J Orthop Sci (2010) 15:531–539
DOI 10.1007/s00776-010-1492-y

Original article
Proposed novel unified nomenclature for range of joint motion:
method for measuring and recording for the ankles, feet, and toes
HIDEO DOYA1,6, NAOKI HARAGUCHI2,6, HISATERU NIKI3,6, MASATO TAKAO4,6, and HARUYASU YAMAMOTO5,6
1

Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
Department of Orthopaedic Surgery, West Tokyo Metropolitan Police Hospital, Tokyo, Japan3
Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
4
Department of Orthopaedic Surgery, Teikyo University Graduate School of Medicine, Tokyo, Japan
5
Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
6
The Ad Hoc Committee on Terminology of the Japanese Society for Surgery of the Foot
2

Abstract The Ad Hoc Committee of Terminology of the Japanese Society for Surgery of the Foot (JSSF) proposes novel
terminology for motion of the ankle, foot, and toe because
there are some ambiguities in the current terminology. Articles were identified by searching the electronic databases of
PubMed that compared definitions of American Orthopaedic
Foot and Ankle Society (AOFAS), International Society ofBiomechanics (ISB), and in the textbook of Kapandji as wellas the American Academy of Orthopaedic Surgeons (AAOS).
A total of 11 articles described the transverse (horizontal)
plane motion in the hindfoot as external rotation/internalrotation and 10 as abduction/adduction. In all, 2 articles
described the transverse (horizontal) plane motion in midfoot
as external rotation/internal rotation and 10 as abduction/
adduction. Another 4 articles described the transverse (horizontal) plane motion in the forefoot as external rotation/internal rotation and 8 as abduction/adduction. Altogether, 109
articles described the sagittal plane motion of the foot/ankle
as dorsiflexion/plantarflexion and 20 as extension/flexion. In
all, 99 articles described the frontal (coronal) plane motion of
the foot/ankle as inversion/eversion and 4 as supination/pronation. Furthermore, 12 articles described the sagittal planemotion of toes as dorsiflexion/plantarflexion and 15 as extension/flexion. Another 16 articles described the frontal (coronal)
plane motion of toes as supination/pronation and 1 as inversion/eversion. The transverse (horizontal) plane motion of thefoot/ankle was defined as abduction/adduction in the hindfoot,midfoot, and forefoot; the sagittal plane motion of the foot/ankle was defined as dorsiflexion/plantarflexion; and thefrontal (coronal) plane motion of the foot/ankle as inversion/
eversion. The transverse (horizontal) plane motion of toes was
defined as abduction/adduction; the sagittal plane motion of
toes was defined as extension/flexion; and the frontal (coronal)
plane motion of toes was defined as supination/pronation.

Offprint requests to: H. Yamamoto
Received: January 17, 2010 / Accepted: April 19, 2010

Introduction
It is known that the terminology used to describe motionof the foot and ankle contains a number of ambiguities.1,2 Especially, there are two opinions about the
motions inversion/eversion and supination/pronation:
One is the concept defining inversion/eversion ascoronal plane motion and supination/pronation as triplane motion, advocated by the American Orthopaedic
Foot and Ankle Society (AOFAS)3 and International
Society of Biomechanics (ISB).4 The other is the concept
defining inversion/eversion as triplane motion and supination/pronation as coronal plane motion, advocated by
Kapandji5 and the American Academy of Orthopaedic
Surgeons (AAOS)6 (Tables 1-1, 1-2).
To solve this problem, the Ad Hoc Committee ofTerminology of the Japanese Society for Surgery of theFoot (JSSF) prepared a novel proposal for terminology
of motion of the ankle, foot, and toe. The purpose of thisstudy was thus to present a novel proposal for measuring the range of joint motion (ROM) based on the terminology for motion of the ankle, foot, and toe.

