Dayton Paul, Feilmeier Mindi, Parker Kalani, Otti Riane, Reimer Rachel, Kauwe Merrell, Eisenschink Jake, Wolfe Joshua
Director, Podiatric Medicine and Surgery Residency, UnityPoint Clinic, Fort Dodge, IA; Assistant Professor, College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA.
Assistant Professor, College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA.
J Foot Ankle Surg. 2017 Sep-Oct;56(5):1036-1040. doi: 10.1053/j.jfas.2017.05.008.
Clinical measurement of ankle dorsiflexion is typically used to diagnose limited ankle range of motion. Controversy and a lack of clarity continue regarding the most accurate clinical method of measuring ankle joint dorsiflexion and the effect that the foot position (supinated, neutral, pronated) has on the true tibiotalar position. We investigated the effects of supinated, neutral and pronated foot positions on the clinical dorsiflexion measurements in 50 healthy subjects and compared these results to the radiographic measurement of tibiotalar joint position with the ankle maximally dorsiflexed in each of the 3 foot positions. Interrater reliability was confirmed to be adequate among the 3 clinicians of varied skill levels. Radiographic measurements of the tibiotalar position showed very little change in each of the 3 foot positions, with a total difference of 0.35° between supination and pronation. However, we found a mean difference of 14° of dorsiflexion in the clinical measurements between the pronated and supinated foot position, with a 9.08° difference between the neutral and supinated positions. Motion of the foot between the neutral and supinated positions introduced an additional source of potential error from the measurement technique when using the neutral position as the standard, which has been recommended in the past. We recommend a supinated foot position as a more reliable foot position for measuring the clinical ankle joint range of motion and propose it as a potential standard.
踝关节背屈的临床测量通常用于诊断踝关节活动范围受限。关于测量踝关节背屈最准确的临床方法以及足部位置（旋后、中立、旋前）对真正胫距关节位置的影响，仍存在争议且缺乏明确认识。我们调查了50名健康受试者中旋后、中立和旋前足部位置对临床背屈测量的影响，并将这些结果与在三种足部位置中踝关节最大背屈时胫距关节位置的影像学测量结果进行比较。不同技能水平的3名临床医生之间的评分者间信度被证实是足够的。胫距关节位置的影像学测量显示，在三种足部位置中每种位置的变化都很小，旋后和旋前之间的总差异为0.35°。然而，我们发现旋前和旋后足部位置的临床测量中背屈平均差异为14°，中立和旋后位置之间的差异为9.08°。当以中立位置作为标准时（过去曾有推荐），足部在中立和旋后位置之间的运动引入了测量技术中潜在误差的另一个来源。我们建议旋后足部位置作为测量临床踝关节活动范围更可靠的足部位置，并将其作为一种潜在标准提出。
