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Background: Plantar fasciitis (PF) and Achilles tendinopathy (AT) are common injuries that primarily affect people engaged in sport or occupational weightbearing activities. Identifying modifiable risk factors is important for the treatment and prevention of these injuries. The purpose of this study was to evaluate whether foot posture or ankle dorsiflexion are risk factors for developing AT or PF, and if there were any differences between PF and AT patients. Methods: This was a case-control study of 108 patients with PF and 114 patients with AT, compared to the same number of referred patients in 2 control groups never having had these injuries, matched for sex, age, body mass index (BMI), sport, and occupational weightbearing activities. Included patients were 20-65 years with ultrasonographic-verified PF or midsubstance AT. Foot posture was assessed using Foot Posture Index (FPI) classifying the feet into 3 categories: FPI 0-5 normal foot, 6-12 hyperpronated, <0 hypopronated. Ankle dorsiflexion was measured with a goniometer in weightbearing with straight and bent knee. Results: Abnormal foot posture was associated with an increased risk for sustaining both AT (odds ratio [OR] 3.4-4.1) and PF (OR 3.2-3.8). Hyperpronation being the major reason for this association with ORs 5.4-5.5 compared with hypopronation with ORs 2.6-2.9. However, decreased dorsiflexion was not a risk factor: instead, there was an increased ankle dorsiflexion in patients with AT or PF compared with their control groups. Comparison between PF and AT patients demonstrated that PF affected mostly women, and AT mostly men, PF patients were 2.4 years (CI 0.2-4.5) younger, and had 25% more occupational weightbearing than AT patients. However, no differences in BMI or weightbearing physical activity was demonstrated. Conclusion: Hypopronation and hyperpronation but not limited ankle dorsiflexion was associated with increased risk for AT or PF. [ABSTRACT FROM AUTHOR]

Cupping therapy involves lifting and separating fascial tissue to facilitate stretching and promote blood flow. Although cupping is a common treatment modality for pain, various protocols exist and studies are inconsistent in regards to whether cupping improves outcomes such as range of motion. We aimed to determine the acute effect of different types of cupping therapy on ankle dorsiflexion. Thirty-five generally healthy adults (mean ± SD; age: 22.1 ± 4.52 y; baseline ankle ROM: 34.68 ± 4.22°) were randomly assigned to one of four cupping therapy treatment groups: static, dynamic, static sham, or dynamic sham. Ankle ROM was measured using a digital inclinometer pre- and immediately post-intervention. ANCOVA was used to determine whether ROM differed between groups post-treatment when controlling for baseline ROM and the minimal detectable change (MDC) was used to determine clinical meaningfulness of the changes. Baseline ROM was significantly associated with post-intervention ROM (post-ROM: 38.41 ± 4.95°; p <.001), indicating an overall increase in ROM regardless of the intervention received. There was no difference in ROM between therapy groups post-intervention after controlling for baseline ROM. The dynamic cupping group experienced a change in ROM (baseline ROM: 34.11 ± 4.62°, post-ROM: 39.19 ± 6.44°) above the MDC (5.08°). Our findings support cupping as a modality for improving ankle ROM in individuals with limited ROM. Dynamic cupping may be effective for improving ankle ROM due to the addition of functional movement. Clinicians may consider dynamic cupping as a potential intervention to address limited ankle ROM. Regardless of therapy received, all groups showed improvement in ankle dorsiflexion immediately post intervention. Dynamic cupping increased ROM above the MCD threshold, indicating functional movement with cupping may improve ROM more than other cupping techniques. Further investigation is warranted to explore the long-term effects of cupping therapy, as well as the underlying mechanisms that contribute to its therapeutic effects. [ABSTRACT FROM AUTHOR]

There are relatively few running studies that have attempted to prospectively identify biomechanical risk factors associated with Achilles tendon (AT) injuries. Therefore, the aim was to prospectively determine potential running biomechanical risk factors associated with the development of AT injuries in recreational, healthy runners. At study entry, 108 participants completed a set of questionnaires. They underwent an analysis of their running biomechanics at self-selected running speed. The incidence of AT running-related injuries (RRI) was assessed after 1-year using a weekly questionnaire standardized for RRI. Potential biomechanical risk factors for the development of AT RRI injury were identified using multivariable logistic regression. Of the 103 participants, 25% of the sample (15 males and 11 females) reported an AT RRI on the right lower limb during the 1-year evaluation period. A more flexed knee at initial contact (odds ratio = 1.146, P =.034) and at the midstance phase (odds ratio = 1.143, P =.037) were significant predictors for developing AT RRI. The results suggested that a 1-degree increase in knee flexion at initial contact and midstance was associated with a 15% increase in the risk of an AT RRI, thus causing a limitation of training or a stoppage of running in runners. [ABSTRACT FROM AUTHOR]

Purpose: This study is aimed to determine specific bilateral lower extremity motor performances and coordination patterns in soccer players with healthy controls using the bilateral force control paradigm. We hypothesized that soccer players would show more advanced bilateral force control performances than untrained controls. Methods: Participants were 13 university soccer players and 13 healthy controls. Each group performed bilateral ankle dorsiflexion force control tasks across two vision conditions (i.e., vision and no-vision) and two targeted force levels (i.e., 10% and 40% maximum voluntary contraction). We calculated force accuracy, variability, and symmetry to assess force control performances. To estimate bilateral force coordination, we calculated Pearson's correlation coefficients between feet-within a single trial and considered uncontrolled manifold variables across multiple trials. In the no-vision condition, we performed secondary analyses for initial force control patters after removal of visual feedback. Results: There were no significant group differences in bilateral force accuracy and variability but, compared to the control group, soccer players showed higher force symmetry between left and right ankle dorsiflexion forces. For force coordination between feet, soccer players revealed more negative values of the correlation coefficient and greater good variability from the uncontrolled manifold analysis than those for the control group. The secondary analysis revealed no significant group differences in the time until force drift and amount of force adjustments. Conclusions: Soccer players have more compensatory and flexible interlimb force coordination strategies between feet. [ABSTRACT FROM AUTHOR]

To investigate the relationship between predicted risk of injury based on the dichotomous classification of the weight-bearing lunge (WBL) test scores and variables related to jumping and sprinting ability in young athletes. Furthermore, to compare the impact of the classical dichotomous classification versus a more specific quartile subdivision of the WBL test scores on the explored variables. Cross-sectional study. 125 healthy athletes (mean age 10.38 (SD = 2.28) years) were recruited. Ankle dorsiflexion was evaluated with the WBL test, jumping distance with the standing long jump (SLJ) test, and maximal running speed with the 14-m and 28-m sprint test. Athletes with WBL test scores lower than 10 cm exhibited significantly poorer results for the SLJ test as well as lower 14-m and 28-m sprint times than those with WBL test scores higher than 10 cm (p < 0.05). Likewise, when WBL test scores were subdivided by quartiles, a positive trend between range of motion and improved performance was shown. Reduced ankle dorsiflexion mobility may affect sprinting and jumping ability in young athletes. In addition, a more detailed classification of ankle restriction by quartiles is proposed in this study in order to prevent injury and enhance athletic performance. [ABSTRACT FROM AUTHOR]

BackgroundLow-frequency acupuncture is used to maintain skeletal muscle flexibility and improve joint range of motion; however, its definite effects are unclear. This study aimed to determine the effects of low-frequency acupuncture on muscle and fascial stiffness and ankle dorsiflexion range of motion.MethodsThe participants included 12 randomly selected healthy adults. The medial head of the gastrocnemius muscle was selected as the target muscle, and changes in hardness and dorsiflexion range of motion of the ankle joint in the deep fascia, muscle, and deep intermuscular fascia of the same region were measured before and after low-frequency acupuncture intervention. Acupuncture needles were inserted until they passed through the deep intermuscular fascia and electrically stimulated at a frequency of 2 Hz for 15 min. The 12 right legs were the intervention legs, and the 12 left legs were the non-intervention legs.ResultsIn the intervention leg, hardness increased in the deep fascia immediately after low-frequency acupuncture, but decreased in all regions (deep fascia, muscle, and deep intermuscular fascia) after 15 min. The rate of change in hardness was the greatest in the muscles and deep intermuscular fascia. Additionally, the ankle's dorsiflexion range of motion increased after 15 min. In contrast, the non-intervention leg showed no significant changes in stiffness or ankle dorsiflexion angle.ConclusionsLow-frequency acupuncture may decrease muscle stiffness and improve fascial gliding. The change in hardness tended to be greater in the deeper areas.

