Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis

Foot Posture and Ankle Dorsiflexion as Risk Factors for Developing Achilles Tendinopathy and Plantar Fasciitis: A Case-Control Study

BACKGROUND

Plantar fasciitis (PF) and Achilles tendinopathy (AT) are common injuries that primarily affect people engaged in sport or occupational weightbearing activities. Identifying modifiable risk factors is important for the treatment and prevention of these injuries. The purpose of this study was to evaluate whether foot posture or ankle dorsiflexion are risk factors for developing AT or PF, and if there were any differences between PF and AT patients.

METHODS

This was a case-control study of 108 patients with PF and 114 patients with AT, compared to the same number of referred patients in 2 control groups never having had these injuries, matched for sex, age, body mass index (BMI), sport, and occupational weightbearing activities. Included patients were 20-65 years with ultrasonographic-verified PF or midsubstance AT. Foot posture was assessed using Foot Posture Index (FPI) classifying the feet into 3 categories: FPI 0-5 normal foot, 6-12 hyperpronated, <0 hypopronated. Ankle dorsiflexion was measured with a goniometer in weightbearing with straight and bent knee.

RESULTS

Abnormal foot posture was associated with an increased risk for sustaining both AT (odds ratio [OR] 3.4-4.1) and PF (OR 3.2-3.8). Hyperpronation being the major reason for this association with ORs 5.4-5.5 compared with hypopronation with ORs 2.6-2.9. However, decreased dorsiflexion was not a risk factor: instead, there was an increased ankle dorsiflexion in patients with AT or PF compared with their control groups. Comparison between PF and AT patients demonstrated that PF affected mostly women, and AT mostly men, PF patients were 2.4 years (CI 0.2-4.5) younger, and had 25% more occupational weightbearing than AT patients. However, no differences in BMI or weightbearing physical activity was demonstrated.

CONCLUSION

Hypopronation and hyperpronation but not limited ankle dorsiflexion was associated with increased risk for AT or PF.

High Medial Longitudinal Arch of the Foot and Latent Trigger Points in Lower Limb Muscles

Background: The objective was to evaluate the prevalence of latent trigger points (LTrPs) in lower limb muscles in participants with a high medial longitudinal arch (MLA) of the foot compared to controls. Methods: Participants with a navicular drop test of 4-9 mm were included in the control group; the high MLA group included navicular drop test values of ≤4 mm. The presence of LTrPs was assessed by palpation techniques. The muscles evaluated were medial gastrocnemius (LTrP1), lateral gastrocnemius (LTrP2), soleus (LTrP1), peroneus longus, peroneus brevis, tibialis anterior, extensor digitorum longus, flexor digitorum longus, rectus femoris, vastus medialis (LTrP1 and LTrP2), and the vastus lateralis of the quadriceps (LTrP1 and LTrP2). Results: Thirty-seven participants with high MLA and thirty-seven controls were included in the study. Twenty-nine (78.4%) participants in the high MLA group had at least 1 LTrP, compared to twenty-three (62.2%) in the control group. No statistical difference (p < 0.05) was found in the total number of LTrPs between groups (4.46 ± 3.78 vs. 3.24 ± 3.85). There were more participants (p < 0.05) with LTrPs in the tibialis anterior, extensor digitorum longus, and vastus lateralis (LTrP1 and LTrP2) in the high MLA group than in the control group. Conclusion: Although no differences were found in the number of total LTrPs between groups, the prevalence was statistically significantly higher in the tibialis anterior, extensor digitorum longus, and vastus lateralis of the participants with high MLA of the foot.

Lower Extremity Muscle Performance and Foot Pressure in Patients Who Have Plantar Fasciitis with and without Flat Foot Posture

Abnormal foot posture and poor muscle performance are potential causes of plantar fasciitis (PF). However, no study has compared the differences between lower extremity muscle performance and foot pressure in patients who have PF with and without abnormal foot postures. This study aimed to compare the differences in lower extremity muscle performance, such as in the hip, quadriceps, hamstring, and plantar flexor, and foot pressure in patients who have PF with and without flat foot postures. Seventy patients with plantar heel pain were enrolled (37 flat feet and 33 without flat feet). The hip muscle strength was measured using a handheld digital dynamometer. The strength and reaction time of the quadriceps, hamstring, and plantar flexor muscles were evaluated using an isokinetic device. Foot pressure parameters were assessed using pedobarography. The strength of the plantar flexor muscles was significantly lower (p = 0.008), while the reaction time of the plantar flexor muscles was significantly faster (p = 0.007) for the involved feet of PF patients with flat feet than in those without flat feet. This study confirmed the differences in muscle performance between patients who have PF with different foot postures. Therefore, clinicians and therapists should plan treatment considering the differences in these characteristics for the management of these patients.

Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial

BACKROUND

Calcaneal spurs are described as bony outgrowths arising on medial calcaneal, where inappropriate footwear can promote disease progression.

OBJECTIVE

Investigate the effectiveness of mechanical treatment with customized insole and minimalist flexible footwear during gait training program in women with calcaneal spur.

METHODS

Design: A single-blinded, randomized and controlled trial.

SETTING

Biomechanics laboratory.

PARTICIPANTS

Forty-three women, 29 with calcaneal spur and 14 control.

