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Journal Article (Refereed)
May 2013

Reliability of ultrasound to measure morphology of the toe flexor muscles

Mickle, K J & Nester, C & Crofts, G & Steele, J R 2013, 'Reliability of ultrasound to measure morphology of the toe flexor muscles', Journal of Foot and Ankle Research.



Background: Measuring the strength of individual foot muscles is very challenging; however, measuring muscle
morphology has been shown to be associated with strength. A reliable method of assessing foot muscle atrophy and
hypertrophy would therefore be beneficial to researchers and clinicians. Thus, the aim of this study was to evaluate the
test-retest intra-observer reliability of ultrasound to measure the morphology of the primary toe flexor muscles.
Method: The abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, quadratus plantae and abductor digiti
minimi muscles in the foot, and the flexor digitorum longus and flexor hallucis longus muscles in the shank were
assessed in five males and five females (mean age = 32.1 ± 10.1 years). Muscles were imaged using a GE Venue 40
ultrasound (6-9 or 7.6-10.7 MHz transducer) in a random order, and on two occasions 1-6 days apart. Muscle thickness
and cross-sectional area were measured using Image J software with the assessor blinded to muscle and day of scan.
Intraclass correlation coefficients (ICC) and limits of agreement were calculated to assess day-to-day repeatability
of the measurements.
Results: The method was found to have good reliability (ICC = 0.89-0.99) with limits of agreement between 8-28%
of the relative muscle size.
Conclusion: The protocol described in this paper showed that ultrasound is a reliable method to measure
morphology of the toe flexor muscles. The portability and advantages of ultrasound make it a useful tool for
clinical and research settings.
Keywords: Anatomy, Foot structure, Muscle atrophy, Ultrasonography


SEEK Members

External Authors

Julie R Steele

Karen J Mickle

Publication Details

Journal Name
Journal of Foot and Ankle Research