The tape measure method is also hypothesized to be more sensitive to change compared to measures of motion in degrees. 1 This method is inexpensive, can be performed in a variety of settings, and does not require the technical proficiency associated with a goniometer or inclinometer. This position places the ankle in maximal dorsiflexion, and the distance from the great toe to the wall is measured in centimeters, with each centimeter corresponding to approximately 3.6° of ankle dorsiflexion. The foot is moved away from the wall until the knee can only make slight contact with the wall while the foot remains flat on the ground. The patient places the test foot on a tape measure perpendicular to the wall and lunges forward so the knee touches the wall. 1, 13 This method utilizes the knee-to-wall principle, in which the subject performs a weight-bearing lunge. Although the inclinometer is easy to use, the cost is usually higher than a standard goniometer.Īn additional way to quantify ankle dorsiflexion ROM is with a tape measure. There is no consensus regarding the preference of using a goniometer or inclinometer for the measurement of ankle dorsiflexion ROM. 12 To the authors' knowledge, only one study 11 has compared novice and expert raters using a digital inclinometer versus a goniometer in a weight-bearing position the study demonstrated similar reliability between techniques (ICC=0.89 goniometer, 0.88 digital inclinometer). The use of the inclinometer may improve reliability measures (ICC=0.84 to 0.95) for novice raters, when compared to goniometer (ICC=0.65 to 0.77) measures, in a non-weight-bearing position. The digital display may potentially reduce recording errors, since the display provides a single numeric value versus requiring the rater to determine the location of the dial or bubble relative to the nearest tick-mark. 5 The inclinometer may utilize a dial, bubble, or digital display to provide the angle of the slope relative to the ground. ![]() 11, 12 Alternatively, an inclinometer may be used to measure ankle dorsiflexion ROM and only requires the rater to identify the tibial tuberosity for consistent inclinometer placement in a weight-bearing position 1, 6, 8 or to identify the base of the fifth metatarsal in a non-weight-bearing position. 3 The technical proficiency required to obtain measures of ROM with a goniometer may contribute to lower reported reliability values (ICC=0.65–0.89) when compared to other measurement methods (ICC=0.84–0.95). The goniometer is inexpensive and commonly used in clinical environments, but also requires the greatest degree of technical proficiency, due to the necessity of aligning the axis with the joint fulcrum and positioning the two arms with established reference points. 2 Most measurement techniques for ankle dorsiflexion ROM include the use of a standard goniometer, 3, 4 an inclinometer, 5– 8 or a tape measure, 1, 9, 10 and have varying levels of technical difficulty for the individual obtaining the measures. Weight-bearing measures are thought to more accurately reflect the available ROM during functional activities 1 such as walking, running, or stair ambulation, and may be more reliable (ICC=0.93–0.96) than measures obtained in a non-weight-bearing position (ICC 0.32–0.72). There are a number of methods and tools available to measure ankle dorsiflexion range of motion (ROM) in both non-weight-bearing and weight-bearing positions.
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