Feet deformities are correlated with impaired balance and postural stability in seniors over 75

A Strong Correlation Between the Severity of Flatfoot and Symptoms of Knee Osteoarthritis in 95 Patients

Objective

The purpose of this study is to assess the association between the presence and severity of flatfoot and symptoms of knee OA.

Methods

95 participants with knee OA were recruited from a patient cohort at a regional hospital. Symptoms of knee OA, including knee degeneration, femorotibial alignment, pain, stiffness and dysfunction were assessed using the Kellgren-Lawrence (K-L) grading system, femoral-tibial angle (FTA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Participants were divided into groups with flatfoot (mild, moderate and severe) and without flatfoot based on the Clarke's angle. Linear regression and ordinal logistic regression were used for statistical analysis, as appropriate.

Results

Having flatfoot was associated with a significantly increased risk of having a higher K-L grade (OR: 20.03; 95% CI, 5.88, 68.27; p < 0.001), smaller FTA (Beta: −2.96; 95% CI, −4.41, −1.50; p < 0.001), higher pain score (Beta: 0.47; 95% CI, 0.24, 0.69; p < 0.001) and greater loss of function (Beta: 0.25; 95% CI, 0.02, 0.48; p = 0.03). Severe grades of flat feet were associated with a higher K-L grade (OR: 0.19; 95% CI, 0.08, 0.44; p < 0.001), smaller FTA (Beta: 1.51; 95% CI, 0.66, 2.35; p = 0.001), higher pain score (Beta: −0.25; 95% CI, −0.39, −0.11; p = 0.001), greater stiffness (Beta: −0.24; 95% CI, −0.38, −0.09; p = 0.002) and greater loss of function (Beta: −0.27; 95% CI, −0.41, −0.14; p < 0.001).

Conclusion

The results indicated that the severity of flattening is significantly associated with symptoms of knee OA. For the conservative management of knee OA, both flatfoot and its severity should be carefully considered.

Relationships between the Perception of Footwear Comfort and the Fear of Falls in People at the Early Period of Old Age

Objective: The present study aimed to analyze the relationships between the perceptions of footwear comfort with fear of falls in younger-old women and men. Participants: the population sample involved 100 free-living community dwellers aged 65−74. Design: the Falls Efficacy Scale-International and a visual analogue scale to assess perception of footwear comfort were used as research tools. Results: there were statistically significant differences in the FES-I results in people who suffered a fall in the last year compared to those who did not experience a fall (p < 0.001), as well as in the subjective assessment of mediolateral control in people who have suffered and have not suffered a fall in the last year (p = 0.033). In women, statistically significant relationships were found in the subjective assessment of shoe comfort in terms of arch height (p = 0.025) and material properties of the footwear (p = 0.036) with the results of FES-I. Conclusions: People who have fallen show a higher level of fear of falling. The assessment of footwear comfort in terms of mediolateral control was lower in the younger-old who had experienced a fall in the last year. In women, a worse assessment of arch height and material properties of the footwear is accompanied by greater fear of falling.

Perception of footwear comfort and its relationship with the foot structure among youngest-old women and men

Background

Adequate footwear comfort and functionality are important regardless of age, but they become particularly important in the youngest-old women and men, mainly due to the fact that this age range is the initial period of old age with changes in shoe preferences. The aim of this study was to assess the perception of footwear comfort and its relationship with the feet structure in youngest-old women and men.

Methods

The cross-sectional study covered community dwellers living on their own aged 65–74 years (50 women; 50 men). The feet characteristics were measured using the CQ-ST podoscope (Electronic System, Ltd, EU), and the perception of footwear comfort was assessed with a visual analogue scale. The assessment took into account gender-specific footwear of a certain brand (Befado Dr orto).

