Advertisement

Reliability and Reference Norms of Single Heel-Rise Test Among Children: A Cross-sectional Study

  • Rajnee Mishra
    Affiliations
    Department of Pediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India

    Department of Physiotherapy and Rehabilitation, Bengal Cancer Foundation, Bardhaman Institute of Medical Science Hospital, Burdwan, West Bengal, India
    Search for articles by this author
  • Vencita Priyanka Aranha
    Affiliations
    Department of Pediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India

    Aikya Physiotherapy and Rehabilitation Centre, Karkala, Karnataka, India
    Search for articles by this author
  • Asir John Samuel
    Correspondence
    Address correspondence to: Dr. Asir John Samuel, MPT, PhD, Additional Professor cum Vice Principal, Yenepoya Physiotherapy College, Yenepoya (Deemed to be University), Mangalore University Road, Deralakatte, Mangalore 575018, Karnataka, India.
    Affiliations
    Department of Pediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India

    Yenepoya Physiotherapy College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
    Search for articles by this author
Published:October 27, 2022DOI:https://doi.org/10.1053/j.jfas.2022.10.007

      ABSTRACT

      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 to 12 years. About 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 2 occasions for intrarater (on the same day) and test-retest reliability (on different days) and by 2 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. Intrarater, 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 intrarater, 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.

      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 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:

