A functional calibration protocol for ankle plantar-dorsiflexion estimate using magnetic and inertial measurement units: Repeatability and reliability assessment

The ankle joint complex presents a tangled functional anatomy, which understanding is fundamental to effectively estimate its kinematics on the sagittal plane. Protocols based on the use of magnetic and inertial measurement units (MIMUs) currently do not take in due account this factor. To this aim, a joint coordinate system for the ankle joint complex is proposed, along with a protocol to perform its anatomical calibration using MIMUs, consisting in a combination of anatomical functional calibrations of the tibiotalar axis and static acquisitions. Protocol repeatability and reliability were tested according to the metrics proposed in Schwartz et al. (2004) involving three different operators performing the protocol three times on ten participants, undergoing instrumented gait analysis through both stereophotogrammetry and MIMUs. Instrumental reliability was evaluated comparing the MIMU-derived kinematic traces with the stereophotogrammetric ones, obtained with the same protocol, through the linear fit method. A total of 270 gait cycles were considered. Results showed that the protocol was repeatable and reliable for what concerned the operators (0.4 +/- 0.4 deg and 0.8 +/- 0.5 deg, respectively). Instrumental reliability analysis showed a mean RMSD of 3.0 +/- 1.3 deg, a mean offset of 9.4 +/- 8.4 deg and a mean linear relationship strength of R2 = 0.88 +/- 0.08. With due caution, the protocol can be considered both repeatable and reliable. Further studies should pay attention to the other ankle degrees of freedom as well as on the angular convention to compute them.