Reliability of measures of ankle-foot morphology, mobility, and strength
Creators: name: Fraser, John J.
name: Koldenhoven, Rachel M.
name: Hertel, Jay
Publisher: name: F1000Research
Year: 2017

description: Purpose/Hypothesis: Lateral ankle and midfoot sprains result from high velocity moments and extremes of plantarflexion, adduction, and inversion.<sup>1–3</sup> Clinical assessment of foot posture, morphology, intersegmental mobility, and strength of the ankle-foot complex following sprain is recommended for instruction in physical therapy education programs<sup>4</sup> and in practice.<sup>5</sup> The purpose was to determine test-retest reliability and inter-rater reliability of innovative and established clinical measures of morphology, joint excursion and accessory motion, and strength of the ankle-foot complex. We hypothesized reliability to be excellent for morphologic measures, fair to good for joint excursion and strength, and poor for joint accessory measures.<br>Subjects: Data from 24 healthy, recreationally active individuals ages 18-50 with no history of ankle or foot sprain or fracture were included (12 males, 12 females; mean age 21.5±4.8 years; BMI 23.5±2.9 ).<br><br>Materials/Methods: Participants were assessed by 2 clinicians (a physical therapist with 14-years experience and an athletic trainer with 2-years experience) on two separate days. Order of clinician assessment was randomized using a Latin-square. Washout period between test sessions was 3-10 days. Foot posture and morphology was assessed using the Foot Posture Index and measures of foot length, width, truncated length and arch height. Joint mobility was assessed using goniometry (rearfoot and hallux excursion), inclinometry (forefoot), linear measures of sagittal excursion (first ray and loaded rearfoot), and rating of joint accessory motion. Strength was assessed using handheld dynamometry. Reliability was assessed with intraclass coefficients (ICC, form 2,<i>k</i>), with &gt;.75 interpreted as being excellent, .40-.75 as fair to good, and &lt;.40 as poor.<sup>6</sup><br><br>Results: Test-retest reliability was excellent in all foot posture and morphologic measures (.80-1.00), talocrural (.81-.97) and hallux (.82-.95) joint excursion measures; fair to excellent for first ray sagittal excursion (.62-.90) and frontal plane rearfoot (.58-.73) and forefoot (.72-.86) excursion, and strength (.67-.92) measures. Intra-tester reliability of joint accessory motion (-.67-.84) varied on clinical experience, with the more experienced clinician demonstrating greater consistency (67% of measures &gt;.40) compared the novice clinician (36% of measures &gt;.40). Inter-rater reliability was excellent in morphologic measures (.81-1.00) and talocrural (.76-.97) and hallux (.85-.91) excursion measures, fair to excellent in forefoot (.66-.86) excursion and strength measures (.53-.90), fair to good in rearfoot frontal plane excursion (.53-.69), poor to good in hallux excursion (.32-.53), and poor (-1.06-.39) in 73% of joint accessory measures.<br><br>Conclusion: Measures of ankle-foot posture, morphology, joint excursion, and strength demonstrated fair to excellent test-retest and inter-rater reliability. Joint accessory measures had poor to fair agreement overall.<br><br>Clinical Relevance: These findings should be considered when selecting ankle-foot assessment measures.<br><br>References<br><br>1.         Kristianslund E, Bahr R, Krosshaug T. Kinematics and kinetics of an accidental lateral ankle sprain. <i>J Biomech</i>. 2011;44(14):2576-2578. doi:10.1016/j.jbiomech.2011.07.014.<br>2.         Fong DT-P, Ha SC-W, Mok K-M, Chan CW-L, Chan K-M. Kinematics analysis of ankle inversion ligamentous sprain injuries in sports: five cases from televised tennis competitions. <i>Am J Sports Med</i>. 2012;40(11):2627-2632. doi:10.1177/0363546512458259.<br>3.         Mok K-M, Fong DT-P, Krosshaug T, et al. Kinematics Analysis of Ankle Inversion Ligamentous Sprain Injuries in Sports 2 Cases During the 2008 Beijing Olympics. <i>Am J Sports Med</i>. 2011;39(7):1548-1552. doi:10.1177/0363546511399384.<br>4.         Foot and Ankle Curricular Guideline Task Force, Foot and Ankle Special Interest Group, Orthopaedic Section, APTA, Inc. Foot and Ankle Curricular Guidelines for Physical Therapist Progressional Degree Programs. 2015. http://www.orthopt.org/uploads/content_files/FASIG/FASIG_curricular_guidelines_June_24_FINAL.pdf. Accessed June 17, 2016.<br>5.         Martin RL, Davenport TE, Paulseth S, Wukich DK, Godges JJ. Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. <i>J Orthop Sports Phys Ther</i>. 2013;43(9):A1-A40. doi:10.2519/jospt.2013.0305.<br>6.         Fleiss JL. <i>Design and Analysis of Clinical Experiments</i>. John Wiley &amp; Sons; 2011.