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      Reliability of doming and toe flexion testing to quantify foot muscle strength

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          Abstract

          Background

          Quantifying the strength of the intrinsic foot muscles has been a challenge for clinicians and researchers. The reliable measurement of this strength is important in order to assess weakness, which may contribute to a variety of functional issues in the foot and lower leg, including plantar fasciitis and hallux valgus. This study reports 3 novel methods for measuring foot strength – doming (previously unmeasured), hallux flexion, and flexion of the lesser toes.

          Methods

          Twenty-one healthy volunteers performed the strength tests during two testing sessions which occurred one to five days apart. Each participant performed each series of strength tests (doming, hallux flexion, and lesser toe flexion) four times during the first testing session (twice with each of two raters) and two times during the second testing session (once with each rater). Intra-class correlation coefficients were calculated to test for reliability for the following comparisons: between raters during the same testing session on the same day (inter-rater, intra-day, intra-session), between raters on different days (inter-rater, inter-day, inter-session), between days for the same rater (intra-rater, inter-day, inter-session), and between sessions on the same day by the same rater (intra-rater, intra-day, inter-session).

          Results

          ICCs showed good to excellent reliability for all tests between days, raters, and sessions. Average doming strength was 99.96 ± 47.04 N. Average hallux flexion strength was 65.66 ± 24.5 N. Average lateral toe flexion was 50.96 ± 22.54 N.

          Conclusions

          These simple tests using relatively low cost equipment can be used for research or clinical purposes. If repeated testing will be conducted on the same participant, it is suggested that the same researcher or clinician perform the testing each time for optimal reliability.

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          Most cited references26

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          Atrophy of foot muscles: a measure of diabetic neuropathy.

          Diabetic neuropathy is a length-dependent process that leads to reduced muscle strength and atrophy of leg muscles in some patients. We hypothesized that intrinsic foot muscles are atrophied in diabetic neuropathy and that the degree of atrophy is a measure of motor dysfunction closely related to the neuropathic process. Consecutive cross-sectional magnetic resonance images of the nondominant foot were obtained for stereological determination of the total volume of the intrinsic foot muscles (VFM) in 23 long-term diabetic patients with (n = 15) and without (n = 8) chronic neuropathy and in 23 matched healthy nondiabetic control subjects. Based on clinical examination, nerve conduction studies, and quantitative sensory examination, a neuropathy rank-sum score was calculated for each patient. Total VFM was 86 +/- 52, 165 +/- 34, and 168 +/- 42 cm3 in neuropathic patients, nonneuropathic patients, and healthy control subjects, respectively (P < 0.001). There was a close inverse relationship between the neuropathy rank-sum score and the VFM (r = -0.75, P < 1 x 10(-5)). Total volume of the foot muscles is halved in patients with diabetic neuropathy. Atrophy of foot muscles is closely related to the severity of neuropathy and reflects motor dysfunction. Copyright 2004 American Diabetes Association
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            Foot and ankle strength assessment using hand-held dynamometry: reliability and age-related differences.

            Age-related reduction in lower limb muscle strength has been shown to be related to disability, falls and loss of independence. While there have been a number of studies on age-related changes in muscle strength, they have concentrated on more proximal muscle groups with little research into how ageing affects the muscles of the foot and ankle. To evaluate the intra- and interrater reliability of hand-held dynamometry for the assessment of foot and ankle strength, and to compare the values obtained between young and older people. The muscle groups which perform ankle dorsiflexion, plantar flexion, inversion, eversion and plantar flexion of the hallux and lesser digits were recorded for 36 young participants (17 males, 19 females, mean age 23.2 ± 4.3 years) and 36 older people (17 males, 19 females, mean age 77.1 ± 5.7 years) using a Citec hand-held dynamometer. Differences in muscle strength between the groups as well as intrarater and interrater reliability of two assessors were determined. The reliability of the hand-held dynamometry procedure was excellent for both intrarater (ICC(3,1) = 0.78-0.94) and interrater (ICC(3,1) = 0.77-0.88) comparisons. There were significant differences between the muscle strength of the young and older participants for all muscle groups tested (p < 0.001) with older participants being weaker than the young participants by a magnitude of between 24 and 37%. Hand-held dynamometry is a reliable instrument to measure the foot and ankle strength of young and older adults. Ageing is associated with a reduction in strength of between 24 and 37% for the muscles responsible for movement of the foot and ankle. Copyright © 2009 S. Karger AG, Basel.
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              The effect of minimal shoes on arch structure and intrinsic foot muscle strength

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                Author and article information

                Contributors
                sarah_ridge@byu.edu
                bill_myrer@byu.edu
                marktolsen@gmail.com
                kevinjurgensmeier@gmail.com
                wayne_johnson@byu.edu
                Journal
                J Foot Ankle Res
                J Foot Ankle Res
                Journal of Foot and Ankle Research
                BioMed Central (London )
                1757-1146
                8 December 2017
                8 December 2017
                2017
                : 10
                : 55
                Affiliations
                ISNI 0000 0004 1936 9115, GRID grid.253294.b, Department of Exercise Sciences, , Brigham Young University, ; Provo, UT 84602 USA
                Author information
                http://orcid.org/0000-0002-1975-0181
                Article
                237
                10.1186/s13047-017-0237-y
                5723035
                29234467
                3435251d-cee3-48c6-a371-9c7d64aa7fca
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 March 2017
                : 27 November 2017
                Categories
                Methodology
                Custom metadata
                © The Author(s) 2017

                Orthopedics
                intrinsic foot muscles,strength testing,doming/short foot exercise,toe flexion
                Orthopedics
                intrinsic foot muscles, strength testing, doming/short foot exercise, toe flexion

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