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Background: The medial longitudinal arch of the foot is a variable structure, and a decrease in its height could affect several functions and increase the risk of injuries in the lower limbs. There are many different techniques for evaluating it. Objective: The objective of this study was to evaluate the correlations of the Navicular Drop Test, several footprint parameters, and the Foot Posture Index-6 in people with a low medial longitudinal arch. Intrarater reliability and interrater reliability were also estimated. Design: This was a repeated-measures, observational descriptive study. Methods: Seventy-one participants (53.5% women; mean age = 24.13 years; SD = 3.41) were included. All of the parameters were collected from the dominant foot. The correlation coefficients were calculated. The reliability was also calculated using the intraclass correlation coefficient, 95% CI, and kappa coefficient. Results: Statistically significant correlations were obtained between the Navicular Drop Test and the footprint parameters, with r absolute values ranging from 0.722 to 0.788. The Navicular Drop Test and the Foot Posture Index-6 showed an excellent correlation (Spearman correlation coefficient = 0.8), and good correlations (Spearman correlation coefficient = |0.663-0.703|) were obtained between the footprint parameters and the Foot Posture Index-6. Excellent intrarater reliability and interrater reliability were obtained for all of the parameters. Limitations: Radiographic parameters, the gold standard for evaluating the medial longitudinal arch height, were not used. In addition, the results of this research cannot be generalized to people with normal and high medial longitudinal arches. Conclusions: In participants with a low medial longitudinal arch, the Navicular Drop Test showed significant correlations with footprint parameters; correlations were good for the arch angle and Chippaux-Smirnak Index, and excellent for the Staheli Index. The Foot Posture Index-6 showed an excellent correlation with the Navicular Drop Test and a good correlation with the footprint parameters evaluated. All of the parameters showed high reliability.
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Original Research
J.C. Zuil-Escobar, PT, PhD, Depart-
ment of Physiotherapy, Faculty of
Medicine, CEU-San Pablo University,
Avenida Montepríncipe s/n Boadilla del
Monte, 28668 Madrid, Spain. Address
all correspondence to Mr Zuil-Escobar
at: jczuil@ceu.es.
C.B. Martínez-Cepa, PT, PhD, De-
partment of Physiotherapy, Faculty of
Medicine, CEU-San Pablo University.
J.A. Martín-Urrialde, PT, PhD, Depart-
ment of Physiotherapy, Faculty of
Medicine, CEU-San Pablo University.
A. Gómez-Conesa, PT, PhD, Depart-
ment of Physiotherapy, Faculty of
Medicine, Espinardo Campus, Univer-
sity of Murcia, Murcia, Spain.
[Zuil-Escobar JC, Martínez-Cepa CB,
Martín-Urrialde JA, Gómez-Conesa A.
Evaluating the medial longitudinal arch
of the foot: correlations, reliability, and
accuracy in people with a low arch.
Phys Ther. 2019;99:364–372.]
C
2018 American Physical Therapy As-
sociation
Published Ahead of Print:
December 7, 2018
Accepted: July 16, 2018
Submitted: November 13, 2017
Evaluating the Medial Longitudinal
Arch of the Foot: Correlations,
Reliability, and Accuracy in People
With a Low Arch
Juan C. Zuil-Escobar, Carmen B. Martínez-Cepa, Jose A. Martín-Urrialde,
Antonia Gómez-Conesa
Background. The medial longitudinal arch of the foot is a variable structure, and a
decrease in its height could affect several functions and increase the risk of injuries in the
lower limbs. There are many different techniques for evaluating it.
Objective. The objective of this study was to evaluate the correlations of the Navicular
Drop Test, several footprint parameters, and the Foot Posture Index-6 in people with a low
medial longitudinal arch. Intrarater reliability and interrater reliability were also estimated.
Design. This was a repeated-measures, observational descriptive study.
Methods. Seventy-one participants (53.5% women; mean age =24.13 years; SD =3.41)
were included. All of the parameters were collected from the dominant foot. The corre-
lation coefcients were calculated. The reliability was also calculated using the intraclass
correlation coefcient, 95% CI, and kappa coefcient.
Results. Statistically signicant correlations were obtained between the Navicular Drop
Test and the footprint parameters, with rabsolute values ranging from 0.722 to 0.788.
The Navicular Drop Test and the Foot Posture Index-6 showed an excellent correlation
(Spearman correlation coefcient =0.8), and good correlations (Spearman correlation
coefcient =|0.663–0.703|) were obtained between the footprint parameters and the Foot
Posture Index-6. Excellent intrarater reliability and interrater reliability were obtained for
all of the parameters.
Limitations. Radiographic parameters, the gold standard for evaluating the medial lon-
gitudinal arch height, were not used. In addition, the results of this research cannot be
generalized to people with normal and high medial longitudinal arches.
Conclusions. In participants with a low medial longitudinal arch, the Navicular Drop
Test showed signicant correlations with footprint parameters; correlations were good for
the arch angle and Chippaux-Smirnak Index, and excellent for the Staheli Index. The Foot
Posture Index-6 showed an excellent correlation with the Navicular Drop Test and a good
correlation with the footprint parameters evaluated.All of the parameters showed high
reliability.
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Evaluating the Medial Arch in People With Low Arch
The medial longitudinal arch (MLA) is a
variable structure1and its height could affect several
functions during static standing and walking.2,3A
decrease in the MLA height is related to modications in
the lower limb alignment, including subtalar pronation,4
tibial internal torsion,5tibial internal rotation,6greater
genu recurvatum,5anterior knee laxity,7pelvic
anteversion,8and lumbar lordosis.9The height of the MLA
may affect muscular activity. A Navicular Drop Test (NDT)
score of 13 mm is associated with decreased concentric
plantar exion strength compared to normal MLA.10 In
addition, the height of the MLA is considered a relevant
factor for several lower limb pathologies, including medial
tibial stress syndrome,11,12 patellofemoral syndrome,13,14
and noncontact anterior cruciate ligament injuries15 and
foot pain.1
Owing to the consequences of a low MLA, it is necessary
to evaluate the height of the MLA in clinical practice to
obtain information for treatment decisions. The evaluation
of the MLA height comprises several methods.16 Many
parameters can be calculated from the footprints,
including the arch angle (AA), the Staheli Index (SI),17 and
the Chippaux-Smirnak Index (CSI).18 Ink footprint is a
noninvasive method that can be used in clinical practice
and investigation16,19 ,20 but has some limitations, such as
the inaccuracy of measurements and difculties in
interpretation.19 Digital systems overcome these
limitations and are widely used in both clinical practice
and investigation,20 but they are expensive. Clinical
techniques include the navicular measurements.16,20
The NDT was described by Brody21 and shows the
difference (in mm) of the height of the navicular
tuberosity in 2 positions: subtalar neutral position and
relaxedposture.TheNDTisaninexpensive,easy,and
quick method; high NDT values are associated with a low
MLA and pronated foot.21 Posture-related indices are other
methods for evaluating the MLA height.20 The Foot
Posture Index (FPI) is a valid and reliable method used to
quantify foot posture22 and the height of the MLA.20
Although the original FPI evaluated 8 items (FPI-8),23 a
6-item version (FPI-6) was redened and assessed across
the 3 planes of the foot.22,24 Each criterion of the FPI-6 is
scored on a 5-point scale (ranging from 2to+2), and
the scores are summed to provide a total score (ranging
from 12 to +12) for the determination of foot posture.22
The FPI-6 is commonly used in both research and clinical
practice.16,20 ,24,25 Therefore, there are several methods for
studying the height of the MLA. However, clinicians need a
reliable, valid, and inexpensive measurement that is useful
for clinical practice.
