A digital photographic measurement method for quantifying foot posture: validity, reliability, and descriptive data

Foot kinematics in runners with plantar heel pain during running gait

BACKGROUND

Plantar heel pain associated with plantar fascia pathology (PHP) is one of the most common running overuse injuries. Degeneration and changes in the mechanical properties of the plantar fascia associated with PHP can result in changes in foot kinematics during gait.

RESEARCH QUESTION

How do running gait foot kinematics differ between female and male runners with and without PHP?

METHODS

Retrospective study of 13 runners with PHP (7 female, 6 male) and a matched group of 13 uninjured runners (6 female, 7 male). A seven-segment foot model was used to quantify six functional articulations (rearfoot complex, lateral and medial midfoot, lateral and medial forefoot, and first metatarsophalangeal). Functional articulation ROM during early, mid, and propulsion running stance subphases was assessed. Two-way ANOVAs and Friedman's two-way ANOVA for ranks tests were conducted for normally distributed variables and non-normally distributed variables, respectively.

RESULTS

During early stance, PHP runners demonstrated significantly increased lateral midfoot eversion ROM compared to uninjured runners. During the propulsion phase, male runners with PHP demonstrated increased medial midfoot eversion and dorsiflexion ROM and increased medial forefoot plantar flexion compared to uninjured male runners. Also during propulsion, females with PHP went through significantly less medial forefoot plantar flexion ROM compared to uninjured female runners.

SIGNIFICANCE

Given the function of the plantar fascia to assist foot supination, the differences in runners with PHP, which were consistent with increased pronation or inadequate supination, may be the result of insufficient tension during the stance phase of running gait caused by degeneration of the plantar fascia. Further, the significant medial midfoot and medial forefoot group by sex interactions during propulsion suggest that PHP may affect male and female runners differently. Understanding the effect of PHP on foot function during running may aid in the development of future rehabilitation programs and/or treatment outcome assessments.

Reliability and Convergent Validity of Digital Photography in Assessing Postural Orientation of Children with Cerebral Palsy: A Methodological Study

Background: This study aimed to assess the test-retest intra-rater reliability and convergent validity of digital photography (DP) in detecting the postural orientation of children with cerebral palsy (CP). Methods: The study recruited children with various types of CP with the Gross Motor Function Classification System level I or II and spasticity < 2 on the Ashworth Scale, without any visual or cognitive impairments. Children who had undergone any surgical intervention or received a botulinum toxin injection within the previous six months were excluded. A digital camera was fixed at 1.5 meters from the participants at the height of 90 cm. Non-reflective markers were attached to eight anatomical landmarks to localize the upper and lower center of mass on both sides. The same examiner took three digital photos to detect intra-rater reliability using the intraclass correlation coefficient (ICC). Pearson's correlation and linear regression analysis were used to assess the convergent validity of the DP method compared with the Pediatric Balance Scale (PBS) scores. Results: Thirty children (7.44 ± 2.38 years) were assessed to test the reliability of DP, and 55 others (8.06 ± 2.19 years) participated in the convergent validity study. Intra-rater reliability was found to be perfect (ICC > 0.995) and there was a strong significant negative correlation between DP measures and PBS scores (Pearson's correlation > 0.75) with high adjusted R2 (R2 > 0.567), indicating goodness of fit between the measures. Conclusions: Digital photography (DP) is a reliable and valid method for assessing postural orientation in children with various types of CP.

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.

2D:4D Ratio and Autism Spectrum Disorder in Brunei Darussalam

Background

Despite the global increase in the prevalence of autism spectrum disorders (ASD), relevant research studies are lacking in Brunei Darussalam. Various studies have shown a significant association between a lowered 2D:4D ratio (ratio of second digit/index finger to the fourth digit/ring finger) and ASD, making it one of the potential phenotypic biomarkers for early detection of autism, which is important for early intervention and management.