Joint motion of the foot/ankle
Planes of joint motion
As defined by the terminology of the AOFAS3 and the
ISB, we established three planes to express joint motions:transverse (horizontal), sagittal, and frontal (coronal).
The neutral zero starting position was modified to theposition standing with the long axis of both feet parallel
each other. The transverse (horizontal) plane wasdefined as the plane that included the plantar surface
when standing still. The sagittal plane was defined as theplane perpendicular to the transverse (horizontal) planethat included the long axis of the second metatarsalbone. The frontal (coronal) plane was defined as the

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H. Doya et al.: Proposed nomenclature for the footTable 1-1. Definition of joint motion of foot and ankle
Plane
Transverse (horizontal)

Sagittal
Frontal (coronal)

AOFAS (1996)

ISB (2002)

Forefoot/midfootAbduction
Adduction
Ankle/hindfootExternal rotation
Internal rotation
Dorsiflexion
Plantarflexion
Eversion
Inversion

Forefoot/midfootExternal rotation
Internal rotation
Ankle/hindfootExternal rotation
Internal rotation
Dorsiflexion
Plantarflexion
Eversion
Inversion

AOFAS, American Orthopaedic Foot and Ankle Society; ISB, International Society ofBiomechanics

Table 1-2. Definition of joint motion of foot and ankle
Plane
Transverse (horizontal)
Sagittal
Frontal (coronal)

AAOS6 (1965)

Kapandji5 (1987)

Abduction
Adduction
Extension (dorsiflexion)
Flexion (plantarflexion)
Forefoot
Pronation
Supination
Hindfoot
Eversion
Inversion

Abduction
Adduction
FlexionExtension
Forefoot
Pronation
Supination
Hindfoot
Pronation
Supination

AAOS, American Academy of Orthopaedic Surgeons

plane perpendicular to the transverse (horizontal) plane
and the sagittal plane2 (Fig. 1).
Joint motion of the foot/ankle
Dorsiflexion/plantarflexion is not only the motion of theankle; the motions of the subtalar joint and Chopart/
Lisfranc joint are involved in dorsiflexion/plantarflexion
as well. The motions not only of the joints of the footbut also the ankle joint constitute supination/pronation
or inversion/eversion. We described these motions as
the unifying motion of the foot and ankle because it isdifficult to separate them.
Joint motion in transverse (horizontal) plane
According to the terminology of AOFAS3 the motionin the transverse (horizontal) plane is described asexternal rotation/internal rotation of the hindfoot andabduction/adduction of the forefoot, whereas the ISB
terminology4 adopts only external rotation/internalrotation and does not define abduction/adduction.
We reviewed previous articles describing the transverse (horizontal) plane motion of the foot/ankle in thehindfoot, midfoot, and forefoot. The terminology utilized in the literature was explored by examining related

academic papers retrieved through a search of the
PubMed medical literature database (www.pubmed.
com) up to 2008. The following search terms were usedin combination: ankle rotation abduction, ankle rotation
adduction, foot rotation abduction, foot rotation adduction. Only articles in the English language were included.
A total of 160 references were retrieved.
For the hindfoot, 11 articles described the transverse(horizontal) plane motion as external rotation/internalrotation, 10 as abduction/adduction, and 18 as both
external rotation/internal rotation and abduction/
adduction; 121 articles did not mention specific terms.
For the midfoot, 2 articles described the transverse (horizontal) plane motion as external rotation/internal rotation and 10 as abduction/adduction; 148 articles did
not mention specific terms. For the forefoot, 4 articles
described the transverse (horizontal) plane motion as
external rotation/internal rotation and 8 as abduction/
adduction; and 148 articles did not mention specificterms (Table 2-1).
Based on the results of the current study, it seems
preferable to define the transverse (horizontal) planemotion of the foot/ankle as abduction/adduction of thehindfoot, midfoot, and forefoot because abduction/
adduction is somewhat commonly used to describe theH. Doya et al.: Proposed nomenclature for the foot533

Fig. 2. Joint motion of the foot/ankle in the transverse (horizontal) plane

Table 2-2. Results of searching electronic databases for foot/ankle motion in the sagittal plane
Dorsiflexion/plantarflexion
Extension/flexion
Both
Dorsal extension/plantar flexion
Not specified
Total

Fig. 1. Three-dimensional view of planes of joint motion at a
modified neutral zero starting position
Table 2-1. Results of searching electronic databases for foot/ankle motion in the transverse (horizontal) plane
Condition
External/internal rotation
Abduction/adduction
Both
Not specified
Total