To our knowledge, the correlations of the NDT, the
footprint parameters, and the FPI-6 in people with a low
MLA have not yet been studied. The 2 aims of this study
were to evaluate the correlations of the NDT, the footprint
parameters (including the AA, SI, and CSI), and the FPI-6
in people with a low MLA, and to estimate the intrarater
reliability and interrater reliability of these parameters.
Methods
Design
A repeated-measures, observational, descriptive study was
carried out.
Participants
The study included university student volunteers. The
participants were asked to complete a consent form and
were informed about the procedure and the aims of the
study. The principles outlined in the Declaration of
Helsinki of 1975 were observed and the project was
approved by the Research Ethics Committee of Centro de
Estudios Universitarios San Pablo University.
Volunteers were included if their MLA was low. A low MLA
was considered if the NDT presented a value of 10
mm.3,26,27 The dominant foot was evaluated in each
volunteer by using the kicking ball test to determine the
dominant limb.28 The following exclusion criteria were
established: had a body mass index (BMI) of 30, had
undergone lower extremity surgery, had lower extremity
injuries in the previous 6 months, and had lower limb
deformities. A clinical examination of each volunteer was
performed to determine the presence of leg length
discrepancy, hip anteversion/retroversion, genu
recurvatum/exum, genu varum/valgum, tibial torsion,
tibial varum, or hallux valgus. Volunteers were excluded
when 1 or more deformities were observed. Demographic
variables, including age, sex, height, weight, and BMI,
were collected.
The required sample size was calculated using the
correlations between the NDT and the AA, SI, CSI, and
FPI-6 for the rst 20 participants (age =25.32 years;
SD =4.96). The G-power program was used to calculate
the sample size, using an alpha level of 0.05 and 80%
statistical power. The minimum value in the internal pilot
study and the correlation obtained by Nakhaee et al26
between the NDT and the AI (0.44) were used. The sample
size required was 71 participants.
The intrarater reliability and interrater reliability of the
measurements were also evaluated in the rst 20
participants, with an interval of 48 hours, by 2 physical
therapists with more than 6 years of experience in the use
of these techniques. The testers and participants were
unaware of the reliability results.
Procedure
A modication of the Brody procedure21 was used to
collect the NDT: the participants stood barefoot, in
bilateral standing, on the oor, and the navicular
tuberosity was marked. The lateral and medial aspects of
the talar dome of the foot were palpated. The foot was
everted and inverted until the talus was in a central
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Evaluating the Medial Arch in People With Low Arch
position. This was determined to be the subtalar neutral
position. The distance between the navicular tuberosity
and the oor was measured. The height of the navicular
tuberosity was measured in the relaxed position; the NDT
being the difference between the 2 measurements. The
NDT requires previous training, proving less reliable with
inexperienced raters.29
The footprints were collected using a pressure platform
(Footchecker; Loran Engineering, Bologna, Italy). The
participants were asked to stand on the pressure platform,
in bilateral standing, while looking at a reference point
located 1.8 m above the oor with their arms relaxed at
their sides. When the participants were stable, the data
were recorded. From the footprints obtained, 3 parameters
were calculated using pressure platform software
(Footchecker 4.0): AA, SI, and CSI (eFigure, available at
https://academic.oup.com/ptj). The AA is the angle formed
between the line connecting the most medial points at the
heel and forefoot and the line from the most medial point
of the forefoot to the apex of the concavity of the MLA.30
The SI is obtained by dividing the minimal distance of the
midfoot by the widest section of the rear foot region,18
and the CSI is the ratio of the minimal distance of the
midfoot to the maximal distance of the forefoot.18
The 6 items of the FPI-6 (talar head palpation; supra- and
infralateral maleolar curvature; calcaneal frontal plane
position; prominence in the region of the talonavicular
joint; congruence of the MLA; and abduction/adduction of
the forefoot on the rear foot)24 were evaluated with the
participants in a relaxed bipedal position.
In the correlation study, the measurements were collected
by a physical therapist with more than 6 years of
experience in the use of the measurements.
Data Analysis
The data normality was veried using the
Kolmogorov-Smirnov test. Means and standard deviations
were used for the descriptive analysis of the continuous
variables, and frequencies and percentages were used for
discrete variables. The reliability of the NDT and the
footprint parameters was evaluated using the intraclass
correlation coefcient [ICC(2,1)] and the 95% CI. The
kappa coefcient (κ) was used to evaluate the reliability of
the FPI-6. The ICC was determined by using mixed-effect
and absolute agreement or consistency 2-factor alpha
models. In addition, the standard error of measurement
(SEM) and the minimum detectable change at a 95%
condence level (MDC95) were also calculated. The
following formulas were used to calculate the SEM and the
MCD95:SEM=SD (1–ICC)31 ;
MDC95 =SEM ×1.96 ×2.32 Pearson correlation
coefcients (r) were obtained for the NDT relative to each
of the footprint parameters. The correlations between the
FPI-6 and the other measurements were evaluated using
the Spearman correlation coefcient (rs). The ICC was
interpreted as follows: poor reliability (0.5), moderate
reliability (0.5–0.75), good reliability (0.75–0.9), and
excellent reliability (0.9).33 The interpretation of Landis
and Koch34 was used for the κvalues: poor agreement
(<0); slight agreement (0.00–0.20); fair agreement
(0.21–0.40); moderate agreement (0.41–0.60); substantial
agreement (0.61–0.80); and almost perfect agreement
(0.81–1). Correlations were interpreted as follows: poor
(0–0.39), fair (0.4–0.59), good (0.60–0.74), and excellent
(0.75).35 The statistical analysis was conducted using
SPSS 20.0 (IBM SPSS, Chicago, IL), and a Pvalue of <.05
was considered statistically signicant.
Results
Reliability
Twelve women (60%) and 8 men (40%) were included in
the reliability study. All of the MLA variables showed a
normal distribution. Table 1shows the ICC, 95% CI, SEM,
and MCD95 of the NDT and the footprint parameters. Both
intrarater reliability and interrater reliability were excellent
for all of the parameters studied (P<.001), being higher
than 0.9, except for the CSI in interrater time 2
(ICC =0.898). The SEM and the MDC95 were low, giving a
high level of accuracy. The FPI-6 showed almost perfect
agreement for both intrarater reliability (κ=0.872) and
interrater reliability (κ=0.829).
