Limited dorsiflexion predisposes to injuries of the ankle in children

Abstract

Injuries to the ankle are common in children. We investigated whether decreased dorsiflexion predisposes to such fractures and sprains. Passive dorsiflexion in children with ankle injuries was compared with that in a control group of patients with a normal ankle. The uninjured side was examined to determine flexibility in those patients with ankle injuries. In 82, the mean dorsiflexion was 5.7° with the knee extended and 11.2° with the knee flexed. In 85 controls, the mean dorsiflexion was 12.8° with the knee extended and 21.5° with the knee flexed (p < 0.001, Student's t-test). There was a strong association between decreased ankle dorsiflexion and injury in children. A flexible triceps surae appeared to absorb energy and protect the bone and ligaments, while stiffness predisposed to injury. We suggest that children with tight calf muscles should undergo a regimen of stretching exercises to improve their flexibility. decreased range of ankle movement may predispose to these injuries. In the normal ankle, the range of dorsiflexion is 8° to 26°5 past the anatomical position, i.e., with the foot at right angles to the linear axis of the leg. During normal gait, about 10° of dorsiflexion is needed during the stance phase and toe-off.6-8 Dorsiflexion of more than 10° is used when going downstairs, kneeling, and in many sports activities. For example, in athletes, Lindsjo et al 6 believe that a loaded range of dorsiflexion of 20° to 30° is necessary. In infants and children, greater mobility and flexibility may be present than in adults, and in the newborn the foot can sometimes be dorsiflexed so that the toes and dorsum of the foot touch the skin over the tibia.We have frequently noted diminished ankle dorsiflexion secondary to tightness of the triceps surae in growing children. Our hypothesis is that flexibility of the triceps surae has a protective effect against injuries to the ankle. When subjected to loading, energy is dissipated gradually by a prolonged, eccentric muscle contraction, preventing injury. In a computerised search of the medical literature, we were unable to find any research which has tested this hypothesis. Therefore, we have attempted to ascertain if decreased dorsiflexion of the ankle secondary to tight musculature of the calf is associated with an increased incidence of injury to the ankle. Patients and MethodsWe measured dorsiflexion of the ankle in a consecutive series of 82 patients with fractures or sprains at this joint seen at a children's hospital. A control group consisted of patients seen in the orthopaedic clinic and plaster room mostly with injuries to the upper limbs. In the control group patients were excluded if they had had a previous injury to the lower limb which required medical attention or had other confounding conditions, such as a deformity of or surgery on the lower limb, or a neuromuscular disorder.In the patients with fractures and sprains of the ankle, pain and inaccessibility of the ankle because of a cast or splint, limited our examination to the uninjured ankle. I...

Comparison of the Loading Rate and Lower Limb Angles on Drop-landing between a Normal Foot and Flatfoot

“…Further, Tabrizi et al 34) reported that the rate of ankle injury can increase if the movements of the ankle joints decrease during drop-landing. The results of the present study correspond with these research results in that they present a statistically significant decrease in the right joint angle in the flatfoot group.…”

Talocrural Joint Mobilization's Lack of Effect on Postural Control in Healthy Subjects

“…These results suggest that a single application of a posterior talar glide does not have any acute effects on postural control and perhaps sensorimotor control in asymptomatic individuals. 6 However, McKeon and Hertel 32 suggested that differences in postural control among chronic ankle-instability patients may be partially a result of measurement sensitivity. Therefore, other methods of assessing postural control may elicit different findings.…”

“…6,36 Although the ankle complex moves in a triplanar motion, the mobilizations were performed in a single plane. Therefore, it is reasonable to believe that sway in the AP direction would be more affected than that in the ML direction.…”

“…3 Therefore, soft-tissue restrictions for dorsiflexion, which position the talocrural joint in increased plantar flexion, could possibly predispose the ankle to a lateral sprain. [4][5][6] Furthermore, after an initial sprain, an estimated 80% of athletes will suffer a recurrent sprain to the lateral ligaments. 7 Previous studies have shown the association between sensorimotor deficits, such as increased ankle repositioning errors and decreased postural control, and ankle sprains.…”

“…16 This is an important treatment because range of motion (ROM) is often compromised after injury, and a lack of ROM can predispose athletes to reinjury. 5,6 Other effects attributed to this treatment include decreased pain, increased muscle tone, and improved postural and kinesthetic awareness (proprioception). [17][18][19][20] More specifically, ankle-joint mobilizations have been reported to decrease pain, increase ROM, and improve function among patients diagnosed with both acute and chronic ankle sprains.…”