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Published in: Journal of Foot and Ankle Research 1/2016

Open Access 01-12-2016 | Research

The relationship of foot and ankle mobility to the frontal plane projection angle in asymptomatic adults

Authors: Narelle Wyndow, Amy De Jong, Krystal Rial, Kylie Tucker, Natalie Collins, Bill Vicenzino, Trevor Russell, Kay Crossley

Published in: Journal of Foot and Ankle Research | Issue 1/2016

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Abstract

Background

The frontal plane projection angle (FPPA) is frequently used as a measure of dynamic knee valgus during functional tasks, such as the single leg squat. Increased dynamic knee valgus is observed in people with knee pathologies including patellofemoral pain and anterior cruciate injury. As the foot is the primary interface with the support surface, foot and ankle mobility may affect the FPPA. This study investigated the relationship between foot and ankle mobility and the FPPA in asymptomatic adults.

Methods

Thirty healthy people (aged 18–50 years) performed 5 single leg squats. Peak FPPA and FPPA excursion were determined from digital video recordings. Foot mobility was quantified as the difference in dorsal midfoot height or midfoot width, between non-weightbearing and bilateral weightbearing positions. Ankle joint dorsiflexion range was measured as the maximum distance in centimetres between the longest toe and the wall during a knee-to-wall lunge. Linear regressions with generalised estimating equations were used to examine relationships between variables.

Results

Higher midfoot width mobility was associated with greater peak FPPA (β 0.90, p < 0.001, odds ratio [OR] 2.5), and FPPA excursion (β 0.67, p < 0.001, OR 1.9). Lower midfoot height mobility was associated with greater peak FPPA (β 0.37, p = 0.030, OR 1.4) and FPPA excursion (β 0.30, p = 0.020, OR 1.3). Lower ankle joint dorsiflexion was also associated with greater peak FPPA (β 0.61, p = 0.008, OR 1.8) and greater FPPA excursion (β 0.56, p < 0.001, OR 1.7).