Objective

The objective of this study is to explore the association between 2D:4D ratio and ASD in Brunei Darussalam, as a potential tool to complement early ASD diagnosis.

Methods

We conducted a case–control study comprising 28 ASD and 62 typically developing (TD) children in the case and control group, respectively (age range: 3–11 years old; median age: 6 years old). Median 2D:4D ratios were measured, compared and analysed between the two groups. Logistic regression models were used to explore potential associations between the median 2D:4D ratio and ASD in respective gender, for both left and right hands, independently.

Results

Our study shows that the median 2D:4D ratio of left hand in ASD males is significantly lower than those in TD males, after adjusting for ethnicity and age [Odds Ratio (OR) = 0.57 (95% Confidence Interval (CI): 0.31–0.96); p = 0.044]. For females, there is no association of ASD with the median left hand 2D:4D ratio [OR = 3.09 (95% CI: 0.98–19.86); p = 0.144] or the median right hand 2D:4D ratio [OR = 1.23 (95% CI: 0.42–3.88); p = 0.702]. Our study also shows a significant positive correlation and/or a reduced asymmetry between the average 2D:4D ratio of left hands and right hands in ASD males (Pearson’s correlation (r) = 0.48; 95% CI: 0.076–0.75, p = 0.023).

Conclusions

There is significant association between a lowered median 2D:4D ratio of the left hand (in males only) and ASD diagnosis. Once validated in a larger sample size, a lowered median 2D:4D ratio on the left hand may be a potential tool to complement ASD diagnosis for males in our study population. There is no association between the median 2D:4D ratio (left or right hands) and ASD in females, which could be due to the small female sample size and/or the possibility of different aetiology for ASD in females. Reduced asymmetry between the average 2D:4D ratio of left and right hands observed in ASD males only (not in ASD females) also suggests the importance of considering gender-specific biomarkers for ASD diagnosis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10803-021-04899-9.

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.

THE CONSTRAINING EFFECT OF THE LATERAL FEMORAL INTERMUSCULAR SEPTUM ON PASSIVE HIP ADDUCTION IN UN-EMBALMED CADAVERS

BACKGROUND

Due to the lack of verifiable iliotibial band elongation in response to stretching, the anatomical, biomechanical, and physiological responses to treatment of iliotibial band syndrome remain unclear. The lateral intermuscular septum, consisting of multiple myofibroblasts, firmly anchors the iliotibial band to the femur.

PURPOSE AND HYPOTHESIS

The purpose of this in-situ study was to examine the constraining effect of the lateral intermuscular septum on available passive hip adduction range of motion in un-embalmed cadavers. It was hypothesized that an iliotibial band-septum-complex release would significantly increase passive hip adduction.

DESIGN

Within-specimen repeated measures in-situ design.

SETTING

Anatomy laboratory.

METHODS

Metal markers were inserted into selected anatomical landmarks in eleven (11) un-embalmed human cadavers. With the specimen supine, the test-side lower limb was passively adducted until maximum passive hip adduction was reached. This movement was repeated three times each within two conditions: (1) band-septum-complex intact and (2) band-septum-complex dissected. Digital video of marker displacement was captured throughout each trial. Still images from a start and an end position were extracted from each video sequence. A custom Matlab program was used to calculate frontal plane hip adduction angle changes from obtained images.

RESULTS

Mean change in passive hip adduction after band-septum-complex release was -0.3 ° (SD 1.6 °;95% CI: -1.33,0.76). A paired samples t-test revealed a non-significant difference (t=-.611; p=.555) in passive hip adduction for the band-septum-dissected condition (18.8 ± 3.9 °) versus the band-septum-intact condition (18.5 °±4.7 °).

CONCLUSION

The lateral intermuscular septum does not appear to have a constraining effect on passive hip adduction in un-embalmed cadavers. Future research should evaluate the constraining effect of other selected tissues and conditions on hip adduction. Furthermore, inflammatory, metabolic, viscoelastic, and sensorimotor control properties within the iliotibial band in response to stretching should be investigated.