IntroductionClinically, knowing whether a static stretching (SS) intervention program conducted for several weeks can reduce passive muscle stiffness is important. Still, only a few previous studies have evaluated the chronic effects of an SS intervention program in older adults, and the potential relationship between ROM changes and muscle stiffness changes is still unclear. This study aimed to investigate the effects of a 10- week SS intervention partially supervised program on joint range of motion (ROM) and tissue hardness in older adults.MethodsThe SS intervention program was conducted at least three times a week for 10 weeks in the ankle plantar flexor muscles of 24 community-dwelling older adults (73.8 ± 5.1 years; height: 156.0 ± 6.8 cm; body mass: 52.7 ± 8.0 kg). The SS intervention program consisted of 4 × 30-s repetitions. Ankle joint dorsiflexion (DF) ROM and tissue hardness of the medial gastrocnemius were measured before and after the 10-week SS intervention program.Results and discussionThe results showed that the 10-week SS intervention program significantly increased DF ROM (+9°, p

Importance: Neuromodulation may be one of the underlying mechanisms of dry needling (DN); however, the mechanism has not yet been fully clarified.Objective: This randomized controlled trial is designed to evaluate DN stimulation of the tibialis anterior and peroneus longus muscles in chronic ankle instability (CAI) and healthy subjects, employing functional magnetic resonance imaging (fMRI).Design: Clinical study protocol, SPIRIT compliant.Setting: Brain Mapping Laboratory.Population: A total of thirty participants aged between 18 and 40 years old will be included in this study. Twenty healthy participants will be randomized into 2 groups (real DN and sham DN). Ten patients with CAI will also be recruited to the third group and receive only real DN for comparison.Exposures: Real and sham DN.Main Outcomes and Measures: The voxel count, coordinates of peak activation, and peak intensity will be obtained as primary outcomes to report brain map activation. Measurements will be taken before, during, and after DN treatment. The strength of the ankle dorsiflexors, active dorsiflexion range of motion, and McGill pain questionnaire short-form will be used as secondary outcome measures.Results : : The results from this study will be published in peer-reviewed journals and disseminated as presentations at national and international congresses.Conclusion : : This trial will explore brain responses to real and sham DN in healthy participants and to real DN in CAI patients. Overall, our results will provide preliminary evidence of the neural mechanism of DN.

Abstract Background The Single Leg Squat (SLS) test is widely used in the clinical setting to examine and evaluate rehabilitation goals. It is simple to perform and is proposed to have biomechanical and neuromuscular similarities to athletic movements. The aim of the present study was to investigate whether demographics, previous injuries, and biomechanical and psychosocial factors are associated with the outcome of the SLS, assessed as a total score for all segments and as a separate knee segment in elite and sub-elite female soccer players. Methods We conducted a cross-sectional study involving 254 female soccer players (22 yrs; SD ± 4, height 1.69 m; SD ± 0.1, weight 64 kg; SD ± 6) from divisions 1–3 of the Swedish Soccer League. During the preseason, we assessed the participants using the SLS and tested their hip strength and ankle mobility. Demographics, previous injury, sleep quality, fear of movement, anxiety, and perceived stress were assessed with questionnaires. Logistic regression models were built to analyse the association between the outcome of the SLS and the independent variables for the dominant and non-dominant leg. Results Significantly more participants failed the SLS on the dominant leg compared with the non-dominant leg (p

Importance: Neuromodulation may be one of the underlying mechanisms of dry needling (DN); however, the mechanism has not yet been fully clarified. Objective: This randomized controlled trial is designed to evaluate DN stimulation of the tibialis anterior and peroneus longus muscles in chronic ankle instability (CAI) and healthy subjects, employing functional magnetic resonance imaging (fMRI). Design: Clinical study protocol, SPIRIT compliant. Setting: Brain Mapping Laboratory. Population: A total of thirty participants aged between 18 and 40 years old will be included in this study. Twenty healthy participants will be randomized into 2 groups (real DN and sham DN). Ten patients with CAI will also be recruited to the third group and receive only real DN for comparison. Exposures: Real and sham DN. Main Outcomes and Measures: The voxel count, coordinates of peak activation, and peak intensity will be obtained as primary outcomes to report brain map activation. Measurements will be taken before, during, and after DN treatment. The strength of the ankle dorsiflexors, active dorsiflexion range of motion, and McGill pain questionnaire short-form will be used as secondary outcome measures. Results: The results from this study will be published in peer-reviewed journals and disseminated as presentations at national and international congresses. Conclusion: This trial will explore brain responses to real and sham DN in healthy participants and to real DN in CAI patients. Overall, our results will provide preliminary evidence of the neural mechanism of DN. [ABSTRACT FROM AUTHOR]

Background: The Single Leg Squat (SLS) test is widely used in the clinical setting to examine and evaluate rehabilitation goals. It is simple to perform and is proposed to have biomechanical and neuromuscular similarities to athletic movements. The aim of the present study was to investigate whether demographics, previous injuries, and biomechanical and psychosocial factors are associated with the outcome of the SLS, assessed as a total score for all segments and as a separate knee segment in elite and sub-elite female soccer players. Methods: We conducted a cross-sectional study involving 254 female soccer players (22 yrs; SD ± 4, height 1.69 m; SD ± 0.1, weight 64 kg; SD ± 6) from divisions 1–3 of the Swedish Soccer League. During the preseason, we assessed the participants using the SLS and tested their hip strength and ankle mobility. Demographics, previous injury, sleep quality, fear of movement, anxiety, and perceived stress were assessed with questionnaires. Logistic regression models were built to analyse the association between the outcome of the SLS and the independent variables for the dominant and non-dominant leg. Results: Significantly more participants failed the SLS on the dominant leg compared with the non-dominant leg (p < 0.001). The outcome of the SLS associated with various biopsychosocial factors depending on if the dominant or non-dominant leg was tested. The total score associated with hip strength for the dominant (OR 0.99, 95% CI 0.98–0.99, p = 0.04) and the non-dominant leg (OR 0.99, 95% CI 0.97–0.99, p = 0.03). The knee segment associated with division level for the dominant (div 2; OR 2.34, 95% CI 1.01–5.12, p = 0.033. div 3; OR 3.07, 95% CI 1.61–5.85, p = 0.001) and non-dominant leg (div 2; OR 3.30, 95% CI 1.33-8.00, p = 0.01. div 3; OR 3.05, 95% CI 1.44–6.43, p = 0.003). Conclusions: This study identified that leg dominance, division level, hip strength, and psychosocial factors were associated with the outcome of the SLS when assessed as a total score and as a separate knee segment. This indicates that clinicians need to understand that movement control is associated with factors from several domains. Whether these factors and, the results of the SLS are related to injury need to be studied prospectively. Trial registration: Clinical Trials Gov, date of registration 2022-03-01. Clinical trials identifier: NCT05289284A. [ABSTRACT FROM AUTHOR]

Objective: Ankle dorsiflexion during walking causes the tibia to roll forward relative to the foot to achieve body forward. Individuals with ankle dorsiflexion restriction may present altered movement patterns and cause a series of dysfunction. Therefore, the aim of this research was to clearly determine the effects of peak ankle dorsiflexion angle on lower extremity biomechanics and pelvic motion during walking and jogging. Method: This study involved 51 subjects tested for both walking and jogging. The motion capture system and force measuring platforms were used to synchronously collect kinematics and kinetics parameters during these activities. Based on the peak ankle dorsiflexion angle during walking, the 51 subjects were divided into a restricted group (RADF group, angle <10°) and an ankle dorsiflexionunrestricted group (un-RADF group, angle >10°). Independent-Sample T-tests were performed to compare the pelvic and lower limb biomechanics parameters between the groups during walking and jogging test on this cross-sectional study. Results: The parameters that were significantly smaller in the RADF group than in the un-RADF group at the moment of peak ankle dorsiflexion in the walking test were: ankle plantar flexion moment (p < 0.05), hip extension angle (p < 0.05), internal ground reaction force (p < 0.05), anterior ground reaction force (p < 0.01), pelvic ipsilateral tilt angle (p < 0.05). In contrast, the external knee rotation angle was significantly greater in the RADF group than in the un-RADF group (p < 0.05). The parameters that were significantly smaller in the RADF group than in the un-RADF group at the moment of peak ankle dorsiflexion in the jogging test were: peak ankle dorsiflexion angle (p < 0.01); the anterior ground reaction force (p < 0.01), the angle of pelvic ipsilateral rotation (p < 0.05). Conclusion: This study shows that individuals with limited ankle dorsiflexion experience varying degrees of altered kinematics and dynamics in the pelvis, hip, knee, and foot during walking and jogging. Limited ankle dorsiflexion alters the movement pattern of the lower extremity during walking and jogging, diminishing the body's ability to propel forward, which may lead to higher injury risks. [ABSTRACT FROM AUTHOR]