Correlations
Seventy-one participants (24.13 years old [SD =3.41]; 38
women [53.5%] and 33 men [46.5%]) were included in the
correlation study. The mean values were 11.83 mm
(SD =1.68) for the NDT, 25.32 degrees (SD =3.63) for
the AA, 47.43 (SD =8.98) for the SI, and 64.71
(SD =12.49) for the CSI. Figure 1shows the frequencies
of the FPI-6 categories.
Statistically signicant correlations (P<.001) were
obtained between the NDT and the footprint parameters.
Pearson rabsolute values ranged from 0.722 to 0.788. The
correlation between the NDT and the FPI-6 was excellent
(P<.001; rs=0.818), and that between the footprint
parameters and the FPI-6 was good (P<.001;
rs=|0.663–0.703|). The footprint parameters showed an
excellent correlation (P<.001) with each other
(r=|0.901–0.931|). Table 2shows the r, 95% CI, and
coefcients of determination (r2) among all of the outcome
measures. Figures 2through 4show the correlations
between the NDT and the footprint parameters evaluated.
Discussion
Reliability
The reliability and SEM are important elements for the
validity and interpretation of measurements. In our
research, the reliability (both intrarater and interrater) of
all of the measurements was high, making them
satisfactory for clinical use.
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Evaluating the Medial Arch in People With Low Arch
Tab le 1 .
Intraclass Correlation Coefficient (ICC), 95% CI, Standard Error of Measurement (SEM), and Minimum Detectable Change at
95% Confidence Level (MDC95) for the Navicular Drop Test (NDT) and Footprint Parametersa
Reliability Measure RaterorTime ICC 95% CI SEM MDC95
Intrarater NDT Rater 1 0.955b0.886–0.982 0.318 0.883
Rater 2 0.950b0.895–0.976 0.314 0.870
AA Rater 1 0.977b0.941–0.991 0.739 2.048
Rater 2 0.973b0.942–0.987 0.722 2
SI Rater 1 0.972b0.928–0.989 0.585 1.622
Rater 2 0.975b0.947–0.988 0.580 1.608
CSI Rater 1 0.959b0.897–0.984 1.002 2.778
Rater 2 0.946b0.888–0.975 1.043 2.890
Interrater NDT Time 1 0.914b0.795–0.965 0.440 1.220
Time 2 0.919b0.836–0.960 0.442 1.226
AA Time 1 0.954b0.888–0.982 1.045 2.896
Time 2 0.947b0.891–0.976 1.011 2.803
SI Time 1 0.945b0.866–0.978 0.820 2.273
Time 2 0.951b0.899–0.982 0.812 2.251
CSI Time 1 0.921b0.813–0.968 1.391 3.857
Time 2 0.898b0.798–0.950 1.433 3.972
aAA =arch angle; CSI =Chippaux-Smirnak Index; SI =Staheli Index.
bP<.001.
Figure 1.
Frequencies of Foot Posture Index-6 (FPI-6) categories.
The NDT demonstrated excellent intrarater reliability and
interrater reliability, with ICC values higher than 0.9. With
regard to intrarater reliability, rater 1 presented an ICC of
0.955 and rater 2 presented one of 0.950. Various
researchers have demonstrated good to excellent intrarater
reliability in people who were healthy (0.88–0.98),13,27,29
similar to our results. In people who were injured, the
intrarater reliability was good in those with patellofemoral
pain (0.76–0.81),13 excellent in people with anterior
cruciate ligament injury (0.9),36 and moderate to excellent
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Evaluating the Medial Arch in People With Low Arch
Tab le 2 .
Pearson Coefficient Correlation (r), 95% CI, and Coefficient of Determination (r2)a
Measure
AA SI CSI
FPI-6 r(95% CI)
r(95% CI) r2r(95% CI) r2r(95% CI) r2
NDT 0.732 (0.601 to 0.825)b0.536 0.788 (0.680 to 0.863)b0.622 0.722 (0.588 to 0.818)b0.521 0.818 (0.723 to 0.882)b
AA 0.901 (0.845 to 0.937)b0.812 0.930 (0890 to 0.956)b0.865 0.663 (0.509 to 0.776)b
SI 0.931 (0.891 to 0.957)b0.867 0.703 (0.562 to 0.804)b
CSI 0.669 (0.517 to 0.780)b
aAA =arch angle; CSI =Chippaux-Smirnak Index; FPI-6 =Foot Posture Index-6; NDT =Navicular Drop Test; SI =Staheli Index.
bP<.001.
Figure 2.
Correlation between the Navicular Drop Test and the arch angle.
in people with rheumatoid arthritis (0.73–0.98).37 The
interrater reliability obtained in our study was also
excellent, demonstrating lower ICC values than the
intrarater reliability (0.908 and 0.917). Other researchers
previously identied less interrater reliability—moderate
to excellent interrater reliability in people who were
healthy (0.56–0.93)29,37 and people with rheumatoid
arthritis (0.67–0.92)37—and good interrater reliability in
those with patellofemoral pain (0.76–0.81).13 In our
research, the SEM was less than 0.5 mm in all cases; our
values were lower than the SEM obtained in other
studies.29,36,38 An explanation for this result could be that
only participants with a low MLA were included in our
sample, being a homogeneous sample. In addition, the
reliability of the NDT is related to the level of experience
of the testers.29,39 This could be related to the difculty in
locating the navicular tuberosity40 and placing the subtalar
joint in a neutral position.39 In our research, the testers
were trained in the management of the NDT and they
consistently and accurately identied the navicular
tuberosity, and demonstrated consistency in identifying
the subtalar neutral position.
With regard to the reliability of the footprint parameters,
both intrarater reliability and interrater reliability showed
ICC values near to or higher than 0.9. Previous studies
obtained excellent reliability for the SI and the CSI
(0.914–0.998).30,41 However, the reliability of the AA
shown previously ranged from moderate to excellent
(0.605–0.993).30,41,42 These ndings could be related to the
variations in identifying footprint landmarks.41 With
regard to the SEM, our values were low. No previous
studies evaluating the SEM in the footprint parameters
were found.
The FPI-6 also showed almost perfect agreement for both
intrarater reliability and interrater reliability, presenting κ
values higher than 0.8. Previous studies showed excellent
intrarater reliability23,43 and moderate44 to excellent
interrater reliability23,24 ,43 in adults who were healthy, and
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Evaluating the Medial Arch in People With Low Arch
Figure 3.
Correlation between the Navicular Drop Test and the Staheli Index.
Figure 4.
Correlation between the Navicular Drop Test and the Chippaux-Smirnak Index.
excellent interrater reliability in people with
patellofemoral pain syndrome.13 Problems in the type of
the foot have been found previously45,46 and a previous
training in the management of the FPI-6 is recommended
to increase the reliability.24,45 ,47 According to our ndings,
the NDT, AA, SI, CSI, and FPI-6 were reproducible and
showed high reliability in participants with a low MLA.
