The effect of subtalar joint position on dorsiflexion of the ankle/rearfoot versus midfoot/forefoot during gastrocnemius stretching. 2014

Marie A Johanson, and Amy DeArment, and Krystol Hines, and Erin Riley, and Meghan Martin, and Justin Thomas, and Kathleen Geist
Emory University School of Medicine, Atlanta, GA, USA.

BACKGROUND Limited ankle joint dorsiflexion passive range of motion (PROM) has been associated with common chronic lower extremity conditions, and clinicians often instruct patients in stretching exercises to increase dorsiflexion. However, little is known about how subtalar joint (STJ) position affects dorsiflexion at the midfoot/forefoot versus ankle/rearfoot during gastrocnemius stretching. The purpose of this study was to determine if more dorsiflexion occurs at the ankle/rearfoot and less at the midfoot/forefoot during gastrocnemius stretching with the STJ positioned in supination versus pronation. METHODS In this repeated measures design, 27 participants (23 females, 4 males; mean age = 31.3 years, SD = 10.7) with current or recent history of lower extremity chronic conditions and less than 10 degrees ankle dorsiflexion measured with the knee in extension on the involved side(s) performed five 30-second gastrocnemius stretching trials in pronation and supination on each side in a randomly determined sequence. A 7-camera Vicon Motion Analysis System and an AMTI force plate were used to measure midfoot/forefoot dorsiflexion, ankle/rearfoot dorsiflexion, knee extension, and normalized vertical ground reaction force. RESULTS Two-way repeated measures ANOVA revealed a significant increase in midfoot/forefoot dorsiflexion when stretching in pronation compared to supination (P < .001). ANOVAs also demonstrated significantly more extension of the knee when stretching in supination compared to pronation (P < .001), and increased normalized vertical ground reaction force when stretching in supination compared to pronation (P = .032). With the numbers available, no significant difference in ankle/rearfoot dorsiflexion when stretching in supination compared to pronation could be detected (P > .05). CONCLUSIONS Gastrocnemius stretching in pronation resulted in more dorsiflexion at the midfoot/forefoot than stretching in supination. CONCLUSIONS Clinicians may want to consider STJ position during gastrocnemius stretching to either facilitate or limit recruitment of dorsiflexion motion at the midfoot/forefoot.

UI MeSH Term Description Entries
D008297 Male Males
D009140 Musculoskeletal Diseases Diseases of the muscles and their associated ligaments and other connective tissue and of the bones and cartilage viewed collectively. Orthopedic Disorders,Musculoskeletal Disease,Orthopedic Disorder
D011403 Pronation Applies to movements of the forearm in turning the palm backward or downward. When referring to the foot, a combination of eversion and abduction movements in the tarsal and metatarsal joints (turning the foot up and in toward the midline of the body). Pronations
D005260 Female Females
D005528 Foot The distal extremity of the leg in vertebrates, consisting of the tarsus (ANKLE); METATARSUS; phalanges; and the soft tissues surrounding these bones. Feet
D005545 Forefoot, Human The forepart of the foot including the metatarsals and the TOES. Human Forefoot
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000843 Ankle Joint The joint that is formed by the inferior articular and malleolar articular surfaces of the TIBIA; the malleolar articular surface of the FIBULA; and the medial malleolar, lateral malleolar, and superior surfaces of the TALUS. Ankle Syndesmosis,Articulatio talocruralis,Distal Tibiofibular Joint,Inferior Tibiofibular Joint,Talocrural Joint,Tibiofibular Ankle Syndesmosis,Tibiofibular Syndesmosis,Ankle Joints,Ankle Syndesmoses,Ankle Syndesmosis, Tibiofibular,Distal Tibiofibular Joints,Inferior Tibiofibular Joints,Joint, Ankle,Joints, Ankle,Syndesmosis, Ankle,Talocrural Joints,Tibiofibular Ankle Syndesmoses,Tibiofibular Joint, Distal,Tibiofibular Syndesmoses
D013380 Subtalar Joint Formed by the articulation of the talus with the calcaneus. Talocalcaneal Joint,Joint, Subtalar,Joint, Talocalcaneal,Joints, Subtalar,Joints, Talocalcaneal,Subtalar Joints,Talocalcaneal Joints

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