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Boryczka-Trefler A, Kalinowska M, Szczerbik E, Stępowska J, Łukaszewska A, Syczewska M. Comparison of 2 Conservative Treatment Approaches for the Flat Foot in Children Aged 5 to 10: Foot Orthoses Versus Foot Orthoses Supplemented With Zukunft-Huber Manual Therapy. Clin Pediatr (Phila) 2024; 63:304-312. [PMID: 37166097 DOI: 10.1177/00099228231172480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The aim was to find if foot orthotics alone can improve flat feet in children and analyze how the addition of Zukunft-Huber manual therapy and corrective bandaging changes the outcome. Forty-nine children aged 5 to 10 with asymptomatic flexible flat feet were divided into 2 groups. The first was treated with foot orthoses alone, in the second wearing foot orthoses was supplemented with Zukunft-Huber manual therapy and corrective bandaging. Pedobarography during gait was performed before the therapy and after a year. In the first group decrease in arch index, width, force, and area of midfoot, increase in force MH2 and area hindfoot was found, in the second decrease in arch index, width, force, and area of midfoot, increase in force under metatarsal head second, third, fourth, and fifth, area metatarsal head fourth and area hindfoot. Both methods showed positive changes, but foot orthoses with additional intervention were more effective.
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Affiliation(s)
- Anna Boryczka-Trefler
- Department of Rehabilitation, Children's Memorial Health Institute, Warszawa, Poland
| | - Małgorzata Kalinowska
- Department of Rehabilitation, Children's Memorial Health Institute, Warszawa, Poland
| | - Ewa Szczerbik
- Department of Rehabilitation, Children's Memorial Health Institute, Warszawa, Poland
| | - Jolanta Stępowska
- Department of Rehabilitation, Children's Memorial Health Institute, Warszawa, Poland
| | - Anna Łukaszewska
- Department of Rehabilitation, Children's Memorial Health Institute, Warszawa, Poland
| | - Małgorzata Syczewska
- Department of Rehabilitation, Children's Memorial Health Institute, Warszawa, Poland
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Sagat P, Bartik P, Štefan L, Chatzilelekas V. Are flat feet a disadvantage in performing unilateral and bilateral explosive power and dynamic balance tests in boys? A school-based study. BMC Musculoskelet Disord 2023; 24:622. [PMID: 37525236 PMCID: PMC10391751 DOI: 10.1186/s12891-023-06752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Little evidence has been provided regarding physical performance and flat-footedness in school-age children. Although flat feet may decrease the level of motor performance, findings remain inconsistent. Therefore, the main purpose of the study was to determine whether children with flat feet had poorer physical task performance, compared to normal-footed children. METHODS A total of 208 primary school boys were included in the study (107 normal-footed and 101 flatfooted boys). Flat footedness (< 42°) was determined using Clark's method. The children were tested by a set of unilateral and bilateral tests selected from the area of explosive power and dynamic balance which included: (i) countermovement jump, (ii) standing broad jump, (iii) the triple crossover hop for distance test, (iv) maximal sprinting speed over 10, 20 and 40 m and (v) the Star Excursion Balance Test. Differences were adjusted for age, body mass index, peak height velocity and physical activity. RESULTS Flat footed children exhibited significantly poorer results in bilateral standing broad jump (effect size [ES] = 0.34), unilateral standing broad jump for dominant (ES = 0.31) and non-dominant leg (ES = 0.20), the triple crossover hop for distance test for dominant (ES = 0.24) and non-dominant leg (ES = 0.23) and the Star Excursion Balance Test (ES = 0.23-0.43) and were slower in maximal sprinting speed test over 20 m (ES = 0.25) and 40 m (ES = 0.30). CONCLUSIONS This study shows that children with flat feet performed poorer in some physical performance tasks, compared to the normal feet counterparts.
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Affiliation(s)
- Peter Sagat
- GSD/Health and Physical Education Department, Sport Sciences and Diagnostics Research Group, Prince Sultan University, Riyadh, 11586, Saudi Arabia
| | - Peter Bartik
- GSD/Health and Physical Education Department, Sport Sciences and Diagnostics Research Group, Prince Sultan University, Riyadh, 11586, Saudi Arabia
| | - Lovro Štefan
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, 625 00, Czech Republic.