Results

Statistically significant intergender differences were observed in the perception of footwear comfort with respect to the shoe heel width (p = 0.022), the arch height (p = 0.013), the overall comfort (p = 0.049) and the material properties of the footwear (p = 0.017). In women, there were statistically significant positive relationships among the heel angle (γ) and the perception of footwear comfort in terms of heel cushioning (p = 0.021), forefoot cushioning (p = 0.015), arch height (p = 0.029). In men, there was a statistically significant negative relationship of the left foot Clarke’s angle with the heel height (p = 0.043), and a positive relationship between the right foot width and the arch height (p = 0.044).

Conclusions

Youngest-old women, compared to men of the same age range, have a higher perception of shoe comfort in terms of the shoe heel width, the arch height, the overall comfort of the footwear and the material properties of the footwear. The appropriate profile and construction of the shoe allows for an increase in the contact surface of the foot with the shoe, hence the improvement in the perception of footwear comfort in people with lowered arch or widened forefoot.

Preventive strategy of flatfoot deformity using fully automated procedure

A non-invasive, no radiation, out-of-hospital automated system is proposed to identify low arch integrated in the design and manufacturing of personalized orthoses using parametric modelling. The aim of the design process is to integrate assistive technology with assessment and prevent low arch progressing to a more serious case - flatfoot. In the automated procedure, we developed an assessment method including reliable thresholds of foot type classification and test protocol to reduce interferences due to preceding activities, an automation to translate scanned data into parametric design for orthotic customization, finite element model evaluating effectiveness of the personalized design, and a personalized comparative test to evaluate the long-term improvement of foot arch shape. Our low arch threshold established by subject-specific 3D models reduced the misclassification rate from 55%, as previously reported to 6.9%. Individuals who engaged in sedentary activity (i.e. sitting) had the greater change in arch height compared to active activity (i.e. standing and walking), which is more likely to affect the obtained measure. Therefore, a test protocol now states that participants are not allowed to sit over 100 min prior the measurement to reduce such interference. We have proposed and tested an automated algorithm to translate scanned data including seven foot's parameters into customised parametric design of the insert. The method decreases the required time of orthotic computer-aided design from over 3 h to less than 2 min. A finite element analysis procedure was additionally developed to assess the performance of geometries and material of designed orthotic based on the distribution of plantar pressure and internal stress. The personalized comparative assessment based on midfoot contact area was carried out periodically for follow-up and the orthotic could be re-designed if necessary. The proposed automated procedure develops a pre-screening system to distinguish low arch and provide preventatives before it becomes symptomatic. Furthermore, non-symptom flatfoot can be detected at early stages and referred to medics for further diagnosis or treatment.

Vulnerability of the foot's morphological structure to deformities caused by foot loading paradigm in school-aged children: a cross-sectional study

The study aimed to assess the association between the key predictive foot structure variables and its loading paradigm in 625 school-aged children. Clinical appraisal relied primarily on having the plantar parts of their feet comprehensively assessed with Podoscan 2D Foot CAD, and a dynamometer platform, the research tools of choice widely acknowledged for their overall accuracy and reliability, with a view to determining the distribution of respective foot loads, as well as addressing both balance and gait issues. The Clarke's angle, Wejsflog index, length and width of the feet, regardless of gender, proved the key predictive variables for the foot-loading paradigm. Notably the Clarke's angle, construed the most sensitive variable in assessing flat-footedness, offered an extra added value in overall investigative effort. The actual design of the study protocol effectively complements a standard clinical assessment procedure, whereas by comprehensively addressing those variables, it is also believed to aid clinicians in gaining an extra, hands-on, diagnostic potential, so that any teenagers exposed to the highest risk of developing foot deformities could effectively be identified through pertinent screening tests, and consequently offered a task-oriented, therapeutic management, specifically aimed at preventing potential postural complaints in later life.

Magnitude of Podoconiosis and Its Associated Factors among an Adult Population in Waghmra Zone, Ethiopia: A Cross-Sectional Study

Background

Podoconiosis is one of the neglected tropical diseases, and it is a nonfilarial elephantiasis caused by prolonged barefoot exposure to irritant soil. This is manifested by slowly progressive swelling of the foot and lower leg which may lead to an irreversible disability among affected people. Podoconiosis is an entirely noncommunicable preventable disease with a low-cost preventive mechanism. This study is aimed at assessing the magnitude and factor affecting Podoconiosis in Waghmra zone, Amhara region, Ethiopia, 2019.

