![]() ![]() Bennell, K.L., et al., Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. ![]() Mudge, A.J., et al., Normative reference values for lower limb joint range, bone torsion, and alignment in children aged 4-16 years. Peet, The foot posture index, ankle lunge test, Beighton scale and the lower limb assessment score in healthy children: a reliability study. The Tiltmeter app on the iPhone has been shown to be reliable to measure ankle range of motion. ![]() With smart phone technology, there are increasing numbers of apps being introduced to assist in assessment. There are a number of tools used to assist clinicians in measurement of ankle joint range of motion, with the use of digital inclinometers and angle finders being commonly used in clinical practice. This test has been used in children as young as two years old [4}. Bennell’s study demonstrated excellent inter and intra observer reliability of the weight bearing lunge test with older children standing to measure the amount of available ankle range of motion. The reported differences may be due to the way the child has laid or the force applied to provide the stretch. Large variations in normative values have been reported in studies with ankle dorsiflexion measurements ranging from 9 degrees to 28 degrees with the knee extended. Ankle dorsiflexion changes as children get older. Non-weightbearing ankle joint range of motion normative reference values in children have been published with knee in flexion (soleus) and knee extension (gastrocnemius). There have been a number of methods mentioned within the literature on measurement, including weight-bearing and non-weight bearing techniques. The accurate measurement of available ankle range of motion is an important part of clinical decision making when considering treatment for any number of lower limb musculoskeletal conditions, including children who are toe walking, children with Charcot Marie Tooth, cerebral palsy or even calcaneal apophysitis. This can cause premature activity of ankle plantarflexors. The most common cause of reduced dorsiflexion is ankle equinus from tightness or shortening of the gastrocnemius/soleus muscle group (triceps surae). Surgical: ligation suture (less complex) removal of duplicated structures (more complex)Ĭould present as partial (i.e.Lack of ankle dorsiflexion often presents as altered gait with early heel lift (bouncy gait) or sometimes a gait type with total lack of heel strike. Usually involves border toes, most commonly the fifth Plantarflexed ankle joint with upwardly extended midfoot and forefoot Initial conservative therapy to stretch soft tissues, followed by surgical correction Rigid foot appearance with “reversed” arch Severe: serial castings, followed by nightly splinting or bivalved castingĭorsal forefoot can be touching outer legĬongenital vertical talus (rocker-bottom foot) Moderate: splinting and high-top, rigid-sole, lace-up shoes Radiographs show parallel axes of talus and calcaneusįoot in extreme dorsiflexion (hyperextension) Intrinsic (rigid): initial casting, usually followed by surgical correctionĬoncave medial foot border, convex lateral “V”-finger test deviation of lateral foot borderĮxtrinsic (supple): serial castings, followed by maintenance splinting Prominent styloid process of fifth metatarsal When surgery is indicated, procedures generally are postponed for six to nine months so that the child will better tolerate anesthesia. Cases that require surgical correction should be referred to a subspecialist with expertise in correcting lower extremity deformities in children. Most treatments include conservative measures, such as observation, stretching, and splinting, which can be performed easily in the family medicine setting. Common newborn foot abnormalities include metatarsus adductus, clubfoot deformity, calcaneovalgus (flexible flatfoot), congenital vertical talus (rigid flatfoot), and multiple digital deformities-polydactyly, syndactyly, overlapping toes, and amniotic bands. A thorough examination includes assessment of vascular, dermatologic, and neurologic status of the lower extremities, and observation, palpation, and evaluation of joint range of motion in both feet. Most deformities can be diagnosed easily with physical examination alone, using few diagnostic studies. Despite its small size, the newborn foot is a complex structure. A thorough examination can be performed quickly. An examination of the feet is an essential component of an evaluation of a newborn. ![]()
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