This study aimed to (a) detail the interlimb asymmetries during multi-directional jumping, change of direction and for ankle dorsiflexion range of motion and (b) determine how asymmetries and performance in multi-directional jumping and ankle dorsiflexion predict performance during change of direction tests. Twenty-two male semi-professional players completed a testing session which consisted of unilateral ankle dorsiflexion range of motion, vertical and horizontal unilateral and lateral countermovement jumps and left and right leg 90° (COD90L&R) and 180° (COD180L&R) change of direction tests. No significant differences between limbs were observed for any of the variables (P > 0.05), though vertical countermovement jump (11.1% ± 9.1%) and dorsiflexion range of motion (10.5% ± 10.3%) imbalances were greater than those during lateral (2.7% ± 2.2%) and horizontal (2.2% ± 1.9%) countermovement jumps, and 90° (3.6% ± 3.1%) and 180° change of direction (2.9% ± 3.6%). Subjects presented 3.4 ± 1.4 real asymmetries (i.e., one greater than the coefficient of variation) across the tests, with all subjects having at least one real asymmetry. Stepwise linear regression models explained a reasonable amount of variance in change of direction180R (70%), COD90L (57%), COD90R (39%), COD180L (23%) using the countermovement jump and dorsiflexion range of motion variables (P < 0.05). The current findings indicate that semi-professional soccer players have real bilateral asymmetries (particularly in countermovement jump and dorsiflexion range of motion), which practitioners should be cognizant of. Given the prediction value, change of direction performance can be predicted using performance and asymmetries during multi-directional jumping and ankle dorsiflexion. [ABSTRACT FROM AUTHOR]

Restricted ankle dorsiflexion is common after lower limb injury. The aim of this pilot study was to investigate the effect of passive ankle joint mobilization and calf muscle massage on ankle dorsiflexion range of motion in adults with residual restricted dorsiflexion. The secondary aim was to assess the methodology of the pilot study to inform a larger clinical trial. The study design was a randomized crossover trial with assessor blinding. Twenty-five healthy participants with a history of lower limb injury were included in the study. Ankle joint mobilization and calf muscle massage were applied for 5 min in a random order, one to two weeks apart. Ankle dorsiflexion was measured by using the weight-bearing lunge pre- and post-intervention (cm). Paired t-tests were used to analyze the effect of the manual therapy interventions on restricted ankles. A minimal detectable difference 95% (MMD 95) was calculated. The pilot study was analyzed for suitability of inclusion criteria, blinding of assessors and the manual therapist, and the washout period. A significant increase in dorsiflexion was demonstrated for ankle joint mobilization (change score = 0.51 ± 0.76, p = 0.003) and calf muscle soft tissue massage (change score = 0.91 ± 1.07, p < 0.001). There was no difference in change scores between manual therapy techniques (mobilization 0.51 ± 0.76, massage 0.91 ± 1.07, p = 0.12). Evaluation of the pilot study revealed limitations to be modified in future studies. These preliminary data indicate ankle joint mobilization and calf muscle soft tissue massage had similar effects on increasing ankle dorsiflexion range of motion in ankles with residual dorsiflexion restriction. [ABSTRACT FROM AUTHOR]

Objective Due to the substantial prevalence of patellofemoral pain syndrome and the importance of quadriceps strengthening in knee rehabilitation, determining the best way to activate and strengthen the patella stabilizing muscles is considered as one of important keys of treatment. The aim of this study is to evaluate the effect of different hip rotations associated with ankle dorsiflexion during maximal straight leg raising (SLR) maneuver in the sitting position on thickness and fibers angle of vastus medialis oblique (VMO) and vastus lateralis (VL) muscles using ultrasonography. Materials & Methods This quasi-experimental study was performed on 40 individuals (healthy group: 20, patellofemoral pain syndrome [PFPS] group: 20). VMO and VL thickness and fiber angle were measured using ultrasonography during maximal SLR in 6 positions: hip internal, hip external, and neutral rotations with and without ankle dorsiflexion. Results In between-group comparison, no significant difference was found for all variables with different SLR maneuvers (P>0.05). In the within-group comparison, hip external rotation compared to other hip positions without ankle dorsiflexion resulted in a significant increase in VMO thickness and fiber angle in both groups (P

Background: Floating toes are a condition and deformity in which some of the toes are afloat. Many functional impairments in floating toes have been previously studied lately and several factors related to floating toes have also been reported. However, no reports have considered the relationship between lifestyle and floating toes among children. The purpose of this study was to reveal the prevalence of floating toes among school children and reveal its relationship with lifestyle. Methods: In total, 138 young male baseball players were recruited. Lifestyle was evaluated by using a questionnaire and chosen whether the main lifestyle was Japanese or Western, if the bedding was futons or beds, and if the toilet was Japanese style (a squat toilet) or Western style. Floating toes were defined as toes that were not in contact with the mat. Ankle dorsiflexion in the knee-flexed and knee-extended positions was measured in a weight-bearing position. The relationship between the floating toes and lifestyles, and the comparison of ankle dorsiflexion range of motion between the lifestyles were statistically analyzed. Results: Players living in a Western style showed a significantly higher prevalence of floating toes on both feet compared with the players living in a Japanese style (throwing side; 39% vs. 19%, p = 0.04, and non-throwing side; 43% vs. 19%, p = 0.01). Players living in a Western style with beds showed a significantly smaller range of motion on both sides of ankle dorsiflexion in the knee-flexed position compared with those who were not (throwing side; 37.2 ± 5.7° vs. 39.0 ± 6.6°, p = 0.04, and non-throwing side; 36.8 ± 5.8° vs. 38.6 ± 6.1°, p = 0.04). Conclusion: Children mainly living in a Western lifestyle showed a significantly higher prevalence of floating toes on both feet compared to those mainly living in a Japanese lifestyle. The prevalence of floating toes may be related to lifestyles among children. Trial registration: The study was approved by the institutional review board of the Waseda University Graduate School of Sport Sciences (IRB number 2021–185). [ABSTRACT FROM AUTHOR]

This study was aimed at observing how the limitation of ankle dorsiflexion ROM affects hamstring muscle Peak Torque/BW (%), Average Power (W), and Total Work (J), and whether this effect is similar in football players after ACL rupture and reconstruction and in those without injuries. The study included 47 professional football players who were divided into two groups: Group 1 (n = 24) after ACL reconstruction and Group 2 (n = 23) without injuries in the past 3 years. Based on the Weight-Bearing Lunge Test (WBLT), the following subgroups in Groups 1 and 2 were distinguished: N (normal ankle joint dorsiflexion) and R (restricted ankle joint dorsiflexion). The concentric isokinetic test (10 knee flexions and extensions at 60°/s) was performed on both limbs. Significantly lower values of Peak Torque/BW and Average Power were observed in Group 1 compared to Group 2, as well as in subjects with normal and restricted ankle dorsiflexion. However, no significant differences were noted for either group in any of the strength variables comparing subjects with normal and restricted ankle dorsiflexion. A poor and non-significant correlation was exhibited between the ankle joint range of dorsiflexion and all the strength variables. The area under the ROC curve (AUC) for all the evaluated variables in both groups was below 0.5, or very close to this value, indicating that ankle dorsiflexion ROM has no diagnostic accuracy for hamstring muscle strength. Based on the obtained results, it can be assumed that ankle dorsiflexion limitation, which is common in football players, is not a factor in weakening hamstring muscle strength, either in football players after ACL reconstruction or among those without injuries. However, some authors have reported that limited mobility of the ankle joint can have a destructive effect on the work of the lower limbs and may also be a factor in increasing the risk of football injuries in this area. Therefore, we have suggested that hamstring muscle weakness and increased risk of injury may occur due to factors other than limited ankle mobility. These observations may be of great importance in the selection of prevention methods by including a broad spectrum of physical techniques, not just exercises that focus on the improvement of mobility or stability of the lower limbs. [ABSTRACT FROM AUTHOR]