Hindfoot

Midfoot

Forefoot

11
10
18
121
160

2
10
0
148
160

4
8
0
148
160

transverse (horizontal) plane motion of the midfoot andforefoot, although external rotation/internal rotation
and abduction/adduction are equally used for the hindfoot (Fig. 2).
Joint motion in the sagittal plane
There are some ambiguities describing the joint motion
in sagittal plane, it was defined as extension/flexion

109
20
5
3
53
190

(dorsiflexion/plantarflexion) in the terminology of
AAOS,6 however extension/flexion is defined to thereverse motion by Kapandji.5 In the textbook of
Kapandji, he describes that flexion of the ankle is the
movement, which approximates the dorsum of the footand anterior surface of the leg, and extension of theankle is the movement of the dorsum of the foot awayfrom the anterior surface of the leg. He also mentioned
to the term dorsiflexion, which is incorrect because
flexion always correspond to the movement of approximation of the segments of a limb and the trunk.
We reviewed the previous papers describing the sagittal plane motion of foot/ankle. The terminology utilized
in the literature was explored by examining related academic papers retrieved through a search of the PubMed
up to 2008. The following search terms were used in
combination: ankle, foot, flexion, extension. Only papers
in the English language were included. A total of 190
references were retrieved.
There were 109 papers describing the sagittal planemotion as dorsiflexion/plantarflexion, 20 papers describing the sagittal plane motion as extension/flexion, 5
papers describing the sagittal plane motion as both dorsiflexion/plantarflexion and extension/flexion and 3
papers describing the sagittal plane motion as dorsal
extension/plantar flexion, and 53 papers not describing
specific terms (Table 2-2). In the 20 papers describing

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H. Doya et al.: Proposed nomenclature for the footFig. 3. Joint motion of the foot/ankle in the sagittal plane
Fig. 4. Joint motion of the foot/ankle in the frontal (coronal)
plane

the sagittal plane motion as extension/flexion, the direction of the motion was corresponding to the definitionof Kapandji5 and we could not find any paper describing
the dorsiflexion for the upward motion of the ankle andplantarflexion for the downward motion of the ankle as
described by AAOS.6
In the novel proposition, we eliminated extension/
flexion, and defined the sagittal plane motion of foot/ankle as dorsiflexion/plantarflexion, because dorsiflexion/plantarflexion is commonly used to describe thesagittal plane motion of foot/ankle (Fig. 3).
Joint motion in frontal (coronal) plane
In some textbooks, coronal plane motion of foot/ankle
is defined as inversion/eversion,1,2,7,8 but it is also definedas supination/pronation in other textbooks.5,9–11
Doya et al reviewed the previous papers describing
the frontal (coronal) plane motion of foot/ankle.12 They
explored the terminology utilized in the literature
examining related academic papers retrieved through asearch of the PubMed up to 2006. The following searchterms were used in combination: ankle, foot, inversion,
eversion. Only papers in the English language were
included. A total of 141 references were retrieved. They
reported that there were 92 papers describing the frontal(coronal) plane motion as inversion/eversion, 4 papers
describing the frontal (coronal) plane motion as supination/pronation, and 45 papers not describing specificterms (Table 2-3).
According to the results of the current study, it may
be preferable to define the frontal (coronal) planemotion of foot/ankle as inversion/eversion, because
inversion/eversion is commonly used to describe thecoronal plane motion of foot/ankle (Fig. 4).

Fig. 5. Combined joint motion of the foot/ankle in a triplaneview

Table 2-3. Results of searching electronic databases for foot/ankle motion in the frontal (coronal) plane
Inversion/eversion
Supination/pronation
Not specified
Total

92
4
45
141

Complex motion
We defined the complex motion in two or three planes
as a combination of the motions. Especially, the triplanemotion — composed of plantarflexion, adduction, andinversion of the foot/ankle — is defined as supination;and the motion composed of dorsiflexion, abduction,and eversion is defined as pronation (Fig. 5) This isH. Doya et al.: Proposed nomenclature for the foot535

Table 2-4. Results of searching electronic databases for proposition of terminology offoot/ankle motion
Plane

Ankle joint

Subtalar joint

Chopart/Lisfranc
jointsTransverse (horizontal)

