DOI QR코드

DOI QR Code

Effect of Subtalar Joint Neutral Position and Knee Position on the Passive Ankle Dorsiflexion Range of Motion

목말밑 관절의 중립자세와 무릎관절 자세가 수동적인 발등굽힘 가동범위에 미치는 영향

  • Jung, Do-young (Dept. of Physical Therapy, Kinesiopathologic Science Institute, Joongbu University)
  • 정도영 (중부대학교 물리치료학과, 운동병리과학연구소)
  • Received : 2019.05.17
  • Accepted : 2019.06.27
  • Published : 2019.09.17

Abstract

Background: Measurement of passive ankle dorsiflexion range of motion (ADROM) is often part of a physical therapy assessment. Objects: The objective of this study was to identify the effects of subtalar joint neutral position (SJNP) on passive ADROM according to knee position in young adults. Methods: We recruited 14 young adult participants for this study. Two examiners used a universal goniometer to measure passive ADROM with and without SJNP. Dorsiflexion force was applied to the forefoot until maximum resistance was reached in two knee positions (extension and $90^{\circ}$ flexion) in the prone position. Subtalar joint position was also recorded at maximum ADROM. Passive ADROM was measured three times at different knee and subtalar joint positions, in random order. Two-way repeated-measures analysis of variance was used to compare the effects of subtalar joint and knee position on passive ADROM. Results: Passive ADROM was significantly lower with than without SJNP during both knee extension (mean difference: $7.4^{\circ}$) and $90^{\circ}$ flexion (mean difference: $16.9^{\circ}$) (p<.01). Passive ADROM was significantly higher during $90^{\circ}$ knee flexion than during knee extension both with (mean difference: $5.8^{\circ}$) and without SJNP (mean difference: $15.2^{\circ}$) (p<.01). The valgus position of the subtalar joint was significantly lower with than without SJNP during both knee extension (mean difference: $3.3^{\circ}$) and $90^{\circ}$ flexion (mean difference: $4.3^{\circ}$) (p<.01). Conclusion: Our results indicate that the gastrocnemius may limit ankle dorsiflexion more than the soleus does. Greater dorsiflexion at the subtalar and midtarsal joints was observed during passive ADROM measurement without than that with SJNP; therefore, SJNP should be maintained for accurate measurement of ADROM.