The objective of this literature review is to understand the role of ankle dorsiflexion range of motion in sports performance and the risk of injuries. The ankle harmonizes the interaction between the body and the supporting surface through adjusting to the supporting surface and handling forces to contribute effectually to different functional activities. Ankle dorsiflexion is an essential construct in many sport-specific skills. Ankle dorsiflexion is associated with activation of brain areas involved in movement preparation, sensory integration, motor planning/execution, balance, and visuomotor coordination. Ankle dorsiflexion was associated with enhanced activation of deep core and quadriceps muscles. Decreased ankle dorsiflexion is linked to compensations and altered kinetics and kinematics that can potentially affect sports performance and increase the chances of sustaining injuries. It is vindicated to consider more focus on ankle dorsiflexion range of motion in research studies, sports-related pre-season screening, clinical examination, injury rehabilitation, and return-to-sports judgment. [ABSTRACT FROM AUTHOR]

Marine Corps Recruit Depot (MCRD) recruits undergo demanding training. Musculoskeletal injury (MSKI) accounts for attrition and graduation delays. Functional tests, such as Functional Movement Screen (FMS), Y-Balance Test-Lower Quarter (YBT-LQ), and ankle dorsiflexion range of motion (AD-ROM), may identify individuals at greater MSKI risk. This study tested the hypothesis that functional assessments may inform injury prediction. Male recruits (N = 407; mean ± SD: age, 20 ± 2 years) performed baseline functional tests. Marine Corps Recruit Depot staff tracked MSKI and graduation outcomes. The chi-square test of independence (individual FMS exercises) and Mann-Whitney U (FMS composite score) test examined the relationship between FMS and MSKI incidence. One-way analysis of variance compared YBT-LQ and AD-ROM with MSKI incidence. Twelve recruits (3%) incurred a lower extremity MSKI and were dropped. Of those 12, 9 had a delayed graduation, and 3 separated from enlistment. The level of significance was set at p < 0.10 to identify between-group differences (yes-MSKI vs. no-MSKI). Functional movement screen composite score (p = 0.064), hurdle step (p = 0.059), and trunk stability (p = 0.001) were lower in yes-MSKI. Y-Balance Test-Lower Quarter anterior direction difference between legs (p = 0.011) and AD-ROM right side (p = 0.055) was greater in yes-MSKI. Odds ratios (OR) were calculated using cut-off scores, with strong odds of sustaining MSKI with FMS trunk stability score <2 (OR: 7.56, 95% confidence interval [CI]: [2.32, 24.61]) and YBT-LQ anterior difference >6.25 cm (OR: 6.38, 95% CI: [1.98, 20.55]). Recruits who incurred MSKI had scores that indicated lesser mobility and stability of the lower extremity, providing preliminary evidence that when assessed together, FMS, YBT-LQ, and AD-ROM, may have predictive value for identifying those at MSKI risk. [ABSTRACT FROM AUTHOR]

Objective Due to the substantial prevalence of patellofemoral pain syndrome and the importance of quadriceps strengthening in knee rehabilitation, determining the best way to activate and strengthen the patella stabilizing muscles is considered as one of important keys of treatment. The aim of this study is to evaluate the effect of different hip rotations associated with ankle dorsiflexion during maximal straight leg raising (SLR) maneuver in the sitting position on thickness and fibers angle of vastus medialis oblique (VMO) and vastus lateralis (VL) muscles using ultrasonography. Materials & Methods This quasi-experimental study was performed on 40 individuals (healthy group: 20, patellofemoral pain syndrome [PFPS] group: 20). VMO and VL thickness and fiber angle were measured using ultrasonography during maximal SLR in 6 positions: hip internal, hip external, and neutral rotations with and without ankle dorsiflexion. Results In between-group comparison, no significant difference was found for all variables with different SLR maneuvers (P>0.05). In the within-group comparison, hip external rotation compared to other hip positions without ankle dorsiflexion resulted in a significant increase in VMO thickness and fiber angle in both groups (P<0.05). Also, adding ankle dorsiflexion to different hip rotations during SLR significantly increased the thickness and fiber angle of VMO and VL. Conclusion By changing hip rotations with or without ankle dorsiflexion during SLR, the trend of changes in VMO and VL thickness and fiber angle in the two groups followed the same pattern. Moreover, performing SLR in hip external rotation with ankle dorsiflexion can be recommendable for the rehabilitation of PFPS. [ABSTRACT FROM AUTHOR]

Ankle flexibility and isokinetic knee torque/power generating capacity were previously suggested to contribute or to be correlated to the vertical countermovement jump (CMJ) performance. The aim of this study was to investigate the effect of the passive ankle joint dorsi flexion (θPDF) and the knee muscle's isokinetic torque and power on the CMJ in adolescent female volleyball players. The θPDF at a knee extension angle of 140 degrees were measured for 37 female post-pubertal volleyball players. Then, the players were assigned to either the flexible (n = 10) or inflexible (n = 14) groups according to earlier recommended criteria. Testing included the CMJ with and without an arm swing, and maximal knee extensions and flexions in 3 angular velocities on an isokinetic dynamometer. CMJ height performed with or without an arm swing (r(22) = 0.563, p = 0.040 and r(22) = 0.518, p = 0.009, respectively) and relative power (r(22) = 0.517, p = 0.010 and r(22) = 0.446, p = 0.030, respectively) were positively correlated with the extensors' torque at 180°/s and were negatively correlated with the flexibility level of the dominant side ankle (r(22) = −0.529, p = 0.008 and r(22) = −0.576, p = 0.030, respectively). A moderate positive correlation was also revealed between the CMJ height with and without an arm swing and the power of the non-dominant knee extensors (r(22) = 0.458, p = 0.024 and r(22) = 0.402, p = 0.049, respectively) and flexors (r(22) = 0.484, p = 0.016 and r(22) = 0.477, p = 0.018, respectively). Results of the 2 × 2 repeated ANOVA measurements revealed that flexible players jumped significantly (p < 0.05) higher during the CMJs, whilst there was a group effect only on the isokinetic knee extensor muscles' torque. In conclusion, a more flexible ankle joint and a higher isokinetic knee extensor's torque generating capacity resulted in higher CMJ performance. Therefore, ankle flexibility should be emphasized in training and is suggested to be included in preseason screening tests of youth female volleyball players. [ABSTRACT FROM AUTHOR]

Although Dimeglio and Pirani scores are frequently employed to rate the severities of clubfoot and to evaluate treatment outcomes, it is unclear if these scores predict relapse after treatment. Ankle dorsiflexion has been suggested in recent years to be a promising predictor of relapse. The aim of this study was to investigate ankle dorsiflexion and Dimeglio and Pirani scores in predicting the relapse of clubfoot after treatment with the Ponseti method. We included patients with clubfoot previously treated by the Ponseti method, and retrospectively analyzed their initial ankle dorsiflexion, Pirani and Dimeglio scores, number of castings, and the occurrence of relapse. We analyzed 218 feet of 176 infants with clubfoot who showed an incidence of relapse of 17.0% (30/176). The mean initial Pirani and Dimeglio scores of the feet showing recurrence were significantly higher than individuals with non-recurrence (p <.001 each). We observed a robust association between Pirani and Dimeglio scores and the recurrence of clubfoot at the last follow-up (γ = 0.53, p =.001). In contrast, ankle dorsiflexion was negatively correlated with recurrence of clubfoot (γ = -0.21, p =.001). Dimeglio scores significantly predicted the recurrence of clubfoot (p =.014). Receiver operating characteristic curve analysis exhibited slightly better performance regarding the Dimeglio score relative to the Pirani score and ankle dorsiflexion in predicting recurrence. Ankle dorsiflexion and Pirani and Dimeglio scores were related to recurrence in patients with clubfoot. However, the Dimeglio score reflected superior accuracy in predicting the prognosis of clubfoot treated with the Ponseti method. [ABSTRACT FROM AUTHOR]

