Foot and Ankle Strength Assessment Using Hand-Held Dynamometry: Reliability and Age-Related Differences

Abstract

Background: Age-related reduction in lower limb muscle strength has been shown to be related to disability, falls and loss of independence. While there have been a number of studies on age-related changes in muscle strength, they have concentrated on more proximal muscle groups with little research into how ageing affects the muscles of the foot and ankle. Objective: To evaluate the intra- and interrater reliability of hand-held dynamometry for the assessment of foot and ankle strength, and to compare the values obtained between young and older people. Methods:The muscle groups which perform ankle dorsiflexion, plantar flexion, inversion, eversion and plantar flexion of the hallux and lesser digits were recorded for 36 young participants (17 males, 19 females, mean age 23.2 ± 4.3 years) and 36 older people (17 males, 19 females, mean age 77.1 ± 5.7 years) using a Citec hand-held dynamometer. Differences in muscle strength between the groups as well as intrarater and interrater reliability of two assessors were determined. Results: The reliability of the hand-held dynamometry procedure was excellent for both intrarater (ICC_3,1 = 0.78–0.94) and interrater (ICC_3,1 = 0.77–0.88) comparisons. There were significant differences between the muscle strength of the young and older participants for all muscle groups tested (p < 0.001) with older participants being weaker than the young participants by a magnitude of between 24 and 37%. Conclusions:Hand-held dynamometry is a reliable instrument to measure the foot and ankle strength of young and older adults. Ageing is associated with a reduction in strength of between 24 and 37% for the muscles responsible for movement of the foot and ankle.

Psychometric Properties of a Clinical Strength Assessment Protocol in People with Multiple Sclerosis

“…8 Although efficient, MMT is objective only at grades 0 to 3, whereas grades 4 and 5 require a more subjective interpretation by the tester. Furthermore, MMT may not detect subtle changes in strength or early weakness that can be present in people with MS. [9][10][11] The HHD in healthy adults 23,29,32 and in patients with other neurologic conditions 31 is likely not directly applicable to people with MS in part due to the variety of HHD testing protocols and devices but also due to the unique variability that is present in people with MS, who can experience fluctuating symptoms, which might affect HHD measurements. In people with MS, response stability of HHD has been reported between raters for a single session in knee extension, hip extension, and ankle dorsiflexion.…”

Does the weakening of intrinsic foot muscles cause the decrease of medial longitudinal arch height?

“…In this study, besides using the method of Headlee et al7 ) that required flexion of the MP joints without flexion of the IP joints to reduce the extrinsic foot muscles activity, we fixed the subject’s ankle in a maximum plantar flexion position using a plaster cast. In this position, the extrinsic foot flexors would be in a shortened position and, therefore, less able to generate a force16, 17 ) . Furthermore, the activity of the extrinsic foot muscles as fixators would also be decreased.…”

Older People’s Perceptions of a Multifaceted Podiatric Medical Intervention to Prevent Falls

“…The exercises most commonly reported to be too difficult were those involving the toe flexors: picking up marbles (33.1%) and toe grasping using the Archxerciser arch-strengthening device (27.1%). It is now well established that aging is associated with loss of toe flexor strength [18][19][20] and that weakness of the toe flexors is associated with impaired balance 20,21 and an increased risk of falls. 22,23 As such, it is perhaps not surprising that these exercises were perceived to be difficult by some participants, particularly given that one of the main recruitment avenues for this study was through a podiatric medical clinic.…”