INTERVENTION

Gait training program with use of the minimalist flexible footwear (MFG n = 15, age: 48.9 ± 9.4, height: 1.61 ± 0.1, BMI: 32.1 ± 7.0) and customized insole on footwear (COIG n = 14, age: 50.3 ± 5.8, height: 1.62 ± 0.1, BMI: 32.2 ± 4.3) and control (CG n = 14, age: 47.8 ± 8.6, height: 1.63 ± 0.1, BMI: 27.5 ± 4.5), followed of the evaluations: baseline (T0) and after three (T3) and six (T6) months. Duration of the intervention was of the six months consecutive for at least 42 h per week (six hours a day, seven days a week). Outcome primary were calcaneus pain (visual analogue scale), Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br) and 6-min walk test (6MWT). Secondary was plantar pressure distribution by a pressure platform system during gait and static index foot posture (FPI).

STATISTICAL ANALYSIS

analysis of variance for repeated measure and between groups were used to detect treatment-time interactions (α = 5%). Effect size with D Cohen's also was used between T0 and after six (T6) months of intervention.

RESULTS

The MFG and COIG were effective at reducing pain after six months (MFG: 2.5-4.5 CI, p = 0.001; COIG: 1.5-3.5 CI, p = 0.011). The FFI and FHSQ-Br showed improvements with MFG and COIG after T6 (MFG: 13.7-15.4 CI, p = 0.010; COIG: 11.3-15.0 CI, p = 0.001). The 6MWT increased with MFG (589.3-622.7 CI) and COIG (401.3-644.7 CI) and foot pronation was decreased after T3 and T6 MFG (FPI Right: 4.2-5.4 CI; Left: 3.6-5.4 CI) COIG (FPI Right: 3.4-6.8 CI; Left: 3.3-5.7 CI). The contact area reduced on forefoot and rearfoot with MFG and GOIG and midfoot and rearfoot with MFG. Maximum force was reduced on foot with MFG after T3 and T6. The peak pressure was reduced on the forefoot with MFG and COIG and on midfoot and rearfoot with MFG.

CONCLUSIONS

The mechanical treatment with customized insole and minimalist flexible footwear during gait training program during six months in women with calcaneal spur reduced the calcaneus pain, increased function and health feet and reduced plantar load on the rearfoot, midfoot and forefoot. However, the footwear alone was more effective than when combined customized insole, given the greater efficacy on clinical and biomechanical aspects.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03040557 (date of first registration: 02/02/2017).

Plantar fasciitis injury status influences foot mechanics during running

BACKGROUND

The biomechanical factors related to plantar fasciitis are not well understood. A history of injury is considered a risk factor for subsequent injury, but it is unknown if differences in mechanics exist before, during, and after injury. This study compared gait mechanics among individuals with plantar fasciitis, resolved plantar fasciitis, and uninjured controls.

METHODS

Thirty male and female runners were divided into three groups: 1) plantar fasciitis (n = 10, age 43 ± 11 years); 2) resolved plantar fasciitis (n = 10, age 43 ± 13 years); and 3) control (n = 10, age 38 ± 11 years). Participants ran at preferred velocity and 3.3 m/s while kinematics and kinetics were collected. Variables of interest include vertical loading rate, foot, ankle, knee, and hip kinematics, arch height index, arch rigidity index, and arch drop. Group differences were analyzed at each velocity using one-way analysis of variance.

FINDINGS

The plantar fasciitis group exhibited less forefoot extension (P = 0.02), more midfoot inversion (P < 0.01), and more midfoot extension (P < 0.01) than the resolved plantar fasciitis group. Foot mechanics in controls did not differ. Sagittal knee range of motion was greater in the plantar fasciitis group than resolved or control (P = 0.01). No other variables were significantly different among groups.

INTERPRETATION

The plantar fasciitis group exhibited dynamic foot mechanics which suggest a lower, more flexible arch compared to the resolved group, although static measures of foot structure and ankle motion did not differ. The differences between these groups indicate that the motion of the forefoot and midfoot during gait are important to consider for plantar fasciitis.

Do Arch Height and Arch Stiffness Relate to Physical Performance in Adult Men?

Foot arch plays an important role in bearing body weight, absorbing ground reaction forces and maintaining balance, and its structure and function are bound to have a profound effect on physical activities and sports. Arch height and arch stiffness are 2 factors that represent the structure and function of the arch. Therefore, the purpose of this study was to explore the associations of arch height and arch stiffness with physical performance. A total of 56 men (aged 49.00 ± 7.95 years, mean body mass index [BMI] 26.80 ± 3.75 kg/m²) participated in this study. A 3-dimensional laser scanner was employed to obtain foot structure information of each participant, from which the arch height index (AHI) and arch stiffness index (ASI) were computed. Physical performance measures including agility, power, and proprioception were tested in a random order. The results indicated that the stepping forward and backward and vertical jump that represent agility and force respectively were negatively and significantly associated with AHI (r = -0.27, p = .045; r = -0.35, p = .009). When adjusted for age and BMI, only height of vertical jump was found to be correlated significantly with AHI (r = -0.29, p = .040); while no significant relationships were observed between physical performance measures and ASI. Multivariate linear regression analysis showed that AHI, age, and BMI can effectively predict the height of vertical jump. This study demonstrates that there is a negative correlation between arch height and muscle power of lower limbs in adult men.

Relationships between Plantar Pressure Distribution and Rearfoot Alignment in the Taiwanese College Athletes with Plantar Fasciopathy during Static Standing and Walking

BACKGROUND

Plantar fasciopathy (PF) is usually related to changes in foot arch, foot shape and rearfoot posture. However, little research has been implemented by using large-scale datasets, and even less has been conducted centering on plantar pressure distributions (PPDs) of different genders of PF athletes. This study aimed to investigate the relationships among the arch index (AI), the PPDs and the rearfoot postural alignment in hundreds of college athletes with PF during static standing and walking.

METHODS

Cross-sectional study of 100 male and 102 female athletes with PF was undertaken. The PF athletes' pain assessment and self-reported health status were examined for evaluating their musculoskeletal painful areas.