Abduction
Adduction
Dorsiflexion
Plantarflexion
Eversion
Inversion

Abduction
Adduction
Dorsiflexion
Plantarflexion
Eversion
Inversion

Abduction
Adduction
Dorsiflexion
Plantarflexion
Eversion
Inversion

Sagittal
Frontal (coronal)

because “supination” originates from supino in Latin(to bend backward), and pronation originates fromprono in Latin (to bend forward).13 In the forearm, themotion of rotating outward around the axis of theforearm from the neutral zero starting position resultsin the hand turning upward is called supination, and the
motion of rotating it inward around the axis of theforearm from the neutral zero starting position resultsin the hand turning downward is called pronation. In
the modified neutral zero position of the foot/ankle, thefoot is already rotated inward around the axis of the leg,and the ankle is dorsiflexed corresponding to the neutral
zero position of the forearm. The motion of making thefoot/ankle bend backward consists of rotating outward
around the leg axis, thereby plantarflexing the ankle andadducting the foot; and the motion of making the foot/ankle bend forward consists of rotating inward aroundthe leg axis, thereby dorsiflexing the ankle and abducting the foot. From the etymological point of view,
this indicates that supination is a complex motion ofplantarflexion, adduction, and inversion; and pronation
is a complex motion of dorsiflexion, abduction, andeversion.

Proposed terminology for joint motion of
the foot/ankle

Fig. 6. Three-dimensional view of planes of joint motion of
the foot/ankle
Table 2-5. Results of searching electronic databases for supination/pronation of the foot/ankle
Plane

Supination

Pronation

Transverse (horizontal)
Sagittal
Frontal (coronal)

Adduction
Plantarflexion
Inversion

Abduction
Dorsiflexion
Eversion

See Fig. 6 for reference.
• Abduction/adduction (Table 2-4): Abduction/adduction comprises motion of the ankle joint, subtalar
joint, and Chopart/Lisfranc joint in the transverse(horizontal) plane.
• Dorsiflexion/plantarflexion (Table 2-4): Dorsiflexion/
plantarflexion comprises motion of the ankle joint,
subtalar joint, and Chopart/Lisfranc joint in the sagittal plane.
• Inversion/eversion (Table 2-4): Inversion/eversion
comprises motion of the ankle joint, subtalar joint,
and Chopart/Lisfranc joint in the frontal (coronal)
plane.
• Supination/pronation (Table 2-5): Supination/pronation is complex joint motion in the triplane. Supina-tion is the complex motion of plantarflexion,
adduction, and inversion comprised of motion of theankle joint, subtalar joint, and Chopart/Lisfranc joint.
Pronation is the complex motion of dorsiflexion,
abduction, and eversion comprised of motion of theankle joint, subtalar joint, and Chopart/Lisfranc joint.

Joint motion of toes
We defined the joint motion of toes with three planes,
as described for the foot/ankle. Motion in the transverse(horizontal) plane was defined as abduction/adduction
according to the motion of forefoot.

536

H. Doya et al.: Proposed nomenclature for the footWe reviewed previous articles that described the sagittal plane motion of toes. The terminology utilized in
the literature was explored by examining related academic articles retrieved through a search of the PubMed
up to 2008. The following search terms were used in
combination: hallux, toe, flexion, extension. Only articles in the English language were included. A total of
112 references were retrieved. A total of 12 articles
described the sagittal plane motion as dorsiflexion/plantarflexion and 15 as extension/flexion; 85 articles did
not mention specific terms (Table 3-1). We defined thesagittal plane motion of toes as extension/flexion as it
was described in the conventional terminology of theJapanese Orthopaedic Association (JOA) because bothof them were used equally.
Articles describing the frontal (coronal) plane motionof toes were also reviewed. The terminology was
explored by examining papers retrieved through asearch of the PubMed up to 2008. The following searchterms were used in combination: hallux, toe, supination,
pronation, inversion, eversion. Only English-language
articles were included. A total of 145 references wereretrieved. Altogether, 16 papers described the frontal(coronal) plane motion as supination/pronation and 1
as inversion/eversion; 128 papers did not mention specific terms (Table 3-2). In the preparation of the novel

proposal for the terminology motion of toes, we defined
the frontal (coronal) plane motion as supination/pronation. Care must be taken because the definitions aredifferent from those of supination/pronation of the foot/ankle.
Based on the results of the current study, it is preferable to define motion of the toes as motion in the MTP
joint and the IP (PIP and DIP) joint, respectively,
because it is difficult to determine the basic axis andmoved axis as the whole motion of the toes.

