle arthroplasty.Clin Orthop Relat Res. 2004; 424: 27-31
- Ankle joint range of motion measurements in spastic cerebral palsy children: intraobserver and interobserver reliability and reproducibility of goniometry.J Pediatr Orthop B. 2002; 11: 236-239
- McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery.Wolters Kluwer Health, Philadelphia2012
- Making sense of Cronbach’s alpha.Int J Med Educ. 2011; 2: 53-55
- Interrater and intrarater reliability in the measurement of ankle joint dorsiflexion is independent of examiner experience and technique used.J Am Podiatr Med Assoc. 2011; 101: 407-414
- Measurement of passive ankle dorsiflexion: procedure and reliability.Aust J Physiother. 1991; 37: 175-181
- Passive ankle mobility: clinical measurement compared with radiography.J Bone Joint Surg. 1989; 71: 696-698
Article info
Footnotes
Financial Disclosure: A grant from the American College of Foot and Ankle Surgeons.
Conflict of Interest: Dr. Dayton discloses a consultant/advisory role with Treace Medical Concepts; and he has received research funding from the ACFAS and IOER; and he has received honoraria in relation to multiple continuing medical education seminars; and he serves on committees for the ACFAS and is a Section Editor for the journal.
Identification
Copyright
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