RESULTS

The PF athletes' PPDs mainly concentrated on inner feet in static standing, and transferred to lateral forefeet during the midstance phase of walking. The males' PPDs from the static standing to the midstance phase of walking mainly transferred to anterolateral feet. The females' PPDs mainly transferred to posterolateral feet. The PF athletes' static rearfoot alignment matched the valgus posture pattern. The medial band of plantar fascia and calcaneus were the common musculoskeletal pain areas.

CONCLUSIONS

Characteristics of higher plantar loads beneath medial feet associated with rearfoot valgus in bipedal static stance could be the traceable features for PF-related foot diagrams. Higher plantar loads mainly exerted on the lateral forefoot during the midstance phase of walking, and specifically concentrated on outer feet during the transition from static to dynamic state. Pain profiles seem to echo PPDs, which could function as the traceable beginning for the possible link among pronated low-arched feet, PF, metatarsalgia, calcanitis and Achilles tendinitis.

Gait Retraining With Visual Biofeedback Reduces Rearfoot Pressure and Foot Pronation in Recreational Runners

CONTEXT

Running is a popular sport globally. Previous studies have used a gait retraining program to successfully lower impact loading, which has been associated with lower injury rates in recreational runners. However, there is an absence of studies on the effect of this training program on the plantar pressure distribution pattern during running.

OBJECTIVE

To investigate the short-term effect of a gait retraining strategy that uses visual biofeedback on the plantar pressure distribution pattern and foot posture in recreational runners.

DESIGN

Randomized controlled trial.

SETTING

Biomechanics laboratory.

PARTICIPANTS

Twenty-four recreational runners were evaluated (n = 12 gait retraining group and n = 12 control group).

INTERVENTION

Those in the gait retraining group underwent a 2-week program (4 sessions/wk, 30 min/session, and 8 sessions). The participants in the control group were also invited to the laboratory (8 times in 2 wk), but no feedback on their running biomechanics was provided.

MAIN OUTCOME MEASURES

The primary outcome measures were plantar pressure distribution and plantar arch index using a pressure platform. The secondary outcome measure was the foot posture index.

RESULTS

The gait retraining program with visual biofeedback was effective in reducing medial and lateral rearfoot plantar pressure after intervention and when compared with the control group. In the static condition, the pressure peak and maximum force on the forefoot and midfoot were reduced, and arch index was increased after intervention. After static training intervention, the foot posture index showed a decrease in the foot pronation.

CONCLUSIONS

A 2-week gait retraining program with visual biofeedback was effective in lowering rearfoot plantar pressure, favoring better support of the arch index in recreational runners. In addition, static training was effective in reducing foot pronation. Most importantly, these observations will help healthcare professionals understand the importance of a gait retraining program with visual biofeedback to improve plantar loading and pronation during rehabilitation.

Correlation of medial longitudinal arch morphology with body characteristics and locomotive function in community-dwelling older women: A cross-sectional study

PURPOSE

This cross-sectional study aimed to investigate the effects of foot arch deformities on physical characteristics, muscular strength, and motor function in older women depending on the presence or absence of pain.

METHODS

Overall, 145 community-dwelling women aged 65 to 90 years were included in this study. We measured the foot arch height ratio (AHR, dorsal height/truncated foot length) and classified participants with AHR values above, below, or within 1.5 standard deviations into the high-arched group (HAG), Low-Arched Group (LAG), or normal-arched group (NAG), respectively. We also compared body characteristics (age, height, weight, body mass index (BMI), and skeletal mass index), muscle strength (handgrip strength and intrinsic foot strength (IFS)), and locomotive function (two-step value and gait speed) among the three groups.

RESULTS

Locomotive examination and muscle strength showed significant differences among the three groups only in the presence of pain; in the two-step test, HAG, NAG, and LAG values were 0.98 cm/cm, 1.19 cm/cm, and 1.18 cm/cm, respectively. The IFS measured 19.2 N, 24.2 N, 31.0 N, respectively, in the HAG, NAG, and LAG.

CONCLUSION

This study suggests that decreased IFS affects the mobility function of high-arched feet in older women. Although there was no significant difference in the evaluation of pain, HAG showed the highest average value, which is considered to contribute to the decreased two-step value. It has been suggested that a high-arched foot in the presence of pain is associated with IFS weakness and may affect the decline of mobility function in older women.

Differences in lower-extremity kinematics between the male military personnel with and without plantar fasciitis

OBJECTIVE

To evaluate the factors that influence gait by comparing lower extremity kinematics during the stance phase of the gait cycle between individuals with and without plantar fasciitis.

DESIGN

A cross-sectional study.

SETTING

Motion analysis research laboratory.

PARTICIPANTS

Thirty subjects with plantar fasciitis and 30 aged-matched controls.

MAIN OUTCOME MEASURE(S)

Range of motion of the lower extremity and multi-segment foot during gait using a three-dimensional motion analysis system.

RESULTS

The plantar fasciitis group showed significant differences in motion in the multi-segment foot, ankle, knee, and hip from the control group during various subphases of the stance phase. Specifically, relative to the control group, the plantar fasciitis group had more rearfoot adduction, forefoot eversion, ankle abduction, and hip abduction. They also had less midfoot dorsiflexion, forefoot dorsiflexion, knee extension, knee external rotation, and hip extension (all Ps < 0.05).

CONCLUSIONS

Individuals with plantar fasciitis exhibited more flexibility in the ankle-foot complex and poorer quality of lower-extremity movement than the group that did not have plantar fasciitis. Thus, differences in structures in both the ankle-foot complex as well as those in the hip and knee joints appear to be associated with the presence of plantar fasciitis.

