Physiotherapy and Rehabilitation in Melorheostosis: A Case Report

The SF-12 is a self-reported questionnaire used to assess health-related quality of life. It evaluates both physical and mental health components, yielding two summary measures: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Scores range from 0 to 100, where higher scores indicate a better level of health and a higher quality of life.

The PKE test is used to assess hamstring muscle flexibility. The participant is positioned supine, with the non-tested limb stabilized and the tested hip fixed at 90 degrees of flexion. As the knee is extended, the angle between the tibia and the vertical vector is measured using an inclinometer placed 15 cm distal to the tibial tuberosity. The measurement is recorded in degrees (°). A smaller angle relative to the vertical line indicates greater knee extension and better hamstring flexibility.

Ankle AROM (dorsiflexion, plantarflexion, inversion, and eversion) is evaluated using a goniometer in standard anatomical positions. For dorsiflexion and plantarflexion, the participant is seated with knees slightly flexed; the axis of the goniometer is placed over the lateral malleolus, the stationary arm parallel to the fibular line, and the moving arm parallel to the lateral aspect of the 5th metatarsal. For inversion and eversion, the participant sits with legs hanging off the edge of the table; the axis is placed at the midpoint between the two malleoli, the stationary arm on the anterior surface of the tibia, and the moving arm parallel to the longitudinal axis of the 2nd metatarsal. All measurements are recorded in degrees (°), with higher values indicating a greater active range of motion.

The Ely's test is used to assess the flexibility of the rectus femoris muscle. With the participant in a prone position and the pelvis stabilized, the examiner passively flexes the knee to its maximal limit just before compensatory pelvic flexion occurs. The maximum knee flexion angle is measured using a goniometer and recorded in degrees (°). A higher degree of knee flexion indicates greater quadriceps flexibility.

Flexibility of the calf muscles is assessed by measuring ankle dorsiflexion range of motion using a goniometer in standing positions. For the gastrocnemius, the participant stands facing a wall, keeps the tested knee fully extended, and shifts weight forward. For the soleus, the participant assumes a weight-bearing lunge position with the tested knee flexed, keeping both heels firmly on the floor. Measurements are recorded in degrees (°), with higher values representing greater muscle flexibility.

The WBLT evaluates closed kinetic chain ankle dorsiflexion under a loaded, functional condition. The participant performs a maximal forward lunge toward a wall, maintaining heel contact with the floor. The angle between the tibia and the vertical axis is measured using a digital inclinometer placed 15 cm distal to the tibial tuberosity. The measurement is recorded in degrees (°). Higher angle values indicate greater dorsiflexion mobility.

Quadriceps strength is evaluated using a digital handheld myometer (dynamometer). The participant is seated with legs hanging from the edge of the table, with both hip and knee positioned at 90 degrees of flexion. The myometer is placed on the anterior surface of the tibia, approximately 5 cm proximal to the lateral malleolus. The participant performs a maximal isometric knee extension for 5 seconds. The peak force is recorded. Higher values indicate greater quadriceps muscle strength.

Hamstring strength is evaluated using a digital handheld myometer (dynamometer). The participant is in a prone position, and the tested knee is passively brought to an angle of 30° to 45° of flexion. The myometer is placed on the posterior surface of the tibia, just proximal to the heel (calcaneus). The peak force is recorded. Higher values indicate greater hamstring muscle strength.

Hip external rotator strength is evaluated using a digital handheld myometer. The participant is assessed in a side-lying position with the knees flexed at 90 degrees. The myometer is placed on the medial aspect of the leg, just proximal to the medial malleolus of the tested limb. The peak force is recorded. Higher values indicate greater hip external rotator muscle strength.

The Y-Balance Test evaluates dynamic balance. The participant stands on one leg and reaches as far as possible with the contralateral leg in three directions: anterior, posteromedial, and posterolateral. To standardize the measurements, the reach distances are normalized to the participant's lower limb length, measured from the anterior superior iliac spine (ASIS) to the medial malleolus. Higher normalized composite scores indicate better dynamic balance and stability.

The Feiss Line Test evaluates the height of the medial longitudinal arch and static foot posture. While the participant is seated (non-weight bearing) and then standing, the medial malleolus, navicular tubercle, and the center of the first metatarsophalangeal (MTP) joint are marked. An imaginary line (Feiss Line) is drawn between the medial malleolus and the first MTP joint. The position of the navicular tubercle relative to this line is examined to grade the arch height.

The Navicular Drop Test assesses excessive foot pronation and the dynamic stability of the medial longitudinal arch under load. With the participant seated (non-weight bearing) and the subtalar joint in a neutral position, the height of the navicular tubercle from the floor is measured in millimeters. The participant then stands with weight distributed evenly on both feet (weight-bearing position), and the measurement is repeated. The difference between the two measurements is recorded as the navicular drop (in mm). A higher drop value indicates greater dynamic foot pronation and reduced arch stability.