Ankle Plantarflexor Strength and Endurance in 7–9 Year Old Children as Measured by the Standing Single Leg Heel-Rise Test

Abstract

Background and Purpose. The standing single-leg (SSL) heel-rise test is a measure of plantarflexor strength and endurance. However, reference values have yet to be determined for children. The purposes of this study were to: (1) determine the average number, minimum number (cut-off score) of SSL heel-rises for healthy, 7–9 year old children, (2) examine the influence of age, gender, height, weight, and physical activity characteristics upon the number of heel-rises completed, (3) examine interrater reliability, and (4) examine reliability between the number of repetitions counted by observation, and by video-analysis. Method. A total of ninety-five children, aged 7–9, performed SSL heel-rises until fatigue. The number of heel-rises were counted by two examiners and was determined from videotape. Results. The children completed an average of 36 ± 18 SSL heel-rises (COV = 50%). Age, gender, height, weight, or activity level had no significant effect upon heel-rise performance. Excellent interrater reliability (ICC = 0.99), reliability between the motion analysis system and the examiners (ICC = 0.93), was established. Discussion, Conclusion. Therapist visual observation can determine heel-rise count as accurately as when using a motion analysis system. Children who have functional limitations, who perform 13 or fewer heel-rises should repeat the SSL heel-rise test at a later date and/or perform other tests to confirm the plantarflexion muscle strength-endurance impairment prior to initiating an intervention program.

Key Words:

• Plantarflexion
• strength testing
• muscle endurance
• children
• heel-rise test

Additional information

Notes on contributors

Amanda Finley

Michael Lepp, PT, is in private practice, Associate Instructor of the Upledger Institute, and Clinical Instructor, Case Western Reserve University School of Dentistry, Cleveland, OH.

Marie McKenzie, MS, OTR, is in private practice. She was Coordinator of Occupational Therapy at Scottish Rite Hospital at the time of this study.

Heather Miller, MS, OTR/L, is currently employed by Madison County Educational Service Center, providing therapy services to the county's pre-schools. This research was completed in partial fulfillment of the requirements of an MS degree at Ohio State University.

Linda Viscardis, BA, is Team Leader and Community Development Worker, Peterborough Family Enrichment Centre. She is Co-Founder of P.R.O.S.P.E.C.T.S., a support and advocacy group for families who have children with special needs.

Debra Stewart, BSc, OT(C), is Occupational Therapist, Erinoak, Serving Young People with Physical Disabilities, Mississauga, ON, and Clinical Lecturer, School of Rehabilitation Science, McMaster University.

Janette McDougall, MA, was Project Coordinator

Kip Husted, BEd, was a parent representative on the study team.

Aviva Yochman, MA, OTR, was a student in the School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Israel at the time of this study.

Imelda Burgman, MA OTR/L BCP, completed her MA in Movement Sciences at Teachers College, Columbia University, and was an Occupational Therapist at The Shield Institute, Bronx, NY. She is currently Lecturer, Habilitation, School of Community Health, Faculty of Health Studies, Charles Sturt University, Albury, N.S.W., Australia.

Barbara J. Steva, OTWL, BCP, is Occupational Therapist, University of New England Community Occupational Therapy Clinic, Saco, ME. She was Director of Occupational Therapy and Therapeutic Recreation, Franciscan Children's Hospital and Rehabilitation Center, Boston, MA, when this work was completed.

Mary-Ann L. Fulks, MSc, OT(C), is Occupational Therapist, Vancouver Community Mental Health Service and Clinical Assistant Professor, School of Rehabilitation Sciences, University of British Columbia. This study was completed in partial fulfillment of a Master of Science degree.

Laura Zawacki, MS, PT, PCS, currently practices Pediatric Physical Therapy in the Chicago metropolitan area.

Judy T. Jennings holds a Certificate in PT and an MA in Special Education and has 25 years of experience as a PT working with children from infancy to high school.

Barbara G. Sarbaugh, BS and MA in OT, has worked with children for 20 years and is on the faculty, occupational therapy program at Xavier University, Cincinnati, OH.

Nicholas S. Payne, PhD, recently retired from 40 years of experience in statistics and data analysis at Proctor & Gamble, Cincinnati, OH. He was recently Research Fellow in Data Analysis, clarifying the needs of mothers and babies.

At the time of this study, Marianne Kratochvil, MA, was a social worker at the Glenrose Rehabilitation Hospital, Edmonton, Alberta. She has since retired.