      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

      References

        • André H-I
        • Carnide F
        • Borja E
        • Ramalho F
        • Santos-Rocha R
        • Veloso AP.
        Calf-raise senior: a new test for assessment of plantar flexor muscle strength in older adults: protocol, validity, and reliability.
        Clin Interv Aging. 2016; 11: 1661-1674
        • Metz R
        • van der Heijden GJMG
        • Verleisdonk E-JMM
        • Tamminga R
        • van der Werken C
        Recovery of calf muscle strength following acute achilles tendon rupture treatment: a comparison between minimally invasive surgery and conservative treatment.
        Foot Ankle Spec. 2009; 2: 219-226
        • Bäcker HC
        • Yenchak AJ
        • Trofa DP
        • Vosseller JT
        Strength measurement after achilles tendon repair.
        Foot Ankle Spec. 2019; 12: 471-479
        • Chimera NJ
        • Castro M
        • Manal K
        Function and strength following gastrocnemius recession for isolated gastrocnemius contracture.
        Foot Ankle Int. 2010; 31: 377-384
        • Park YH
        • Kim W
        • Kim JY
        • Choi GW
        • Kim HJ
        Clinical impact of metabolic syndrome on eccentric exercises for chronic insertional achilles tendinopathy.
        J Foot Ankle Surg. 2022; 61: 726-729
        • Holzgrefe RE
        • McCarthy TP
        • Wilson JM
        • Bariteau JT
        • Labib S
        Association of strength following achilles tendon repair with return to same level of play in high-level athletes.
        Foot Ankle Int. 2020; 41: 1041-1048
        • Jupiter DC
        • Hsu ES
        • Liu GT
        • Reilly JG
        • Shibuya N.
        Risk factors for short-term complication after open reduction and internal fixation of ankle fractures: analysis of a large insurance claims database.
        J Foot Ankle Surg. 2020; 59: 239-245
        • Karol LA
        • Concha MC
        • Johnston 2nd, CE
        Gait analysis and muscle strength in children with surgically treated clubfeet.
        J Pediatr Orthop. 1997; 17: 790-795
        • Kordi Yoosefinejad A
        • Khademi S
        • Vosoughi AR.
        Consequences of extensile lateral approach to the calcaneal fractures on balance and isokinetic strength of muscle groups crossing the ankle joint.
        Foot Ankle Surg. 2022; 28: 732-737
        • Markhede G
        • Nistor L.
        Strength of plantar flexion and function after resection of various parts of the triceps surae muscle.
        Acta Orthop Scand. 1979; 50: 693-697
        • Shibuya N
        • Jasper J
        • Peterson B
        • Sessions J
        • Jupiter DC.
        Relationships between first metatarsal and sesamoid positions and other clinically relevant parameters for hallux valgus surgery.
        J Foot Ankle Surg. 2019; 58: 1095-1099
        • Song W
        • Shibuya N
        • Jupiter DC
        Association between opioid use and diabetes in patients with ankle fracture repair.
        Foot Ankle Int. 2022; 43: 560-567
        • Toyooka S
        • Takeda H
        • Nakajima K
        • Masujima A
        • Miyamoto W
        • Pagliazzi G
        • Nakagawa T
        • Kawano H
        Correlation between recovery of triceps surae muscle strength and level of activity after open repair of acute achilles tendon rupture.
        Foot Ankle Int. 2017; 38: 1324-1330
        • Antoniak KS
        • Abousamra O.
        Absence of peroneus tertius in split anterior tibialis tendon transfer surgery.
        J Foot Ankle Surg. 2022; 61: 886-887
        • Dreher T
        • Buccoliero T
        • Wolf SI
        • Heitzmann D
        • Gantz S
        • Braatz F
        • Wenz W.
        Long-term results after gastrocnemius-soleus intramuscular aponeurotic recession as a part of multilevel surgery in spastic diplegic cerebral palsy.
        J Bone Joint Surg Am. 2012; 94: 627-637
        • Putz C
        • Mertens EM
        • Wolf SI
        • Geisbüsch A
        • Niklasch M
        • Gantz S
        • Döderlein L
        • Dreher T
        • Klotz MC.
        Equinus correction during multilevel surgery in adults with cerebral palsy.
        Foot Ankle Int. 2018; 39: 812-820
        • Saisongcroh T
        • Shrader MW
        • Lennon N
        • Church C
        • Sees JP
        • Miller F.
        Residual deformity and outcome of ambulatory adults with cerebral palsy: a long-term longitudinal assessment.
        J Pediatr Orthop. 2022; 42: 215-221
        • Caird MS
        • Wills BPD
        • Dormans JP.
        Down syndrome in children: the role of the orthopaedic surgeon.
        J Am Acad Orthop Surg. 2006; 14: 610-619
        • Khallaf ME
        • Fayed E
        • Sweif RE
        • Alsalem A.
        Relationship between dynamic foot-ground contact area and balance impairments in adolescents with down syndrome.
        J Pediatr Rehabil Med. 2021; 14: 425-432
        • Kwok-Oleksy C
        • Berenji M
        • Argerakis NG
        • Trepal M
        • Wallack MK.
        Subungual melanoma of the great toe in a Hispanic male with Down syndrome: a case report and review of the literature.
        J Foot Ankle Surg. 2012; 51: 337-341
        • Karol LA
        • Haideri NF
        • Halliday SE
        • Smitherman TB
        • Johnston 2nd, CE
        Gait analysis and muscle strength in children with congenital pseudarthrosis of the tibia: the effect of treatment.
        J Pediatr Orthop. 1998; 18: 381-386
        • Hébert-Losier K
        • Wessman C
        • Alricsson M
        • Svantesson U.
        Updated reliability and normative values for the standing heel-rise test in healthy adults.
        Physiotherapy (United Kingdom). 2017; 103: 446-452
        • Droegemeier AN
        • Ensz KA
        • Hildebrand DM
        • Moore KS.
        The Relationship of Plantar Flexor Strength to Functional Balance in Older Adults.
        in: Proceedings of the 5th Annual GRASP Symposium. Wichita State University, Kansas, USA2009: 90-91
        • Moraux A
        • Canal A
        • Ollivier G
        • Ledoux I
        • Doppler V
        • Payan C
        • Hogrel J-Y.
        Ankle dorsi- and plantar-flexion torques measured by dynamometry in healthy subjects from 5 to 80 years.
        BMC Musculoskelet Disord. 2013; 14: 104
        • Örtqvist M
        • Gutierrez-Farewik EM
        • Farewik M
        • Jansson A
        • Bartonek Å
        • Broström E.
        Reliability of a new instrument for measuring plantarflexor muscle strength.
        Arch Phys Med Rehabil. 2007; 88: 1164-1170
        • Sman AD
        • Hiller CE
        • Imer A
        • Ocsing A
        • Burns J
        • Refshauge KM.
        Design and reliability of a novel heel rise test measuring device for plantarflexion endurance.
        Biomed Res Int. 2014; 391646: 1-8
        • Hislop HJ
        • Montgomery J.
        Testing the muscles of the lower extremity.
        in: Saunders Daniels and Worthingham's Muscle Testing. Techniques of Manual Examination. Elsevier, California2002: 228-232
        • Lunsford BR
        • Perry J.
        The standing heel-rise test for ankle plantar flexion: criterion for normal.
        Phys Ther. 1995; 75: 694-698
        • Yocum A
        • McCoy SW
        • Bjornson KF
        • Mullens P
        • Burton GN.
        Reliability and validity of the standing heel-rise test.
        Phys Occup Ther Pediatr. 2010; 30: 190-204
        • Yocum AA
        • Westcott SL
        • Bjornson KF
        • Mullens P
        • Burton GN.
        Reliability and validity of the heel-rise test in children.
        Pediatr Phys Ther. 2004; 16: 76
        • Donner A
        • Eliasziw M.
        Sample size requirements for reliability studies.
        Stat Med. 1987; 6: 441-448
        • Walter SD
        • Eliasziw M
        • Donner A.
        Sample size and optimal designs for reliability studies.
        Stat Med. 1998; 17: 101-110
      1. International Standards for Anthropometric Assessment [Internet]. Available at: http://www.ceap.br/material/MAT17032011184632.pdf. Accessed August 22, 2018.