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Khan F, Chevidikunnan MF, BinMulayh EA, Al-Lehidan NS. Plantar pressure distribution in the evaluation and differentiation of flatfeet. Gait Posture 2023; 101:82-89. [PMID: 36758426 DOI: 10.1016/j.gaitpost.2023.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 08/03/2022] [Accepted: 01/25/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although foot diseases are common, only a few studies have detailed the biomechanical and anatomical components of each disorder. The most reliable diagnostic tool for flatfoot is X-ray radiography. Achieving a similar accurate and objective diagnosis using another assessment tool, such as plantar pressure measurements, can be more convenient in clinical practice. RESEARCH QUESTION To identify foot plantar pressure characteristics that primarily detect flatfoot based on X-ray, which addresses the use of such assessments for flatfoot diagnosis. In addition, to compare between the normal foot, flatfoot with positive Foot Posture Index-6 (FPI), and flatfoot with positive FPI and radiographic measures. METHODS Sixty-two feet were examined from healthy female subjects aged 20.38 ± 1.10 years. According to the results of FPI and X-ray, each sample was assigned to one of the three groups (normal: negative FPI; FPI+: FPI ≥ +6; X-ray and FPI+: Arch Angle ≥ 165°, CP ≤ 12.3° and FPI ≥ +6) and compared using plantar pressure variables. RESULTS As per normal group compared to X-ray and FPI+ group, there was a significant difference in the surface area (P-value: 0.01, 95 % CI: -26.58 to -3.62), force (P-value: 0.04, 95 % CI: -10.37 to -0.09), and pressure (P-value: 0.01, 95 % CI: -56.78 to -6.35) in the medial foot. Similarly, the arch index among the normal group and the X-ray and FPI+ group showed significant differences (Static AI; P-value: 0.003, 95 % CI: -0.21 to -0.04). CONCLUSION There was a significant difference in plantar pressure between the normal feet and flatfeet with positive FPI and X-ray in the medial foot area. SIGNIFICANCE To attain a consensus among diagnostic approaches to identify flatfoot, the combined comparison of observational, foot pressure, and radiographic methods that have shown considerable reliability can be useful for clinical practice.
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Affiliation(s)
- Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Ejlal Abdullah BinMulayh
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Nada Saleh Al-Lehidan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
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Xu L, Gu H, Zhang Y, Sun T, Yu J. Risk Factors of Flatfoot in Children: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148247. [PMID: 35886097 PMCID: PMC9319536 DOI: 10.3390/ijerph19148247] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 02/05/2023]
Abstract
Background: This study aimed to explore the risk factors for flatfoot in children and adolescents to provide a reference basis for studying foot growth and development in children and adolescents. Methods: We examined the cross-sectional research literature regarding flatfoot in children and adolescents published in the past 20 years, from 2001 to 2021, in four electronic databases: PubMed, Web of Science, EBSCO, and Cochrane Library. Two researchers independently searched the literature according to the inclusion and exclusion criteria and evaluated the literature quality of the selected research; from this, a total of 20 articles were included in our review. After the relevant data were extracted, the data were reviewed using Manager 5.4 software (The Cochrane Collaboration, Copenhagen, Denmark), and the detection rate and risk factors for flatfoot in children were analyzed. Results: In total, 3602 children with flatfoot from 15 studies were included in the analysis. The meta-analysis results showed that being male (OR = 1.33, 95% CI: 1.09, 1.62, p = 0.005), being aged <9 years (age <6, OR = 3.11, 95% CI: 2.47, 3.90, p < 0.001; age 6−9 years, OR = 0.54, 95% CI: 0.41, 0.70, p < 0.001), joint relaxation (OR = 4.82, 95% CI: 1.19, 19.41, p = 0.03), wearing sports shoes (OR = 2.97, 95% CI: 1.46, 6.03, p = 0.003), being a child living in an urban environment (OR = 2.10, 95% CI: 1.66, 2.64, p < 0.001) and doing less exercise (OR = 0.25, 95% CI: 0.08, 0.80, p = 0.02) were risk factors for the detection of flatfoot. Conclusion: In summary, the detection rate of flatfoot in children in the past 20 years was found to be 25% through a meta-analysis. Among the children included, boys were more prone to flatfoot than girls, and the proportion of flatfoot decreased with age.
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Affiliation(s)
- Liya Xu
- Faculty of Sports and Human Sciences, Beijing Sports University, Beijing 100084, China; (L.X.); (H.G.)
| | - Hongyi Gu
- Faculty of Sports and Human Sciences, Beijing Sports University, Beijing 100084, China; (L.X.); (H.G.)
| | - Yimin Zhang
- Key Laboratory of Sports and Physical Health Ministry of Education, China Institute of Sports and Health, Beijing Sports University, Beijing 100084, China; (T.S.); (J.Y.)
