# Passive Ankle Dorsiflexion and Single-Leg Balance Are Independently Associated with Locomotive Syndrome Severity in Community-Dwelling Older Adults: A Cross-Sectional Study

## TL;DR

Reduced ankle flexibility and poor balance are linked to worse mobility issues in older adults, suggesting these factors could help identify those at risk.

## Contribution

This study identifies passive ankle dorsiflexion and single-leg balance as independent predictors of locomotive syndrome severity in older adults.

## Key findings

- Greater passive ankle dorsiflexion is independently associated with lower locomotive syndrome severity.
- Higher BMI is associated with greater locomotive syndrome severity, though this link weakens when mobility and balance are considered.
- Hallux valgus angle and navicular height do not independently predict locomotive syndrome severity.

## Abstract

What are the main findings?
Reduced passive ankle dorsiflexion and poorer single-leg balance were independently associated with greater locomotive syndrome severity in community-dwelling older adults.Static foot morphology measures (hallux valgus angle and navicular height) were not independently related to locomotive syndrome severity.

Reduced passive ankle dorsiflexion and poorer single-leg balance were independently associated with greater locomotive syndrome severity in community-dwelling older adults.

Static foot morphology measures (hallux valgus angle and navicular height) were not independently related to locomotive syndrome severity.

What are the implications of the main findings?
Simple assessments of ankle dorsiflexion and single-leg balance may aid screening and early risk stratification for locomotive syndrome in community settings.Interventions targeting ankle dorsiflexion and balance warrant prospective evaluation to prevent progression of mobility decline.

Simple assessments of ankle dorsiflexion and single-leg balance may aid screening and early risk stratification for locomotive syndrome in community settings.

Interventions targeting ankle dorsiflexion and balance warrant prospective evaluation to prevent progression of mobility decline.

Background/Objectives: Foot impairments are common in older adults, but the independent associations of specific foot indices with locomotive syndrome (LS) severity remain unclear. We examined hallux valgus angle (HV), navicular height (NH), and passive ankle dorsiflexion (ADF). Methods: This cross-sectional study included 119 community-dwelling older adults classified into LS stages 0–3. Bilateral measures were summarized as maximum HV and minimum NH/ADF, reflecting the worst-affected side. Proportional-odds ordinal logistic regression modeled LS stage (0–3) with foot indices and covariates (age, sex, body mass index [BMI]). Extended models additionally adjusted for Timed Up and Go (TUG), gait speed, or single-leg stance (SLS). Sensitivity analysis used binary logistic regression (LS ≥ 2 vs. <2). Results: Greater ADF was independently associated with lower LS severity (OR per 1°, 0.91; 95% CI, 0.85–0.98; p < 0.01), whereas higher BMI was associated with greater LS severity (OR per 1 kg/m2, 1.15; 95% CI, 1.01–1.30; p < 0.05). HV and NH were not significant. After adjustment for TUG, gait speed, or SLS, ADF remained inversely associated with LS severity (ORs, 0.92–0.93; p < 0.05), while the BMI association was attenuated. In binary logistic regression, greater ADF was associated with lower odds of LS ≥ 2 (OR per 1°, 0.85; 95% CI, 0.76–0.94; p < 0.005). Conclusions: Reduced passive ankle dorsiflexion is independently associated with greater LS severity, robust after accounting for key mobility and balance measures. Interventions targeting ankle mobility may represent a potentially modifiable factor and warrants confirmation in longitudinal and interventional studies.