Ankle range of motion norms

Middle column: right-side means from 987 healthy adults measured with the AAOS technique (Hallaçeli 2014), rounded to whole degrees. The textbook column is the sagittal pair on our ROM chart; it carries no inversion or eversion figure, so use the measured column for those.

Two things stand out. Passive readings run a few degrees above active ones at every motion — so a note that says “DF 19°” without saying which is unreadable at re-test. And inversion is the big frontal-plane motion: in that sample it was well over one and a half times eversion, which matters when you judge an “equal” loss in both directions.

The CDC’s normal-ROM study had physical therapists measure passive motion in 674 healthy people aged 2 to 69. Its dorsiflexion means sit well below the textbook in every adult group; its plantarflexion means sit at or above it.

Degrees, mean (95% confidence interval of the mean). Passive goniometry.

Dorsiflexion falls steadily with age — women go from 24.8° in early childhood to 11.6° at 45–69. Plantarflexion carries the sex gap: women out-range men in every band, by about 7° in the oldest group. A second large sample of young adults found sex differences under 3° at every lower-limb motion, so the gap is real in one dataset and trivial in another.

Twelve degrees of dorsiflexion is a deficit against the textbook and dead average against the CDC. Which table you quote decides whether the patient has a problem.

Symmetry is steadier ground. The young-adult sample found no clinically meaningful right–left difference at the ankle, and an older Swedish study of 192 ankles in men aged 30–40 found none either and said so plainly: use the healthy limb as the comparison. The same logic runs through the hip norms.

Dorsiflexion is two measurements wearing one name. The gastrocnemius crosses the knee; the soleus does not. With the knee straight, a short gastrocnemius stops the ankle early. Bend the knee and the gastrocnemius goes slack, so what is left limiting the range is the soleus, the posterior capsule and the joint itself.

Technique moves the number as much as anatomy does. In 40 uninjured high-school athletes measured supine by one experienced examiner, mean dorsiflexion was about 0° knee-straight and about 5° knee-bent — far below every table on this page. A podiatry study that set a normal non-weight-bearing range of 0–16.5° found a weight-bearing range of 7.1–34.7° in the same people, and the two correlated poorly.

Because lying-down dorsiflexion predicts standing dorsiflexion so poorly, it is worth pairing with a loaded test. In the lunge test the patient faces a wall and drives the knee forward to touch it with the heel kept down, sliding the foot back until the heel just stays on the floor. Score it as the distance from big toe to wall, or as the angle of the shin with an inclinometer — pick one and keep it.

Pooled from 12 reliability studies (Powden 2015). Smallest real change = minimal detectable change.

Read that bottom pair as the noise floor: a patient who moves from 8 cm to 9 cm has not changed. Two centimetres, measured by the same person, is where a gain starts to be believable.

For a reference, a 899-adult normative study published in 2026 found no meaningful difference between limbs, a steady fall with age that steepens from the 60–69 group, and only a slight edge for men. That makes side-to-side asymmetry the useful number; its age- and sex-specific percentile tables are in the paper, and we have not copied a cut-off from anywhere else.

In the 987-adult sample, inversion and eversion were measured sitting, with the axis at the base of the calcaneus: 34° and 20° passive. A small 1986 study using a different method put the whole inversion-plus-eversion arc at 28° — roughly half of that. Frontal-plane numbers swing with method far more than the sagittal pair, so one is only comparable with another taken the same way.

Reliability follows the same pattern. One study had three observers measure active inversion and eversion sitting and prone on two days: the same observer within a session was highly reliable, different observers much less so, and between sessions eversion held up worse than inversion. Position mattered little for one observer; between observers, sitting did better.

First-toe extension is the motion most often left off an ankle exam and the one late stance cannot do without. Filming 20 healthy adults walking put the extension actually used at about 65°. All four static techniques tested were reliable and all read higher than that walking figure — but they did not agree with each other, so they are not interchangeable.

A stiff first toe below what walking uses is worth watching for in the gait: an early heel lift or a roll off the outer border of the foot. If you are retraining that pattern, the gait training (97116) guide covers what makes it billable.

1. 1

   Position: supine or long sitting for the sagittal pair, sitting for inversion and eversion. Note the knee angle for dorsiflexion.

2. 2

   Axis on the lateral malleolus. Stationary arm along the fibula toward the fibular head; moving arm parallel to the fifth metatarsal.

3. 3

   Zero the reading at neutral — foot at a right angle to the shin — before you move anything.

4. 4

   Take the end of range, passive or active, and write which. Then the end-feel.

5. 5

   Measure the other ankle the same way, in the same visit.

The general goniometer habits — same position, marked landmarks, same clinician — are in the goniometer measurement guide. If you are billing a stand-alone measurement rather than folding it into an evaluation, read the CPT 95851 guide first.

Enter both ankles. The checker leads with the side-to-side difference, then sets the involved ankle against the CDC mean for the patient’s age and sex, and writes the objective line for you.

Pair every ankle range with a task the patient names — stairs, squatting to a low shelf, running downhill — and a functional score such as the LEFS, because degrees that change nothing the patient does are not yet a result. The objective line drops straight into the SOAP note generator, and the re-measure date belongs in the plan of care, not in your memory.

For the home programme, knee-straight and knee-bent calf stretches are two different exercises; prescribe the one your measurement pointed at in the home exercise program builder.

Empirical values by age and sex: Soucie JM et al. Range of motion measurements: reference values and a database for comparison studies. Haemophilia. 2011;17(3):500-507 — the CDC-funded normal joint ROM study, which measured healthy subjects by age and sex.