- Correspondence: ; Tel.: +86-13641108252
| | - Tingting Sun
- Key Laboratory of Sports and Physical Health Ministry of Education, China Institute of Sports and Health, Beijing Sports University, Beijing 100084, China; (T.S.); (J.Y.)
| | - Jingjing Yu
- Key Laboratory of Sports and Physical Health Ministry of Education, China Institute of Sports and Health, Beijing Sports University, Beijing 100084, China; (T.S.); (J.Y.)
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Calculation of the Rearfoot Angle Representing Flatfoot from Comparison to the Cavanagh Arch Index. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A type of flatfoot can be analyzed accurately using the footprint when a human is standing; however, this method cannot be applied when a human is wearing orthotic shoes. This study aims to analyze flatfoot using the rearfoot angle (RFA) measurement. The result is then compared to a footprint measurement known as Cavanagh’s Arch Index (AI). A total of 31 static footprints of the participants consisting of 14 males and 17 females aged 18 to 25 years were collected. According to Cavanagh’s AI as a gold standard, the correlation equation was obtained as RFA = 46.04AI − 6.41 and RFA = 45.32AI − 6.26 for left and right foot, respectively. The correlation coefficient R2 for the left and the right foot is 0.63 and 0.73, respectively. Other statistical analyses using ANOVA and t-tests are presented in this paper. The correlation results obtained from this study are necessary for estimating the reduction in the degree of flatfoot when using orthotic shoes, which is difficult to calculate using the typical AI method from footprint measurements.
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Metin Tellioğlu A, Aydın E, İpek ED, Can İ. Plantar Sole Characteristics are Associated with Postural Stability. MEANDROS MEDICAL AND DENTAL JOURNAL 2022. [DOI: 10.4274/meandros.galenos.2021.94546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yao M, Cheng W, Liu F, Wang J, Liu J. Six-Year Follow-Up of a Rare Bifid Talus and Eight-Toed Central Polydactyly: A Case Report. Indian J Orthop 2022; 56:1096-1100. [PMID: 35669031 PMCID: PMC9123131 DOI: 10.1007/s43465-022-00614-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
Eight-toed central polydactyly is a rare congenital foot deformity and no other case with a bifid talus has been reported in the literature. We present a 6-year follow-up of a male child who had eight-toed central polydactyly with a duplicate cuneiform bone and bifid talus in his right foot. During preoperative planning, CT scans were conducted to evaluate the duplicate tarsals and to assist in reaching surgical decisions. In 2013, when the child was 1 year and 8 months old, the fourth, fifth and sixth phalanges and metatarsals as well as the duplicate cuneiform bone were excised. A portion of the malformed talus was also resected. This case report discusses functional and aesthetic outcomes after 6 years and provides an analysis on relevant reconstructive follow-up practices.
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Affiliation(s)
- Manye Yao
- Department of Orthopedic Surgery, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, 33 Longhu Waihuan East Road, Zhengzhou, 450018 Henan China
| | - Weyland Cheng
- Department of Orthopedic Surgery, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, 33 Longhu Waihuan East Road, Zhengzhou, 450018 Henan China
- Henan Provincial Key Laboratory of Children’s Genetics and Metabolic Diseases, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Fangna Liu
- Department of Orthopedic Surgery, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, 33 Longhu Waihuan East Road, Zhengzhou, 450018 Henan China
| | - Junjian Wang
- Department of Orthopedic Surgery, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, 33 Longhu Waihuan East Road, Zhengzhou, 450018 Henan China
| | - Jiaojing Liu
- Department of Radiology, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
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Hegazy F, Aboelnasr E, Abdel-Aziem A, Hassan A, Kim IJ. Validity and Diagnostic Accuracy of the Clarke's Angle in Determining Pediatric Flexible Flatfoot Using Radiographic Findings as a Criterion Standard Measure: A Cross-sectional Study. J Am Podiatr Med Assoc 2022; 112:20-133. [PMID: 33687447 DOI: 10.7547/20-133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Clinical diagnosis of pediatric flexible flatfoot is still a challenging issue for health-care professionals. Clarke's angle (CA) is frequently used clinically for assessing foot posture; however, there is still debate about its validity and diagnostic accuracy in evaluation of static foot posture especially in the pediatric population, with some previous studies supporting and others refuting its validity. The present study aimed to investigate the validity and diagnostic accuracy of the CA using radiographic findings as a criterion standard measure to determine flexible flatfoot between ages 6 and 18 years. METHODS A cross-sectional study of 612 participants (1224 feet) with flexible flatfoot aged 6 to 18 years (mean ± SD age, 12.36 ± 3.39 years) was recruited. The clinical measure results were compared with the criterion standard radiographic measures and displayed on the receiver operating characteristic curve, and the area under the curve was computed. Intrarater reliability, sensitivity, specificity, predictive values, and likelihood ratios were calculated for the CA. A Fagan nomogram was used to detect post-test probability. RESULTS The CA demonstrated higher intrarater reliability (intraclass correlation coefficient = 0.997), sensitivity (98.4%), specificity (98.8), positive predictive value (97.3), negative predictive value (99.3), positive likelihood ratio (84), and negative likelihood ratio (0.02). The area under the curve was 0.98. The positive likelihood ratio yielded a post-test probability of 97%, and the negative likelihood ratio yielded a post-test probability of 0.02. CONCLUSIONS The CA is a valid measure with high diagnostic accuracy in the diagnosis of flexible flatfoot between ages 6 and 18 years.