Correlations
With regard to the principal aim of the study, the
correlations of the NDT, the footprint parameters, and the
FPI-6 in participants with a low MLA were signicant
(P<.001).
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Evaluating the Medial Arch in People With Low Arch
In terms of the correlations between the NDT and the
footprint parameters, the rvalues were higher than 0.7,
and the correlation was good for the AA (r=−0.732) and
the CSI (r=0.722) and excellent (r=0.788) for the SI. To
our knowledge, this is the rst research to evaluate this
relationship. However, the correlations between other
navicular measurements and the footprint parameters have
been studied before. Thus, the correlation between the
navicular height and the AA ranged from poor (r=0.39)42
to fair (r=0.457 to 0.571).30,48 The correlation between
the navicular height and the CSI was fair (r=−0.483 to
0.498),30,48 and the correlation between the navicular
height and the SI ranged from poor (r=0.302)48 to fair
(r=−0.469).30 The correlation increased when
normalized navicular height was used (ranging from 0.619
to 0.645).30 The normalized navicular height is obtained
by dividing the navicular height by the total length of the
foot.49 In the present research, we included only a low
MLA, whereas previous studies30 ,42,48 included a broad
spectrum of MLA heights. Moreover, we did not include
people with a BMI of 30 because the body composition
and BMI could inuence the interpretation of the
footprints.5052
The correlation between the NDT and the AI was also
studied. Billis et al53 obtained, in 26 people, a poor
correlation between the NDT and the AI, both in single-leg
stance AI (r=0.320) and bipedal stance AI (r=0.317).
Nakhaee et al26 found a fair correlation between the NDT
and the AI (r=0.44). The correlations obtained by us
were higher. This could be related to the fact that the AI is
inuenced by the soft tissues53 and the body
composition.51 In our study, there were no people with a
BMI of 30, and our sample included only individuals
with a low MLA. In addition, we used footprint parameters
related to the width of the foot, not dependent on the
contact area, such as the AI. Billis et al53 evaluated the
correlation between the NDT and the Valgus Index,
nding values similar to our own (r=0.631–0.657). This
could be explained by the fact that the Valgus Index, like
the footprint parameters studied in this work, does not
depend on the contact area of the foot.
The NDT and the FPI-6 showed an excellent correlation in
our study (rs=0.818). Our research included only
individuals with a low MLA (NDT values of 10 mm).
The observed category frequencies of the FPI-6 (Fig. 1)
also fell into ranges that indicated a low MLA.
Menz and Munteanu49 studied the correlations among
several parameters, including the FPI-8, the navicular
height, and the normalized navicular height in older
people, and included a broad spectrum of MLA height.
They obtained rvalues ranging from 0.722 to 0.735.
With regard to the correlations between the FPI-6 and the
footprint parameters, we obtained good correlations
(rs=|0.663–0.703|). We were unable to nd studies that
considered them. The few studies that have evaluated the
correlations between the FPI and the footprint parameters
used the FPI-8. Redmond et al22 compared the FPI-8 and
the Valgus Index, showing that the FPI-8 total scores
predicted 59% of the total variance of the Valgus Index.
Menz and Munteanu49 studied the correlation between the
FPI-8 and the AI in older people, nding a fair correlation
(r=0.424).
The evaluation of the MLA height should be included in
the clinical exploration of the foot posture. The decrease
of the height of the MLA is related to several lower limb
injuries,1,11,1315 back pain,54 ,55 and foot mobility.56 To our
knowledge, this is the rst research which has evaluated
the correlations of the NDT, the footprint parameters, and
the FPI-6 in people with a low MLA. In our study, the NDT
was well correlated with the footprint parameters and the
FPI-6 in the evaluation of the height of the MLA in people
with a low arch. Therefore, the clinicians can use different
measurements in the study of the MLA in such individuals.
However, the characteristics, advantages, and
disadvantages of these parameters need to be considered.
The NDT had fewer disadvantages than digital footprint
parameters and is an inexpensive method for evaluating
the MLA height. Pressure platforms are expensive and
many clinicians cannot use them in their clinical practice.
An alternative to this could be ink footprints, but they
present several disadvantages, including inaccurate
measurements and difculties in interpreting them.19 In
addition, footprint parameters could be affected by body
composition,50,51 while having no inuence on
measurements of navicular height.57 The FPI is commonly
used to quantify foot posture,22 being correlated to
radiographs,49 as it presents good interval construct
validity.58 The FPI evaluates the foot position using 6 or 8
items, whereas the NDT uses only 2 measurements. In
addition, the NDT is also correlated with radiographs.59
Therefore, clinicians should consider the NDT as the rst
option for examining foot posture in individuals with a
low MLA. The NDT is less time-consuming, has less
opportunity for error (compared with the other forms,
which require multiple measurements), and is highly
correlated with the other options.
Study Limitations
A limitation of the study is that we have not used
radiographic parameters, the gold standard for evaluating
the MLA height.16 A further study including radiographs
may be necessary to validate the NDT, the footprint
parameters, and the FPI-6. We have only evaluated the
dominant foot. However, asymmetries could be found
between the dominant foot and the nondominant foot60
and could affect the results of the research. Another
limitation is that the results of this research were from
individuals who were healthy, and they cannot be
generalized to individuals with normal and high MLAs.
370 Physical Therapy Volume 99 Number 3 2019
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Evaluating the Medial Arch in People With Low Arch
Especially important is the high MLA, which is a less
exible structure61,62 and which is related to several
injuries.1,1115 Further research should focus on a higher
MLA.
In addition, the examiner bias needs to be considered. The
NDT is a test related to the level of experience of the
testers29,39 and has shown less reliability in inexpert
raters.29 A previous experience is needed to locate the
navicular tuberosity40 and place the subtalar joint in a
neutral position.39
Conclusion
From our research ndings, in people with a low MLA, the
NDT showed signicant correlations with the footprint
parameters, being moderate for the AA and CSI and
excellent for the SI. In addition, an excellent correlation
was found between the NDT and the FPI-6. All of the
evaluated parameters showed high intrarater reliability
and interrater reliability. We recommend the use of the
NDT as the rst choice for examining foot posture in
individuals with a low MLA.
Author Contributions
Concept/idea/research design: J.C. Zuil-Escobar, C.B. Martínez-Cepa,
J.A. Martín-Urrialde, A. Gómez-Conesa
Writing: J.C. Zuil-Escobar, C.B. Martínez-Cepa, A. Gómez-Conesa
Data collection: J.C. Zuil-Escobar, C.B. Martínez-Cepa, J.A. Martín-Urrialde
Data analysis: J.C. Zuil-Escobar, J.A. Martín-Urrialde, A. Gómez-Conesa
Project management: J.C. Zuil-Escobar, C.B. Martínez-Cepa,
A. Gómez-Conesa
Fund procurement: J.C. Zuil-Escobar
Providing participants: J.C. Zuil-Escobar, J.A. Martín-Urrialde
Providing facilities/equipment: J.C. Zuil-Escobar, C.B. Martínez-Cepa,
J.A. Martín-Urrialde, A. Gómez-Conesa
Providing institutional liaisons: J.C. Zuil-Escobar, A. Gómez-Conesa
Clerical/secretarial support: J.C. Zuil-Escobar, C.B. Martínez-Cepa
Consultation (including review of manuscript before submitting):
J.C. Zuil-Escobar, C.B. Martínez-Cepa, J.A. Martín-Urrialde, A.
