Related Experiment Video
Updated: Jan 7, 2026
Author Spotlight: Exploring the Complexities of Achilles Tendon Injuries — Research and Future Directions
Published on: October 27, 2023
Comparing Quantification Methodologies for the Single-Leg Heel-Rise in Patients Following Operative and Non-Operative
Rebecca Franklin1,2, Josh Garofalo3,4, Sophie Zhu4
1Faculty of Kinesiology and Recreation Management University of Manitoba.
Background:
The Single-Leg Heel-Rise test (SLHR) is commonly used to determine the functional status of patients following Achilles tendon rupture (ATR). Several methods exist to quantify performance variables during the SLHR including repetition counting, linear position transducers (LPT) and motion capture/analysis systems; however, they have not been directly compared following operative or non-operative management of ATR. Hypothesis/Purpose: The purpose of this study was to compare three methods to quantify repetition number, heel-rise height, and total work during the SLHR test in patients managed either operatively or non-operatively for ATR.
Study Design:
Cross-sectional study.
Methods:
Twenty-four patients who underwent either operative or nonoperative treatment for complete ATR completed SLHR to failure on a 10° angle board. LPT, two-dimensional motion capture, and the Calf Raise smartphone application recorded heel-rise repetitions and height. Intraclass correlation coefficients and Bland-Altman plots (95% limits of agreement) compared devices. Work was reported as absolute values and limb symmetry index. Two-way analyses of variance were completed for all variables.
Results:
In this sample of 17 males and 7 females (operative [n=12; 39.0±8.9 years; 9 male] and non-operative [n=12; 46.2±14.1 years; 8 male] groups) strong, positive correlations were demonstrated between all devices, with the highest occurring between motion capture and the app (r2 =0.997). Bland-Altman Limits of Agreement showed wide limits of agreement across all methods. Peak and accumulated heel-rise height was reduced on the affected limb when measured by all devices, translating to reduced affected limb total work (mean difference: motion capture -403.5 Joules [J] (95%CI -41.5-902.6), app -434.7 J (95%CI -924.3-54.8), and LPT -370.4 J (95%CI -802.6-61.9).
Conclusion:
LPT, motion capture, and the calf raise app can be used to quantify repetitions, work, and heel-rise height in patients following ATR. However, device values should not be used interchangeably due to wide limits of agreement across methodologies.
Level Of Evidence:
Level 2c.