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Affiliation(s)
- Fatma Hegazy
- *Department of Physiotherapy, College of Health Sciences, University of Sharjah, United Arab Emirates
| | - Emad Aboelnasr
- †Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Amr Abdel-Aziem
- †Faculty of Physical Therapy, Cairo University, Giza, Egypt.,‡Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Ali Hassan
- §Faculty of Physical Therapy, South Valley University, Qena, Egypt
| | - In-Ju Kim
- ‖Department of Industrial Engineering and Engineering Management, College of Engineering, University of Sharjah, Sharjah, United Arab Emirates
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Hegazy F, Aboelnasr E, Abuzaid M, Kim IJ, Salem Y. Comparing Validity and Diagnostic Accuracy of Clarke's Angle and Foot Posture Index-6 to Determine Flexible Flatfoot in Adolescents: A Cross-Sectional Investigation. J Multidiscip Healthc 2021; 14:2705-2717. [PMID: 34611407 PMCID: PMC8486009 DOI: 10.2147/jmdh.s317439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/31/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Clinically, the foot posture index-6 (FPI-6) and Clarke's angle (CA) are widely utilized to assess static foot posture; however, due to scarcity of scientific evidence, clinicians continue to debate the validity and diagnostic accuracy of these measures in children and adolescents. This study aimed to evaluate and compare the validity and diagnostic accuracy of the FPI-6 and CA in determining adolescents' flexible flatfoot between ages of 12 and 18 years, considering radiographic investigation as a reference standard measure. DESIGN Cross-sectional study. SETTING Governmental hospitals. PARTICIPANTS AND METHODS A sample of 460 people (920 feet) with flexible flatfoot between the ages of 12 and 18 (15.23 ± 0.84 years) was enrolled in the study. The findings of the investigated measures were compared to the reference standard radiographic measure and plotted on the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was determined as a measure of FPI-6 and CA diagnostic accuracy. Intra-rater reliability, sensitivity, specificity, predictive values, and likelihood ratios of FPI-6 and CA were calculated and compared. The post-test probability of flatfoot was determined using the Fagan nomogram. RESULTS CA had a substantially higher intra-rater reliability (ICC=0.99) than the FPI-6 (ICC=0.96), with p-value of 0.001. CA has greater sensitivity (98%) than FPI-6, as well as a superior specificity (99%), positive predictive value (98%), negative predictive value (98.9%), positive likelihood ratio (97), and a lower negative likelihood ratio (0.02). CA had such an area under ROC curve of 0.98 with a 95% confidence interval of 0.95-1.00, while FPI-6 had an area under ROC curve of 0.80 with a 95% confidence interval of (0.77-0.85). CONCLUSION FPI-6 and Clarke's angle are both valid and diagnostically accurate clinical tests for flatfoot detection, with Clarke's angle outperforming FPI-6 in adolescents aged 12 to 18 years with a normal BMI.
