Open Access Research article

Reproducibility of and sex differences in common orthopaedic ankle and foot tests in runners

Maarten P van der Worp123*, Anton de Wijer14, J Bart Staal23 and Maria WG Nijhuis- van der Sanden5

  • * Corresponding author: Maarten P van der Worp

  • † Equal contributors

Author Affiliations

1 Department of Physical Therapy, Academic Institute, University of Applied Sciences Utrecht, Utrecht, the Netherlands

2 Institute Health Studies, HAN, University of Applied Sciences Nijmegen, Nijmegen, the Netherlands

3 Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, the Netherlands

4 Department of Oral Function & Prosthetic Dentistry, Radboud university medical center, Nijmegen, the Netherlands

5 Department of Rehabilitation, Radboud university medical center, Nijmegen, the Netherlands

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BMC Musculoskeletal Disorders 2014, 15:171  doi:10.1186/1471-2474-15-171

Published: 23 May 2014



For future etiologic cohort studies in runners it is important to identify whether (hyper)pronation of the foot, decreased ankle joint dorsiflexion (AJD) and the degree of the extension of the first Metatarsophalangeal joint (MTP1) are risk factors for running injuries and to determine possible sex differences.

These parameters are frequently determined with the navicular drop test (NDT) Stance and Single Limb-Stance, the Ankle Joint Dorsiflexion-test, and the extension MTP1-test in a healthy population. The aim of this clinimetric study was to determine the reproducibility of these three orthopaedic tests in runners, using minimal equipment in order to make them applicable in large cohort studies. Furthermore, we aimed to determine possible sex differences of these tests.


The three orthopaedic tests were administered by two sports physiotherapists in a group of 42 (22 male and 20 female) recreational runners. The intra-class correlation (ICC) for interrater and intrarater reliability and the standard error of measurement (SEM) were calculated. Bland and Altman plots were used to determine the 95% limits of agreements (LOAs). Furthermore, the difference between female and male runners was determined.


The ICC’s of the NDT were in the range of 0.37 to 0.45, with a SEM in the range of 2.5 to 5 mm. The AJD-test had an ICC of 0.88 and 0.86 (SEM 2.4° and 8.7°), with a 95% LOA of -6.0° to 6.3° and -5.3° to 7.9°, and the MTP1-test had an ICC of 0.42 and 0.62 (SEM 34.4° and 9.9°), with a 95% LOA of -30.9° to 20.7° and -20° to 17.8° for the interrater and intrarater reproducibility, respectively.

Females had a significantly (p < 0.05) lower navicular drop score and higher range of motion in extension of the MTP1, but no sex differences were found for ankle dorsiflexion (p ≥ 0.05).


The reproducibility for the AJD test in runners is good, whereas that of the NDT and extension MTP1 was moderate or low. We found a difference in NDT and MTP1 mobility between female and male runners, however this needs to be established in a larger study with more reliable test procedures.

Injury prediction; Evaluation; Reliability; Agreement; Running