Clinical measures of foot posture and ankle joint dorsiflexion do not differ in adults with and without plantar heel pain

Foot posture and ankle joint dorsiflexion have long been proposed to be risk factors for plantar heel pain, however body mass may be a confounder when investigating these factors. The aim of this study was to determine if clinical measures of foot posture and ankle joint dorsiflexion differ in adults with and without plantar heel pain after accounting for body mass. This was a cross-sectional observational study that compared 50 participants with plantar heel pain to 25 control participants without plantar heel pain who were matched for age, sex and body mass index. Foot posture was assessed using the Foot Posture Index and the Arch Index. Ankle joint dorsiflexion was assessed with a weightbearing lunge test with the knee extended and with the knee flexed. No significant differences (P < 0.05) were found between the groups for foot posture, whether measured with the Foot Posture Index or the Arch Index. Similarly, no significant differences were found in the weightbearing lunge test whether measured with the knee extended or with the knee flexed. Clinical measures of foot posture and ankle joint dorsiflexion do not differ in adults with and without plantar heel pain when body mass is accounted for. Therefore, clinicians should not focus exclusively on foot posture and ankle dorsiflexion and ignore the contribution of overweight or obesity.

Risk Factors for Plantar Fasciitis in Physically Active Individuals: A Systematic Review and Meta-analysis

CONTEXT

Plantar fasciitis (PF) is a common condition in active individuals. The lack of agreement on PF etiology makes treatment challenging and highlights the importance of understanding risk factors for preventive efforts.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to determine what factors may put physically active individuals at risk of developing PF.

DATA SOURCES

CENTRAL, CINAHL, EMBASE, Gray Lit, LILACS, MEDLINE (PubMed), ProQuest, Scopus, SPORTDiscus, and Web of Science were searched through April 2018 and updated in April 2020.

STUDY SELECTION

Studies were included if they were original research investigating PF risk factors, compared physically active individuals with and without PF, were written in English, and were accessible as full-length, peer-reviewed articles.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 3, because of inconsistent definitions and blinding used in the included observational studies.

DATA EXTRACTION

Data on sample characteristics, study design and duration, groups, PF diagnosis, and risk factors were extracted. The methodological quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology statement. When means and standard deviations of a particular risk factor were presented 2 or more times, that risk factor was included in the meta-analysis.

RESULTS

Sixteen studies were included in the systematic review and 11 risk factors in the meta-analysis. Increased plantarflexion range of motion (weighted mean difference [MD] = 7.04°; 95% CI, 5.88-8.19; P < 0.001), body mass index (MD = 2.13 kg/m²; 95% CI, 1.40-2.86; P < 0.001; I² = 0.00%), and body mass (MD = 4.52 kg; 95% CI, 0.55-8.49; P = 0.026) were risk factors for PF.

CONCLUSION

Interventions focused on addressing a greater degree of plantarflexion range of motion, body mass index, and body mass and their load on the force-absorbing plantar surface structures may be a good starting point in the prevention and treatment of active individuals with PF.

Variable Lower Limb Alignment of Clinical Measures With Digital Photographs and the Footscan Pressure System

OBJECTIVE

This study examines the effect of the lower limb misalignment and its possible compensatory effect on plantar pressure in a normal population. The aim of this paper is to present a structured method for the analysis of posture and its changes using a standardized digital photography technique and plantar pressure measuring device.

DESIGN

Cohort.

SETTING

Laboratory.

PARTICIPANTS

A total of 200 adult volunteers between 18 and 22 years of age who had no current symptoms of pain and foot or ankle pathology participated in the study.

MAIN OUTCOME MEASURES

The gold standard measure of lower limb alignment with weight-bearing status is the mechanical axis and their angles using Image J software. Structural and functional measurements of the same foot were taken using a plantar pressure measuring device. In this study, 5 alignment (thigh, knee, leg, ankle, and foot) characteristics were measured on the lower limb using the 2 techniques, and, additionally, the foot contact area, peak pressure, foot axis, rearfoot angle, and subtalar joint flexibility score were analyzed in 10 different regions of the foot.

RESULTS

This study has shown a reasonable correlation between digitalized measurements and plantar pressures values. Quadriceps angle affected midfoot impulse, foot axis angle, subtalar joint minimum angle, and rearfoot angle positively. Subtalar joint flexibility scores were analyzed in 10 different regions of the foot. There was a positive correlation between rearfoot angle and quadriceps angle (P = .009, r = .261). Results of both methods show that they endorse each other.

CONCLUSIONS

The posture of the standing feet may have influence on lower limb alignment. Currently, there are no studies carried out by using digital photogrammetry and foot scan. The authors claim that patient-friendly digital photogrammetry would have a positive contribution to the monitoring of patients, even including new ones in the treatment programs, reducing any possible loss in the personal and national economy.

Plantar pressure distribution and spatiotemporal gait parameters after the radial shock wave therapy in patients with chronic plantar fasciitis

Radial shock wave therapy (RSWT) has been recommended as an appropriate, safe and effective method in the treatment of chronic plantar fasciitis (PF). The main purpose of this study was to examine how RSWT affects gait parameters. This study included 23 patients with unilateral, chronic PF. RSWT were administered in 5 interventions, during a consecutive 3-week period. Objective kinetic (force distribution under the forefoot, midfoot, rearfoot) and spatiotemporal parameters (cadence, step length, stance phase duration) during treadmill walking at, preferred" speed were evaluated on. 4 sessions: before therapy, immediately after (primary endpoint), 3 and 6 weeks after therapy. The mean reduction in the reported pain when taking first steps in the morning from baseline to the primary endpoint, 3- and 6-weeks post procedure was 42.7%, 50.1% and 66.9% respectively. Similar reduction was seen in the reported pain during walking. After the therapy during gait at the preferred speed patients had a significantly higher force beneath the rearfoot and forefoot of both limbs. Force beneath the midfoot was not significantly affected by treatment. The step length in both limbs increased by 3.3-3.6 cm after RSWT. After the therapy stance phase duration in symptomatic foot was longer by 7% and it slightly decreased until POST-6wk. Similar changes were seen in an asymptomatic limb. The spatiotemporal and kinetic results indicate that RSWT therapy induces changes in patient's gait structure and alter regional loading in the affected foot.