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Affiliation(s)
- Fatma Hegazy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Emad Aboelnasr
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Mohamed Abuzaid
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - In-Ju Kim
- Department of Industrial Engineering and Engineering Management; College of Engineering, University of Sharjah, Sharjah, United Arab Emirates
| | - Yasser Salem
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Long Island, NY, USA
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Gorwa J, Michnik R, Nowakowska-Lipiec K. In Pursuit of the Perfect Dancer's Ballet Foot. The Footprint, Stabilometric, Pedobarographic Parameters of Professional Ballet Dancers. BIOLOGY 2021; 10:435. [PMID: 34068846 PMCID: PMC8153616 DOI: 10.3390/biology10050435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Abstract
This work aims to assess footprint parameters in a group of professional ballet dancers and to determine the correlation between the aforementioned parameters and lateralization, stabilometric parameters, pedobarographic parameters and work environment conditions. A group subjected to tests consisted of 44 elite professional ballet dancers and the reference group was composed of 44 students. The test of balance and thrust under feet involved 30 s-long free standing with open eyes on a podographic platform. The research-related analysis was concerned with footprint parameters (foot length and width, Clarke angle, and Weissflog index), stabilometric parameters (path length and ellipse field, mean value of the velocity and deflection of the displacement of the center of the foot pressure on the ground) and pedobarographic parameters (percentage thrust on the right, left foot as well as the front and rear part the foot). Statistically significant differences between the groups were observed in relation to the stabilometric parameters, the percentage pressure of the left forefoot and the right heel, as well as the value of the Clarke angle (p ≤ 0.05). The longitudinal arch of the foot and the width of the foot in ballet dancers are not dependent on the total and professional career duration and weekly training volume.
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Affiliation(s)
- Joanna Gorwa
- Department of Biomechanics, Faculty of Sport Sciences, Poznan University of Physical Education, 61-871 Poznań, Poland
| | - Robert Michnik
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland; (R.M.); (K.N.-L.)
| | - Katarzyna Nowakowska-Lipiec
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland; (R.M.); (K.N.-L.)
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Toyooka S, Shimazaki N, Yasui Y, Ando S, Saho Y, Nakagawa T, Kawano H, Miyamoto W. Validity of a simple footprint assessment board for diagnosing the severity of flatfoot: a prospective cohort study. BMC Musculoskelet Disord 2021; 22:285. [PMID: 33736625 PMCID: PMC7977274 DOI: 10.1186/s12891-021-04154-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A simple, non-quantitative, and cost-effective diagnostic tool would enable the diagnosis of flatfoot without need for specialized training. A simple footprint assessment board that investigates which toe the cord passes through from the centre point of the heel to the most lateral point of the medial contour of the footprint has been developed to assess flatfoot. The purpose of this study was to verify the validity of a simple footprint assessment board for flatfoot. METHODS Thirty-five consecutive patients with foot pain, foot injury, or any associated symptoms who underwent computed tomography (CT) were analysed prospectively. At the time of the CT scan, a footprint analysis using a simple footprint assessment board was performed. The navicular index, tibiocalcaneal angle, and calcaneal inclination angle were evaluated by CT to assess flat feet. These three criteria were compared to those evaluated with the simple footprint assessment board by regression analysis. In addition, the same analysis was conducted separately for young, middle-aged, and older patients in order to investigate each age group. RESULTS The navicular index and tibiocalcaneal angle generally decreased as the score of the simple footprint assessment board increased. Calcaneal inclination angle generally increased as the score of the simple footprint assessment board increased. As the scores of the simple footprint assessment board decreased by approaching the great toe, the navicular index and tibiocalcaneal angle were higher and calcaneal inclination angle was lower, which is indicative of a higher likelihood of flatfoot. The scores derived from the simple footprint assessment board was correlated with these three criteria measured by CT, not only when the result of simple footprint assessment board was set as a non-continuous variable but also when the result was set as a continuous variable. The results of the age-stratified survey were similar for all groups. CONCLUSIONS The findings of this study suggest that a simple footprint assessment board can be potentially useful to detect flatfoot. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Seikai Toyooka
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoya Shimazaki
- Department of Orthopaedic Surgery, Shimazaki Hospital, Ibaraki, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuji Ando
- Department of Information Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yasuaki Saho
- Faculty of Medical Technology, Teikyo University Institute of Sports Science and Medicine, Tokyo, Japan
| | - Takumi Nakagawa
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
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Vulnerability of the foot's morphological structure to deformities caused by foot loading paradigm in school-aged children: a cross-sectional study. Sci Rep 2021; 11:2749. [PMID: 33531593 PMCID: PMC7854665 DOI: 10.1038/s41598-021-82475-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
The study aimed to assess the association between the key predictive foot structure variables and its loading paradigm in 625 school-aged children. Clinical appraisal relied primarily on having the plantar parts of their feet comprehensively assessed with Podoscan 2D Foot CAD, and a dynamometer platform, the research tools of choice widely acknowledged for their overall accuracy and reliability, with a view to determining the distribution of respective foot loads, as well as addressing both balance and gait issues. The Clarke's angle, Wejsflog index, length and width of the feet, regardless of gender, proved the key predictive variables for the foot-loading paradigm. Notably the Clarke's angle, construed the most sensitive variable in assessing flat-footedness, offered an extra added value in overall investigative effort. The actual design of the study protocol effectively complements a standard clinical assessment procedure, whereas by comprehensively addressing those variables, it is also believed to aid clinicians in gaining an extra, hands-on, diagnostic potential, so that any teenagers exposed to the highest risk of developing foot deformities could effectively be identified through pertinent screening tests, and consequently offered a task-oriented, therapeutic management, specifically aimed at preventing potential postural complaints in later life.
