Are static foot posture and ankle dorsiflexion range of motion associated with Achilles tendinopathy? A cross-sectional study

Rodrigo Scattone Silva; Hayley Powell Smitheman; Andy K Smith; Karin Grävare Silbernagel

doi:10.1016/j.bjpt.2022.100466

Are static foot posture and ankle dorsiflexion range of motion associated with Achilles tendinopathy? A cross-sectional study

Braz J Phys Ther. 2022 Nov-Dec;26(6):100466. doi: 10.1016/j.bjpt.2022.100466. Epub 2022 Nov 30.

Authors

Rodrigo Scattone Silva¹, Hayley Powell Smitheman², Andy K Smith², Karin Grävare Silbernagel³

Affiliations

¹ Delaware Tendon and Ligament Research Team, Department of Physical Therapy, University of Delaware, Newark, DE, United States; Postgraduate Program in Rehabilitation Sciences and Postgraduate Program in Physical Therapy, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil.
² Delaware Tendon and Ligament Research Team, Department of Physical Therapy, University of Delaware, Newark, DE, United States.
³ Delaware Tendon and Ligament Research Team, Department of Physical Therapy, University of Delaware, Newark, DE, United States. Electronic address: kgs@udel.edu.

Abstract

Background: Subtalar hyperpronation and ankle dorsiflexion restriction have been theoretically associated with Achilles tendinopathy (AT). However, evidence to support these associations is lacking.

Objectives: To compare foot alignment and ankle dorsiflexion range of motion (ROM) between the symptomatic and non-symptomatic limbs of individuals with unilateral AT. And to verify whether differences exist between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain, structure, and symptom severity.

Methods: Sixty-three participants with unilateral AT underwent a bilateral evaluation of pain during tendon palpation, symptom severity, tendon thickening, tendon neovascularization, ankle dorsiflexion ROM, and foot posture alignment [foot posture index (FPI), navicular drop, navicular drift, and longitudinal arch angle (LAA)]. Side and group comparisons were made using t-tests and correlations were evaluated using the Pearson test.

Results: There were no differences between the symptomatic and non-symptomatic limbs regarding foot posture alignment. Specifically, non-significant negligible differences were observed between limbs regarding FPI [mean difference (MD)=-0.23; 95% confidence interval (CI)=-0.70, 0.25), navicular drop (MD=0.58 mm; 95%CI=-0.25, 1.43), navicular drift (MD=0.16 mm; 95%CI=-0.77, 1.09), and LAA (MD=0.30º; 95%CI=-1.74, 2.34). There was no difference between limbs regarding ankle dorsiflexion ROM. However, lower ankle dorsiflexion was associated with worse symptom severity (r = 0.223). Finally, no difference was observed between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain or structure.

Conclusions: Static foot alignment measures do not seem to be clinically relevant in patients with AT. Smaller ankle dorsiflexion ROM, however, was associated with greater symptom severity in this population.

Keywords: Calcaneal; Pronation; Supination; Tendinitis; Tendinosis; Tendon.

MeSH terms

Achilles Tendon*
Ankle
Ankle Joint
Cross-Sectional Studies
Humans
Posture
Range of Motion, Articular
Tendinopathy*