Helps to control the knee by preventing hyperextension and/or hyperflexion (depending on the angle at the ankle) Note – may be indicated to help in knee instability or hyperextension. However, in significant cases, successful control of the knee joint may require going above the knee joint with a KAFO type design. Dynasplint ® offers dorsiflexion and plantar flexion systems to aid in ankle rehabilitation and recovery from various injuries, surgeries and trauma to the ankle and surrounding area. There are many advantages of using the Dynasplint System.
Imagine running, squatting or going downstairs in a ski boot. Do you think your legs and pelvis would move differently? Have you ever tried to do those things with ski boots on? It’s pretty tough. What if you were allowed to loosen the boot a little? There would still be altered movement, but just not quite as bad. That is the nature of this post: Limited ankle dorsiflexion and its effects on kinematics and injury.Previously, I made a post called.
This is another lengthy, detailed post, but now I’m moving up the kinetic chain. This post is on restricted ankle dorsiflexion (DF). It is really designed for clinicians, but if you are not a clinician you’re in luck.
I created a.If you’re still reading, I’m assuming you have a working background education of anatomy and biomechanics.There are a couple reasons that made me research this article: 1) The huge numbers of patients that I see with restricted ankle DF and 2) An open challenge by Dr. Greg Lehman in where he wrote, “ Can you with certainty conclude that a lack of dorsiflexion is a true dysfunction? I think a massive post on restricted dorsiflexion and injury, form and performance would be cool. Any takers?”Did he say “massive” post? Yes, but most readers will lose their attention span if I made it massive, so this isn’t massive. It’s just over 7,000 words.
But, it’s still detailed and comprehensive. Let me warn you ahead of time, the research is plagued with problems. Various researchers have different definitions of what “limited” ankle DF is and how to measure it.
Consistency is not a pillar of strength when it comes to this topic.Because of the breadth of the post, I have made headings with hyperlinks within the post:.Section 1. What is “Normal” Ankle Dorsiflexion Range of Motion?Establishing normative data on range of motion (ROM) should be a simple task.
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I mean how hard can it be to reliably measure ankle DF? Well, very difficult when you consider the possibilities: Do you use a goniometer, inclinometer or tape measure? Open chain or closed chain?
Knee straight, knee bent or both? Do you eliminate pronation or allow the subject to pronate? Healthcare is a funny business.
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We can make arguments out of the simplest things.Without dragging out what should be the simplest variable in this whole article, I’ll get right to the point – there is no standardized method for measuring ankle DF, but the weight-bearing lunge position seems to be the most used, simplest and most reliable method for measuring ankle DF.In non-weight bearing tests measuring ankle DF, the clinician is required to manually push the foot cephalad in order to get ankle DF. The amount of torque the clinician can generate is highly variable and to make things worse, they have to have a hand free to use a goniometer or inclinometer. You can see how this is a problem.Conversely, in the weight bearing lunge test, the subject’s body weight provides more DF torque than any tester could, so we don’t have to worry too much about the tester not pushing hard enough. In addition, the clinician can have hands free to measure ROM.Since pronation imparts dorsiflexion at the subtalar and midtarsal joints, another hurdle in measuring ankle DF ROM is limiting pronation. In other words, attempting to hold “subtalar neutral”. It has been shown that pronation can add as much as 8-10 degrees of dorsiflexion.It is when measuring ankle DF, however, the weight bearing lunge test is a consistent, reliable method of measuring dorsiflexion. By making sure that the subject lunges forward with the thigh going straight ahead (see video below), pronation can be limited.
If you don’t trust my word, try the test on yourself with the thigh moving straight ahead in the sagittal plane and measure then do the test while allowing yourself some femoral adduction and pronation. You will find your knee travels forward significantly more while in the femoral adducted and pronated position.This technique is very reliable. Measured the distance from the toes to the wall with an intra-rater reliability (via intra-class correlation coefficient) of 0.99. By using an inclinometer or goniometer, the reliability was not quite as good. They did not specifically place the foot in a subtalar neutral position or utilize a small wedge placed under the medial aspect of the foot to maintain a more neutral position of the subtalar joint. Rather, they simply told the subjects to “ progress his or her knee in an anterior direction.”found an inter-rater reliability (via ICC) of 0.99 and again found the test less reliable when using an inclinometerSo, we have a very simple, extremely reliable test (inter and intra rater) that requires little to no equipment and is done weight-bearing.
What else could you ask for? Well, validity is the answer to that question. We always come back to the question, “ What are we actually measuring?” Since we are unable to totally eliminate subtalar and midfoot pronation we cannot be 100% accurate that we are measuring true talocrural dorsiflexion but it’s the best test we have. If you have read my lengthy, you will realize that there is a healthy overlap of combined dorsiflexion and pronation at the talocrural and subtalar joints. The talocrural joint isn’t just a sagittal plane mover as we were taught in school.Validity is going to be tough in any test designed to measure ankle DF. For example, anchored pins in the bones of 5 subjects and measured the motion of the bones of the foot while walking.