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Context: Heel lifts are often prescribed as part of the treatment program for patients with overuse injuries associated with limited ankle dorsiflexion. However, little is known about how joint kinematics and temporal variables are affected by heel lifts.
Objective: To determine the effects of heel lifts on selected lower extremity kinematic and temporal variables during the stance phase of gait in subjects with limited ankle dorsiflexion.
Design: Two-way, fully repeated-measures design. The 2 factors were side (right or left) and walking condition (shoes alone, 6-mm heel lifts in shoes, 9-mm heel lifts in shoes). Setting: University biomechanics laboratory. Patients or Other Participants: Twenty-six volunteers (21 females, 5 males) with no more than 5 degrees of ankle joint dorsiflexion. Intervention(s): Subjects were tested in shoes alone and in shoes with 6-mm and 9-mm heel lifts. Main Outcome Measure(s): We used the Qualisys Motion Analysis System to measure ankle dorsiflexion excursion, maximal knee extension, and time to heel off during the stance phase of gait under the 3 walking conditions.
Results: On the right side, ankle dorsiflexion excursion increased significantly with the 6-mm and 9-mm heel lifts compared with shoes alone ( P < .05). On the left side, ankle dorsiflexion increased significantly with the 9-mm heels lifts over shoes alone and with the 9-mm heel lifts compared with the 6-mm heel lifts ( P < .05). Time to heel off increased significantly for walking with the 9-mm heel lifts compared with shoes alone ( P < .05). No differences were noted for maximal knee extension ( P > .05).
Conclusions: Clinicians may consider prescribing heel lifts for patients with limited dorsiflexion range of motion if increasing ankle dorsiflexion excursion and time to heel off during the stance phase of gait may be beneficial.
Just read the full text and was struck by the fact that mean passive dorsiflexion was < 5 deg., while (in all test conditions) mean dorsiflexion was about 20 degrees or more.
Can anyone help me out with an explanation? Thanks.
No explanation for it, but seen it many times in different projects. Seen some who have large range passively. but never go past, for eg, 5 degrees when walking; then seen others with very limited ROM, but dynamically, they easily go past 10 degrees.
CONCLUSION: Static ankle ROM has nothing to do with what is used dynamically.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Just read the full text and was struck by the fact that mean passive dorsiflexion was < 5 deg., while (in all test conditions) mean dorsiflexion was about 20 degrees or more.
Can anyone help me out with an explanation? Thanks.
Read the methods section of the paper more closely and you will find that the researchers measured passive dorsiflexion when clinically examining the subjects and then measured "ankle dorsiflexion excursion" (difference of maximum vs minimum ankle motion) when studying the kinematics of gait. In other words, ankle dorsiflexion and ankle dorsiflexion excursion are two totally different measures and should not be compared against each other.
__________________
Sincerely,
Kevin
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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
I have read a lot recently about the lunge test since I heard about it at your Foot Orthoses Seminar Craig (BTW, the seminar was excellent).
Although much less experienced / learned than many, I have a bit of trouble getting used to the idea of putting a heel raise in a shoe / on an orthotic as a first line of treatment when AJ range is limited. My instinct is to try and increase that range with stretches, mobilisations, night splints, etc rather than accommodate that lack of range and potentially cause further tightness / stiffness.
Heel lifts for limited ankle dorsiflexion
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