LEVEL OF EVIDENCE

3.

Inter- and intraclass correlations for three standard foot radiographic measurements for plantar surface angles. Which measure is most reliable?

BACKGROUND

The purpose of this study was to evaluate the reliability and reproducibility of three commonly used radiographic measures for plantar surface angles.

METHODS

The calcaneal angle (CA), calcaneal pitch angle (CPA), and length-height index (LHI) was measured by three independent examiners on two occasions on lateral foot radiographs. Intra- and inter-rater correlations were calculated using a general linear estimate model and post-hoc tests for repeated measures. Bland-Altman's plots with limits of agreement were used for observer differences in scores.

RESULTS

The intra-class correlations for the CA ranged from 0.91 to 0.94, for the CPA from 0.93 to 0.98, and for the LHI from 0.96 to 0.97. The inter-class correlations were 0.80 for CA, 0.83 for CPA and 0.93 for LHI.

CONCLUSIONS

The results of this study strongly suggest that the length-height index was the most consistent and reliable measure for arch height.

LEVEL OF EVIDENCE

Diagnostic Level II, validity.

The influence of operator and wheelchair factors on wheelchair propulsion effort

Purpose: The goal of this study was to evaluate the relative influence of operator and wheelchair factors on propulsion effort during over-ground wheelchair manoeuvres.Method: This observational study included 23 full-time manual wheelchair users and 13 able-bodied subjects. The operator factors included shoulder position, aerobic capacity and propulsion strength. The wheelchair factors included system mass, weight distribution, and frictional loss in straight and turning trajectories. The performance of over-ground manoeuvres was defined as the propulsion effort measured by VO₂ as operators propelled along a modified figure-8 course on tile and carpet surfaces.Results: According to our regression model, shoulder position was the only significant contributor within operator factors, whereas weight distribution was the only significant contributor within wheelchair factors in influencing propulsion efforts. When combining operator and mechanical factors in the regression model, weight distribution became the only significant contributor to influence propulsion effort.Conclusion: Weight distribution and shoulder position had a significant influence on propulsion effort. These variables are related to the operator's relationship to the drive wheels. However, system mass and muscle strength had the least influence on wheelchair manoeuvres. Our finding can help clinicians to improve wheelchair configurations and manufacturers to improve wheelchair design by understanding the importance of shoulder position and weight distribution.Implication for rehabilitationStudying wheelchair manoeuvers by considering both wheelchair and operator factors might provide a unique insight to address the complex interactions among wheelchair designs and users.Propulsion effort decreases as percentage weight is increased on the drive wheels and the shoulder becomes more aligned with the axle position, which highlights the need to optimize wheelchair axle position.Wheelchair configuration, as represented by weight distribution, had a more significant influence on everyday manoeuvre than wheelchair mass does.It is essential for wheelchair users to choose a wheelchair that can match their daily needs and anthropometric measurements for saving propulsion efforts.

THE EFFECTS OF POSTERIOR TIBIAL MOBILIZATION ON MENISCAL MOVEMENT: AN IN-SITU INVESTIGATION

BACKGROUND

Anterior knee pain during knee extension may be related to a meniscal movement restriction and increased meniscal load during function. One method of treatment involves the use of manual posterior mobilization of the tibia to specifically target the meniscotibial interface of the knee joint.

PURPOSE

The purpose of this study was to measure motion at a cadaveric medial meniscus anterior horn during a posterior tibial mobilization.

STUDY DESIGN

Prospective, multifactorial, repeated-measures laboratory study.

METHODS

Eight unembalmed cadaveric knee specimens were mounted in a custom apparatus and markers were placed in the medial meniscus, tibia and femur. The tibia was posteriorly mobilized in two randomized knee positions (0 degrees and 25 degrees) using three randomly assigned loads (44.48N, 88.96N, and 177.93N). Markers were photographed and digitally measured and analyzed.