Abstract Background Floating toes are a condition and deformity in which some of the toes are afloat. Many functional impairments in floating toes have been previously studied lately and several factors related to floating toes have also been reported. However, no reports have considered the relationship between lifestyle and floating toes among children. The purpose of this study was to reveal the prevalence of floating toes among school children and reveal its relationship with lifestyle. Methods In total, 138 young male baseball players were recruited. Lifestyle was evaluated by using a questionnaire and chosen whether the main lifestyle was Japanese or Western, if the bedding was futons or beds, and if the toilet was Japanese style (a squat toilet) or Western style. Floating toes were defined as toes that were not in contact with the mat. Ankle dorsiflexion in the knee‐flexed and knee‐extended positions was measured in a weight‐bearing position. The relationship between the floating toes and lifestyles, and the comparison of ankle dorsiflexion range of motion between the lifestyles were statistically analyzed. Results Players living in a Western style showed a significantly higher prevalence of floating toes on both feet compared with the players living in a Japanese style (throwing side; 39% vs. 19%, p = 0.04, and non‐throwing side; 43% vs. 19%, p = 0.01). Players living in a Western style with beds showed a significantly smaller range of motion on both sides of ankle dorsiflexion in the knee‐flexed position compared with those who were not (throwing side; 37.2 ± 5.7° vs. 39.0 ± 6.6°, p = 0.04, and non‐throwing side; 36.8 ± 5.8° vs. 38.6 ± 6.1°, p = 0.04). Conclusion Children mainly living in a Western lifestyle showed a significantly higher prevalence of floating toes on both feet compared to those mainly living in a Japanese lifestyle. The prevalence of floating toes may be related to lifestyles among children. Trial registration The study was approved by the institutional review board of the Waseda University Graduate School of Sport Sciences (IRB number 2021–185).

Ankle range of motion abnormalities have been often linked with alteration in knee kinematics leading to the development of patellofemoral pain syndrome (PFPS). Literature exploring the relationship between ankle dorsiflexion range of motion (DF ROM) and knee kinematics during functional tasks is scanty. This study aims to assess the relation between ankle DF ROM and frontal plane projection angle (FPPA), one of the knee kinematic variables, in individuals with and without PFPS during a step-down test. This is a case-control study in which seventy PFPS patients and other 70 asymptomatic control subjects had their ankle DF ROM measured using an inclinometer with the knee flexed and extended. Their FPPA angles were measured using Kinovea software while doing the step-down test. When the two groups were compared, ankle DF ROM measured with the knee flexed was higher in the control group (33.15 ± 4.96) than in the PFPS group (30.20 ± 6.93) (p = 0.03). In both the PFPS group and the control group, the correlation between FPPA and ankle DF ROM with the knee flexed was statistically insignificant (p = 0.075 and 0.323 respectively). Decreased ankle DF ROM can be one of the contributing factors to the development of PFPS in the context of greater dynamic knee valgus. [ABSTRACT FROM AUTHOR]

The force steadiness capabilities of the hip abductors and ankle dorsiflexors can explain a significant amount of the variance in postural sway during four types of standing balance tests. Control over balance, as well as force steadiness, generally worsens with aging, although the latter can be improved with unique training interventions. The purpose of our study was to assess how tempo-controlled, light-load resistance training of the hip abductors and ankle dorsiflexors influences performance in clinical movement tests, postural sway, muscle strength, and force steadiness in older adults. Participants (n = 28, 70 ± 7 years, 8 men) completed nine training sessions for either the hip abductors or ankle dorsiflexors in the nondominant leg. Training involved lifting a load equal to 15% of the maximal force achieved during an isometric contraction. Linear mixed-effects models revealed no changes (p > 0.05) in Sit-To-Stand test, Timed Up-and-Go test, maximal voluntary contraction (MVC) torque, or postural sway from before to after either training intervention. Only the dorsiflexor group significantly improved nondominant leg dorsiflexion force steadiness, but this did not translate to any other tasks. However, absolute and relative measures of MVC torque and force steadiness of the hip abductors and ankle dorsiflexors in the dominant and nondominant legs could predict sway-area rate in each of the four standing balance conditions. The responsiveness of leg muscles to light-load steadiness training in older adults appears to depend on the type of exercises performed during the intervention. [ABSTRACT FROM AUTHOR]

Background: This study aims to determine the effects of kinesio tape (KT) application on acute-onset muscle soreness and the extensibility of the calf muscles in endurance athletes. Methods: A one-arm repeated-measures randomized cross-over controlled study design investigated 55 endurance athletes, including 10 cyclists, 30 badminton players, and 15 long-distance runners (mean age 16.40 ± 2.69) from different stadia in Delhi NCR, India. KT and sham tapes (ST) were applied randomly to right and left legs (prone position) in a cross-over manner with a gap of 72 h. Ankle dorsiflexion range of motion (ADFROM) and pain due to acute-onset muscle soreness were assessed immediately and 10 min and 30 min after treadmill running, using a universal goniometer and numeric pain rating scale (NPRS), respectively, along with the time to fatigue. Results: A statistically significant difference was observed for the NPRS when the mean scores obtained for the KT and ST groups were compared immediately after cessation of running; however, the difference was not statistically significant in the NPRS score that was recorded ten or thirty minutes after. The range of motion increased significantly after the application of both the KT and the ST. After running on a treadmill, the range of motion decreased significantly with both the KT and ST, and the decrease was similar. Conclusion: KT was more effective in reducing the pain intensity immediately after running and increased the time spent running on the treadmill before fatigue set in among endurance athletes. In addition, the two taping methods (KT or ST) were equally effective in enhancing calf muscle extensibility (for both right and left legs) immediately after application. However, both taping methods failed in limiting the decrease in ankle ADFROM after treadmill running. [ABSTRACT FROM AUTHOR]

This study sought to determine whether the inclusion of an opponent on an isoinertial crossover step task influenced the post-activation response and power production. Twenty adult male team-sports athletes participated in a randomized crossover trial. We used a novel design in which the performance of an isoinertial flywheel exercise was tested with or without the inclusion of sport-specific constraints (inclusion of an opponent vs. no opponent) in one of the two sequences (sequence one: constraint manipulation followed by no constraint manipulation; and sequence two: no constraint manipulation followed by constraint manipulation). Maximal power was recorded during exercise; then the coefficient of variation of maximal power was estimated. Post-activation responses were measured using unilateral jump height and change-of-direction time. Also, ankle dorsiflexion range of motion was measured. The use of an isoinertial flywheel resulted in improved ankle dorsiflexion and the capacity to repeat change-of-direction. Furthermore, the inclusion of an opponent was associated with a higher variability of the power output in the concentric phase of the movement. Importantly, performing the crossover step task in front of an opponent was also linked to a positive correlation between unilateral countermovement jump and power output. We conclude that the inclusion of typical constraints of the performance environment may have induced movement adaptations to accommodate the unpredictability associated with the actions of the opponent. [ABSTRACT FROM AUTHOR]

Introduction: Clinically, knowing whether a static stretching (SS) intervention program conducted for several weeks can reduce passive muscle stiffness is important. Still, only a few previous studies have evaluated the chronic effects of an SS intervention program in older adults, and the potential relationship between ROM changes and muscle stiffness changes is still unclear. This study aimed to investigate the effects of a 10- week SS intervention partially supervised program on joint range of motion (ROM) and tissue hardness in older adults., Methods: The SS intervention program was conducted at least three times a week for 10 weeks in the ankle plantar flexor muscles of 24 community-dwelling older adults (73.8 ± 5.1 years; height: 156.0 ± 6.8 cm; body mass: 52.7 ± 8.0 kg). The SS intervention program consisted of 4 × 30-s repetitions. Ankle joint dorsiflexion (DF) ROM and tissue hardness of the medial gastrocnemius were measured before and after the 10-week SS intervention program., Results and Discussion: The results showed that the 10-week SS intervention program significantly increased DF ROM (+9°, p < 0.01, Cohen's d  = 1.37) and decreased tissue hardness (-0.9, p = 0.04, Cohen's d  = -0.27). However, there was no significant correlation between these changes ( r  = 0.086, p  = 0.561). The results of this study suggest that a 10-week SS intervention program can effectively increase DF ROM and decrease tissue hardness but that the increase in DF ROM is related to stretch tolerance rather than changes in tissue hardness., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Nakamura, Scardina, Thomas, Warneke and Konrad.)