Gómez-Conesa
Ethics Approval
The project was approved by the Research Ethics Committee of Centro de
Estudios Universitarios San Pablo University.
Funding
There are no funders to report.
Disclosure
The authors completed the ICJME Form for Disclosure of Potential Conflicts
of Interest. They reported no conflicts of interest.
DOI: 10.1093/ptj/pzy149
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... Though, Zuil-Escobar et al. (2019) found in FF subjects, statistically significant results (p < 0.01) between the Navicular Drop Test and the Arch Angle (r = −0.732), Staheli Index (r = 0.788), and Chippaux-Smirak Index (r = 0.722) where absolute values corresponded to very high correlation values [24]. Alongside this, in another study, found in subjects without any foot posture inclusion criteria, the same statistically significant results (p < 0.05) for several correlations namely the Arch Angle (r = −0.643), ...
... However, there was a discordance about the correlation coefficient since the authors found a higher coefficient respectively nearly perfect absolute scores (r = 0.901−0.930) [24]. Finally, all the correlations between the other FootPrint parameters, the FootPrint Index, Arch Index, Chippaux-Smirak Index, and Staheli Index, presented statistically significant results (p = 0.01) with absolute very high and nearly perfect coefficient scores (r = 0.875−0.964). ...
... Finally, all the correlations between the other FootPrint parameters, the FootPrint Index, Arch Index, Chippaux-Smirak Index, and Staheli Index, presented statistically significant results (p = 0.01) with absolute very high and nearly perfect coefficient scores (r = 0.875−0.964). The Chippaux-Smirak Index/Staheli Index correlation followed the results found by Zuil-Escobar et al. (2019), which was statistically significant (p = 0.01/r = 0.931) [24]. Therefore, since the Staheli Index is related to the mid-hindfoot and the Chippaux-Smirak Index to the fore-mid foot, this accordance among the Chippaux-Smirak Index/Staheli Index correlation can state an entire foot complex analysis and inner relationship. ...
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Background: Authors refer to different methods to assess subjects’ foot posture. All methods present several limitations depending on the examiner or the chosen test. This study aims to investigate the relationship between different tests and Footprints parameters to diagnose subjects with a flat and neutral foot. Methods: The sample consisted of 37 participants, where 16 were included in the flatfoot group and 21 in the neutral foot group. Only subjects who presented a Navicular Drop Test value of >9 mm were included in the flatfooted group. All participants were submitted to Resting Calcaneal Stance Position and plantar pressure platform assessment for Footprints analysis. Associations between all tests and Footprints parameters were determined by Pearson’s correlation analysis. Results: Regarding both groups, significant correlations between tests were moderate to nearly perfect to identified both conditions of foot posture. All correlations were statistically significant (p < 0.05). Conclusions: The diagnosis accuracy of foot posture condition can be compromised depending on the used test. The Navicular Drop Test and the Resting Calcaneal Stance Position were shown to mislead foot posture condition assessment, unlike Footprints parameters that can be important evaluation tools in a clinical environment.
... This includes MRI, ultrasound, and laser scanners [5][6][7][8]. Radiographic procedure is the golden standard for evaluating the medial longitudinal arch height [9,10], even though radiographic measures typically provide only a uni-plantar assessment of the foot posture [5]. In contrast, the foot posture index (FPI-6) is a clinical and multiplanar tool that displays three planes for the assessment of the foot. ...
... In contrast, the foot posture index (FPI-6) is a clinical and multiplanar tool that displays three planes for the assessment of the foot. FPI-6 classifies the posture of the foot in pronated, supinated, or neutral positions [5,10]. Previous studies showed that FPI-6 is a reliable test for measuring the foot position; therefore, it has acquired popularity over the years [1,4,5,11,12]. ...
... It reflects movements of the medial longitudinal arch and is associated with the pronated foot [6]. In a cohort of adults, the FPI-6 showed an excellent correlation with the ND [10]. However, a recent study has concluded an ND as an unreliable measure with only fair agreement across test sessions [5]. ...
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Background The foot posture is age dependent. The purpose of this study was to investigate the relationship between the 6-item version of the foot posture index (FPI) and other clinical, foot anthropometric, radiological measurements for the foot position in 5–8-year-old children. Methods A total of 301 participants with a mean age of 6.4 ± 1.14 years were enrolled in the study. Children were examined physically, clinically, and radiologically to measure the FPI and navicular drop (ND) test, resting calcaneal stance position (RCSP) angle, Chippaux–Smirak index (CSI), Staheli index (SI), calcaneal pitch (CP) angle, talocalcaneal angle (TCA), and the first lateral metatarsal angle. Tibial torsions, internal rotation of the hip as an indirect method of femoral anteversion, and Beighton scale were analyzed for factors associated with flatfoot prevalence. Results The study included children with normal and flexible flatfeet. Statistical analysis showed a significant FPI score correlation with other parameters (SI, CSI, RCSP, ND, CP, TMA, and TCA showed strong and moderate correlations, p < 0.001). Overall, the strongest associates are CSI ( β = 0.34) and ND ( β = 0.28). Other indicators have relatively small relationships with the FPI. Conclusion A positive correlation was observed between FPI-6 and ND test, CSI in 5–8-year-old children. All three prominent foot posture indicators (FPI-6, ND, and CSI) might be used as a primary or preferred tool in clinical practice.
... gait pattern [15,16]. Moreover, foot sole afferent input affects postural awareness and FF triggered by neurological or muscular restrictions, ligament or joint laxity, excessive motion, and muscle activity [13]. ...
... Initially, the recorded data were pre-processed using the Qualisys Track Manager v2. 15 (Qualisys AB, Götebor, Sweden) software. The resulting data were then exported to Vis-ual3D (C-Motion, Germantownm, MD, USA) for further analysis. ...
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Background: Foot postural alignment has been associated with altered gait pattern. This study aims to investigate gait kinematic differences in flatfoot subjects’ regarding all lower limb segments compared to neutral foot subjects. Methods: A total of 31 participants were recruited (age: 23.26 yo ± 4.43; height: 1.70 m ± 0.98; weight: 75.14 kg ± 14.94). A total of 15 subjects were integrated into the flatfoot group, and the remaining 16 were placed in the neutral foot group. All of the particpants were screened using the Navicular Drop Test and Resting Calcaneal Stance Position test to characterize each group, and results were submitted to gait analysis using a MOCAP system. Results: Significant kinematic differences between groups were found for the ankle joint dorsiflexion, abduction, and internal and external rotation (p < 0.05). Additionally, significant differences were found for the knee flexion, extension, abduction, and external rotation peak values (p < 0.001). Significant differences were also found for the hip flexion, extension, external rotation, pelvis rotation values (p < 0.02). Several amplitude differences were found concerning ankle abduction/adduction, knee flexion/extension and abduction/adduction, hip flexion/extension and rotation, and pelvis rotation (p < 0.01). Conclusion: Flatfooted subjects showed kinematic changes in their gait patterns. The impact on this condition on locomotion biomechanical aspects is clinically essential, and 3D gait biomechanical analysis use could be advantageous in the early detection of health impairments related to foot posture.
