Pertinent Considerations With Using The Ankle Joint Lunge Test To Assess Ankle Joint ROM

Ankle dorsiflexion range of motion is vitally important to the normal function of the foot and ankle in gait. I previously discussed the importance of ankle joint dorsiflexion range of motion (ROM) to the proper function of the peroneals and to medial column stiffness of the foot.¹ I also have discussed the use of ankle joint manipulation for increasing the dorsiflexion ROM of the ankle.²

The best way to know if the ankle joint has a limitation of motion is to measure it. Tested measures are the best way to assess your patients. However, not all of the measures podiatrists use on foot and ankle evaluation have had testing and peer review. The most reliable test for this is the ankle joint lunge test, sometimes called the “knee to wall” test.

One can measure the results of the ankle joint lunge test in several different ways. Measure the results either by distance from the longest toe to the wall, with a goniometer at the lateral ankle joint or with use of an inclinometer on the anterior aspect of the lower leg. See the diagram at the left.

Researchers have tested these measures against each other.³ Konor and colleagues found that use of a tape measure from the wall to the longest toe and the use of an inclinometer at the anterior aspect of the shin gave the most reliable and consistent measures. This study also found that in comparing the two measures, namely distance from the wall in centimeters or degrees of angle for inclinometer, the conversion rate is 1 cm to a range of 3.6 to 4.1 degrees. Regardless of which measure you choose, just make sure you use the same technique all the time so you gain proficiency with the test and consistency.

Please keep in mind that when performing the ankle joint lunge test, you want to ensure the patient does not externally rotate the foot at the forefoot or internally position the heel to the forefoot so as not to cheat the test via the subtalar joint and midfoot pronation. Make sure as well that the heel stays in full contact with the floor when the knee moves toward the wall. As soon as the heel lifts or begins to show signs of lifting at the fat pad of the heel, before the knee contacts the wall, have the patient move in and try again.

Eventually, you will have confidence with this measure and will then know, by comparing your before and after measures, whether any stretching programs, manipulation or therapy have benefited the patient.

If the patient has not progressed enough, then you need to consider another option to work around the limitation of dorsiflexion ROM at the ankle. I will discuss that in an upcoming DPM Blog post.

References

1. Williams B. Peroneal function and fibular translation: assessing their impact on the first ray and ankle range of motion. Podiatry Today DPM Blog. Published May 2, 2018. Available at https://www.podiatrytoday.com/blogged/peroneal-function-and-fibular-translation-assessing-their-impact-first-ray-and-ankle-range .

2. Williams B. How ankle joint manipulation affects the peroneal tendons and ankle range of motion. Podiatry Today DPM Blog. Published June 1, 2018. Available at https://www.podiatrytoday.com/blogged/how-ankle-joint-manipulation-affects-peroneal-tendons-and-ankle-range-motion .

3. Konor MM, Morton S, Eckerson JM, Grindstaff TL. Reliability of three measures of ankle dorsiflexion range of motion. Int J Sports Phys Ther. 2012; 7(3):279–87.