ObjectiveThis study aimed to compare the efficacy of contralaterally controlled functional electrical stimulation (CCFES) vs. neuromuscular electrical stimulation (NMES) for motor recovery of the lower extremity in patients with subacute stroke.Materials and methodsSeventy patients within 6 months post-stroke were randomly assigned to the CCFES group (n = 35) and the NMES group (n = 35). Both groups underwent routine rehabilitation plus 20-min electrical stimulation (CCFES or NMES) on ankle dorsiflexion muscles per day, 5 days a week, for 3 weeks. Ankle AROM (dorsiflexion), Fugl-Meyer assessment-lower extremity (FMA-LE), Barthel Index (BI), Functional Ambulation Category scale (FAC), 10-meter walking test, and surface electromyography (sEMG) were assessed at the baseline and at the end of the intervention.ResultTen patients did not complete the study (five in CCFES and five in NMES), so only 60 patients were analyzed in the end. After the 3-week intervention, FMA-LE, BI, Ankle AROM (dorsiflexion), and FAC increased in both groups (p < 0.05). Patients in the CCFES group showed significantly greater improvements only in the measurement of Fugl-Meyer assessment-lower extremity compared with the NMES group after treatment (p < 0.05). The improvement in sEMG response of tibialis anterior by CCFES was greater than NMES (p < 0.05).ConclusionContralateral controlled functional electrical stimulation can effectively improve the motor function of the lower limbs better than conventional neuromuscular electrical stimulation in subacute patients after stroke, but the effect on improving the ability to walk, such as walking speed, was not good.Clinical trial registrationhttp://www.chictr.org.cn/, identifier: ChiCTR2100045423.

Howe, LP, Bampouras, TM, North, JS, and Waldron, M. Improved ankle mobility after a 4-week training program affects landing mechanics: a randomized controlled trial. J Strength Cond Res 36(7): 1875–1883, 2022—This study examined the effects of a 4-week ankle mobility intervention on landing mechanics. Twenty subjects with restricted ankle dorsiflexion range of motion (DF ROM) were allocated to either a strength training only (n = 9) or a strength training and ankle mobility program (n = 11). Subjects performed a weight-bearing lunge test and bilateral drop-landings before and after the intervention. Normalized peak vertical ground reaction force (vGRF), time to peak vGRF, and loading rate were calculated, alongside sagittal-plane initial contact angles, peak angles, and sagittal-plane joint displacement for the ankle, knee, and hip. Frontal-plane projection angles were also calculated. After the intervention, only the strength and mobility group improved ankle DF ROM (mean difference = 4.1°, effect size [ES] = 1.00, p = 0.002). A one-way analysis of covariance found group effects for ankle joint angle at initial contact (p = 0.045), ankle (p < 0.001) and hip joint angle at peak flexion (p = 0.041), and sagittal-plane ankle (p < 0.001) and hip joint displacement (p = 0.024) during bilateral drop-landings. Post hoc analysis revealed that the strength and mobility group landed with greater ankle plantarflexion at initial contact (mean difference = 1.4 ± 2.0°, ES = 0.46) and ankle dorsiflexion at peak flexion (mean difference = 6.3 ± 2.9°, ES = 0.74) after the intervention, resulting in a greater ankle joint displacement (mean difference = 7.7 ± 4.0°, ES = 1.00). However, the strength training only group landed with increased peak hip flexion (mean difference = 14.4 ± 11.0°, ES = 0.70) and hip joint displacement (mean difference = 8.0 ± 6.6°, ES = 0.44) during post-testing. The findings suggest that changes in landing strategies following the performance of a strength training program are specific to whether restrictions in ankle mobility are considered as part of the intervention. [ABSTRACT FROM AUTHOR]

This study aimed to determine the intra-day reliability, individuals performance expectancy, and biomechanical response of nine stretching instructions in assessing the maximal range of motion (mROM) during the passive ankle dorsiflexion test. Twenty healthy young participants were tested in two sessions within the same day. Nine stretching instructions composed by intensity-domain (i.e. minimum, point, and maximum) and sensation-domain (i.e. tolerance, discomfort, and pain) words were used to impose plantar flexors stretching. In the first session, individuals were requested to order the nine stretching instructions in ascending order. The ankle joint torque-angle and medial gastrocnemius, soleus and tibialis anterior electric activity were assessed in both sessions. A moderate to high reliability was observed across instructions (ICC = 0.65–0.87). Most stretching instructions showed high intra-day reliability outcomes, where discomfort and tolerance showed moderate reliability. 70% of individuals performed the stretching maneuvers consistently to stretching instructions performance expectancy. A greater torque-angle response was observed for the instructions involving the word pain (ROM = 40.5 ± 1.6°), compared to discomfort (29.5 ± 1.8°), and tolerance (30.5 ± 2.0°) that produced similar stretching intensities. Instructions involving the terms minimum (29.6 ± 2.0°), point (33.3 ± 7.6°), and maximum (37.6 ± 7.2°) were more discriminative of stretching intensities than sensation-domain terms. In conclusion, stretching instructions targeting the joint maximal range of motion produce different joint torque-angle responses and they may not be understandable by all individuals, although (in general) they can be used reliably. [ABSTRACT FROM AUTHOR]

Background A proximal deep peroneal nerve (DPN) injury can significantly impact the functional capacity of the leg, to include compromised motor function of the tibialis anterior (TA) muscle. Clinical examination can range from weakness in ankle dorsiflexion, to complete foot drop. Diagnostic nerve conduction velocity (NCV) testing can demonstrate abnormalities at select areas of impingement (or) entrapment (i.e., regions affected by a demyelinating compression mono-neuropathy), along the proximal course of the common peroneal nerve. Methods We retrospectively report on 17 patients with clinical weakness involving ankle dorsiflexion. All patients underwent surgical end-to-side anastomosis, transferring a muscular nerve branch from the superficial peroneal nerve (SPN) to a segment of the DPN responsible for TA muscle innervation. Outcomes were based on comparisons of preoperative and postoperative DPN motor function to the TA muscle, standardized to the British Medical Research Council Scale for Muscle Strength. Preoperative scores were generally M2 or below. Results Postoperative outcome scores of M4 to M5 were considered good (or) successful. 94.1% of patients demonstrated successful outcomes. Conclusion An end-to-side SPN motor branch anastomosis, into the motor branch of the DPN responsible for TA muscle innervation, can be a viable treatment option for weakness in ankle dorsiflexion. All reported cases involved a compromised segment of deep peroneal nerve within the proximal one-third of the leg.

To analyze how balance and other physical capacities evolved after surgery in patients with a bimalleolar fracture and how these capacities and clinical variables (immobilization or unloading time) contribute to restoring patients' functionality, 22 patients and 10 healthy people (HC) were assessed for static and dynamic balance (Y-Balance test, YBT), dorsiflexion ankle mobility (ADFROM) and hip strength at 6 and 12 months after surgery. Patients' functional status was assessed through the Olerud Molander Ankle Score (OMAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Twenty-one patients with ankle fractures who completed the study showed a worse static and dynamic balance at 6 months. The YBT in the anterior direction (YBTA) revealed balance deficits in the operated limb at 12 months compared to the non-operated limb (−5.6%) and the HC (−6.7%). They also showed a decreased ADFROM compared to the non-operated limb (−7.4°) and the HC (−11°). In addition, medium-term (6 months) deficits in abductor strength hip but no hip strength deficits were found at 12 months after surgery. Relative weight analyses showed that ADFROM and hip strength explained 35–63% of the YBTA variance and AOFAS/OMAS scores. Balance, hip strength and ADFROM seem to be reliable indexes for assessing the functional status of these patients. These results could help to understand the relationship between these physical capacities and the patients' perceived functional status. [ABSTRACT FROM AUTHOR]