Role of mechanical factors in the clinical presentation of plantar heel pain: Implications for management

Plantar heel pain is a common musculoskeletal foot disorder that can have a negative impact on activities of daily living and it is of multifactorial etiology. A variety of mechanical factors, which result in excessive load at the plantar fascia insertion, are thought to contribute to the onset of the condition. This review presents the evidence for associations between commonly assessed mechanical factors and plantar heel pain, which could guide management. Plantar heel pain is associated with a higher BMI in non-athletic groups, reduced dorsiflexion range of motion, as well as reduced strength in specific foot and ankle muscle groups. There is conflicting, or insufficient evidence regarding the importance of foot alignment and first metatarsophalangeal joint range of motion. Plantar heel pain appears to be common in runners, with limited evidence for greater risk being associated with higher mileage or previous injuries. Conflicting evidence exists regarding the relationship between work-related standing and plantar heel pain, however, longer standing duration may be associated with plantar heel pain in specific worker groups. The evidence presented has been generated through studies with cross-sectional designs, therefore it is not known whether any of these associated factors have a causative relationship with plantar heel pain. Longitudinal studies are needed to ascertain whether the strength and flexibility impairments associated with plantar heel pain are a cause or consequence of the condition, as well as to establish activity thresholds that increase risk. Intervention approaches should consider strategies that improve strength and flexibility, as well as those that influence plantar fascia loading such as body weight reduction, orthoses and management of athletic and occupational workload.

Clinical Measures and Their Contribution to Dysfunction in Individuals With Patellar Tendinopathy

CONTEXT

Patellar tendinopathy (PT) is prevalent in physically active populations, and it affects their quality of living, performance of activity, and may contribute to the early cessation of their athletic careers. A number of previous studies have identified contributing factors for PT; however, their contributions to self-reported dysfunction remain unclear.

OBJECTIVE

The purpose of this investigation was to determine if strength, flexibility, and various lower-extremity static alignments contributed to self-reported function and influence the severity of PT.

DESIGN

Cross-sectional research design.

SETTING

University laboratory.

PARTICIPANTS

A total of 30 participants with PT volunteered for this study (age: 23.4 [3.6] y, height: 1.8 [0.1] m, mass: 80.0 [20.3] kg, body mass index: 25.7 [4.3]).

MAIN OUTCOME MEASURES

Participants completed 7 different patient-reported outcomes. Isometric knee extension and flexion strength, hamstring flexibility and alignment measures of rearfoot angle, navicular drop, tibial torsion, q-angle, genu recurvatum, pelvic tilt, and leg length differences were assessed. Pearson's correlation coefficients were assessed to determine significantly correlated outcome variables with each of the patient-reported outcomes. The factors with the highest correlations were used to identify factors that contribute the most to pain and dysfunction using backward selection, linear regression models.

RESULTS

Correlation analysis found significant relationships between questionnaires and body mass index (r = -.35-.46), normalized knee extension (r = .38-.50) and flexion strength (r = -.34-.50), flexibility (r = .32-.38, q-angle (r = .38-.56), and pelvic tilt (r = -.40). Regression models (R² = .22-.54) identified thigh musculature strength and supine q-angle to have greatest predictability for severity in patient-reported outcomes.

CONCLUSIONS

These findings put an emphasis of bodyweight management, improving knee extensor and flexor strength, and posterior flexibility in PT patients.

Influence of rearfoot alignment on static and dynamic postural stability

Background/Aims:

It has been postulated that foot alignment affects postural stability. However, previous studies reported contradicting results regarding the association between foot alignment and postural stability.

Methods:

A total of 216 healthy participants aged 15 to 24 years were recruited. Their rearfoot alignment was measured in non-weight bearing and weight-bearing positions. Their static balance was assessed using Balance Error Scoring System and dynamic balance by Star Excursion Balance Test. The relationship between the data obtained were analysed using SPSS version 22 software.

Findings:

A Pearson correlation with a 95% confidence interval reported that there was: (i) no significant difference in the rearfoot alignment between both genders; (ii) no significant relationship between the rearfoot alignment measured in prone lying and unilateral stance position; (iii) a weak negative correlation between the rearfoot alignment measured in prone lying position to dynamic balance on medial, posterior, lateral, anterolateral and posteromedial direction; (iv) no significant relationship between the rearfoot alignment measured in unilateral stance position to both static and dynamic postural balance.

Conclusions:

Rearfoot alignment measured in non-weight bearing position plays some role in postural stability and therefore should be considered in sports rehabilitation. However, this can be overlooked in rehabilitation for individuals whose postural stability is not the primary concern.