Methods

A community-based cross-sectional study was conducted among 808 household members. A multistage sampling method was used to select study participants. A pretested semistructured questionnaire, observation, and clinical screening were used to collect data. The data were entered using EpiData version 4.2 and analyzed using SPSS version 24.0. Both bivariable and multivariable logistic regression models were fitted to identify factors associated with Podoconiosis. Odds ratio with 95% confidence interval was computed to determine the level of significance; in multivariable analysis, variables with a P value less than 0.05 were considered as statistically significant.

Result

According this study's results, 4.3% of study participants were affected by Podoconiosis. A family number of four and above [AOR = 3.29, 95% CI (1.013-10.661)], family income of less than 500 ETB [AOR = 3.69, 95% CI (1.271-10.727)], distance from a health facility greater than 3 km [AOR = 6.69, 95% CI (1.610-27.863)], no shoe wearing habits [AOR = 5.02, 95% CI (1.969-12.778)], age at first wearing of shoes at 10 and above [AOR = 4.46, 95% CI (1.792-11.102)], and no feet washing habits [AOR = 3.87, 95% CI (1.516-9.883)] are significant factors of Podoconiosis.

Conclusion

Creating awareness about the importance of shoe wearing, feet hygiene, and building infrastructure such as a road, health facility, and water supply were essential preventive strategies. Training about early diagnosis and effective management of lymphedema, giving emphasis on hygiene education and sanitation program, and reporting any suspected Podoconiosis case as early as possible are some of the recommendations forwarded.

Body weight-dependent foot loads, assessed in terms of BMI and adiposity, in school-aged children: a cross sectional study

Whereas inherently vulnerable structure of both a child's and an adolescent's foot, characteristic for its dynamic, developmental stage, is particularly exposed to numerous environmental factors, excessive body weight gain may potentially become a crucial causal factor, bringing on a cascade of adverse effects throughout the body, e.g. disorders of the skeletal-articular system, gait alterations, abnormally excessive loading of the plantar zones of the foot, and consequently serious postural defects, especially in later life. Since obesity, aptly dubbed the scourge of the 21st c., directly impacts the way the foot biomechanics are developed, whereupon the actual paradigm of foot loading becomes subject to numerous, adverse modifications, the present study focused on gaining an in-depth insight into prevalent association of BMI, adipose tissue content in body composition, and the actual distribution of foot loads in the school-aged children. Since body weight, the simplest anthropometric indicator, is actually non-indicative of the proportion of adipose tissue within body composition, a number of modern, non-invasive diagnostic methods were applied by the investigators to have this deficit effectively addressed, inclusive of comprehensively mapping out the actual load distribution in the plantar zones of the foot.

Influence of footwear fitting on feet morphology in 9 year old girls

Background

The human foot is shaped throughout all life in a way that is individual for every human being. Footwear fitting in the process of foot development is the issue covered by a limited range of empirical studies. This prompted the authors to undertake this subject of the study aimed at the influence of fitting of regularly worn inside the school footwear on feet morphology in primary schoolgirls.

Methods

The study group comprised 100 girls aged 9. Feet characteristics were recorded by CQ-ST podoscope. The footwear fitting to the feet of the examined girls was tested using the Clevermess device. The data were analyzed based on the Student’s t test, Wilcoxon test and regression analysis.

Results

Appropriately fitted right indoor footwear was worn by 48% of the subjects while the left one by 43% of the group. Appropriate fitting in relation to the left and right foot width was noted in 23% of the group. The statistically significant combined effect of predictors characterizing footwear on the value of Wejsflog index of the right (p < 0.001) and left (p < 0.001) foot and influence of the length excess on the heel angle of the left foot (p = 0.006) were found.