Background: Restricted ankle dorsiflexion range of motion (DFROM) has been linked to lower extremity biomechanics that place an athlete at higher risk for injury. Whether reduced DFROM during dynamic movements is due to restrictions in joint motion or underutilization of available ankle DFROM motion is unclear. Hypothesis: We hypothesized that both lesser total ankle DFROM and underutilization of available motion would lead to high-risk biomechanics (ie, greater knee abduction, reduced knee flexion). Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Nineteen active female athletes (age, 20.0 ± 1.3 years; height, 1.61 ± 0.06 m; mass, 67.0 ± 10.7 kg) participated. Maximal ankle DFROM (clinical measure of ankle DFROM [DF-CLIN]) was measured in a weightbearing position with the knee flexed. Lower extremity biomechanics were measured during a drop vertical jump with 3-dimensional motion and force plate analysis. The percent of available DFROM used during landing (DF-%USED) was calculated as the peak DFROM observed during landing divided by DF-CLIN. Univariate linear regressions were performed to identify whether DF-CLIN or DF-%USED predicted knee and hip biomechanics commonly associated with injury risk. Results: For every 1.0° less of DF-CLIN, there was a 1.0° decrease in hip flexion excursion (r 2 = 0.21, P = 0.05), 1.2° decrease in peak knee flexion angles (r 2 = 0.37, P = 0.01), 0.9° decrease in knee flexion excursion (r 2 = 0.40, P = 0.004), 0.002 N·m·N−1·cm−1 decrease in hip extensor work (r 2 = 0.28, P = 0.02), and 0.001 N·m·N−1·cm−1 decrease in knee extensor work (r 2 = 0.21, P = 0.05). For every 10% less of DF-%USED, there was a 3.2° increase in peak knee abduction angles (r 2 = 0.26, P = 0.03) and 0.01 N·m·N−1·cm−1 lesser knee extensor work (r 2 = 0.25, P = 0.03). Conclusion: Lower levels of both ankle DFROM and DF-%USED are associated with biomechanics that are considered to be associated with a higher risk of sustaining injury. Clinical Relevance: While total ankle DFROM can predict some aberrant movement patterns, underutilization of available ankle DFROM can also lead to higher risk movement strategies. In addition to joint specific mobility training, clinicians should incorporate biomechanical interventions and technique feedback to promote the utilization of available motion. [ABSTRACT FROM AUTHOR]

BACKGROUND: Various interventions have been recommended to increase ankle dorsiflexion range of motion (DFROM); however, few studies have investigated the long-term effects of applying gastrocnemius stretching with talus-stabilizing taping (GSTST). OBJECTIVE: To compare the effects of gastrocnemius stretching (GS) and GSTST on DFROM and balance in subjects with limited DFROM. METHODS: Twenty-six subjects with limited DFROM were randomly allocated to either the GS group (n = 13) or GSTST group (n = 13) for 6 weeks. Maximum DFROM before heel-off during gait, passive DFROM, posterior talar glide, flexibility of the gastrocnemius, and the lower-quarter Y-balance test (YBT-LQ) were assessed pre-intervention and post-intervention. Two-way repeated-measures analysis of variance was used to compare the changes in variables. RESULTS: The GSTST group had greater maximum DFROM before heel-off, passive DFROM, and posterior talar glide than the GS group. Gastrocnemius flexibility and YBT-LQ scores increased significantly post-intervention in both groups; however, there was no significant difference between the groups. CONCLUSIONS: GSTST is recommend for improving ankle DFROM and balance in subjects with limited DFROM. [ABSTRACT FROM AUTHOR]

Background: Proper ankle dorsiflexion range of motion (ADF-ROM) allows the anterior roll of the tibia relative to the foot during the midstance phase of gait, which contributes to forward movement of the body. Individuals with reduced passive ADF-ROM may present altered movement patterns during gait due to an inefficient anterior tibial roll over the support foot during the stance phase.Research Question: What is the influence of reduced passive ADF-ROM on the pelvic and lower limb movements and spatiotemporal parameters during gait?Method: Thirty-two participants divided into two groups according to the degree of passive ADF-ROM-less than 10° (lower ADF-ROM group) or greater than 15° (higher ADF-ROM group) -were subjected to gait assessment using a three-dimensional motion analysis system. Independent t-tests were used to compare the pelvic and lower limb movements and spatiotemporal gait parameters between the groups on this cross-sectional study.Results: The lower ADF-ROM group had shorter step length, lower peak of pelvic ipsilateral rotation angle, and lower hip and knee maximum flexion angles in the stance phase (p < 0.05). In addition, the peaks of the ankle and forefoot-rearfoot dorsiflexion angles were smaller in the reduced ADF-ROM group (p < 0.05). The between-group differences presented effect sizes varying from moderate to large.Significance: Individuals with reduced passive ADF-ROM presented reduced foot and ankle dorsiflexion, knee and hip flexion, and pelvis rotation movements and shorter step length during gait. However, no differences in foot pronation were noted between groups. Therefore, individuals with reduced passive ADF-ROM present alterations in the lower limb and pelvic movements during gait. [ABSTRACT FROM AUTHOR]

Abstract Background In planovalgus deformity with triceps contracture, a midfoot break happens, and ankle dorsiflexion (ADF) occurs at the mid-tarsal joint during gait. Results of standard 3D gait analysis may misinterpret the true ankle dorsiflexion because it recognizes the entire foot as a single rigid segment. We performed this study to investigate whether the severity of planovalgus deformity is associated with the discrepancy between the value of ADF evaluated by physical examination and 3-dimensional (3D) gait analysis. In addition, we aimed to identify the radiographic parameters associated with this discrepancy and their relationships. Methods Consecutive 40 patients with 65 limbs (mean age, 11.7 ± 5.5 years) with planovalgus foot deformity and triceps surae contracture were included. All patients underwent 3D gait analysis, and weightbearing anteroposterior (AP) and lateral (LAT) foot radiographs. ADF with knee extension was measured using a goniometer with the patient’s foot in an inverted position. Results Twenty-one limbs underwent operation for planovalgus foot deformity, and 56 limbs underwent operation for equinus deformity. The difference between ADF on physical examination and ADF at initial contact on gait analysis was 17.5 ± 8.4°. Differences between ADF on physical examination and ADF at initial contact on gait analysis were significantly associated with the LAT talus-first metatarsal angle (p = 0.008) and calcaneal pitch angle (p = 0.006), but not associated with the AP talus-first metatarsal angle (p = 0.113), talonavicular coverage angle (p = 0.190), talocalcaneal angle (p = 0.946), and naviculocuboid overlap (p = 0.136). Conclusion The discrepancy between ADF on physical examination and 3D gait analysis was associated with the severity of planovalgus deformity, which was evaluated on weightbearing LAT foot radiographs. Therefore, physicians should be cautious about interpreting results from 3D gait analysis and perform a careful physical examination to assess the degree of equinus deformity in patients with planovalgus foot deformity.

BackgroundFoam rolling has been shown to acutely improve joint range of motion (ROM). However, limited knowledge exists on the chronic and residual effects. The primary purpose of this study was to examine the chronic and residual effects of a 2-week roller–massager intervention on ankle dorsiflexion ROM and dynamic balance.MethodsForty-two participants (24.3 ± 2.5 years, 33 males, 9 females) were randomly assigned to either roller-massage (RM) or control group (= no intervention). Ankle ROM was assessed with the weight-bearing lunge test (WBLT) and dynamic balance with the Y-Balance test for both limbs. The RM group was instructed to roll their calf muscles for three sets of 60 s per leg on 6 days a week over 2 weeks. Acute effects were measured during baseline testing for dorsiflexion ROM and dynamic balance immediately after foam rolling. Chronic and residual effects were measured 1 day and 7 days after the intervention period. Multivariate ANOVA was performed for post-hoc comparisons to determine acute, chronic, and residual effects.ResultsSignificant acute and chronic foam rolling effects (p

BACKGROUND: Although the instrument-assisted manual (IM) technique has been widely utilised to improve soft tissue and joint mobility, its therapeutic benefits and underlying neuromechanical mechanisms remain unknown compared to those of conventional static stretching (SS) and hold-relax (HR) manual techniques. OBJECTIVE: This study aimed to compare the effects of the SS, HR, and IM techniques on muscle activity, kinematics, and strength during deep squatting in limited ankle dorsiflexion (DF) syndrome. METHODS: This was a cross-sectional randomised controlled study including 39 adults divided into three groups: SS group: 13, HR group: 13, IM group: 13. Outcome measures were the tibialis anterior (TA): gastrocnemius (GCM) balance ratio and ankle, knee, hip and thoracolumbar junction angles. TA muscle strength was analysed to evaluate the limited ankle DF. Analysis of variance was performed, with P < 0.05. RESULTS: The TA:GCM balance ratio, ranges of motion of ankle DF and knee flexion, and TA muscle strength in the IM group improved significantly compared to that in either the SS group or HR group (P < 0.05). CONCLUSIONS: Our novel results demonstrated that IM was most effective in normalising TA:GCM balance, ankle DF range of motion, and TA muscle strength during deep squatting in adults with limited ankle DF. [ABSTRACT FROM AUTHOR]