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Beliche TWDO, Hamu TCDDS, Santos RND, Toledo RCD, Bizinotto T, Porto CC, Formiga CKMR. Intra- and inter-rater reliability in the assessment and classification of the longitudinal plantar arch of children 6 to 10 years of age. MOTRIZ: REVISTA DE EDUCACAO FISICA 2021. [DOI: 10.1590/s1980-657420210000151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hösl M, Böhm H, Oestreich C, Dussa CU, Schäfer C, Döderlein L, Nader S, Fenner V. Self-perceived foot function and pain in children and adolescents with flexible flatfeet - Relationship between dynamic pedobarography and the foot function index. Gait Posture 2020; 77:225-230. [PMID: 32059141 DOI: 10.1016/j.gaitpost.2020.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/12/2020] [Accepted: 01/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is considerable debate as to which parameters to include in the assessment of paediatric flatfeet. Dynamic pedobarography is an objective, dynamic method to measure foot function. Information about its associations to patient-reported measures may help to focus on the most relevant parameters. RESEARCH QUESTION What is the association between the Foot Function Index and pedobarographic assessments in flatfeet of children and adolescents? METHODS A consecutive clinical case series of 51 participants with idiopathic flexible flatfeet aged 7-17 years underwent barefooted pedobarography during gait and completed the Foot Function Index Questionnaire. Pedobarographic data categorized into values related to area, peak pressure and force with respect to the hind-, mid- and forefoot were extracted. To test the associations between the Foot Function Index and pedobarographic assessments, bivariate partial correlations were tested and contact times served as co-variate. RESULTS Several significant associations between peak pressure or forces beneath the hindfoot, midfoot and hallux to self-perceived function were found (|rho| = 0.28-.46, P < 0.05). In particular, reduced peak forces and pressures underneath the hindfoot and hallux, a lateral shift (smaller medio-lateral ratios) of hindfoot pressure and force and a medial shift (larger medio-lateral ratios) of midfoot pressure seem to be negatively associated with foot-related disability. Overall, less evidence was noted for associations to pain scores. Area related outcomes (including the arch index) contained no information for function while a larger BMI was the strongest thread for disability (rho = 0.42, P = 0.002) and pain (rho = 0.31, P = 0.027). SIGNIFICANCE When using pedobarography for the assessment of flexible flatfeet of children and adolescents, less attention should be paid to area related measurements which do not provide information about self-perceived function or disability. Instead, peak pressures or forces in the hind- or midfoot or beneath the hallux may be focussed. Weight reductions are potentially an effective strategy to reduce or prevent symptoms.
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Affiliation(s)
- Matthias Hösl
- Schön Klinik Vogtareuth, Gait and Motion Analysis Laboratory, Krankenhausstraße 20, 83569, Vogtareuth, Germany.
