Effect of treadmill walking with ankle stretching orthosis on ankle flexibility and gait

[Purpose] The purpose of this study was to evaluate the kinematics of the ankle in the lunge to estabilish effectiveness of an ankle stretching orthosis (ASO) on the ankle dorsiflexion range of motion (ROM) of individuals with limited dorsiflexion ROM. [Subjects and Methods] Forty ankles with decreased dorsiflexion ROM of 20 participants were evaluated in this study. After wearing the ASO, participants walked on a treadmill for 15 minutes. Participants walked on the treadmill at a self-selected comfortable speed. Ankle dorsiflexion ROM, maximum dorsiflexion ROM before heel-off, and time to heel-off during the stance phase of gait were measured before and after 15 minutes of treadmill walking with the ASO. The differences in all variables between before and after treadmill walking with ASO were analyzed using the paired t-test. [Results] Ankle active and passive ROM, and dorsiflexion ROM during lunge increased significantly after treadmill walking with ASO. Treadmill walking with the ASO significantly increased the angle of maximal dorsiflexion before heel-off and time to heel-off during the stance phase. [Conclusion] The results of this study show that treadmill walking with the ASO effectively improved ankle flexibility and restored the normal gait pattern of the ankle joint by increasing dorsiflexion ROM, maximal angle of dorsiflexion, and time to heel-off in the stance phase.     

Immediate effects of anterior to posterior talocrural joint mobilizations following acute lateral ankle sprain

Restrictions in ankle dorsiflexion range of motion (ROM) have been associated with decreased posterior talar glide in individuals with an acute lateral ankle sprain. Talocrural joint mobilizations may be used to restore joint arthrokinematics. Our purpose was to examine the effects of a single bout of anterior to posterior (AP) talocrural joint mobilization on self-reported function, dorsiflexion ROM, and posterior talar translation in individuals with an acute lateral ankle sprain. This single-blinded, randomized controlled trial utilized 17 volunteers (nine treatment and eight control) with an acute lateral ankle sprain (grade I/II) who were immobilized for a period of 1–7 days. The treatment group received a single 30-second bout of grade III AP talocrural joint mobilization the day their immobilization device was removed, while the control group did not receive any intervention. Active dorsiflexion ROM and posterior talar translation were assessed before, immediately after, and 24 hours after receipt of the treatment or control interventions. Self-reported function and pain were assessed before and 24 hours after the receipt of the treatment or control interventions using the foot and ankle disability index. Collectively all groups demonstrated improved dorsiflexion ROM and self-reported function. There was a significant decrease in pain perception at 24-hour follow-up for the treatment group. A single bout of AP talocrural joint mobilizations may not have an immediate effect on ankle dorsiflexion ROM, posterior talar translation, or self-reported function; however, they may have an immediate effect on pain perception in individuals with an acute lateral ankle sprain.     

Immediate Effects of Anterior-to-Posterior Talocrural Joint Mobilization after Prolonged Ankle Immobilization: A Preliminary Study

Ankle dorsiflexion range of motion (ROM) typically decreases after prolonged immobilization. Anterior-to-posterior talocrural joint mobilizations are purported to increase dorsiflexion ROM and decrease joint stiffness after immobilization. The purpose of this study was to determine if a single bout of Grade III anterior-to-posterior talocrural joint mobilizations immediately affected measures of dorsiflexion ROM, posterior ankle joint stiffness, and posterior talar translation in ankles of patients who had been immobilized at least 14 days. Ten physically active patients (5 males, 5 females; age=21.4±3.3 years) participated. Each had the ankle immobilized following a lower extremity injury for at least 14 days and presented with at least a 5° dorsiflexion ROM deficit compared to the contralateral ankle. A crossover design was employed so that half of the subjects received joint mobilizations first and half of the subjects received the control intervention (no treatment) first. All subjects ultimately received both treatments. Active dorsiflexion ROM was assessed with a bubble inclinometer, and posterior ankle stiffness and talar translation were assessed with an instrumented ankle arthrometer. After a single application of grade III anterior-to-posterior talocrural joint mobilization, dorsiflexion ROM and posterior ankle joint stiffness were significantly increased. There was also a trend toward less posterior talar translation immediately after mobilization. The trend toward decreased posterior talar translation and increased posterior ankle joint stiffness supports the positional fault theory. Correction of an anterior talar positional fault offers a possible explanation for these results.     