Background: Isolated gastrocnemius tightness (IGT) has been suggested as an etiologic factor in mechanical disorders of the foot and ankle without a clear pathophysiological mechanism in the literature. We hypothesized that restricted ankle dorsiflexion inducing increased forefoot pressure in IGT patients could be this pathophysiological mechanism.Methods: Case/control experimental observational investigation. Forty lower limbs in 20 asymptomatic IGT patients were included and compared to controls. Quantitative gait analyses coupled with dynamic baropodometry were used for comparison between groups. The primary outcome was maximum ankle dorsiflexion during stance phase. Secondary outcomes were knee flexion and forefoot pressure.Results: Maximum ankle dorsiflexion and maximum forefoot pressure were similar between groups. Increased knee flexion was found in the asymptomatic IGT group.Conclusions: IGT induced compensatory knee flexion during stance phase, which probably prevents increased pressure on the forefoot by allowing ankle dorsiflexion.Level Of Evidence: Level IV, Case/control experimental observational investigation. [ABSTRACT FROM AUTHOR]

Motor imagery (MI) is known to improve motor function through enhancement of motor cortex activity. Spinal reciprocal inhibition (RI) is modulated by motor cortex activity, and, therefore, MI may change RI. The aim of this study was to examine the changes in RI during MI involving the lower extremity. Spinal RI was measured from the tibialis anterior (TA) to the soleus (SOL). Eleven healthy adults participated in experiment 1. All participants performed the following three conditions, and RI was assessed during each condition: (1) resting condition; (2) MI of ankle dorsiflexion condition (MI-DF); and (3) MI of ankle plantarflexion condition (MI-PF). Twelve healthy adults participated in experiment 2. All participants performed the following two conditions, and RI was assessed before and after MI practice for 10 min: (1) resting condition and (2) MI-DF. The interval between the conditioning and test stimulus (inter-stimulus interval; ISI) was set at 0, 1, 2, or 3 ms and 20 ms. In experiment 1, RI during MI-PF was significantly decreased compared with that during resting with both stimulus intervals. RI during MI-DF showed no significant change compared with that during resting with both ISIs. In experiment 2, the difference between the rest condition and the MI-DF condition after the MI task with ISI of 20 ms was significantly higher than before the MI task. Our findings suggest that real-time changes in RI during MI involving the lower extremity may vary depending on the direction of motion and MI practice. [ABSTRACT FROM AUTHOR]

Restricted gastrocnemius length may impair movement efficiency during functional movements. However, this is yet to be examined among tactical athletes. This study examined the relationship between gastrocnemius muscle length and movement compensations during a two-leg overhead squat among career firefighters. Bilateral ankle dorsiflexion passive range of motion data were collected from 50 firefighters, and movement compensations observed during a two-leg overhead squat were recorded. Firefighters with reduced average ankle dorsiflexion passive range of motion were more likely to demonstrate movement compensations during the overhead squat. Clinicians should utilize interventions that lengthen gastrocnemius musculature to improve the squat movement efficiency of firefighters. [ABSTRACT FROM AUTHOR]

Background: Peak Torque (PT), Rate of Torque Development (RTD) and Average Torque (AT) over a single contraction assess the three components of muscle function during isometric contractions. Surprisingly, AT has never been reported or its reliability confirmed. Objectives: This study aims to establish protocol reliability for ankle dorsiflexion and elbow extension isometric muscle function (PT, RTD, AT) in healthy participants using the Biodex System 3 Dynamometer. Methods: Twelve participants (6 male, 6 female, mean age 39.8±16.0 years) performed four maximal isometric contractions on two occasions. Intraclass Correlation Coefficient (ICC), Typical Error (TE) and Coefficient of Variation (CV) for PT, RTD and AT were reported. Results: The ICC for all strength parameters varied from 0.98–0.92. TE for ankle dorsiflexion PT was 1.38Nm, RTD 7.43Nm/s and AT 1.33Nm, CV varied from 6.26±6.25% to 11.72±8.27%. For elbow extension, TE was 3.36Nm for PT, 14.87Nm/s for RTD and 3.03Nm for AT, CV varied from 5.97±4.52% to 18.46±14.78%. Conclusion: Maximal isometric ankle dorsiflexion and elbow extension PT, RTD and AT can be evaluated with excellent reliability when following the described protocol. This testing procedure, including the application of AT, can be confidently applied in research, exercise or clinical settings.

As visual stimuli for exercise and cognitive rehabilitation of biomechanics, virtual reality (VR) and augmented reality (AR) devices have getting popularity. In the process of developing the relevant content for VR and AR, there has been a problem that only a specific platform must be supported or multiple programs must be used. Recently, the Unity 3D platform has been developed for the convenience of game development for VR or AR environments that potentially solve these problems. Unity 3D’s game engine and animation can easily implement a moving avatar as visual stimuli, and the speed of the avatars can be checked in real-time. Therefore, we developed a moving avatar as the visual stimuli using Unity 3D and conducted pilot experiments with four healthy subjects by performing the knee extension and ankle dorsiflexion tasks with and without visual stimuli. The number of movements was counted to check the feasibility of the effectiveness using visual stimuli using Unity 3D. The results showed that the number of movements was higher when the visual stimuli were presented compared to that without the visual stimuli in both ankle dorsiflexion and knee extension. Our findings and approach can be a basis for further developing rehabilitation training protocols using various visual stimuli with Unity 3D.

The aim of this study was to examine the relationship between deep squatting or ROM of lower limbs, and physical function in typically developing children. 337 elementary school students were recruited for this study. The subjects were performed to squat with their heels down and then were divided into 2 groups: possible squatting and impossible squatting. ROM of lower limbs (hip flexion, knee flexion, and ankle dorsiflexion), circumference of leg, standing long jump, the five-repetition sit-to stand test (FTSST) and a standing test were analyzed. Unpaired t-test or Mann-Whitney U test was used for the two-group comparison. Logistic regression analysis was used to determine variables associated with squatting, and multiple regression analysis was used to determine variables associated with physical function. The rate of impossible squatting was 11.9%. The ROM of the lower limbs was significantly decreased in the impossible group. Multiple regression analysis showed that the ankle dorsiflexion ROM and BMI were correlated with squatting. In physical function, the FTSST and standing test were correlated with squatting. However, in the multiple regression analysis squatting did not significantly affect physical function. In this study, ROM of the ankle dorsiflexion and BMI affected the squatting. It was suggested that the squatting might be useful as a screening for ankle dorsiflexion ROM. [ABSTRACT FROM AUTHOR]

Objective: Reliable measurement of voluntary human effort is essential for effective and safe interaction between the wearer and an assistive robot. Existing voluntary effort prediction methods that use surface electromyography (sEMG) are susceptible to prediction inaccuracies due to non-selectivity in measuring muscle responses. This technical challenge motivates an investigation into alternative non-invasive effort prediction methods that directly visualize the muscle response and improve effort prediction accuracy. The paper is a comparative study of ultrasound imaging (US)-derived neuromuscular signals and sEMG signals for their use in predicting isometric ankle dorsiflexion moment. Furthermore, the study evaluates the prediction accuracy of model-based and model-free voluntary effort prediction approaches that use these signals. Methods: The study evaluates sEMG signals and three US imaging-derived signals: pennation angle, muscle fascicle length, and echogenicity and three voluntary effort prediction methods: linear regression (LR), feedforward neural network (FFNN), and Hill-type neuromuscular model (HNM). Results: In all the prediction methods, pennation angle and fascicle length significantly improve the prediction accuracy of dorsiflexion moment, when compared to echogenicity. Also, compared to LR, both FFNN and HNM improve dorsiflexion moment prediction accuracy. Conclusion: The findings indicate FFNN or HNM approach and using pennation angle or fascicle length predict human ankle movement intent with higher accuracy. Significance: The accurate ankle effort prediction will pave the path to safe and reliable robotic assistance in patients with drop foot. [ABSTRACT FROM AUTHOR]