Forefoot transverse arch height asymmetry is associated with foot injuries in athletes participating in college track events

[Purpose] The association between foot injuries and foot alignment, including the transverse arch height (TAH) and asymmetry, was examined in athletes participating in college track events. [Participants and Methods] This study included 55 male athletes participating in a college track and field club. Data including demographic information and the incidence of foot injuries within a year prior to participation in this study were obtained via questionnaires. TAH and the medial longitudinal arch height during 10 and 90% loading, leg-heel alignment, and the heel angle were measured before calculating the asymmetry of each alignment parameter measured. Participants were categorized into an injury or a normal group. Unpaired t-tests were used to perform between-group comparisons for each alignment parameter measured and asymmetry. Additionally, logistic regression analysis was performed to identify factors associated with foot injuries after adjustment for demographic data. [Results] TAH asymmetry during 10 and 90% loading was significantly greater in the injury group. Further logistic regression analysis performed showed that only TAH asymmetry during 90% loading was significantly associated with foot injuries after adjustment for demographic data. [Conclusion] With regard to track events, a greater asymmetry of forefoot TAH in a weight-bearing position was observed to be associated with foot injuries.

Risk and Protective Factors for Middle- and Long-Distance Running-Related Injury

BACKGROUND

Despite a rapidly growing body of research, a systematic evidence compilation of the risk and protective factors for middle- and long-distance running-related injury (RRI) was lacking.

OBJECTIVES

Our objective was to compile the evidence about modifiable and non-modifiable training-related and behavioral risk and protective factors for middle- and long-distance RRI.

METHODS

We searched five databases (PubMed, CINAHL, MEDLINE, SPORTDiscus, and PsycINFO) for the dates 1 January 1970 to 31 December 2015, inclusive, for original peer-reviewed articles. The eligible designs were cross-sectional, case-control, longitudinal observational studies, and randomized controlled trials involving runners competing at distances from ≥800 m to ≤42.2 km. Outcomes were any specific and/or general RRI, and exposures included training-related and behavioral factors. We extracted authors and date, study design, injury type(s), descriptors and comparators for each exposure, and results and measures of association from the selected studies. Methodological quality was independently appraised using two separate checklists: a modified checklist for observational study designs and the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials.

RESULTS

Among 73 articles eligible for inclusion, 19 (26.0%) and 30 (41.0%) were of high or satisfactory methodological quality, respectively. As a non-modifiable exposure, a history of previous injury was found to be associated with an increased risk of both general and specific RRI. In terms of modifiable exposures, irregular and/or absent menstruation was found to be associated with an increased risk of stress fracture development, whereas the use of oral contraceptives was found to be associated with a decreased risk. High clinical, methodological, and statistical heterogeneity meant it was not feasible to estimate a pooled effect size across similar studies.

CONCLUSIONS

A history of previous injury was associated with an increased risk of both general and specific RRI. The use of oral contraceptives was found to be associated with a decreased risk of skeletal stress fracture. Conversely, irregular and/or absent menstruation was associated with an increased risk. The varied effect directions and/or a number of statistically insignificant results associated with the majority of factors hindered our ability to draw any definitive conclusions about their relationship to RRI risk.

Use of high speed stereo radiography to assess the foot orthoses effectiveness in controlling midfoot posture during walking: A pilot study

BACKGROUND

The intent of this pilot study was to determine the feasibility of using high-speed stereo radiography (HSSR) to assess the effectiveness of footwear and foot orthoses in controlling the change in the position of the midfoot during walking in individuals with a flexible pes planus foot type.

METHODS

Four individuals (1 female; 3 male) with a mean age of 25 years (range 22-29) and a bilateral flexible pes planus foot type participated in the study. The HSSR system was used to measure 3-dimensional changes in the longitudinal arch angle (LAA) with each participant walking barefoot, shoe only and shoes with orthoses.

RESULTS

The HSSR system was found to be highly effective in measuring the change in the position of the midfoot, as measured using the LAA, when wearing footwear with or without foot orthoses. Based on an assessment of mean values, three out of the four participants demonstrated a change in the LAA as a result of using either shoes only or shoes with orthoses. The methodology used in this pilot study for assessing the effect of footwear and foot orthoses on the posture of the midfoot was highly effective with no side-effects noted by any of the study participants.

CONCLUSIONS

Future studies using the HSSR will require modifications to participant inclusion criteria as well as alterations to the data collection methodology. The HSSR system used in this study is feasible for use in larger cohort studies assessing footwear and foot orthosis effectiveness with the described modifications.

Gender difference in factors affecting the medial longitudinal arch height of the foot in healthy young adults

[Purpose] Medial longitudinal arch (MLA) height is associated with various injuries and diseases and gender differences, if any. This study aimed to examine factors affecting the MLA height associated with gender differences in healthy subjects with no orthopedic disorders. [Subjects and Methods] This study included 36 healthy adults (19 males, 17 females; mean age, 21.8 ± 3.6 years; body mass index, 21.1 ± 2.0 kg/m²). Their height, body weight, foot length, muscle strength of the tibialis posterior muscle (TPM), toe-gripping strength, hallux valgus angle, inversion microdactylia angle, angle of leg-heel alignment, femoro-tibial angle, and navicular height were measured. Correlation between the ratio of arch height and other measurement parameters was examined. [Results] In females, the ratio of arch height was significantly positively correlated with muscle strength of the TPM and toe-gripping strength and negatively correlated with the hallux valgus angle and the leg-heel alignment, whereas in males, only a positive correlation between the ratio of arch height and muscle strength of the TPM was observed. [Conclusion] These results reveal that etiological mechanisms determining MLA height are different between males and females. Overall, the present results indicate that further studies identifying causes of MLA height variation must include gender-based analysis.

Biomechanical Parameters in Plantar Fasciitis Measured by Gait Analysis System With Pressure Sensor

Objective

To investigate the differences in biomechanical parameters measured by gait analysis systems between healthy subjects and subjects with plantar fasciitis (PF), and to compare biomechanical parameters between ‘normal, barefooted’ gait and arch building gait in the participants.