... The presence of flatfoot in the participants was evaluated using the Foot Posture Index (FPI) and the Navicular Drop Test (NDT), which have been reported as valid and reliable tools for determining the presence of flatfoot. 2,26,40,41 Measurements to evaluate foot posture were performed by a physiotherapist, who is experienced in foot assessment and is a doctoral student. Participants with an FPI score of 0 to 5 were assumed to have a normal foot posture, whereas participants with a FPI score larger than 6 were assumed to have a flatfoot. ...
Article
Background: Changes in lower extremity alignment in individuals with flatfoot may be associated with differences in morphology of the tendons or cartilage in lower extremities. The purpose of the present study was to investigate the potential association of flatfoot with the morphology of the Achilles tendon, patellar tendon, and femoral cartilage. Methods: This study was conducted with 40 participants with flatfoot (28 females, 12 males) and 40 participants with a normal foot posture (28 females, 12 males). The thickness of the Achilles tendon (at points 2 and 3 cm proximal to the superior aspect of the calcaneus), patellar tendon (at the inferior pole of the patella and 1 cm proximal of the inferior pole of the patella), and femoral cartilage (at the intercondylar area, medial condyle, and lateral condyle) was measured by an ultrasonography device. Results: The Achilles tendon thickness at 2 cm (P = .009) and 3 cm (P = .010) proximal of the superior aspect of the calcaneus was on average 4% to 6% lower in individuals with flatfoot compared with controls. The cartilage thickness at the intercondylar area (P = .005) and medial condyle (P = .018) was on average 8% to 12% greater in individuals with flatfoot; however, the cartilage thickness at the lateral condyle and patellar tendon thickness was similar in both groups. Conclusion: The results obtained suggest that foot posture is associated with the morphology of the Achilles tendon and femoral cartilage.
... The most difficult items to be properly assessed were those related to the differences between the neutral and pronated foot types (McLaughlin et al., 2016). Following a brief learning period, FPI-6 proved to be a satisfactory tool in all the studies considered: intra-rater reliability results were very good among studies, with intra-rater ICC > 0.90 (Evans et al., 2012;Terada et al., 2014;Kirmizi et al., 2020;Patel et al., 2020) or Cohen's k > 0.85 (Zuil-Escobar et al., 2019) or Pearson's r ≥ 0.89 (Oleksy et al., 2010). The inter-rater ICC varied among the studies, ranging from fair to very good when untrained or trained raters were respectively included (see Table 2) (Menz, 2006;Cornwall et al., 2008;Evans et al., 2012;Griffiths and McEwan, 2012;Terada et al., 2014;Evans and Karimi, 2015;Tucker et al., 2015;McLaughlin et al., 2016;Aquino et al., 2018;Kenny et al., 2018;Hegazy et al., 2020;Kirmizi et al., 2020;Patel et al., 2020). ...
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Introduction Charcot-Marie-Tooth disease (CMT) is a slow and progressive peripheral motor sensory neuropathy frequently associated with the cavo-varus foot deformity. We conducted a scoping review on the clinical scales used to assess foot deviations in CMT patients and analyzed their metric properties. Evidence Acquisition A first search was conducted to retrieve all scales used to assess foot characteristics in CMT patients from the Medline, Web of Science, Google Scholar, Cochrane, and PEDro databases. A second search was conducted to include all studies that evaluated the metric properties of such identified scales from the same databases. We followed the methodologic guidelines specific for scoping reviews and used the PICO framework to set the eligibility criteria. Two independent investigators screened all papers. Evidence Synthesis The first search found 724 papers. Of these, 41 were included, using six different scales: “Foot Posture Index” (FPI), “Foot Function Index”, “Maryland Foot Score”, “American Orthopedic Foot & Ankle Society's Hindfoot Evaluation Scale”, “Foot Health Status Questionnaire”, Wicart-Seringe grade. The second search produced 259 papers. Of these, 49 regarding the metric properties of these scales were included. We presented and analyzed the properties of all identified scales in terms of developmental history, clinical characteristics (domains, items, scores), metric characteristics (uni-dimensionality, inter- and intra-rater reliability, concurrent validity, responsiveness), and operational characteristics (normative values, manual availability, learning time and assessors' characteristics). Conclusions Our results suggested the adoption of the six-item version of the FPI scale (FPI-6) for foot assessment in the CMT population, with scoring provided by Rasch Analysis. This scale has demonstrated high applicability in different cohorts after a short training period for clinicians, along with good psychometric properties. FPI-6 can help health professionals to assess foot deformity in CMT patients over the years.
... Two straight lines were drawn on the image with a computer mouse: one horizontal line at half of the isthmus soles (line A), and another at half of the calcaneus impression (line B) ( Figure 1). The classification of the morphological foot structure followed the Staheli index as described by Zuil-Escobar et al. 24 . This index divides values of lines A and B (measured in cm). ...
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Introduction: Tuberculosis (TB) remains the leading cause of death from a single infectious agent and a major public health problem in Europe and worldwide. The present study pretends to characterize and evaluate the tendency of TB infections over a 6-year period. Methods: We performed a retrospective study on patients admitted to a tertiary hospital with tuberculosis, from 2011 to 2016, through electronic medical files’ data collection. Results: We included 591 patients with a peak in 2013, as well as a slight increase in male gender prevalence and length of stay over the 6 years. There was a spike of comorbidities in 2012. A decrease in prevalence in white patients, due to increase in African and Asian was also reported, besides a decline in HIV status, homelessness and IV drugs use. This coincided with an increase in laboratory changes and radiological changes, along with a rise in microbiological resistance. Discussion: Our data is in line with current health policy reports. It is of utmost importance the effort towards control and elimination of TB, through rapid diagnosis, prompt report and complete treatment.
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This book contains information obtained from authentic and highly regarded sources. This is an edition made for publication of the works resulting from the ICHWBI2021 which are available on Congress website, where the reader will find a significant heterogeneity. Abstracts are ongoing or completed project-based research papers submitted by researchers from various academic degrees. This diversity is also found in the authors' scientific areas, reflecting on the variety of research themes presented at the Congress itself.