RESULTS

All load x position conditions produced anterior displacement of the meniscus on the tibia, where the displacement was significant [t (7) = -3.299; p = 0.013] at 0 degrees loaded with 177.93N (mean 0.41 ± 0.35 mm). The results of 2(position) x 3(load) repeated measures ANOVA for meniscotibial displacement produced no significant main effects for load [F (2,14) = 2.542; p = 0.114) or position [F (1,7) = 0.324, p = 0.587]. All load x position conditions produced significant posterior tibial and meniscal displacement on the femur. The 2(position) x 3(load) repeated measures ANOVA revealed a significant main effect for load for both femoral marker displacement relative to the tibial axis [F (2,14) = 77.994; p < 0.001] and meniscal marker displacement relative to the femoral marker [F (2,14) = 83.620; p < 0.001].

CONCLUSION

Use of a mobilization technique to target the meniscotibial interface appears to move the meniscus anteriorly on the tibia. It appears that this technique may be most effective at the end range position.

LEVEL OF EVIDENCE

2 (laboratory study).

Foot Structure and Function in Habitually Barefoot and Shod Adolescents in Kenya

Habitually barefoot (HB) children from the Kalenjin tribe of Kenya are known for their high physical activity levels. To date, there has been no comprehensive assessment of foot structure and function in these highly active and HB children/adolescents and link with overuse injuries.

PURPOSE

The aim of this research is to assess foot structure, foot function, injury and physical activity levels in Kenyan children and adolescents who are HB compared with those who were habitually shod (HS).

METHODS

Foot structure, function, injury prevalence, and physical activity levels were studied using two studies with equal numbers of HS and HB. HS and HB children and adolescents were matched for age, sex, and body mass. Foot arch characteristics, foot strength, and lower-limb injury prevalence were investigated in Study 1 (n = 76). Heel bone stiffness, Achilles tendon moment arm length and physical activity levels in Study 2 (n=62). Foot muscle strength was measured using a strength device TKK 3360 and heel bone stiffness by bone ultrasonometry. The moment arm length of the Achilles tendon was estimated from photographs and physical activity was assessed using questionnaires and accelerometers.

RESULTS

Foot shortening strength was greater in HB (4.8 ± 1.9 kg vs 3.5 ± 1.8 kg, P < 0.01). Navicular drop was greater in HB (0.53 ± 0.32 cm vs 0.39 ± 0.19 cm, P < 0.05). Calcaneus stiffness index was greater (right 113.5 ± 17.1 vs 100.5 ± 116.8, P < 0.01 left 109.8 ± 15.7 vs 101.7 ± 18.7, P < 0.05) and Achilles tendon moment arm shorter in HB (right, 3.4 ± 0.4 vs 3.6 ± 0.4 cm, P < 0.05; left, 3.4 ± 0.5 vs 3.7 ± 0.4 cm, P < 0.01). Lower-limb injury prevalence was 8% in HB and 61% in HS. HB subjects spent more time engaged in moderate to vigorous physical activity (60 ± 26 min·d vs 31 ± 13 min·d; P < 0.001).

CONCLUSIONS

Significant differences observed in foot parameters, injury prevalence and general foot health between HB and HS suggest that footwear conditions may impact on foot structure and function and general foot health. HB children and adolescents spent more time engaged in moderate to vigorous physical activity and less time sedentary than HS children and adolescents.

Two-dimensional digital photography for child body posture evaluation: standardized technique, reliable parameters and normative data for age 7-10 years

BACKGROUND

Digital photogrammetry provides measurements of body angles or distances which allow for quantitative posture assessment with or without the use of external markers. It is becoming an increasingly popular tool for the assessment of the musculoskeletal system. 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.