Does microcurrent stimulation increase the range of movement of ankle dorsiflexion in children with cerebral palsy?

Aim:?To determine whether microcurrent stimulation (MENS) increases the range of motion (ROM) of the ankle joint in children with cerebral palsy.

Design:?Twelve children with spastic hemiplegia (age range 4.5 to 16 years) with moderate myocontracture of the triceps surae, received MENS for 1?h five times a week for 4 weeks. An equally long baseline period was preceded. The assessments were: active and passive ROM of ankle dorsiflexion, popliteal flexion and ankle dorsiflexion in maximal flexion of knees in standing position while maintaining the heels in contact with the floor, one foot standing and hopping on one foot.

Results:?After the treatment with MENS, the passive ROM of ankle dorsiflexion with both knees flexed and extended (p?<?0.001) increased significantly. Increases were also observed in popliteal flexion (p?<?0.001) and ankle dorsiflexion (p?=?0.0012) during maximal flexion of the knees in a standing position. The ROM of active dorsiflexion with the knee flexed (p?<?0.05) and one foot standing (p?<?0.05) also improved. Children and parents found this treatment easy to carry out.

Conclusions:?MENS relieves myocontracture and can enhance conventional rehabilitation programmes for children with cerebral palsy.     

The influence of gastrocnemius stretching combined with joint mobilization on weight-bearing ankle dorsiflexion passive range of motion

[Purpose] The purpose of this study was to investigate the effect of gastrocnemius stretching combined with talocrural joint mobilization on weight-bearing ankle dorsiflexion passive range of motion. [Subjects] Eleven male subjects with bilateral limited ankle dorsiflexion passive range of motion with knee extended participated in this study. [Methods] All subjects received talocrural joint mobilization while performing gastrocnemius stretching. Ankle dorsiflexion passive range of motion was measured using an inclinometer under weight-bearing conditions before and immediately after intervention. A paired t-test was used to analyze the difference between weight-bearing ankle dorsiflexion passive range of motion pre- and post-intervention. [Results] A significant increase in weight-bearing ankle dorsiflexion passive range of motion was found post-intervention compared with pre-intervention. [Conclusion] These findings demonstrate that gastrocnemius stretching combined with joint mobilization is effective for increasing weight-bearing ankle dorsiflexion passive range of motion.Key words: Gastrocnemius stretching, Talocrural joint mobilization, Weight-bearing ankle dorsiflexion     

The effect of isolated gastrocnemius contracture and gastrocnemius recession on lower extremity kinematics and kinetics during stance

Background

Isolated gastrocnemius contracture limits ankle dorsiflexion with full knee extension and is potentially problematic during mid-stance of gait when 10° of dorsiflexion and full knee extension are needed. It is during this time that patients with isolated gastrocnemius contracture may demonstrate altered kinematics and/or kinetics. When conservative management fails to resolve painful foot pathologies associated with non-spastic isolated gastrocnemius contracture, gastrocnemius recession surgery has been suggested to resolve contracture and improve function and strength. However, there are no published reports on lower extremity kinematics/kinetics in the non-spastic isolated gastrocnemius contracture population. Assessment of alterations in gait mechanics is necessary to examine the effects of this potential surgical intervention.

Methods

Lower extremity kinematics and kinetics were assessed in 6 patients clinically diagnosed with isolated gastrocnemius contracture pre- and post-surgical recession compared with 33 healthy control participants.

Findings

Pre-operatively, patients with isolated gastrocnemius contracture demonstrated significantly increased peak knee flexion angles and knee flexion moments during mid-stance. There were no differences in peak ankle dorsiflexion angle or peak plantar flexion moment. Gastrocnemius recession did not alter gait kinematics/kinetics following surgery. Joint kinematic strategies utilized to compensate for isolated gastrocnemius contracture varied minimally between participants with IGC; most employed a flexed knee strategy, while one participant utilized a reduced ankle dorsiflexion strategy.

Interpretation

Select post-surgical gait mechanics were unaltered; however, gait mechanics were not similar between non-spastic isolated gastrocnemius contracture patients and healthy control participants. Surgical intervention for patients with isolated gastrocnemius contracture does not appear to create any negative gait adaptations; however, patients may benefit from gait retraining post-recession as maladaptive gait patterns persist post operatively.     

