Ankle Girth Measurement

Ankle Girth Measurement is used to measure ankle girth following injury so that there can be clinical quantification of the volume of edema.

Girth measurements provide a quantifiable and reproducible measure of a limb’s volume.

See Also: The Ottawa Ankle Rules

Ankle Girth Measurement Methods

There are two methods described for assessing Ankle Girth:

Figure of eight tape method:

In figure of 8 ankle measurement, the patient lies in the supine position or seated, with the ankle in 20° of plantarflexion. The clinician places a tape measure midway between the tibialis anterior tendon and lateral malleolus. The tape is then drawn medially and is placed just distal to the navicular tuberosity.

The tape is then pulled across the arch and just proximal to the fifth metatarsal. The tape is then pulled across the tibialis anterior tendon and around the ankle to a point just distal to the medial malleolus, before being finally pulled across the Achilles tendon and placed just distal to the lateral malleolus and across the start of the tape.

1. Pull the tape snugly and read the circumference in centimeters or inches.
2. Take three measurements and record the average.
3. Repeat these steps for the uninjured limb.

The test is positive if a significant difference in the girth (volume) between the two ankles (The minimal clinically important difference is approximately 1 cm.).

Tatro-Adams et al. reported the ankle figure of eight method to be a reliable tool for measuring ankle girth.

Do not use a measuring tape made of cloth. (They tend to stretch and fade.)

Volumetric Measurement:

The tank is filled with water up to the specified level and the limb is gently immersed. The overflow water is collected and poured into a calibrated beaker to determine the mass (volume) of the limb. This measurement is obtained by either reading a graduate cylinder or, more accurately, by weighing the water expelled.

Volumetric measurement of limb volume is most commonly used as a research tool, but can provide important clinical information.

Ankle Girth Measurement Reliability

Petersen et al. performed a study to determine the interrater and intrarater reliability of water volumetry and the figure of eight method on subjects with ankle joint swelling and found high interrater reliability for both the water volumetry (ICC ¼ 0.99) and the figure-of-eight methods (ICC ¼ 0.98).

In addition, intrarater reliability was high for both (ICCs ¼ 0.98 –0.99). The authors concluded that both methods are reliable measures of ankle swelling, although they recommended the figure of eight method because of its ease of use, time efficiency, and cost effectiveness. However, water volumetry may be more appropriate when measuring diffuse lower extremity swelling.

References

1. Tatro-Adams D, McGann SF, Carbone W. Reliability of the figure-of-eight method of ankle measurement. J Orthop Sports Phys Ther. 1995 Oct;22(4):161-3. doi: 10.2519/jospt.1995.22.4.161. PMID: 8535474.
2. Rohner-Spengler, M, Mannion, AF, and Babst, R: Reliability and minimal detectable change for the figure-of-eight-20 method of measurement of ankle edema. J Orthop Sports Phys Ther, 37:199, 2007