Conclusions

Most examined girls wear poorly fitted indoor footwear. The length excess of the indoor footwear has connections with the Wejsflog index of the right and left foot and the heel angle of the left foot. The larger the length excess, the lower the transverse arch. In the production of indoor footwear the differences in the feet width should be taken into account.

Extraction of the Proximal Phalanx: A New Option in Surgical Treatment of the Crossover Second Toe

One of the biggest and commonest problems that is seen and treated by foot and ankle surgeons is the deformity where the second toe crosses over the hallux. According to available literature, this is the first published case of extraction of the proximal phalanx due to crossover toe deformity. We present the case of a 64-year-old Caucasian female with a crossover second toe deformity of her left foot. Because of this deformity, she was completely disabled to wear normal shoes and she felt intensive pain in her front part of the foot. She underwent a total extraction of the proximal phalanx of the second toe. After the operation, she was very satisfied with the status of the operated foot and the final result of the surgical treatment. The procedure that we performed could be a good possibility for the treatment of crossover second toe deformity because we got a good functional and cosmetic result, the morbidity associated with more advanced reconstruction is avoided, and the rehabilitation period was short. Patient satisfaction was high, and complications were minimal.

Detailed analysis of the transverse arch of hallux valgus feet with and without pain using weightbearing ultrasound imaging and precise force sensors

Background

Hallux valgus is the most common forefoot deformity and affects the transverse arch structure and its force loading patterns. This study aims to clarify the differences in the transverse arch structure and the force under the metatarsal heads individually, between normal feet and hallux valgus feet, and between hallux valgus feet with pain and without pain. We further test the association between the parameters of the transverse arch and hallux valgus angle and between the parameters and pain in hallux valgus.

Methods

Women’s feet (105 feet) were divided into normal group (NORM) and hallux valgus group (HVG); and further into subgroups: hallux valgus without pain (HV Pain (-)) and hallux valgus with pain (HV Pain (+)). Transverse arch height and metatarsal heads height were measured using weight-bearing ultrasound imaging. Force under the metatarsal heads was measured using force sensors attached directly on the skin surface of the metatarsal heads. The measurements were taken in three loading positions: sitting, quiet standing and 90% weight shift on the tested foot. Differences between the groups were compared using Student t-test and Wilcoxon Exact test. Multivariate logistic analysis with adjustment for physical characteristics was also conducted.

Results

Transverse arch height was significantly higher in HVG than in NORM in all positions; there were no significant differences between HV Pain (+) and HV pain (-). Lateral sesamoid was significantly higher in HVG and HV Pain (+) than in NORM and HV Pain (-) respectively when bearing 90% of the body weight unilaterally. There was a trend of higher forces under the medial forefoot without significant difference. Transverse arch height and lateral sesamoid height were associated with the hallux valgus angle, while lateral sesamoid height was associated with forefoot pain in hallux valgus deformity.

Conclusions

This study shows the differences in the transverse arch structure between normal feet and feet with hallux valgus, and between hallux valgus feet with and without pain. This finding is noteworthy when considering future treatments of painful feet, notably the height of the lateral sesamoid which seems to play a role in forefoot pain.

Feet deformities and their close association with postural stability deficits in children aged 10-15 years

BACKGROUND

Children and young people make up an age group most vulnerable to falls. Various stability disorders may become instrumental in sustaining more frequent falls and resultant fractures. Correct morphological structure impacts overall efficiency of the foot, as well as offers significant diagnostic potential. Even minor foot disorders may affect the entire bio kinematic chain, also impacting the foot's motility. Structural alterations within a foot may also impair balance in the standing position, and contribute to more frequent injuries. The study aimed to assess the relationship between feet deformities and postural stability deficits in schoolchildren prone to sustain accidental falls.

METHODS

The study involved 200 children (101 girls and 99 boys) aged 10-15 years, randomly selected from primary schools. A 2D podoscan was used to assess the plantar part of the foot, while stabilometric examination was aided by the FreeMed dynamometric platform.