Age and passive ankle stiffness in healthy women

The purpose of the study was to evaluate passive joint stiffness in ankles of young (aged 21-40 years; n = 15), middle-aged (aged 41-60 years; n = 15), and young elderly (aged 61-80 years; n = 15) women. The effect of knee position on passive joint stiffness was also evaluated by testing the subjects with the knee flexed (90 degrees) and with the knee extended (0 degrees). A torque motor system was used to record angular displacement and resistive torque during a 6 degrees/sec ankle rotation from 10 degrees of plantar flexion to 10 degrees of dorsiflexion (DF). Passive torque and passive elastic stiffness were measured at 0, 5, and 10 degrees of DF. Both measures increased nonlinearly as the ankle was rotated into DF, but showed no significant differences between the three age groups tested. There was also no significant difference in the passive stiffness measurements when the knee was flexed or extended. We concluded that within the range of motion tested, the factors of age and knee position do not affect the passive stiffness observed in the ankle joints of healthy women. We have now established baseline values of passive ankle joint stiffness for healthy women during DF within a functional ROM, which will be useful in the clinical evaluation of passive ankle joint stiffness and in studies where treatment efficacy is being investigated.     

脑卒中偏瘫患者膝过伸步态运动学特点分析

目的:探讨脑卒中偏瘫患者膝过伸步态的三维运动学特点及其与步行速度的相关性,从运动学角度探讨影响膝过伸患者步行速度的主要因素。方法:利用三维步态分析系统对15例伴有膝过伸步态的脑卒中偏瘫患者和15例健康老年人进行运动学定量比较,并将其与步行速度进行相关性分析。结果:与正常对照组相比,膝过伸患者的步长、步频减小,步速减慢,支撑期百分比延长(均P0.05);膝过伸患者髋、膝、踝关节活动范围减小,最大伸髋、屈膝、踝背屈角度减小,最大伸膝角度增加(均P0.05)。步行速度与步频、支撑相百分比、膝踝关节活动范围、最大屈膝角度和最大踝跖屈角度均相关(均P0.05)。结论:脑卒中偏瘫膝过伸患者下肢关节活动不同程度受限,步行速度下降,其中屈膝和踝跖屈异常是影响膝过伸患者步行速度的主要因素。     

Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report

A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsiflexion and knee extension, respectively. Treatment included a high-velocity low amplitude thrust manipulation to the talocrural joint, which helped restore normal ankle dorsiflexion range of motion. The patient also received tibiofemoral joint non-thrust manual therapy to regain normal knee extension mobility prior to implementing further functional progression exercises to her home program (HEP). This case report highlights the importance of a detailed evaluation of knee and ankle joint mobility in patients presenting with anterior knee pain. Further, manual physical therapy to the lower extremity was found to be successful in restoring normal movement patterns and pain-free function in a patient with chronic anterior knee pain.     

The relationship between hallux dorsiflexion and ankle joint complex frontal plane kinematics: a preliminary study

BACKGROUND: It has been suggested that the function of the first metatarsophalangeal joint may be related to the motion of the ankle joint complex. OBJECTIVE: This study explored the relationship between ankle joint complex and first metatarsophalangeal joint motion during gait in a group of 14 who demonstrated clinically limited passive hallux dorsiflexion in quiet standing (cases), and 15 matched controls. METHOD: An electromagnetic tracking system was used to measure the ankle joint complex frontal plane motion and first metatarsophalangeal joint sagittal plane motion during gait, in both cases and controls. The case group was then evaluated further to investigate the effect of an orthosis on first metatarsophalangeal joint motion. FINDINGS: The correlation between maximum ankle joint complex eversion and maximum first metatarsophalangeal joint dorsiflexion during gait was r=0.471. Within the case group, maximum rearfoot eversion was reduced following the application of the orthoses, but there was no change in sagittal first metatarsophalangeal joint rotations. INTERPRETATION: The relationship between maximum ankle joint complex eversion and first metatarsophalangeal joint dorsiflexion kinematics found in this study was moderate, and decreasing maximum ankle joint complex eversion with an orthosis did not result in any increase in first metatarsophalangeal joint dorsiflexion during gait in patients with functional first metatarsophalangeal joint limitation. These results do not support the assumption that ankle joint complex eversion influences first metatarsophalangeal joint motion substantially.     