Proposed terminology for joint motion of toes
See Fig. 7 for reference.
• Abduction/adduction (Table 3-3): Abduction/adduction is composed by the motion of MTP joint, IP jointof great toe and PIP and DIP joints of toes in transverse (horizontal) plane.

Table 3-1. Results of searching the electronic databases fortoe motion in the sagittal plane
Dorsiflexion/plantarflexion
Extension/flexion
Not specified
Total

12
15
85
112

Table 3-2. Results of searching the electronic databases fortoe motion in the frontal (coronal) plane
Supination/pronation
Inversion/eversion
Not specified
Total

16
1
128
145

Fig. 7. Three-dimensional view of planes of joint motion of
the toes

Table 3-3. Results of searching the electronic databases for proposition ofterminology of the motion of toes
Plane

MTP joint

IP joint of great toe

PIP and DIP jointsof toes

Transverse (horizontal)

Abduction
Adduction
Extension
FlexionSupination
Pronation

Abduction
Adduction
Extension
FlexionSupination
Pronation

Abduction
Adduction
Extension
FlexionSupination
Pronation

Sagittal
Frontal (coronal)

MTP, metatarsophalangeal; IP, interphalangeal; PIP, proximal interphalangeal; DIP, distalinterphalangeal

H. Doya et al.: Proposed nomenclature for the foot537

• Extension/flexion (Table 3-3): Extension/flexion iscomposed by the motion of MTP joint, IP joint ofgreat toe and PIP and DIP joints of toes in sagittal
plane.
• Supination/pronation (Table 3-3): Supination/pronation is composed by the motion of MTP joint, IP jointof great toe and PIP and DIP joints of toes in frontal(coronal) plane.

Notes
1. Valgus/varus is not used for motion of the forefoot
and toes but as the term describing motion in thetransverse (horizontal) plane for the foot/ankle andtoe. For instance, hallux valgus is the deformity of
Table 4. Proposition of joint motion of foot/ankle and toe
Plane

Range of joint motion; method of measuring andrecording for ankle, foot, and toe

Transverse (horizontal)
Sagittal

In consideration of the above, we established a novel
joint motion of the foot/ankle and toe as well as therange of joint motion. Refer to Tables 4–7 for details.

Frontal (coronal)

Foot/ankle

Toe

Abduction
Adduction
Dorsiflexion
Plantarflexion
Inversion
Eversion

Abduction
Adduction
Extension
FlexionSupination
Pronation

Table 5. Range of joint motion: method of measuring and recording for foot/ankle
Measuring
Joint motion

ROM

Plane

Basic axisa

Moved axisa

Abduction

0–10

Adduction

0–20

Transverse(horizontal)
Transverse(horizontal)

Long axis of second
metatarsal boneLong axis of second
metatarsal boneLong axis of second
metatarsal boneLong axis of second
metatarsal bone

Figurea

Abduction

Dorsiflexion

0–20

Sagittal

Plantarflexion

0–60

Sagittal

Perpendicular to axisof legPerpendicular to axisof legAdduction

Plantar surface
Dorsiflexion

Plantar surface

Plantarflexion

Inversion (midfootand forefoot)Eversion (midfootand forefoot)

0–20

Frontal (coronal)

Plantar surface

Plantar surface

0–20

Frontal (coronal)

Plantar surface

Plantar surface

Inversion (hindfoot)Eversion (hindfoot)

0–30
0–30

Eversion

Frontal (coronal)
Frontal (coronal)

Axis of leg
Axis of leg

Axis of calcareous
Axis of calcareous
Inversion

ROM, range of motionaBasic axis, solid line; moved axis, broken line

Inversion

E version

538

H. Doya et al.: Proposed nomenclature for the footTable 6. Range of joint motion: method of measuring and recording for the great toe
Measuring (in the sagittal plane)
Joint motion

ROM

Basic axisa

Moved axisa

MP joint
Extension
Flexion

0–60
0–35

Long axis of first metatarsal boneLong axis of first metatarsal boneLong axis of first basal phalanxLong axis of first basal phalanx