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Background Scoliogauge, has been developed for the measurement of ATR on iPhone smartphones. This study was to evaluate the reliability for the smartphone-aided ATR measurement method and to compare its reliability with that of the manual method. Methods Sixty-four AIS patients with single thoracic or lumbar curve participated in this study. Of these patients, thirty-two patients had main thoracic scoliosis while other thirty-two had main thoracolumbar/lumbar scoliosis. Two spine surgeons performed the measurements with Scoliometer and Scoliogauge. The Scoliogauge measurements were conducted on an iPhone 4 smartphone. The intraclass correlation coefficient (ICC) 2-way mixed model on absolute agreement was used to analyze the reliability categorized according to regions: thoracic or lumbar, and Cobb angles: <20 degrees and >40 degrees. ICC < 0.40 is considered as poor, 0.40–0.59 as fair, 0.60–0.74 as good, and 0.75–1.00 as excellent. Results The overall intraobserver variability was 0.954 and the overall interobserver variability was 0.943 for the scoliometer set, whereas the intraobserver variability was 0.965 and interobserver variability was 0.964 for the scoliogauge set. Both the intraobserver and interobserver ICCs reached the excellent value in the 2 sets for both observers. The mean Cobb angle of thoracic curves in patients with main thoracic scoliosis was similar to that of lumbar curves in those with main thoracolumbar/lumbar scoliosis (35.7 degrees vs. 36.1 degrees). The intraobserver and interobserver reliability was similar between two groups (thoracic vs. lumbar) in the 2 sets. There were 21 patients having Cobb angles < 20 degrees, while 20 patients >40 degrees. The intraobserver and interobserver reliability was better in severe curve(>40 degrees) group. Conclusion Smartphone-aided measurement for ATR showed excellent reliability, and the reliability of measurement with either scoliometer or scoliogauge could be influenced by Cobb angle that reliability was better for curves with larger Cobb angles.
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Background: For future etiologic cohort studies in runners it is important to identify whether (hyper)pronation of the foot, decreased ankle joint dorsiflexion (AJD) and the degree of the extension of the first Metatarsophalangeal joint (MTP1) are risk factors for running injuries and to determine possible sex differences.These parameters are frequently determined with the navicular drop test (NDT) Stance and Single Limb-Stance, the Ankle Joint Dorsiflexion-test, and the extension MTP1-test in a healthy population. The aim of this clinimetric study was to determine the reproducibility of these three orthopaedic tests in runners, using minimal equipment in order to make them applicable in large cohort studies. Furthermore, we aimed to determine possible sex differences of these tests. Methods: The three orthopaedic tests were administered by two sports physiotherapists in a group of 42 (22 male and 20 female) recreational runners. The intra-class correlation (ICC) for interrater and intrarater reliability and the standard error of measurement (SEM) were calculated. Bland and Altman plots were used to determine the 95% limits of agreements (LOAs). Furthermore, the difference between female and male runners was determined. Results: The ICC's of the NDT were in the range of 0.37 to 0.45, with a SEM in the range of 2.5 to 5 mm. The AJD-test had an ICC of 0.88 and 0.86 (SEM 2.4° and 8.7°), with a 95% LOA of -6.0° to 6.3° and -5.3° to 7.9°, and the MTP1-test had an ICC of 0.42 and 0.62 (SEM 34.4° and 9.9°), with a 95% LOA of -30.9° to 20.7° and -20° to 17.8° for the interrater and intrarater reproducibility, respectively.Females had a significantly (p<0.05) lower navicular drop score and higher range of motion in extension of the MTP1, but no sex differences were found for ankle dorsiflexion (p ≥ 0.05). Conclusion: The reproducibility for the AJD test in runners is good, whereas that of the NDT and extension MTP1 was moderate or low. We found a difference in NDT and MTP1 mobility between female and male runners, however this needs to be established in a larger study with more reliable test procedures.
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Low back pain (LBP) is a significant public health problem in Western industrialised countries and has been reported to affect up to 80% of adults at some stage in their lives. It is associated with high health care utilisation costs, disability, work loss and restriction of social activities. An intervention of foot orthoses or insoles has been suggested to reduce the risk of developing LBP and be an effective treatment strategy for people suffering from LBP. However, despite the common usage of orthoses and insoles, there is a lack of clear guidelines for their use in relation to LBP. The aim of this review is to investigate the effectiveness of foot orthoses and insoles in the prevention and treatment of non specific LBP. A systematic search of MEDLINE, CINAHL, EMBASE and The Cochrane Library was conducted in May 2013. Two authors independently reviewed and selected relevant randomised controlled trials. Quality was evaluated using the Cochrane Collaboration Risk of Bias Tool and the Downs and Black Checklist. Meta-analysis of study data were conducted where possible. Eleven trials were included: five trials investigated the treatment of LBP (n = 293) and six trials examined the prevention of LBP (n = 2379) through the use of foot orthoses or insoles. Meta-analysis showed no significant effect in favour of the foot orthoses or insoles for either the treatment trials (standardised mean difference (SMD) -0.74, CI 95%: -1.5 to 0.03) or the prevention trials (relative risk (RR) 0.78, CI 95%: 0.50 to 1.23). There is insufficient evidence to support the use of insoles or foot orthoses as either a treatment for LBP or in the prevention of LBP. The small number, moderate methodological quality and the high heterogeneity of the available trials reduce the strength of current findings. Future research should concentrate on identification of LBP patients most suited to foot orthoses or insole treatment, as there is some evidence that trials structured along these lines have a greater effect on reducing LBP.
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Medial tibial stress syndrome (MTSS) affects 5%-35% of runners. Research over the last 40 years investigating a range of interventions has not established any clearly effective management for MTSS that is better than prolonged rest. At the present time, understanding of the risk factors and potential causative factors for MTSS is inconclusive. The purpose of this review is to evaluate studies that have investigated various risk factors and their association with the development of MTSS in runners. Medical research databases were searched for relevant literature, using the terms "MTSS AND prevention OR risk OR prediction OR incidence". A systematic review of the literature identified ten papers suitable for inclusion in a meta-analysis. Measures with sufficient data for meta-analysis included dichotomous and continuous variables of body mass index (BMI), ankle dorsiflexion range of motion, navicular drop, orthotic use, foot type, previous history of MTSS, female gender, hip range of motion, and years of running experience. The following factors were found to have a statistically significant association with MTSS: increased hip external rotation in males (standard mean difference [SMD] 0.67, 95% confidence interval [CI] 0.29-1.04, P<0.001); prior use of orthotics (risk ratio [RR] 2.31, 95% CI 1.56-3.43, P<0.001); fewer years of running experience (SMD -0.74, 95% CI -1.26 to -0.23, P=0.005); female gender (RR 1.71, 95% CI 1.15-2.54, P=0.008); previous history of MTSS (RR 3.74, 95% CI 1.17-11.91, P=0.03); increased body mass index (SMD 0.24, 95% CI 0.08-0.41, P=0.003); navicular drop (SMD 0.26, 95% CI 0.02-0.50, P=0.03); and navicular drop >10 mm (RR 1.99, 95% CI 1.00-3.96, P=0.05). Female gender, previous history of MTSS, fewer years of running experience, orthotic use, increased body mass index, increased navicular drop, and increased external rotation hip range of motion in males are all significantly associated with an increased risk of developing MTSS. Future studies should analyze males and females separately because risk factors vary by gender. A continuum model of the development of MTSS that links the identified risk factors and known processes is proposed. These data can inform both screening and countermeasures for the prevention of MTSS in runners.