RESULTS

Correlation between respective variables was reflected by Spearman's rank coefficient. The subjects' age negatively correlated with the COP range of movement along the Y axis, and the COP surface area, while their BMI negatively correlated with the COP trajectory's length. Step regression analysis indicated that the width of the left foot, the left foot Wejsflog index, the left foot Clark's angle, the hallux valgus angle were the essential predictors of stabilometric variables in girls. In boys, though, predictive value was associated with Clarke's angle of the left and right foot, Wejsflog index of the right foot, and the width of both the left and right foot.

CONCLUSIONS

There is a statistically significant correlation between morphological variables of the foot and postural stability. When assessing the key variables of the foot and their interrelationship with postural stability, the Clarke's angle, Wejsflog index, hallux valgus angle, and foot width, should be granted due prominence in the girls. As regards the boys, the following variables were established as predictive in assessing postural stability: Clarke's angle, Wejsflog index, and foot width.

Foot Deformities in Women Are Associated with Wearing High-Heeled Shoes

Background

The aim of this study was to assess the association between foot deformities and type of shoe regularly worn at work.

Material/Methods

We studied 150 employed women ages 30–40 years and divided them into 3 groups according to type of footwear worn: women in Group I wore flat-soled shoes, women in Group II wore mid-heeled shoes (heels 4.0±0.5 cm), and women in Group III wore high-heeled shoes (heels 10.0±0.5 cm). We used the CQ-ST podoscope for measurements.

Results

We found significant differences in right foot γ angle between Groups I and III (p=0.033) and between Groups II and III (p=0.040). For the left foot, differences were noted between Groups I and III (p=0.012). Group III subjects had higher values of α angle compared to Group I (p=0.000) and Group II (p=0.000). Significant correlations were also found between specific type of footwear worn and the incidence of hallux valgus of the right foot (p=0.010) and left foot (p=0.000), and the varus deformity of the fifth toe (β) of the left foot (p=0.015).

Conclusions

The feet of women wearing high-heeled shoes were significantly flatter transversely, with a more laterally flexed hallux, as compared to those wearing low-heeled or flat-soled shoes. Wearing high-heeled shoes was associated with higher incidence of hallux valgus. The incidence of varus deformity of the fifth toe was associated with wearing high-heeled shoes.

Inter-gender differences of balance indicators in persons 60-90 years of age

Introduction

Precision of movements responsible for maintaining balance deteriorates with age due to natural involutionary processes, thus prompting a research question whether the values of gender-related stability indicators might differ significantly among the study subjects over 60 years of age.

Methods

The study group comprised 136 seniors (89 women, 47 men; aged 60–90 years). The CQ-Stab 2P 2-platform posturograph was used as the main research device, whereas the Mann–Whitney U-test was used to evaluate the gender-related differences in the average level of variables.

Results

In the open-eye test, significant gender-related differences were observed with regard to the statokinesiogram’s path length in the mediolateral (ML) direction in the subjects aged 60–69 years (p=0.004), mean frequency of center of pressure (COP) displacement and number of COP displacements in the ML direction in the subjects aged 70–79 years (p=0.028, p=0.019), and mean COP displacement in the anteroposterior (AP) direction in the subjects aged 80–90 years (p=0.026). When the subjects were deprived of visual control, gender-related differences were observed with regard to the mean frequency of COP displacement, number of COP displacements in the ML direction in the subjects aged 60–69 years (p=0.045, p=0.049), and the statokinesiogram’s path length in the AP direction in the subjects aged 70–79 years (p=0.015). In the oldest age group, the differences were noted in the statokinesiogram’s path length in the AP direction (p=0.001), a sway area delimited by the COP point (p=0.003), range of AP stability (p<0.001), and range of ML stability (p=0.048).

Conclusion

Gender-related differences affecting postural stability were found in the elderly. Men were characterized by a lower level of postural stability when compared with women. This highlights the need to have the gender-related differences taken into account, when developing various preventive and therapeutic programs specifically aimed at compensating certain involution-dependent deficits.