挛缩膝关节中肌源性成份的实验研究

目的区分因伸直位制动4周所致兔膝关节挛缩中的肌源性和关节源性成份。方法10只兔子的后肢右侧作为制动侧,左侧为对照侧。将其膝关节伸直位制动4周后,分别测量肌肉切断术前后两侧膝关节的关节活动度(ROM),以反映肌源性成份所占的比例。结果制动侧和对照侧膝关节的ROM分别为79.5°和138.5°,行肌肉切断术后其ROM分别增加了8.7°±0.45°,11.6°±0.58°,肌源性成分在关节挛缩中所占的比例仅为14.75％。结论制动4周后,膝关节的ROM受限,其中肌源性成份所占的比例很小。     

The Single Leg Squat Test: A “Top-Down” or “Bottom-Up” Functional Performance Test?

BackgroundMedial knee deviation (MKD) during the single leg squat test (SLST) is a common clinical finding that is often attributed to impairments of proximal muscular structures. Investigations into the relationship between MKD and the foot and ankle complex have provided conflicting results, which may impact clinicians’ interpretation of the SLST.PurposeThe purpose of this study was to compare ankle dorsiflexion range of motion (ROM) and foot posture in subjects that perform the SLST with MKD (fail) versus without MKD (pass).HypothesisThere will be a difference in ankle dorsiflexion ROM and/or foot posture between healthy individuals that pass and fail the SLST for MKD.Study DesignCross-sectional study.MethodsSixty-five healthy, active volunteers (sex = 50 female, 15 male; age = 25.2 +/- 5.6 years; height = 1.7 +/- .1 m; weight = 68.5 +/- 13.5 kg) who demonstrated static balance and hip abductor strength sufficient for performance of the SLST participated in the study. Subjects were divided into pass and fail groups based on visual observation of MKD during the SLST. Foot Posture Index (FPI-6) scores and measures of non-weight bearing and weight bearing active ankle dorsiflexion (ROM) were compared.ResultsThere were 33 individuals in the pass group and 32 in the fail group. The groups were similar on age (p = .899), sex (p = .341), BMI (p = .818), and Tegner Activity Scale score (p = .456). There were no statistically significant differences between the groups on the FPI-6 (pass group mean = 2.5 +/- 3.9; fail group mean = 2.3 +/- 3.5; p = .599), or any of the measures of dorsiflexion range of motion (non-weight bearing dorsiflexion with knee extended: pass group = 6.9^o +/- 3.7^o, fail group = 7.8^o +/- 3.0^o; non-weight bearing dorsiflexion with knee flexed: pass group = 13.5^o +/- 5.6^o, fail group = 13.9^o +/- 5.3^o; weight bearing dorsiflexion: pass group = 42.7^o +/- 6.0^o, 42.7^o +/- 8.3^o, p = .611).ConclusionsFailure on the SLST is not related to differences in clinical measures of active dorsiflexion ROM or foot posture in young, healthy individuals. These findings suggest that clinicians may continue using the SLST to assess neuromuscular performance of the trunk, hip, and knee without ankle dorsiflexion ROM or foot posture contributing to results.Level of EvidenceLevel 3.     

Measurement of selected hip, knee, and ankle joint motions in newborns

As clinicians become more involved in preventative screening, assessment, and treatment of newborns and infants, an increasing need exists for quantitative, normal joint range-of-motion data for this population. We used a goniometer to assess in 40 healthy, full-term newborns the following passive ranges of motion: hip extension, knee extension, ankle plantar flexion, ankle dorsiflexion, and the popliteal angle. Every infant except one lacked full extension at both the hip and the knee. Plantar flexion was generally limited, but dorsiflexion was unlimited. Popliteal angle measurements showed the greatest amount of variation among the infants. Pearson correlation coefficients indicated that those infants with greater dorsiflexion tended to have less plantar flexion, and those with a greater limitation of knee extension measured with the hip extended tended also to have a smaller popliteal angle. Intrauterine position and newborn flexor tone are discussed as possible contributing factors to the results obtained in this study.     