| | - Harald Böhm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauer Str. 18, 83229, Aschau im Chiemgau, Germany
| | - Claudia Oestreich
- TUM Faculty of Sport and Health Sciences, Department of Preventive Pediatrics, Technical University of Munich, Georg-Brauchle-Ring 60-62, 80992, Munich, Germany
| | - Chakravarthy Ugandhar Dussa
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauer Str. 18, 83229, Aschau im Chiemgau, Germany
| | - Christel Schäfer
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauer Str. 18, 83229, Aschau im Chiemgau, Germany
| | - Leonhard Döderlein
- Helios Aukamm-Klinik, Orthopädie Aukammklinik, Leibnizstraße 21, 65191 Wiesbaden, Germany
| | - Sean Nader
- Schön Klinik Vogtareuth, Pediatric Orthopaedics, Krankenhausstraße 20, 83569, Vogtareuth, Germany
| | - Verena Fenner
- Besser Bewegen, Jahnstr. 26, 78315, Radolfzell, Germany
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Gijon-Nogueron G, Marchena-Rodriguez A, Montes-Alguacil J, Evans AM. Evaluation of the paediatric foot using footprints and foot posture index: A cross-sectional study. J Paediatr Child Health 2020; 56:201-206. [PMID: 31267610 DOI: 10.1111/jpc.14558] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/19/2019] [Accepted: 06/06/2019] [Indexed: 12/14/2022]
Abstract
AIM Footprints have long been used as proxy measures of foot morphology, yet there is little consensus regarding footprints versus measures of foot posture, which address foot anatomy directly. Foot posture in children can be a confusing clinical presentation, with previous studies both supporting and refuting the relationship between childhood obesity and flat feet. The aim of this study was to determine the relationship between footprints and foot posture in children. METHODS A total of 316 school children (153 boys, 163 girls) from Spain, aged 6-9 years, were assessed for both footprint (Clarke's angle (CA)), by Tecniwork Pedrograph Plate, and foot posture (foot posture index (FPI)) measures, with participants barefoot, in a relaxed standing position, on a 50-cm elevated platform. RESULTS A negative correlation was found between FPI and footprints (CA) (rho = -0.505 left, P < 0.001) and by gender (rho = -0.457 for the left foot in girls, P < 0.001; rho = -0.548 for the left foot in boys, P < 0.001). The children with pes cavus according to the CA (73.3%) had normal feet according to FPI, and the children with severe pes planus according to the CA (78.98%) had pronated feet according to the FPI. A χ2 test showed these results to be statistically significant (P > 0.001). CONCLUSIONS An inverse relationship between CA and FPI was identified, that is, the greater the FPI, the smaller the CA, but not all pronated foot are planus feet and not all cavus feet are supinated feet. Footprints may overestimate and misguide paediatric foot posture concerns.
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Affiliation(s)
| | | | | | - Angela M Evans
- Discipline of Podiatry, College of Science, Health, and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Banwell HA, Paris ME, Mackintosh S, Williams CM. Paediatric flexible flat foot: how are we measuring it and are we getting it right? A systematic review. J Foot Ankle Res 2018; 11:21. [PMID: 29854006 PMCID: PMC5975578 DOI: 10.1186/s13047-018-0264-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/11/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Flexible flat foot is a normal observation in typically developing children, however, some children with flat feet present with pain and impaired lower limb function. The challenge for health professionals is to identify when foot posture is outside of expected findings and may warrant intervention. Diagnoses of flexible flat foot is often based on radiographic or clinical measures, yet the validity and reliability of these measures for a paediatric population is not clearly understood. The aim of this systematic review was to investigate how paediatric foot posture is defined and measured within the literature, and if the psychometric properties of these measures support any given diagnoses. METHODS Electronic databases (MEDLINE, CINAHL, EMBASE, Cochrane, AMED, SportDiscus, PsycINFO, and Web of Science) were systematically searched in January 2017 for empirical studies where participants had diagnosed flexible flat foot and were aged 18 years or younger. Outcomes of interest were the foot posture measures and definitions used. Further articles were sought where cited in relation to the psychometric properties of the measures used. RESULTS Of the 1101 unique records identified by the searches, 27 studies met the inclusion criteria involving 20 foot posture measures and 40 definitions of paediatric flexible flat foot. A further 18 citations were sought in relation to the psychometric properties of these measures. Three measures were deemed valid and reliable, the FPI-6 > + 6 for children aged three to 15 years, a Staheli arch index of > 1.07 for children aged three to six and ≥ 1.28 for children six to nine, and a Chippaux-Smirak index of > 62.7% in three to seven year olds, > 59% in six to nine year olds and ≥ 40% for children aged nine to 16 years. No further measures were found to be valid for the paediatric population. CONCLUSION No universally accepted criteria for diagnosing paediatric flat foot was found within existing literature, and psychometric data for foot posture measures and definitions used was limited. The outcomes of this review indicate that the FPI - 6, Staheli arch index or Chippaux-Smirak index should be the preferred method of paediatric foot posture measurement in future research.
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Affiliation(s)
- Helen A. Banwell
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia 5001 Australia
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Maisie E. Paris
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Shylie Mackintosh
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Cylie M. Williams
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
- Allied Health, Peninsula Health, Frankston, VIC 3199 Australia
- School of Primary and Allied Health, Monash University, Frankston, VIC 3199 Australia
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17
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Gogola A, Matyja M, Żoczek K, Wodzisz P. Analyze of relation between passive stiffness of pelvic girdle muscles and foot architecture in preschool children. ACTA ACUST UNITED AC 2018. [DOI: 10.1515/pha-2017-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background: The aim of the study is assessment of relation between passive stiffness of chosen pelvic girdle muscles and formation of heel angle (gamma) and medial longitudinal arch (MLA; determined by the Clarke's angle (AC) ). Material/Methods: 124 preschool children underwent observation. The examined group included 46 five years old children and 78 six years old children (girls (n=53); boys (n=71). Passive stiffness of chosen muscles that have insertions within pelvis were assessed in participants and gamma and Clarke's angles were evaluated with use of plantography. Results: Analysis of ANOVA variance showed significant diversification (p<0.01) of iliopsoas muscles stiffness between groups designated in regard to gamma angle (between body sides). Statistically substantial differences of passive stiffness of hamstrings and adductors (P<0.01, respectively) was also obtained in these groups. In case of analyze of passive stiffness of pelvic girdle muscles in the groups appointed in regard to Clarke's angle the only essential effect (P<0.01) was noted within iliopsoas between body sides, but without important interactions.