MATERIAL AND METHODS

The purpose of the study was twofold. The first one comprised 91 children (44 girls and 47 boys) aged 7-10 (8.2 ± 1.0), i.e., students of primary school, and its aim was to develop the photographic method, choose the quantitative parameters, and determine the intraobserver reliability (repeatability) along with the interobserver reliability (reproducibility) measurements in sagittal plane using digital photography, as well as to compare the Rippstein plurimeter and digital photography measurements. The second one involved 7782 children (3804 girls, 3978 boys) aged 7-10 (8.4 ± 0.5), who underwent digital photography postural screening. The methods consisted in measuring and calculating selected parameters, establishing the normal ranges of photographic parameters, presenting percentile charts, as well as noticing common pitfalls and possible sources of errors in digital photography.

RESULTS

A standardized procedure for the photographic evaluation of child body posture was presented. The photographic measurements revealed very good intra- and inter-rater reliability regarding the five sagittal parameters and good reliability performed against Rippstein plurimeter measurements. The parameters displayed insignificant variability over time. Normative data were calculated based on photographic assessment, while the percentile charts were provided to serve as reference values. The technical errors observed during photogrammetry are carefully discussed in this article.

CONCLUSIONS

Technical developments are allowed for the regular use of digital photogrammetry in body posture assessment. Specific child positioning (described above) enables us to avoid incidentally modified posture. Image registration is simple, quick, harmless, and cost-effective. The semi-automatic image analysis, together with the normal values and percentile charts, makes the technique reliable in terms of child's posture documentation and corrective therapy effects' monitoring.

CADAVERIC EVALUATION OF THE LATERAL-ANTERIOR DRAWER TEST FOR EXAMINING POSTERIOR CRUCIATE LIGAMENT INTEGRITY

BACKGROUND

Common clinical tests often fail to identify posterior cruciate ligament (PCL) ruptures, leading to undetected tears and potential degenerative changes in the knee. The lateral-anterior drawer (LAD) test has been proposed but not yet evaluated regarding its effectiveness for diagnosing PCL-ruptures.

HYPOTHESIS

The LAD will show greater tibial translation values in lateral-anterior direction in a PCL-Cut condition compared to a PCL-Intact condition, thus serving as a useful test for clinical diagnosis of PCL integrity.

STUDY DESIGN

Descriptive laboratory study.

METHODS

Threaded markers were inserted into the distal femur and proximal tibia in eighteen cadaveric knees. Each femur was stabilized and the tibia translated in lateral-anterior direction for the LAD test versus in a straight posterior direction for the posterior sag sign (PSS). Each test was repeated three times with the PCL both intact and then cut, in that order. During each trial, digital images were captured at start and finish positions for the evaluation of tibial marker displacement. Tibial marker translation during each trial was digitally analyzed using photography. The PSS values served as a reference standard.

RESULTS

The LAD tibial translation was significantly greater (U=-3.680; p<;0.002) during the PCL-Cut (10.6±5.6mm) versus PCL-Intact (7.7±5.1mm) conditions. The PSS tibial translation was significantly greater (U=-3.724; p<0.002) during the PCL-Cut (11.0±5.3mm) versus PCL-Intact (6.4±3.5mm) conditions. There was no significant difference (t=2.029; p=0.07) in mean tibial translation in respective directions after PCL dissection during the LAD test (2.9±2.1mm) versus the PSS (4.6±2.8mm).

CONCLUSION

The LAD test detected changes in cadaveric tibial translation corresponding with changes in PCL integrity to a degree at least as effective for assessing PCL integrity as the PSS. Further clinical study will be required to assess the utility of the LAD as a physical examination tool for diagnosing PCL injuries.

LEVEL OF EVIDENCE

2 (laboratory study).

Reliability and Validity of the Footprint Assessment Method Using Photoshop CS5 Software in Young People with Down Syndrome

BACKGROUND

People with Down syndrome present skeletal abnormalities in their feet that can be analyzed by commonly used gold standard indices (the Hernández-Corvo index, the Chippaux-Smirak index, the Staheli arch index, and the Clarke angle) based on footprint measurements. The use of Photoshop CS5 software (Adobe Systems Software Ireland Ltd, Dublin, Ireland) to measure footprints has been validated in the general population. The present study aimed to assess the reliability and validity of this footprint assessment technique in the population with Down syndrome.

