SLR - September 2021 - Joseph A. Cote

Weight Bearing Versus Non-Weight Bearing Ankle Dorsiflexion Measurement in People with Diabetes: A Cross Sectional Study

Reference: Searle, A., Spink, M. J., Chuter, V. H. Weight Bearing Versus Non-Weight Bearing Ankle Dorsiflexion Measurement in People with Diabetes: A Cross Sectional Study. BMC Musculoskeletal Disord. 2018; 19: 183.

Level of Evidence: III

Scientific Literature Review

Reviewed By: Joseph A. Cote, DPM
Residency Program: University of Florida Health – Jacksonville, FL

Podiatric Relevance: Limited joint mobility predisposes an individual to a slew of functional problems. In the foot and ankle specifically equinus is known to precipitate musculoskeletal disorders such as heel pain and Achilles tendonitis. For a diabetic patient, equinus is known to increase plantar foot pressures and subsequent ulcer formation. With this in mind, a consistent clinical test of equinus, whether it is functional or structural is pertinent to the Podiatric Surgeon and will guide treatment efforts to follow. The study in review evaluated non-weight bearing versus weight bearing measures of equinus in patients with and without diabetes as comorbidities.

Methods: One hundred thirty-six adults with Diabetes and 30 adults without diabetes as comorbidities were recruited for the study. Measurements were performed by two testers in the same testing session on two separate testing days. Equinus was tested for non-weight bearing via Modified Lidcombe test, and weight bearing via Lunge test. Inclusion criteria confirmed diagnosis of Type 1 or Type 2 diabetes for the diabetic group. Exclusion criteria was any history of lower limb amputation, open wound, infection, history of fusion, or recent injury causing pain to be elicited from ankle ROM. Primary outcome measure was ankle dorsiflexion recorded in non-weight bearing and weight bearing test and level of association between the two methods.

Results: Participants with diabetes showed less ankle dorsiflexion ROM in both weight bearing and non-weight bearing tests than non-diabetic participants. Weight bearing DF ROM was approximately 4 times greater than NWB DF ROM in the non-diabetic group. However, In the diabetic group WB DF ROM was approximately 10 times larger than NWB DF ROM. Excellent intra-tester and inter-tester reliability was found for both the Modified Lidcombe and Lunge test.

Conclusions: The modified Lidcombe template is a reliable tool for measuring non-weight bearing ankle dorsiflexion. However, a Lunge test is also a reliable measure of weight bearing ankle dorsiflexion and is arguably a more functional measure of ankle dorsiflexion. The disparity of ankle dorsiflexion measures from non-weight bearing to weight bearing tests in the diabetic patient provokes further investigation.

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