Methods

The researchers evaluated 15 subjects (30 feet) with bilateral foot pain and 15 subjects (15 feet) with unilateral foot pain who had a clinical diagnosis of PF. Additionally, 17 subjects (34 feet) who had no heel pain were recruited. Subjects were excluded if they had a traumatic event, prior surgery or fractures of the lower limbs, a leg length discrepancy of 1 cm or greater, a body mass index greater than 35 kg/m², or had musculoskeletal disorders. The participants were asked to walk with an arch building gait on a treadmill at 2.3 km/hr for 5 minutes. Various gait parameters were measured.

Results

With the arch building gait, the PF group proved that gait line length and single support line were significantly decreased, and lateral symmetry of the PF group was increased compared to that of the control group. The subjects with bilateral PF displayed significantly increased maximum pressure over the heel and the forefoot during arch building gait. In addition, the subjects with unilateral PF showed significantly increased maximum pressure over the forefoot with arch building gait.

Conclusion

The researchers show that various biomechanical differences exist between healthy subjects and those with PF. Employing an arch building gait in patients with PF could be helpful in changing gait patterns to normal biomechanics.

The use of a static measure to predict foot posture at midstance during walking

Previous studies have successfully used the longitudinal arch angle (LAA) to assess foot posture, but the measurement consistency and ability of the LAA to predict dynamic foot posture during activity in a variety of foot types have not been evaluated. The purpose of this study was to determine the reliability of the LAA as well as if the clinical method of assessing the LAA could be used to predict the LAA at midstance during walking for supinated, normal, and pronated foot types. The Arch Height Ratio was used to select 35 participants with 12 supinated, 46 normal, and 12 pronated feet. A standard goniometer was used to measure the LAA (CLINIC_LAA) on both feet while standing. Both feet were then filmed using a high speed camera while walking on a treadmill. The LAA was determined by the angle formed by two lines drawn between the markers placed on the first metatatarsal and medial malleolus with the apex the navicular tuberosity. The LAA in midstance (WALK_LAA) was determined using the mean of five walking trials. The reliability of the CLINIC_LAA assessed on both feet by two raters over two days were excellent. There was no difference between the left and right foot for the CLINIC_LAA. The Pearson correlation between CLINIC_LAA and WALK_LAA for all 70 feet was r=0.96 (r²=0.92). The results indicate the LAA is highly predictive of foot posture at midstance in walking explaining over 90% of the variance for a wide range of foot types.

Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study

BACKGROUND

The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined.

OBJECTIVE

The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases.

METHOD

Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces.

RESULTS

The multiple regression analyses indicated that both the force-time integral (R²=0.15 for acute phase PF; R²=0.17 for chronic PF) and maximum force (R²=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R²=0.18) and chronic (R²=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R²=0.19) and chronic (R²=0.40).

CONCLUSION

The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot.

Dynamic Patterns of Forces and Loading Rate in Runners with Unilateral Plantar Fasciitis: A Cross-Sectional Study

Aim/Hypothesis

The etiology of plantar fasciitis (PF) has been related to several risk factors, but the magnitude of the plantar load is the most commonly described factor. Although PF is the third most-common injury in runners, only two studies have investigated this factor in runners, and their results are still inconclusive regarding the injury stage.

Objective

Analyze and compare the plantar loads and vertical loading rate during running of runners in the acute stage of PF to those in the chronic stage of the injury in relation to healthy runners.

Methods

Forty-five runners with unilateral PF (30 acute and 15 chronic) and 30 healthy control runners were evaluated while running at 12 km/h for 40 meters wearing standardized running shoes and Pedar-X insoles. The contact area and time, maximum force, and force-time integral over the rearfoot, midfoot, and forefoot were recorded and the loading rate (20–80% of the first vertical peak) was calculated. Groups were compared by ANOVAs (p<0.05).

Results

Maximum force and force-time integral over the rearfoot and the loading rate was higher in runners with PF (acute and chronic) compared with controls (p<0.01). Runners with PF in the acute stage showed lower loading rate and maximum force over the rearfoot compared to runners in the chronic stage (p<0.01).

Conclusion

Runners with PF showed different dynamic patterns of plantar loads during running over the rearfoot area depending on the injury stage (acute or chronic). In the acute stage of PF, runners presented lower loading rate and forces over the rearfoot, possibly due to dynamic mechanisms related to pain protection of the calcaneal area.

Heel pain-plantar fasciitis: revision 2014

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to nonarthritic heel pain.

Associations of foot posture and function to lower extremity pain: results from a population-based foot study

OBJECTIVE

Studies have implicated foot posture and foot function as risk factors for lower extremity pain. Empirical population-based evidence for this assertion is lacking; therefore, the purpose of this study was to evaluate cross-sectional associations of foot posture and foot function to lower extremity joint pain in a population-based study of adults.

METHODS

Participants were members of the Framingham Foot Study. Lower extremity joint pain was determined by the response to the National Health and Nutrition Examination Survey-type question, "On most days do you have pain, aching or stiffness in your (hips, knees, ankles, or feet)?" The Modified Arch Index classified participants as having planus, rectus (referent), or cavus foot posture. The Center of Pressure Excursion Index classified participants as having overpronated, normal (referent), or oversupinated foot function. Crude and adjusted (age, sex, and body mass index) logistic regression determined associations of foot posture and function to lower extremity pain.