Idiopathic toe walker child. Diagnosis and spontaneous evolution]

AIM OF THE STUDY: To analyse the clinical, the aetiological aspects, the evolution without treatment and the age of correction. MATERIAL: This history of 69 children admitted between 1973 and 1998 was analysed. Forty-one were reviewed during the growth; only 6 were treated. RESULTS: The toe walking was most often observed at the beginning of the walk between the age of 12 and 18 months. The first examination was made between 1 and 4 year old. The ankle dorsiflexion was the same, knee extended or flexed for 41 children and different in 23 cases. Identical cases were present in the family in 16 of 33 when the history family was analysed. The neurological examination was normal in 46 cases. None of the 69 children had a neurological impairment. In 32 cases, spontaneous correction occurred between 3 and 8 years: all these cases presented an ankle dorsiflexion over 10 degrees knee extended. The toe walking persisted in two cases at 10 years and in two cases at 12 and 13 years: the dorsiflexion was under 10 degrees, knee extended at initial examination in these cases. DISCUSSION AND CONCLUSION: It is possible to differentiate the toe walkers with more than 10 degrees of ankle dorsiflexion knee extended where the correction is possible without treatment and the cases with triceps contracture and less than 10 degrees of ankle dorsiflexion where the correction without triceps lengthening is questionnable.     

Efficacy of instrument-assisted soft tissue mobilization in comparison to gastrocnemius-soleus stretching for dorsiflexion range of motion: A randomized controlled trial

ObjectivesTo determine the efficacy of IASTM of the gastrocnemius-soleus complex in comparison to a traditional stretching intervention on dorsiflexion ROM.MethodsSixty healthy participants were randomly allocated to one of 3 groups: IASTM (n = 20), stretching (n = 20), or control group (n = 20). The dependent variables for this study was dorsiflexion range of motion (ROM) via three measurement methods which included Modified root position 1- knee extended (MRP1), Modified root position 2- knee flexed (MRP2), and weight bearing lunge test (WBLT). A multivariate analysis of variance (MANOVA) was utilized to analyze the ROM differences between the groups (IASTM, stretching, and control groups), with a post-hoc Tukey and pairwise least significant difference tests to assess individual pairwise differences between the groups.ResultsThe MANOVA found significant ROM differences between the three intervention groups (F_6,110 = 2.40, p = .032). Statistically significant differences were identified between both the IASTM and control as well as the stretching and control group through the WBLT and MRP2 assessments, but not in the MRP1 assessment. Further, there was no statistically significant difference between the IASTM and stretching groups using any of the three methods.ConclusionA single session of IASTM or stretching increased ankle dorsiflexion ROM in WBLT and MRP2. No significant difference was noted in the MRP1. Both IASTM and stretching appear to have a greater effect on soleus muscle flexibility as evidenced by ROM gains measured with the knee in a flexed position. No clinically significant difference was identified between the intervention groups in weight-bearing conditions; thus empowering patients with the use of self-stretching would seemingly be reasonable and efficient. Combined effects of stretching and IASTM warrant further investigation for increasing dorsiflexion range of motion as a summative effect is unknown.     

Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke: effects of a 4-week intervention program

OBJECTIVE: To investigate the effect of repeated feedback-controlled and programmed "intelligent" stretching of the ankle plantar- and dorsiflexors to treat subjects with ankle spasticity and/or contracture in stroke. DESIGN: Noncontrolled trial. SETTING: Institutional research center. PARTICIPANTS: Subjects with spasticity and/or contracture after stroke. INTERVENTIONS: Stretching of the plantar- and dorsiflexors of the ankle 3 times a week for 45 minutes during a 4-week period by using a feedback-controlled and programmed stretching device. MAIN OUTCOME MEASURES: Passive and active range of motion (ROM), muscle strength, joint stiffness, joint viscous damping, reflex excitability, comfortable walking speed, and subjective experiences of the subjects. RESULTS: Significant improvements were found in the passive ROM, maximum voluntary contraction, ankle stiffness, and comfortable walking speed. The visual analog scales indicated very positive subjective evaluation in terms of the comfort of stretching and the effect on their involved ankle. CONCLUSIONS: Repeated feedback-controlled or intelligent stretching had a positive influence on the joint properties of the ankle with spasticity and/or contracture after stroke. The stretching device may be an effective and safe alternative to manual passive motion treatment by a therapist and has potential to be used to repeatedly and regularly stretch the ankle of subjects with spasticity and/or contracture without daily involvement of clinicians or physical therapists.