Conclusions

Foot and ankle mobility was significantly related to the FPPA during the single leg squat in healthy individuals. Specifically, higher midfoot width mobility, or lower ankle joint dorsiflexion range and midfoot height mobility, were associated with a greater FPPA. These foot mobility factors should be considered in the clinical management of knee-related disorders that are associated with a high FPPA.
Literature
1.
go back to reference Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM. Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med. 2011;39(4):866–73.CrossRefPubMed Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM. Performance on the single-leg squat task indicates hip abductor muscle function. Am J Sports Med. 2011;39(4):866–73.CrossRefPubMed
2.
go back to reference Bittencourt NF, Ocarino JM, Mendonca LD, Hewett TE, Fonseca ST. Foot and hip contributions to high frontal plane knee projection angle in athletes: a classification and regression tree approach. J Orthop Sports Phys Ther. 2012;42(12):996–1004.CrossRefPubMed Bittencourt NF, Ocarino JM, Mendonca LD, Hewett TE, Fonseca ST. Foot and hip contributions to high frontal plane knee projection angle in athletes: a classification and regression tree approach. J Orthop Sports Phys Ther. 2012;42(12):996–1004.CrossRefPubMed
3.
go back to reference Willson JD, Davis IS. Utility of the frontal plane projection angle in females with patellofemoral pain. J Orthop Sports Phys Ther. 2008;38(10):606–15.CrossRefPubMed Willson JD, Davis IS. Utility of the frontal plane projection angle in females with patellofemoral pain. J Orthop Sports Phys Ther. 2008;38(10):606–15.CrossRefPubMed
4.
go back to reference Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40(2):42–51.CrossRefPubMed Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40(2):42–51.CrossRefPubMed
5.
go back to reference Whatman C, Hing W, Hume P. Kinematics during lower extremity functional screening tests-are they reliable and related to jogging? Phys Ther Sport. 2011;12(1):22–9.CrossRefPubMed Whatman C, Hing W, Hume P. Kinematics during lower extremity functional screening tests-are they reliable and related to jogging? Phys Ther Sport. 2011;12(1):22–9.CrossRefPubMed
6.
go back to reference Dugan SA, Bhat KP. Biomechanics and analysis of running gait. Phys Med Rehabil Clin N Am. 2005;16(3):603–21.CrossRefPubMed Dugan SA, Bhat KP. Biomechanics and analysis of running gait. Phys Med Rehabil Clin N Am. 2005;16(3):603–21.CrossRefPubMed
7.
go back to reference Macrum E, Bell DR, Boling M, Lewek M, Padua D. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. J Sport Rehabil. 2012;21(2):144–50.PubMed Macrum E, Bell DR, Boling M, Lewek M, Padua D. Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. J Sport Rehabil. 2012;21(2):144–50.PubMed
8.
go back to reference Myer GD, Ford KR, Khoury J, Succop P, Hewett TE. Clinical correlates to laboratory measures for use in non-contact anterior cruciate ligament injury risk prediction algorithm. Clin Biomech (Bristol, Avon). 2010;25(7):693–9.CrossRef Myer GD, Ford KR, Khoury J, Succop P, Hewett TE. Clinical correlates to laboratory measures for use in non-contact anterior cruciate ligament injury risk prediction algorithm. Clin Biomech (Bristol, Avon). 2010;25(7):693–9.CrossRef
9.
go back to reference Myer GD, Ford KR, Di Stasi SL, Barber Foss KD, Micheli LJ, Hewett TE. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury? Br J Sports Med. 2015;49(2):118–22.CrossRefPubMed Myer GD, Ford KR, Di Stasi SL, Barber Foss KD, Micheli LJ, Hewett TE. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury? Br J Sports Med. 2015;49(2):118–22.CrossRefPubMed
10.
go back to reference Myer GD, Ford KR, Khoury J, Succop P, Hewett TE. Development and validation of a clinic-based prediction tool to identify female athletes at high risk for anterior cruciate ligament injury. Am J Sports Med. 2010;38(10):2025–33.CrossRefPubMedPubMedCentral Myer GD, Ford KR, Khoury J, Succop P, Hewett TE. Development and validation of a clinic-based prediction tool to identify female athletes at high risk for anterior cruciate ligament injury. Am J Sports Med. 2010;38(10):2025–33.CrossRefPubMedPubMedCentral
11.
go back to reference Murphy M, Hides J, Russell T. A Digital Photographic Technique for Knee Range of Motion Measurement: Performance in a Total Knee Arthroplasty Clinical Population. Open J Orthop. 2013;3:4–9.CrossRef Murphy M, Hides J, Russell T. A Digital Photographic Technique for Knee Range of Motion Measurement: Performance in a Total Knee Arthroplasty Clinical Population. Open J Orthop. 2013;3:4–9.CrossRef
12.
