The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis

Phys Ther Sport. 2018 Jan;29:61-69. doi: 10.1016/j.ptsp.2017.07.003. Epub 2017 Jul 19.


Objective: The objective of this systematic review was to evaluate the association between ankle dorsiflexion (ADF) and dynamic knee valgus (DKV).

Methods: Electronic searches were conducted in MEDLINE, EMBASE, CINAHL and SPORTDiscus. A modified Downs and Black checklist was used for quality assessment and meta-analysis was performed to compare standardised mean differences (SMD) of ADF.

Results: Seventeen studies met the inclusion criteria. Meta-analysis showed that reduced ADF is associated with participants presenting with DKV compared to controls (SMD -0.65, 95% CI -0.88 to -0.41). Subgroup analysis showed consistent results regarding different forms of ADF measurement; restriction in ADF measured in weight-bearing position (SMD -1.25, 95% CI -2.24 to -0.25), non-weight-bearing with knee flexed (SMD -0.56, 95% CI -0.97 to -0.16) or non-weight-bearing with knee extended (SMD -0.54, 95% CI -0.80 to -0.28) was significantly associated with DKV.

Conclusion: The meta-analysis results provide evidence that reduced ADF is correlated with DKV. The assessment of ADF in the clinical setting is important, as it may be related to harmful movement patterns of the lower limbs.

Keywords: Ankle dorsiflexion; Knee valgus; Range of motion.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Ankle Joint / physiology*
  • Humans
  • Knee Joint / physiology*
  • Range of Motion, Articular*
  • Weight-Bearing