Figurea

Extension

FlexionIP joint
Extension
Flexion0
0–60Long axis of first basal phalanxLong axis of first basal phalanxLong axis of first distal phalanxLong axis of first distal phalanx
Extension

Flexiona

Basic axis, solid line; moved axis, broken line

Table 7. Range of joint motion: method of measuring and recording for toes
Joint
motionMeasuring (in the sagittal plane)ROM

MP joint
Extension 0–60
Flexion

0–35

Basic axisa
Long axis of 2nd–5th metatarsal
boneLong axis of 2nd–5th metatarsal
bone

Moved axisa

FigureaLong axis of 2nd–5th basal phalanx
Extension
Extension

Long axis of 2nd–5th basal phalanx

Flexion

PIP joint
Extension 0
Flexion
0–60

Long axis of 2nd–5th basal phalanx Long axis of 2nd–5th mid-phalanxLong axis of 2nd–5th basal phalanx Long axis of 2nd–5th mid-phalanx
Extension

FlexionDIP joint
Extension 0
Flexion

0–60

Long axis of 2nd–5th mid phalanxLong axis of 2nd–5th mid phalanxLong axis of 2nd–5th distal
phalanx
Long axis of 2nd–5th distal
phalanx

Extension

FlexionFlexiona

Basic axis, solid line; moved axis, broken line

H. Doya et al.: Proposed nomenclature for the footfirst MTP joint; however, concerning the direction of
the movement, it corresponds to abduction and actually pronation of the great toe.
2. Two methods for measuring inversion/eversion of thefoot/ankle are described because the implications of
inversion/eversion of the hindfoot and mid-forefootare clinically different.
3. Complex motions composed of two or three motions
are described as the combination of the motions (e.g.,dorsiflexion + abduction, dorsiflexion + abduction +inversion).
4. Supination/pronation of the foot/ankle is a particularly complex motion. Supination requires plantarflexion + adduction + inversion; and pronation
requires dorsiflexion + abduction + eversion.
However, supination/pronation of the toes is definedas the frontal (coronal) plane motion.
5. Measuring the motions of toes was defined only inthe sagittal plane because motion in the transverse(horizontal) plane or frontal (coronal) plane is lessfrequently seen in clinical practice.

References
1. Reese NB, Bandy WD. Joint range of motion and muscle length
testing. Philadelphia: Saunders; 2002.

539
2. Resch S. Functional anatomy and topography of the foot andankle. In: Myerson MS, editor. Foot and ankle disorders. Philadelphia: Saunders; 1999. p. 25–9.
3. Saltzman C, Alexander I, Kitaoka H, Trevino S. Orthopaedic Footand Ankle Society Ad Hoc Committee report, January 1996. Foot
Ankle Int 1997;18:310–1.
4. Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, etal. ISB recommendation on definitions of joint coordinate systemof various joints for the reporting of human joint motion. Part 1.
Ankle, hip, and spine. J Biomech 2002;35:543–8.
5. Kapandji IA. The physiology of the joints. Vol 2, 5th edn. London:
Churchill Livingstone; 1987.
6. American Academy of Orthopaedic Surgeons. Joint motion:
method of measuring and recording. Rosemont, IL: AAOS; 1965.
7. Valmassy RL. Clinical biomechanics of the lower extremities. St.
Louis: Mosby; 1996.
8. Clarkson HM. Joint motion and function assessment. Philadelphia: Lippincott Williams & Wilkins; 2005.
9. Norkin CC, White DJ. Measurement of joint motion a guide togoniometry. 3rd edn. Philadelphia: FA Davis; 2003.
10. Soames R. Joint motion clinical measurement and evaluation.
London: Churchill Livingstone; 2003.
11. Smith LK, Weiss EL, Lehmkuhl LD. Brunnstrom’s clinical kinesiology. 5th edn. Philadelphia: FA Davis; 1996.
12. Doya H, Murata A, Asano Y, Moriya H, Yoshinaga K. Defining
inversion/eversion of the foot; is it a triplane motion or a coronalplane motion? Jpn J Rehabil Med 2007;44:286–92 (in Japanese).
13. Lewis CT, Short C. A Latin dictionary. Oxford: Oxford University
Press; 1969.