Original Research| Volume 56, ISSUE 5, P1036-1040, September 2017

Experimental Comparison of the Clinical Measurement of Ankle Joint Dorsiflexion and Radiographic Tibiotalar Position


      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


      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 access
      One-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 to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • D’Amico J.C.
        Equinus: identification and clinical significance.
        Arch Podiatr Med Foot Surg. 1977; 4: 7-16
        • Chen Y.
        • Yu G.
        • Mei J.
        • Zhou J.
        • Wang W.
        Assessment of subtalar joint neutral position: a cadaveric study.
        Chin Med J. 2008; 121: 735-739
        • Elveru R.
        • Rothstein J.
        • Lamb R.
        Goniometric reliability in a clinical setting: subtalar and ankle joint measurements.
        Phys Ther. 1988; 68: 672-677
        • Bohannon R.
        • Tiberio D.
        • Waters G.
        Motion measured from the forefoot and hindfoot landmarks during passive ankle dorsiflexion range of motion.
        J Orthop Sports Phys Ther. 1991; 13: 20-22
        • Coetzee J.
        • Castro M.
        Accurate measurement of ankle range of motion after total ankle arthroplasty.
        Clin Orthop Relat Res. 2004; 424: 27-31
        • Allington N.J.
        • Leroy N.
        • Doneux C.
        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
        • Southerland J.
        • Boberg J.S.
        • Downey M.S.
        • Nakra A.
        • Rabjohn L.V.
        • The Podiatry Institute
        McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery.
        Wolters Kluwer Health, Philadelphia2012
        • Tavakol M.
        • Dennick R.
        Making sense of Cronbach’s alpha.
        Int J Med Educ. 2011; 2: 53-55
        • Kim P.J.
        • Peace R.
        • Mieras J.
        • Thoms T.
        • Freeman D.
        • Page J.
        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
        • Mooseley A.
        • Adams R.
        Measurement of passive ankle dorsiflexion: procedure and reliability.
        Aust J Physiother. 1991; 37: 175-181
        • Backer M.
        • Kofoed H.
        Passive ankle mobility: clinical measurement compared with radiography.
        J Bone Joint Surg. 1989; 71: 696-698