Reliability of a novel heel-rise ROM test

Olivia Full, SPT, Lucas Seehafer, SPT, and Chelsie Walder, SPT

DPT2018 Ankle ROM

16 Comments on “Reliability of a novel heel-rise ROM test

  1. Great study with interesting findings. I like the idea of using this as another assessment tool.

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  2. I find this research quite interesting and clinically practical. Measuring AROM of the ankle with a goni in a non-weight bearing position does not seem to relate to overall functional mobility or translate to arthrokinematics with gait. Over the summer in my rotation at the VA there was a therapist that utilized a half-foam roll with inch measurements to assess pt DF ROM (similar to a quick tip Dr. Ness taught us in our LE Musculoskeletal class). These type of functional measurements seems to correlate to functional movement and from your research appear to have greater intra- and inter- reliability between the two examiners. What do you believe is the next step to taking this research into greater various populations to allow it to be a reliable test measure that could be used within the clinic with norms?

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    • Good question, Dani. There are many directions in which our research could go. First off, I think our unilateral heel-rise test should be studied in other populations, such as geriatrics and pediatrics as well as unhealthy participants. As of now we only know how the test works for healthy 20-year-olds. From their, bigger populations would have to be recruited so normative values could be established. Our present study is really just a launching pad for further research.

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  3. I think the weight bearing heel test is a great way to measure functional abilities and that it also easy for patients to understand and see the measurement as more meaningful in their abilities. I know you talked about it as an area of further research, but I was wondering if any of you had possible reasoning behind the poor correlation between the weight bearing and non-weight bearing tests? I also curious if you think the correlation would increase between them in symptomatic subjects: for instance do you think pain would limit both of these tests equally to make to get a similar picture of the “deficit” or functional limitation the patient experiences?

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  4. Thanks for the question, Hailey! We can not be sure of the exact reason why there is a poor correlation, as there is most likely a combination of multiple factors involved. In a typical non-weight bearing test, you are strictly testing available ROM at the joint, especially when you are testing PROM. In the weight bearing position, you are not only testing available ROM, but how well a patient can achieve that ROM functionally. This requires strength, balance, and motor control! I would hypothesize that the correlation in a symptomatic population would not increase due to the fact that a symptomatic population would most likely have pain, weakness, or motor control issues (or any combination) that would become evident in the weight bearing test, but may not make as big of an impact in the non-weight bearing test. Ideally, these two tests could be used simultaneously in clinical practice to get a measurement of both available ROM in the ankle, as well as additional deficits that could be contributing to how a patient actually uses that ROM.

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  5. Were the volunteers included due to not having a current pathology or was there a strength test component for inclusion? The WB measurements would definitely be less with strength issues, and would be way more obvious in the pathological population. Also, were steps taken to prevent any sort of inversion during NWB measurements, as this would result in a larger measurements vs closed chain in WB.

    I like the functional aspect of it and having an objective measure as it pertains to issues like posterior tibial tendon dysfunction and plantar fasciitis as gastroc strength is often limited, allowing excessive calcaneal eversion and the midfoot being unable to lock up. This then results in overpronation and repetitive microtrauma to the posterior tibial tendon and plantar fascia.

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  6. Jason, there wasn’t a strength test involved for inclusion, just simply that they hadn’t had any pathology in the last 6 months, were within our selected age range, and weren’t currently pregnant. The only steps that were taken to prevent inversion where visual inspection and verbal cuing for proper PF form.

    I agree that WB measurements would decrease if the participant had decreased strength, but I think that speaks to the functionality of this test; just because a patient has an available AROM, doesn’t mean they can functionally utilize it. This is why, in my opinion, an additional tool, such as our heel-rise test, should be used in conjuncture to goniometry, not necessarily replace goniometry. Our test would so that they have a decreased functional AROM and from there other tests, like MMT or dynamometry, could be utilized to pinpoint where the decrease is coming from.

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  7. Overall, I thought that this study was very interesting and proves that this may be an assessment tool to add to our toolbox. Did you go through a round of “practice” before you started the three trials, or was the “practice” round included in these trials? How do you think this would affect your data?

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    • Hi Nicole, thanks for your question! We allowed each participant to practice the single leg heel rise 3 times before we took the 3 measurements. We discussed that this could possibly fatigue the participant and therefore effect the height of their heel-rise, but felt it was necessary so all participants were performing the same movement. All of our participants were also healthy, college aged people so the 3 extra heel-rises should have minimal effect on them.

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  8. I like the concept behind the WB heel rise test. I can see where this technique may come in handy in clinic coming up. Are any of you currently using it with your patients? I am just curious how this test is translating into clinical use and how CI’s are perceiving the test.

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    • Katie, I’ve found that this test definitely as its place in clinical use! I had a patient in my previous clinical who we were seeing after an ankle fracture. Her AROM and PROM were symmetrical to her unaffected side, yet she continued to have an abnormal gait pattern and could not toe off on the affected side. We had her do our heel rise test and sure enough, she was unable rise on the affected side. She had adequate range of motion in a non weight bearing position, but in a weight bearing position she was unable to effectively use her available range. This test is a good way to quantify progress in functional plantarflexion range versus a manual muscle test and non weight bearing range separately. The two CI’s that I have presented this too definitely see the benefit of the test, but as it is not well researched yet and there are no norms, it is currently not being used regularly in practice.

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  9. This was an interesting study. I was really surprised that there was not a WB test already developed because of it’s obvious importance to function. Were participants allowed to touch the wall for balance during the WB heel rise? Why not measure heel rise directly by measuring the displacement from the ground? Did you feel like there was any compensations or “cheating” occurring with the single leg WB heel rise that may have affected measurements, besides anterior movement?

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    • Hi Elizabeth,
      Yes, the participants were allowed to touch the wall with their fingertips for balance. We measured the displacement of the head rather than the heel because we developed a tool that sat upon their head and easily moved up with their heel rise and was then held in place at the highest point. To measure at the heel, the participant would have had to hold the heel rise for a longer period of time for us to get a measurement with a tape measure and this allows more time for them to fatigue and alter their position. As for compensations, we did see some participants rise in a slow and well controlled manner, and others would rise really quickly to use momentum to get higher, so we addressed this in our discussion aspect of our manuscript for this study.

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  10. Great job guys, this was a very interesting study. My question is were there any steps taken to ensure that participants didn’t raise their head when performing the test to better their mark.

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    • Hey Tark. We instructed the participants how to properly perform the single leg heel-rise while looking straight forward and then allowed them 3 practice trials on each leg before measurements were taken. During these practice trials we corrected any alterations they made to the movement. Other than this correction during the practice trials, no other steps were taken to ensure they didn’t raise their heads. However, we did not note any participants that purposefully did this to better their mark,

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