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The heel-rise work test overestimates the performed work with 21–25% after an Achilles tendon rupture

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate concurrent validity of the heel-rise work test performed with use of the heel as a surrogate for the center of body mass.

Methods

The study was a validity study performed on a prospective cohort of consecutive patients. Forty-five patients were included in the study. The heel-rise work test estimates the total work performed by repeated heel-rises until fatigue. In this study, the heel-rise work was assessed by the linear encoder and a motion capture system simultaneously for validation. The linear encoder was attached to the patient’s heel and reflective marker was attached to the pelvis and heel. Student’s paired t-test, linear regression analysis and Bland Altman plots were used to estimate the measurement error of the linear encoder.

Results

The heel-rise work test overestimated the total work with 21.0% on the injured leg and 24.7% on the non-injured leg. Student’s paired t-test showed no difference in measurement error between the limbs (n.s.). The linear regression analysis showed no difference in limb symmetry index between the two methods of heel-rise work estimation (a (slope) = 1.00, R = 0.94, p < 0.0001).

Conclusion

The heel-rise work test performed using the heel as a surrogate for center of body mass overestimates the total work with 21.0–24.7% compared to a gold standard but was able to precisely detect the relative difference between the limbs. The heel marker can be considered a valid measurement device for assessing relative differences between the limbs.

Clinical relevance

Clinical testing of injuries to the lower body using the heel-rise work test is valid when using the relative difference between the limbs.

Level of evidence

I.

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Acknowledgements

The authors thank the Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre for free access to the human analysis laboratory and full support through all phases of the project.

Funding

This study was funded by the Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

    Kristine Rask Andreasen, Per Hölmich & Kristoffer Weisskirchner Barfod

  2. Department of Physical and Occupational Therapy, Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark

    Maria Swennergren Hansen

  3. Department of Orthopaedic Surgery, Sports Orthopaedic Research Center-Copenhagen (SORC-C), Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark

    Kristine Rask Andreasen, Maria Swennergren Hansen, Per Hölmich & Kristoffer Weisskirchner Barfod

  4. Department of Orthopaedic Surgery, Laboratory of Human Movement Analysis, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

    Jesper Bencke

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  1. Kristine Rask Andreasen
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  2. Maria Swennergren Hansen
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  3. Jesper Bencke
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Correspondence to Kristine Rask Andreasen.

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The authors declare no relevant conflicts of interest.

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Ethical approval was obtained from the National Committee on Health Research Ethics (journal number 1–10–72-428-17).

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Andreasen, K.R., Hansen, M.S., Bencke, J. et al. The heel-rise work test overestimates the performed work with 21–25% after an Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 29, 1604–1611 (2021). https://doi.org/10.1007/s00167-020-06369-8

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  • DOI: https://doi.org/10.1007/s00167-020-06369-8

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