go back to reference Munro A, Herrington L, Carolan M. Reliability of 2-dimensional video assessment of frontal-plane dynamic knee valgus during common athletic screening tasks. J Sport Rehabil. 2012;21(1):7–11.PubMed Munro A, Herrington L, Carolan M. Reliability of 2-dimensional video assessment of frontal-plane dynamic knee valgus during common athletic screening tasks. J Sport Rehabil. 2012;21(1):7–11.PubMed
13.
go back to reference Mizner RL, Chmielewski TL, Toepke JJ, Tofte KB. Comparison of 2-dimensional measurement techniques for predicting knee angle and moment during a drop vertical jump. Clin J Sport Med. 2012;22(3):221–7.CrossRefPubMedPubMedCentral Mizner RL, Chmielewski TL, Toepke JJ, Tofte KB. Comparison of 2-dimensional measurement techniques for predicting knee angle and moment during a drop vertical jump. Clin J Sport Med. 2012;22(3):221–7.CrossRefPubMedPubMedCentral
14.
go back to reference Bennell KL, Talbot RC, Wajswelner H, Techovanich W, Kelly DH, Hall AJ. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother. 1998;44(3):175–80.CrossRefPubMed Bennell KL, Talbot RC, Wajswelner H, Techovanich W, Kelly DH, Hall AJ. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother. 1998;44(3):175–80.CrossRefPubMed
15.
go back to reference McPoil TG, Cornwall MW, Medoff L, Vicenzino B, Fosberg KK, Hilz D. Arch height change during sit-to-stand: an alternative for the navicular drop test. J Foot Ankle Res. 2009;2:17.CrossRefPubMedPubMedCentral McPoil TG, Cornwall MW, Medoff L, Vicenzino B, Fosberg KK, Hilz D. Arch height change during sit-to-stand: an alternative for the navicular drop test. J Foot Ankle Res. 2009;2:17.CrossRefPubMedPubMedCentral
16.
go back to reference McPoil TG, Vicenzino B, Cornwall MW, Collins N, Warren M. Reliability and normative values for the foot mobility magnitude: a composite measure of vertical and medial-lateral mobility of the midfoot. J Foot Ankle Res. 2009;2:6.CrossRefPubMedPubMedCentral McPoil TG, Vicenzino B, Cornwall MW, Collins N, Warren M. Reliability and normative values for the foot mobility magnitude: a composite measure of vertical and medial-lateral mobility of the midfoot. J Foot Ankle Res. 2009;2:6.CrossRefPubMedPubMedCentral
17.
go back to reference Hewett TE, Myer GD, Ford KR, Heidt Jr RS, Colosimo AJ, McLean SG, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492–501.CrossRefPubMed Hewett TE, Myer GD, Ford KR, Heidt Jr RS, Colosimo AJ, McLean SG, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492–501.CrossRefPubMed
18.
go back to reference Myer GD, Ford KR, Barber Foss KD, Goodman A, Ceasar A, Rauh MJ, et al. The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech (Bristol, Avon). 2010;25(7):700–7.CrossRef Myer GD, Ford KR, Barber Foss KD, Goodman A, Ceasar A, Rauh MJ, et al. The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech (Bristol, Avon). 2010;25(7):700–7.CrossRef
19.
go back to reference Sinclair J, Isherwood J, Taylor PJ. The effects of orthotic intervention on multisegment foot kinematics and plantar fascia strain in recreational runners. J Appl Biomech. 2015;31(1):28–34.CrossRefPubMed Sinclair J, Isherwood J, Taylor PJ. The effects of orthotic intervention on multisegment foot kinematics and plantar fascia strain in recreational runners. J Appl Biomech. 2015;31(1):28–34.CrossRefPubMed
20.
go back to reference Mills K, Blanch P, Dev P, Martin M, Vicenzino B. A randomised control trial of short term efficacy of in-shoe foot orthoses compared with a wait and see policy for anterior knee pain and the role of foot mobility. Br J Sports Med. 2012;46(4):247–52.CrossRefPubMed Mills K, Blanch P, Dev P, Martin M, Vicenzino B. A randomised control trial of short term efficacy of in-shoe foot orthoses compared with a wait and see policy for anterior knee pain and the role of foot mobility. Br J Sports Med. 2012;46(4):247–52.CrossRefPubMed
21.
go back to reference Vicenzino B, Collins N, Cleland J, McPoil T. A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. Br J Sports Med. 2010;44(12):862–6.CrossRefPubMed Vicenzino B, Collins N, Cleland J, McPoil T. A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. Br J Sports Med. 2010;44(12):862–6.CrossRefPubMed
22.
go back to reference Lack S, Barton C, Malliaras P, Twycross-Lewis R, Woledge R, Morrissey D. The effect of anti-pronation foot orthoses on hip and knee kinematics and muscle activity during a functional step-up task in healthy individuals: A laboratory study. Clin Biomech (Bristol, Avon). 2014;29(2):177–82.CrossRefPubMed Lack S, Barton C, Malliaras P, Twycross-Lewis R, Woledge R, Morrissey D. The effect of anti-pronation foot orthoses on hip and knee kinematics and muscle activity during a functional step-up task in healthy individuals: A laboratory study. Clin Biomech (Bristol, Avon). 2014;29(2):177–82.CrossRefPubMed