METHODS

Using optical podography and photography, 44 footprints from 22 patients with Down syndrome (11 men [mean ± SD age, 23.82 ± 3.12 years] and 11 women [mean ± SD age, 24.82 ± 6.81 years]) were recorded in a static bipedal standing position. A blinded observer performed the measurements using a validated manual method three times during the 4-month study, with 2 months between measurements. Test-retest was used to check the reliability of the Photoshop CS5 software measurements. Validity and reliability were obtained by intraclass correlation coefficient (ICC).

RESULTS

The reliability test for all of the indices showed very good values for the Photoshop CS5 method (ICC, 0.982-0.995). Validity testing also found no differences between the techniques (ICC, 0.988-0.999).

CONCLUSIONS

The Photoshop CS5 software method is reliable and valid for the study of footprints in young people with Down syndrome.

Automated Peripheral Neuropathy Assessment Using Optical Imaging and Foot Anthropometry

A large proportion of individuals who live with type-2 diabetes suffer from plantar sensory neuropathy. Regular testing and assessment for the condition is required to avoid ulceration or other damage to patient's feet. Currently accepted practice involves a trained clinician testing a patient's feet manually with a hand-held nylon monofilament probe. The procedure is time consuming, labor intensive, requires special training, is prone to error, and repeatability is difficult. With the vast increase in type-2 diabetes, the number of plantar sensory neuropathy sufferers has already grown to such an extent as to make a traditional manual test problematic. This paper presents the first investigation of a novel approach to automatically identify the pressure points on a given patient's foot for the examination of sensory neuropathy via optical image processing incorporating plantar anthropometry. The method automatically selects suitable test points on the plantar surface that correspond to those repeatedly chosen by a trained podiatrist. The proposed system automatically identifies the specific pressure points at different locations, namely the toe (hallux), metatarsal heads and heel (Calcaneum) areas. The approach is generic and has shown 100% reliability on the available database used. The database consists of Chinese, Asian, African, and Caucasian foot images.

Reliability and Validity of the Footprint Assessment Method Using Photoshop CS5 Software

BACKGROUND

Several sophisticated methods of footprint analysis currently exist. However, it is sometimes useful to apply standard measurement methods of recognized evidence with an easy and quick application. We sought to assess the reliability and validity of a new method of footprint assessment in a healthy population using Photoshop CS5 software (Adobe Systems Inc, San Jose, California).

METHODS

Forty-two footprints, corresponding to 21 healthy individuals (11 men with a mean ± SD age of 20.45 ± 2.16 years and 10 women with a mean ± SD age of 20.00 ± 1.70 years) were analyzed. Footprints were recorded in static bipedal standing position using optical podography and digital photography. Three trials for each participant were performed. The Hernández-Corvo, Chippaux-Smirak, and Staheli indices and the Clarke angle were calculated by manual method and by computerized method using Photoshop CS5 software. Test-retest was used to determine reliability. Validity was obtained by intraclass correlation coefficient (ICC).

RESULTS

The reliability test for all of the indices showed high values (ICC, 0.98-0.99). Moreover, the validity test clearly showed no difference between techniques (ICC, 0.99-1).

CONCLUSIONS

The reliability and validity of a method to measure, assess, and record the podometric indices using Photoshop CS5 software has been demonstrated. This provides a quick and accurate tool useful for the digital recording of morphostatic foot study parameters and their control.

Foot orthoses for adults with flexible pes planus: a systematic review

BACKGROUND

Foot orthoses are widely used in the management of flexible pes planus, yet the evidence to support this intervention has not been clearly defined. This systematic review aimed to critically appraise the evidence for the use of foot orthoses for flexible pes planus in adults.