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The present study analyzed the impact of the running style and the morphologic and functional characteristics of the foot on the incidence of non-traumatic foot and lower limb disorders in runners. From January 2004 to December 2008, we prospectively examined 166 runners, both recreational and competitive, involved in various running specialities, from three athletics clubs in Northern Italy. They were 86 males and 80 females, with a mean age of 31.1 ± 12.2 years. We considered nontraumatic foot and lower limb diseases reported during the follow-up period, which resulted in a minimum sport rest of two weeks. The incidence of these diseases was examined with respect to general characteristics, type of activity, foot morphology, running style. 59% of athletes reported one or more diseases. The most common were plantar fasciitis (31% of athletes) and Achilles tendinopathies (24%). Overall, the more prone to injuries were males (60.9% of cases), competitive runners (70.9%), middle-distance runners (51.7%), and those using spike shoes (80.3%). Age, body weight and height were not important predictors of running injuries in general. Considering the morphological characteristics of the foot, the most prone to injury were the varus hindfoot (87.5% of cases) and the cavus arch (71.4%). In conclusion, a deep knowledge of the factors predisposing runners to specific diseases, often chronic and highly debilitating for the athlete, may allow implementing effective therapeutic measures.
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Objective: Abnormal foot posture and function have been proposed as possible risk factors for low back pain, but this has not been examined in detail. The objective of this study was to explore the associations of foot posture and foot function with low back pain in 1930 members of the Framingham Study (2002-05). Methods: Low back pain, aching or stiffness on most days was documented on a body chart. Foot posture was categorized as normal, planus or cavus using static weight-bearing measurements of the arch index. Foot function was categorized as normal, pronated or supinated using the centre of pressure excursion index derived from dynamic foot pressure measurements. Sex-specific multivariate logistic regression models were used to examine the associations of foot posture, foot function and asymmetry with low back pain, adjusting for confounding variables. Results: Foot posture showed no association with low back pain. However, pronated foot function was associated with low back pain in women [odds ratio (OR) = 1.51, 95% CI 1.1, 2.07, P = 0.011] and this remained significant after adjusting for age, weight, smoking and depressive symptoms (OR = 1.48, 95% CI 1.07, 2.05, P = 0.018). Conclusion: These findings suggest that pronated foot function may contribute to low back symptoms in women. Interventions that modify foot function, such as orthoses, may therefore have a role in the prevention and treatment of low back pain.
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The Foot Posture Index-6 (FPI-6) is considered a simple quantification tool to assess static foot alignment. Palpation of the foot is required for assessment of one of the six criteria that comprise the FPI-6; the remaining five criteria may be evaluated using still-frame photographs. Using only the image-based criteria may allow multiple clinicians to evaluate large groups of patients quickly. Reliability using only these five image-based criteria has not been established. The purposes of the current study were to establish the inter- and intra-rater reliability using five image-based criteria from the Foot Posture Index-6 (FPI-6) as well as to examine the agreement between the raters in identifying foot type using the composite five FPI scores. Forty participants (23 females, 17 males; 23.67 ± 8.49 years; 64.59 ± 14.43 kg; 166.07 ± 11.79 cm) volunteered for this study. An investigator took three photos with a digital camera of the medial longitudinal arch, posterior ankle, and of the talonavicular joint approximately 45° from the posterior calcaneus for both right and left feet. Two investigators assessed the five image-based criteria of the FPI-6 for both feet of 40 participants on three occasions separated by a day. Inter-and intra-rater reliability were assessed with Intraclass Correlation Coefficients (ICC3,2). The amount of agreement for classification of foot posture type between the two raters was assessed with Cohen's kappa coefficient. Significance was set a priori at P < 0.05. The inter-rater reliability was poor to moderate for all three sessions (ICC3,2 = 0.334-0.634). For the foot posture classification, the amount of agreement between two raters was poor for left (κ= 0.12) and right (κ= 0.19) feet. The intra-rater reliability was excellent for left (ICC3,2=0.956) and right feet (ICC3,2=0.959). Excellent intra-rater and poor to moderate inter-rater reliability was found using only the five image-based criteria of the FPI-6. However, the classification of foot posture did not improve the amount of agreement between raters. Therefore, caution is needed when interpreting FPI scores from five image-based criteria. 3b.
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Objective To examine the associations of foot posture and foot function to foot pain. Methods Data were collected on 3,378 members of the Framingham Study cohort who completed foot examinations in 2002-2008. Foot pain (generalized and at 6 locations) was based on the response to the following question: On most days, do you have pain, aching or stiffness in either foot? Foot posture was categorized as normal, planus, or cavus using static pressure measurements of the arch index. Foot function was categorized as normal, pronated, or supinated using the center of pressure excursion index from dynamic pressure measurements. Sex-specific multivariate logistic regression models were used to examine the effect of foot posture and function on generalized and location-specific foot pain, adjusting for age and weight. ResultsPlanus foot posture was significantly associated with an increased likelihood of arch pain in men (odds ratio [OR] 1.38, 95% confidence interval [95% CI] 1.01-1.90), while cavus foot posture was protective against ball of foot pain (OR 0.74, 95% CI 0.55-1.00) and arch pain (OR 0.64, 95% CI 0.48-0.85) in women. Pronated foot function was significantly associated with an increased likelihood of generalized foot pain (OR 1.28, 95% CI 1.04-1.56) and heel pain (OR 1.54, 95% CI 1.04-2.27) in men, while supinated foot function was protective against hindfoot pain in women (OR 0.74, 95% CI 0.55-1.00). Conclusion Planus foot posture and pronated foot function are associated with foot symptoms. Interventions that modify abnormal foot posture and function may therefore have a role in the prevention and treatment of foot pain.
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Background: Clinical evaluation of foot posture is necessary for assessing and treating patients with lower extremity dysfunction. Although several studies have explored the reliability and validity of different clinical techniques for the measurement of foot posture, there is limited research in studies investigating whether two or more such techniques correlate with each other. Objectives: To explore the correlations between the valgus and arch index measurements with the measurements of the navicular drop and drift in bipedal and single-leg stance. Methods: Clinical measurements of the valgus index, the arch index, the navicular drop and drift were performed on the left foot of 26 healthy subjects in bipedal and in single-leg stance with 30° knee flexion. Results: The valgus index yielded moderate to strong correlations with the measurement of navicular drop (bipedal: r = 0.657, p < 0.001; single-leg stance: r = 0.613, p = 0.001) and small correlations with navicular drift (bipedal: r = 0.481, p = 0.13; single-leg stance: r = 0.335, p = 0.094). The arch index demonstrated small correlations with the navicular drop and drift in both bipedal and single-leg stance (r = 0.317-0.428, p = 0.115-0.029). Conclusions: Although strong associations were obtained between the valgus index and the navicular drop, all other correlations demonstrated low degrees of association. Further research should explore the association of these clinical measurements in patients with foot/lower limb impairments.