Keywords

References

  1. Alawna MA, Unver BH, Yuksel EO. The reliability of a smartphone goniometer application compared with a traditional goniometer for measuring ankle joint range of motion. J Am Podiatr Med Assoc. 2019 ;109(1):22-29. https://doi.org/10.7547/16-128
  2. Albert SF, Curran SA, Root JA, et al. Lower Extremity Biomechanics: Theory and practice volume 1 Kindle edition, Denver, Colorado:Bipedmed, LLC, 2018:1390.
  3. Baggett BD, Young G. Ankle joint dorsiflexion. Establishment of a normal range. J Am Podiatr Med Assoc. 1993;83(5):251-254. https://doi.org/10.7547/87507315-83-5-251
  4. Baumbach SF, Braunstein M, Seeliger F, et al. Ankle dorsiflexion: What is normal? Development of a decisionpathway for diagnosing impaired ankle dorsiflexion and M. gastrocnemius tightness. Arch Orthop Trauma Surg. 2016;136(9):1203-1211. https://doi.org/10.1007/s00402-016-2513-x
  5. Bohannon RW, Tiberio D, Waters G. Motion measured from forefoot and hindfoot landmarks during passive ankle dorsiflexion range of motion. J Orthop Sports Phys Ther. 1991;13(1):20-22. https://doi.org/10.2519/jospt.1991.13.1.20
  6. DiGiovanni CW, Kuo R, Tejwani N, et al. Isolated gastrocnemius tightness. J Bone Joint Surg Am. 2002;84(6):962-970. https://doi.org/10.2106/00004623-200206000-00010
  7. Elveru RA, Rothstein JM, Lamb RL, et al. Methods for taking subtalar joint measurements. A clinical report. Phys Ther. 1988;68(5):678-682. https://doi.org/10.1093/ptj/68.5.678
  8. Fredericson M. Common injuries in runners: Diagnosis, rehabilitation and prevention. Sports Med. 1996;21(1):49-72. https://doi.org/10.2165/00007256-199621010-00005
  9. Gatt A, Chockalingam N. Validity and reliability of a new ankle dorsiflexion measurement device. Prosthet Orthot Int. 2013;37(4):289-297. https://doi.org/10.1177/0309364612465886
  10. Gershman S. A literature review of midtarsal joint function. Clin Podiatr Med Surg. 1988;5(2):385-391.
  11. Johanson M, Baer J, Hovermale H, et al. Subtalar joint position during gastrocnemius stretching and ankle dorsiflexion range of motion. J Athl Train. 2008;43(2):172-178. https://doi.org/10.4085/1062-6050-43.2.172
  12. Jordan RP. Ankle dorsiflexion at the heel-off phase of gait: A photokinegraphic study. J Am Podiatry Assoc. 1979;69:40-46. https://doi.org/10.7547/87507315-69-1-40
  13. Jung DY, Koh EK, Kwon OY, et al. Effect of medial arch support on displacement of the myotendinous junction of the gastrocnemius during standing wall stretching. J Orthop Sports Phys Ther. 2009;39(12):867-874. https://doi.org/10.2519/jospt.2009.3158
  14. Karas M, Hoy DJ. Compensatory midfoot dorsiflexion in the individual with heelcord tightness; implications for orthotic device designs. J Prosthet Orthot. 2002;14(2):82-93. https://doi.org/10.1097/00008526-200206000-00011
  15. Kibler WB, Goldberg C, Chandler TJ. Functional biomechanical deficits in running athletes with plantar fasciitis. Am J Sports Med. 1991;19(1):66-71. https://doi.org/10.1177/036354659101900111
  16. Kim PJ, Peace R, Mieras J, et al. 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(5):407-414. https://doi.org/10.7547/1010407
  17. Kleeblad LJ, van Bemmel AF, Sierevelt IN, et al. Validity and reliability of the Achillometer((R)): An ankle dorsiflexion measurement device. J Foot Ankle Surg. 2016;55(4):688-692. https://doi.org/10.1053/j.jfas.2015.11.006
  18. Levangie PK, Norkin CC. Joint Structure & Function: A Comprehensive Analysis. 5th ed. Philadelphia, PA, FA Davis, 2011:459.
  19. Lilletvedt J, Kreighbaum E, Phillips RL. Analysis of selected alignment of the lower extremity related to the shin splint syndrome. J Am Podiatry Assoc. 1979;69(3):211-217. https://doi.org/10.7547/87507315-69-3-211
  20. Messier SP, Pittala KA. Etiologic factors associated with selected running injuries. Med Sci Sports Exerc. 1988;20(5):501-505.
  21. Murray MP, Kory RC, Clarkson BH, et al. Comparison of free and fast speed walking patterns of normal men. Am J Phys Med. 1966;45(1):8-23.
  22. Norkin CC, Levangie PK. Joint Structure & Function:A comprehensive analysis. 3rd ed. Philadelphia, PA: FA Davis; 2001: 532.
  23. Pope R, Herbert R, Kirwan J. Effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on injury risk in army recruits. Aust J Physiother.1998;44(3):165-172. https://doi.org/10.1016/S0004-9514(14)60376-7
  24. Rabin A, Kozol Z. Weightbearing and nonweightbearing ankle dorsiflexion range of motion: Are we measuring the same thing? J Am Podiatr Med Assoc. 2012;102(5):406-411. https://doi.org/10.7547/1020406
  25. Riddle DL, Pulisic M, Pidcoe P, et al. Risk factors for plantar fasciitis: A matched case-control study. J Bone Joint Surg Am. 2003;85(5):872-877. https://doi.org/10.2106/00004623-200305000-00015
  26. Riemann BL, DeMont RG, Ryu K, et al. The effects of sex, joint angle, and the gastrocnemius muscle on passive ankle joint complex stiffness. J Athl Train. 2001;36(4):369-375.
  27. Saxena A, Kim W. Ankle dorsiflexion in adolescent athletes. J Am Podiatr Med Assoc. 2003; 93(4):312-314. https://doi.org/10.7547/87507315-93-4-312
  28. Smith-Oricchio K, Harris BA. Interrater reliability of subtalar neutral, calcaneal inversion and eversion. J Orthop Sports Phys Ther. 1990;12(1):10-15. https://doi.org/10.2519/jospt.1990.12.1.10
  29. Subotnick SI. Equinus deformity as it affects the forefoot. J Am Podiatry Assoc. 1971;61(11):423-427. https://doi.org/10.7547/87507315-61-11-423
  30. Tiberio D. Evaluation of functional ankle dorsiflexion using subtalar neutral position. A clinical report. Phys Ther. 1987;67(6):955-957. https://doi.org/10.1093/ptj/67.6.955
  31. Tiberio D, Bohannon RW, Zito MA. Effect of subtalar joint position on the measurement of maximum dorsiflexc. Clin Biomech (Bristol, Avon). 1989;4(3):189-191. https://doi.org/10.1016/0268-0033(89)90024-7
  32. Van Gheluwe B, Kirby KA, Roosen P, et al. Reliability and accuracy of biomechanical measurements of the lower extremities. J Am Podiatr Med Assoc. 2002;92(6):317-326. https://doi.org/10.7547/87507315-92-6-317
  33. Wilder RP, Sethi S. Overuse injuries: Tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 2004;23(1):55-81. https://doi.org/10.1016/S0278-5919(03)00085-1
  34. Wilken J, Rao S, Estin M, et al. A new device for assessing ankle dorsiflexion motion: Reliability and validity. J Orthop Sports Phys Ther. 2011;41(4):274-280. https://doi.org/10.2519/jospt.2011.3397
  35. Worrell TW, McCullough M, Pfeiffer A. Effect of foot position on gastrocnemius/soleus stretching in subjects with normal flexibility. J Orthop Sports Phys Ther. 1994;19(6):352-356. https://doi.org/10.2519/jospt.1994.19.6.352