METHODS

Electronic databases (Medline, CINAHL, Cochrane, Web of science, SportDiscus, Embase) were systematically searched in June 2013 for randomised controlled, controlled clinical and repeated measure trials where participants had identified flexible pes planus using a validated and reliable measure of pes planus and the intervention was a rigid or semi-rigid orthoses with the comparison being a no-orthoses (shoes alone or flat non-posted insert) condition. Outcomes of interest were foot pain, rearfoot kinematics, foot kinetics and physical function.

RESULTS

Of the 2,211 articles identified by the searches, 13 studies met the inclusion criteria; two were randomised controlled trials, one was a controlled trial and 10 were repeated measure studies. Across the included studies, 59 relevant outcome measures were reported with 17 calculated as statistically significant large or medium effects observed with use of foot orthoses compared to the no orthoses condition (SMD range 1.13 to -4.11).

CONCLUSIONS

No high level evidence supported the use of foot orthoses for flexible pes planus. There is good to moderate level evidence that foot orthoses improve physical function (medial-lateral sway in standing (level II) and energy cost during walking (level III)). There is low level evidence (level IV) that foot orthoses improve pain, reduce rearfoot eversion, alter loading and impact forces; and reduce rearfoot inversion and eversion moments in flexible pes planus. Well-designed randomised controlled trials that include appropriate sample sizes, clinical cohorts and involve a measure of symptom change are required to determine the efficacy of foot orthoses to manage adult flexible pes planus.

The relationship among foot posture, core and lower extremity muscle function, and postural stability

CONTEXT

Identification of impaired balance as a risk factor for lower extremity injury regardless of injury history has led to subsequent investigation of variables that may adversely affect balance in healthy individuals.

OBJECTIVES

To investigate the relationship among core and lower extremity muscle function, foot posture, and balance.

DESIGN

Descriptive laboratory study.

SETTING

Musculoskeletal injury biomechanics laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 108 individuals (40 men, 68 women; age = 22.8 ± 4.7 years, height = 168.5 ± 10.4 cm, mass = 69.9 ± 13.3 kg) participated in the study.

MAIN OUTCOME MEASURE(S)

Core endurance was assessed during 1 time-to-failure trial, and isometric hip and ankle strength were assessed using a handheld dynamometer and isokinetic dynamometer, respectively. Foot structure was quantified using the digital photographic measurement method. Single-limb-stance time to boundary was assessed using a force plate during an eyes-closed condition. Hierarchical multiple regression analyses were performed to predict balance using lower extremity strength, foot posture, and core endurance.

RESULTS

Foot posture (β = -0.22, P = .03) and ankle-inversion strength (β = -0.29, P = .006) predicted mediolateral balance. Increasing arch posture and ankle-inversion strength were associated with decreased mediolateral single-limb-stance balance.

CONCLUSIONS

Increasing arch height was associated with decreased mediolateral control of single-limb stance. The relationship between time to boundary and injury risk, however, has not been explored. Therefore, the relationship between increasing arch height and injury due to postural instability cannot be determined from this study. If authors of future prospective studies identify a relationship between decreased time to boundary and increased injury risk, foot structure may be an important variable to assess during preparticipation physical examinations. The relationship between increasing ankle-inversion strength and decreased balance may require additional study to further elucidate the relationship between ankle strength and balance.

Influence of foot orthotics upon duration of effects of spinal manipulation in chronic back pain patients: a randomized clinical trial

OBJECTIVE

The purpose of this study was to investigate the effects of 4 weeks of custom foot orthotics on pain, disability, recurrence of spinal fixation, and muscle dysfunction in adult low back pain patients receiving limited chiropractic care.