RESULTS

Participants with planus structure had higher odds of knee (odds ratio [OR] 1.57, 95% confidence interval [95% CI] 1.24-1.99) or ankle (OR 1.47, 95% CI 1.05-2.06) pain, whereas those with a cavus foot structure had increased odds of ankle pain only (OR 7.56, 95% CI 1.99-28.8) and pain at 1 lower extremity site (OR 1.37, 95% CI 1.04-1.80). Associations between foot function and lower extremity joint pain were not statistically significant except for a reduced risk of hip pain in those with an oversupinated foot function (OR 0.69, 95% CI 0.51-0.93).

CONCLUSION

These findings offer a link between foot posture and lower extremity pain, highlighting the need for longitudinal or intervention studies.

Association between foot type and lower extremity injuries: systematic literature review with meta-analysis

STUDY DESIGN

Systematic literature review with meta-analysis.

OBJECTIVES

To investigate the association between nonneutral foot types (high arch and flatfoot) and lower extremity and low back injuries, and to identify the most appropriate methods to use for foot classification.

METHODS

A search of 5 electronic databases (PubMed, Embase, CINAHL, SPORTDiscus, and ProQuest Dissertations and Theses), Google Scholar, and the reference lists of included studies was conducted to identify relevant articles. The review included comparative cross-sectional, case-control, and prospective studies that reported qualitative/quantitative associations between foot types and lower extremity and back injuries. Quality of the selected studies was evaluated, and data synthesis for the level of association between foot types and injuries was conducted. A random-effects model was used to pool odds ratio (OR) and standardized mean difference (SMD) results for meta-analysis.

RESULTS

Twenty-nine studies were included for meta-analysis. A significant association between nonneutral foot types and lower extremity injuries was determined (OR = 1.23; 95% confidence interval [CI]: 1.11, 1.37; P<.001). Foot posture index (OR = 2.58; 95% CI: 1.33, 5.02; P<.01) and visual/physical examination (OR = 1.17; 95% CI: 1.06, 1.28; P<.01) were 2 assessment methods using distinct foot-type categories that showed a significant association with lower extremity injuries. For foot-assessment methods using a continuous scale, measurements of lateral calcaneal pitch angle (SMD, 1.92; 95% CI: 1.44, 2.39; P<.00001), lateral talocalcaneal angle (SMD, 1.36; 95% CI: 0.93, 1.80; P<.00001), and navicular height (SMD, 0.34; 95% CI: 0.16, 0.52; P<.001) showed significant effect sizes in identifying high-arch foot, whereas the navicular drop test (SMD, 0.45; 95% CI: 0.03, 0.87; P<.05) and relaxed calcaneal stance position (SMD, 0.49; 95% CI: 0.01, 0.97; P<.05) displayed significant effect sizes in identifying flatfoot. Subgroup analyses revealed no significant associations for children with flatfoot, cross-sectional studies, or prospective studies on high arch.

CONCLUSIONS

High-arch and flatfoot foot types are associated with lower extremity injuries, but the strength of this relationship is low. Although the foot posture index and visual/physical examination showed significance, they are qualitative measures. Radiographic and navicular height measurements can delineate high-arch foot effectively, with only anthropometric measures accurately classifying flatfoot.

LEVEL OF EVIDENCE

Prognosis, level 2a.

Foot disorders, foot posture, and foot function: the Framingham foot study

INTRODUCTION

Foot disorders are common among older adults and may lead to outcomes such as falls and functional limitation. However, the associations of foot posture and foot function to specific foot disorders at the population level remain poorly understood. The purpose of this study was to assess the relation between specific foot disorders, foot posture, and foot function.

METHODS

Participants were from the population-based Framingham Foot Study. Quintiles of the modified arch index and center of pressure excursion index from plantar pressure scans were used to create foot posture and function subgroups. Adjusted odds ratios of having each specific disorder were calculated for foot posture and function subgroups relative to a referent 3 quintiles.

RESULTS

Pes planus foot posture was associated with increased odds of hammer toes and overlapping toes. Cavus foot posture was not associated with the foot disorders evaluated. Odds of having hallux valgus and overlapping toes were significantly increased in those with pronated foot function, while odds of hallux valgus and hallux rigidus were significantly decreased in those with supinated function.

CONCLUSIONS

Foot posture and foot function were associated with the presence of specific foot disorders.

Effect of image resolution manipulation in rearfoot angle measurements obtained with photogrammetry

The aim of this study was to investigate the influence of image resolution manipulation on the photogrammetric measurement of the rearfoot static angle. The study design was that of a reliability study. We evaluated 19 healthy young adults (11 females and 8 males). The photographs were taken at 1536 pixels in the greatest dimension, resized into four different resolutions (1200, 768, 600, 384 pixels) and analyzed by three equally trained examiners on a 96-pixels per inch (ppi) screen. An experienced physiotherapist marked the anatomic landmarks of rearfoot static angles on two occasions within a 1-week interval. Three different examiners had marked angles on digital pictures. The systematic error and the smallest detectable difference were calculated from the angle values between the image resolutions and times of evaluation. Different resolutions were compared by analysis of variance. Inter- and intra-examiner reliability was calculated by intra-class correlation coefficients (ICC). The rearfoot static angles obtained by the examiners in each resolution were not different (P > 0.05); however, the higher the image resolution the better the inter-examiner reliability. The intra-examiner reliability (within a 1-week interval) was considered to be unacceptable for all image resolutions (ICC range: 0.08-0.52). The whole body image of an adult with a minimum size of 768 pixels analyzed on a 96-ppi screen can provide very good inter-examiner reliability for photogrammetric measurements of rearfoot static angles (ICC range: 0.85-0.92), although the intra-examiner reliability within each resolution was not acceptable. Therefore, this method is not a proper tool for follow-up evaluations of patients within a therapeutic protocol.