23.
go back to reference Jung DY, Koh EK, Kwon OY, Yi CH, Oh JS, Weon JH. Effect of medial arch support on displacement of the myotendinous junction of the gastrocnemius during standing wall stretching. J Orthop Sports Phys Ther. 2009;39(12):867–74.CrossRefPubMed Jung DY, Koh EK, Kwon OY, Yi CH, Oh JS, Weon JH. Effect of medial arch support on displacement of the myotendinous junction of the gastrocnemius during standing wall stretching. J Orthop Sports Phys Ther. 2009;39(12):867–74.CrossRefPubMed
24.
go back to reference Chizewski MG, Chiu LZ. Contribution of calcaneal and leg segment rotations to ankle joint dorsiflexion in a weight-bearing task. Gait Posture. 2012;36(1):85–9.CrossRefPubMed Chizewski MG, Chiu LZ. Contribution of calcaneal and leg segment rotations to ankle joint dorsiflexion in a weight-bearing task. Gait Posture. 2012;36(1):85–9.CrossRefPubMed
25.
go back to reference Nester CJ, Jarvis HL, Jones RK, Bowden PD, Liu A. Movement of the human foot in 100 pain free individuals aged 18–45: implications for understanding normal foot function. J Foot Ankle Res. 2014;7(1):51.PubMedPubMedCentral Nester CJ, Jarvis HL, Jones RK, Bowden PD, Liu A. Movement of the human foot in 100 pain free individuals aged 18–45: implications for understanding normal foot function. J Foot Ankle Res. 2014;7(1):51.PubMedPubMedCentral
26.
go back to reference Joseph MF, Holsing KL, Tiberio D. Lower extremity kinematics of a single-leg squat with an orthotic in male and female collegiate athletes. J Appl Biomech. 2014;30(3):361–5.CrossRefPubMed Joseph MF, Holsing KL, Tiberio D. Lower extremity kinematics of a single-leg squat with an orthotic in male and female collegiate athletes. J Appl Biomech. 2014;30(3):361–5.CrossRefPubMed
27.
go back to reference Mulligan EP, Cook PG. Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic function. Man Ther. 2013;18(5):425–30.CrossRefPubMed Mulligan EP, Cook PG. Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic function. Man Ther. 2013;18(5):425–30.CrossRefPubMed
28.
go back to reference Moon DC, Kim K, Lee SK. Immediate Effect of Short-foot Exercise on Dynamic Balance of Subjects with Excessively Pronated Feet. J Phys Ther Sci. 2014;26(1):117–9.CrossRefPubMedPubMedCentral Moon DC, Kim K, Lee SK. Immediate Effect of Short-foot Exercise on Dynamic Balance of Subjects with Excessively Pronated Feet. J Phys Ther Sci. 2014;26(1):117–9.CrossRefPubMedPubMedCentral
29.
go back to reference Nester CJ, Hutchins S, Bowker P. Effect of foot orthoses on rearfoot complex kinematics during walking gait. Foot Ankle Int. 2001;22(2):133–9.PubMed Nester CJ, Hutchins S, Bowker P. Effect of foot orthoses on rearfoot complex kinematics during walking gait. Foot Ankle Int. 2001;22(2):133–9.PubMed
30.
go back to reference Scattone Silva R, Maciel CD, Serrao FV. The effects of forefoot varus on hip and knee kinematics during single-leg squat. Man Ther. 2015;20(1):79–83.CrossRefPubMed Scattone Silva R, Maciel CD, Serrao FV. The effects of forefoot varus on hip and knee kinematics during single-leg squat. Man Ther. 2015;20(1):79–83.CrossRefPubMed
31.
go back to reference Cashman GE. The effect of weak hip abductors or external rotators on knee valgus kinematics in healthy subjects: a systematic review. J Sport Rehabil. 2012;21(3):273–84.PubMed Cashman GE. The effect of weak hip abductors or external rotators on knee valgus kinematics in healthy subjects: a systematic review. J Sport Rehabil. 2012;21(3):273–84.PubMed
32.
go back to reference Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain. 2011;152 Suppl 3:S90–8.CrossRefPubMed Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain. 2011;152 Suppl 3:S90–8.CrossRefPubMed
33.
go back to reference Fok LA, Schache AG, Crossley KM, Lin YC, Pandy MG. Patellofemoral joint loading during stair ambulation in people with patellofemoral osteoarthritis. Arthritis Rheum. 2013;65(8):2059–69.CrossRefPubMed Fok LA, Schache AG, Crossley KM, Lin YC, Pandy MG. Patellofemoral joint loading during stair ambulation in people with patellofemoral osteoarthritis. Arthritis Rheum. 2013;65(8):2059–69.CrossRefPubMed
Metadata
Title
The relationship of foot and ankle mobility to the frontal plane projection angle in asymptomatic adults
Authors
Narelle Wyndow
Amy De Jong
Krystal Rial
Kylie Tucker
Natalie Collins
Bill Vicenzino
Trevor Russell
Kay Crossley
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Journal of Foot and Ankle Research / Issue 1/2016
Electronic ISSN: 1757-1146
DOI
https://doi.org/10.1186/s13047-016-0134-9

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