METHODS

Adult volunteers with low back pain of greater than or equal to 1 month's duration were randomized to receive custom orthotics (group A) or a flat insole sham (group B) with limited chiropractic care in 5 visits over 4 weeks. Primary outcome measures are as follows: Quadruple Numerical Pain Rating Scale (for back), the Roland-Morris Disability Questionnaire, the number of muscles grade 4 or lower on manual muscle testing, and the number of spinal fixations detected by motion palpation and vertebral challenge at intake (B1), 2 weeks later before treatment began and orthotic use was initiated (B2) and before each subsequent treatment at approximately days 3, 10, 17, and 24 after B2. Secondary outcome measures are correlations of all primary outcomes.

RESULTS

Both groups improved on all Numerical Pain Rating Scale, Roland-Morris Disability Questionnaire, and the number of muscles from intake (B1) to final visit. Only group B yielded significant improvements in the number of spinal fixations. No outcome measures showed statistical difference between groups at any time point; however, those who wore custom orthotics longer each day showed trends toward greater improvements in some outcome measures.

CONCLUSIONS

Both groups improved with chiropractic care including spinal manipulation; however, there were no statistical differences shown between sham and custom orthotic groups. Future studies should formally measure the time that orthotics or shams are worn in a weight-bearing capacity each day.

Photographic analysis of human posture: a literature review

INTRODUCTION

The study of posture is not an easy task, mainly because postural assessment is still scientifically inaccurate. Photographs of bipedalism in the frontal and sagittal planes are one of the most widely used methods for this assessment. The aim of this literature review was to determine which anatomical markers authors of scientific papers have taken to minimize the chances of error in measurements.

MATERIALS AND METHODS

The Medline and Lilacs databases were searched for the period from 2002 to 2012, with the following keywords: "postura"; "posture" and "postural."

DISCUSSION

A number of studies have shown a reasonable correlation between radiographic measurements and the placement of markers. It appears possible to use photography as a form of scientific assessment since the anatomical landmarks are well chosen.

CONCLUSION

The markers that were suggested in this review: malleolus; posterior calcaneal tuberosity; fibular head; tibial tuberosity; greater trochanter of the femur; anterior angle and/or posterior lateral edge of the acromion; spinous processes (particularly C7); inferior angle of the scapula; sternum manubrium; mental protuberance; and the intertragic notch. Iliac spines, both anterior superior and posterior superior, should only be used with lean subjects.

Relationships between clinical measures of static foot posture and plantar pressure during static standing and walking

BACKGROUND

Information is limited about the relationships between clinical measures of static foot posture and peak plantar pressures under the medial column of the foot. The purpose was to examine these relationships during static standing and walking.

METHODS

A single-group exploratory design using correlation and regression was used to determine relationships. Ninety-two healthy volunteers participated. Clinical measures of static foot posture including arch index, navicular drop and navicular drift were obtained during static standing. Peak plantar pressures under the hallux, medial forefoot, medial midfoot, and medial rearfoot were obtained during standing and walking.

FINDINGS

Static foot posture was related to peak plantar pressures during standing and walking, but the strengths of relationships ranged from poor to fair. During standing, navicular drop was correlated (P≤0.05) with hallux (r=0.29) and medial forefoot (r=-0.17) pressures, while arch index (r=-0.17) and navicular drift (r=0.25) were correlated (P≤0.05) with hallux pressure. During walking, arch index, navicular drop and navicular drift were correlated (P≤0.05) with hallux and medial forefoot pressures (r range -0.30 to 0.41), while arch index (r=-0.15) and navicular drop (r=0.16) were correlated (P≤0.05) with medial midfoot pressure. Regression models predicted (P≤0.05) hallux (R(2)=0.08) and medial midfoot (R(2)=0.05) pressures during standing, and hallux (R(2)=0.18), medial forefoot (R(2)=0.07), and medial rearfoot (R(2)=0.05) pressures during walking.

INTERPRETATION

In healthy participants, lower arch foot postures are associated with greater pressures under the hallux and medial mid-foot and lower pressures under the medial forefoot, but the strength of these relationships may be only poor to fair.