        • Monteiro DP
        • Britto RR
        • Fregonezi GA de F
        • Dias FAL
        • Silva MG da
        • Pereira DAG
        Reference values for the bilateral heel-rise test.
        Braz J Phys Ther. 2017; 21: 344-349
        • Shrout PE
        • Fleiss JL.
        Intraclass correlations: uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428
        • Koo TK
        • Li MY.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiropr Med. 2016; 15: 155-163
        • Bland JM
        • Altman DG.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet (London, England). 1986; 1: 307-310
        • Portney LG
        • Watkins MP
        Statistical measures of reliability.
        Statistical Measures of Reliability. FA Davis Company, Philadelphia2015: 612
        • Portney LG
        • Watkins MP
        Regression.
        Foundations of Clinical Research: Applications to Practice. FA Davis Company, Philadelphia2015: 542-556
        • Mishra R
        • Samuel AJ.
        How Reliable Is the Unilateral Heel-Rise Test in Children Aged 8 Years?.
        Synapse-2017 Emerging Trends in Physiotherapy. Chitkara University, Rajpura, Punjab2017
        • Lai A
        • Lichtwark GA
        • Schache AG
        • Lin Y-C
        • Brown NAT
        • Pandy MG.
        In vivo behavior of the human soleus muscle with increasing walking and running speeds.
        J Appl Physiol. 2015; 118: 1266-1275
        • Kasner E
        • Hunter CA
        • Kariko K.
        The association between unilateral heel-rise performance with static and dynamic balance in community dwelling older adults.
        Geriatr Nurs (Minneap). 2013; 70: 1-3
        • Svantesson U
        • Wessman C
        • Alricsson M.
        The standing heel-rise test: reference values and test–retest reliability for healthy individuals from 20 to 81 years of age.
        Phys Ther. 2015; 101: eS1458
        • Khadilkar Vaman
        Growth and development: revised Indian academy of pediatrics 2015 growth charts for 5–18 years old Indian children.
        in: Parthasarathy A IAP Textbook of Pediatrics. Jaypee Brothers, New Delhi, India2016: 98-109
        • Wako M
        • Fujimaki T
        • Koyama K
        • Furuya N
        • Shinohara R
        • Otawa S
        • Kobayashi A
        • Horiuchi S
        • Kushima M
        • Yamagata Z
        • Haro H.
        A cross-sectional study on the correlations between floating toe, plantar arch posture, and body composition in 8-year-old children.
        Foot Ankle Surg. 2022; 28: 1035-1039
        • Krabak BJ
        • Roberts WO
        • Tenforde AS
        • Ackerman KE
        • Adami PE
        • Baggish AL
        • Barrack M
        • Cianca J
        • Davis I
        • D'Hemecourt P
        • Fredericson M
        • Goldman JT
        • Harrast MA
        • Heiderscheit BC
        • Hollander K
        • Kraus E
        • Luke A
        • Miller E
        • Moyer M
        • Rauh MJ
        • Toresdahl BG
        • Wasfy MM
        Youth running consensus statement: minimising risk of injury and illness in youth runners.
        Br J Sports Med. 2021; 55: 305-318