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Affiliation(s)
- Anna Gogola
- Department of Physiotherapy, Chaire of Basis of Physiotherapy, The Jerzy Kukuczka University of Physical Education, Katowice , Poland
| | - M. Matyja
- Department of Physiotherapy, Chair of Physiotherapy of the Nervous System and Locomotory System, The Jerzy Kukuczka University of Physical Education, Katowice , Poland
| | - K. Żoczek
- MSc Student, Faculty of Physiotherapy, The Jerzy Kukuczka University of Physical Education, Katowice , Poland
| | - P. Wodzisz
- MSc Student, Faculty of Physiotherapy, The Jerzy Kukuczka University of Physical Education, Katowice , Poland
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Abstract
In 1975, Evans published an article describing the surgical management of the "calcaneo-valgus deformity," pointing out that the deformity was due to relative shortening of the lateral column of the foot. Correction involved "equalizing" both columns by performing an osteotomy in the neck of the calcaneus 1.5 cm from the calcaneocuboid joint, where a trapezoidal wedge of tricortical bone was placed. Although it was considered a success, there were complications, including sural nerve injury, surgical wound dehiscence, undercorrection, and graft subsidence. The osteotomy grew in popularity. Indications extended to other forms of flatfoot with a low incidence of complications.
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Affiliation(s)
- Marcelo E Jara
- Orthopaedic Department, Clínica Dávila, Santiago, Chile.
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Correlation of physical activity and fitness with arches of the foot in children. BIOMEDICAL HUMAN KINETICS 2017. [DOI: 10.1515/bhk-2017-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
Study aim: Physical activity is crucial for a child’s development, as well as for the development of the foot. The aim of this study was to assess the correlation of the level of physical activity and physical fitness with the arches of the foot in children in non-weight-bearing and weight-bearing conditions.
Material and methods: The study population consisted of 92 children aged 10 to 14 years. We assessed their physical fitness with a modified Zuchora test. The modification consisted in choosing three (speed, jumping ability, and flexibility) out of a total of six trials. To assess the physical activity, we used a screening test - the anonymous Moderate to Vigorous Physical Activity questionnaire. To analyze the arches of the foot, we used computer equipment based on the Moiré projection method.
Results: Pearson’s chi-squared test did not reveal any significant correlation between physical activity, physical fitness, and longitudinal and transversal arches in children. The percentage of normal and high foot arches increased with increasing levels of physical activity and physical fitness. A Wilcoxon signed-rank test analysis confirmed a statistically significant difference (with p < 0.001) in the longitudinal and transversal arches in measurements in non-weight-bearing and weight-bearing conditions.
Conclusions: 1. In the examined group, there were functional lateral and longitudinal flat feet. 2. A lowered longitudinal arch foot might reduce physical activity and fitness in adolescents.
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PAUK JOLANTA, ZAWADZKA NINA, WASILEWSKA AGNIESZKA, GODLEWSKI PAWEL. GAIT DEVIATIONS IN CHILDREN WITH CLASSIC HIGH-FUNCTIONING AUTISM AND LOW-FUNCTIONING AUTISM. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519417500427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The most significant symptoms of autism are abnormal movement patterns that can lead to the decrease of life quality. The purpose of the study was to compare quantitatively the gait strategy of the typical subjects, children with classic high-functioning autism (HFA), and children with low-functioning autism (LFA). Secondly, the comparison and the evaluation of main changes of plantar pressure parameters between groups were presented. The evaluation was carried out on 18 children with HFA, 10 children with LFA, and 30 age-matched children as a control group. A six camera motion capture system, two force plates and a pedobarograph were used to measure gait kinematics, joint kinetics, and pressure distribution under foot during walking. The analysis shows significant differences between children with HFA, LFA, and typical children in velocity, cadence, and magnitude of plantar pressure distribution. The magnitude of plantar pressure was reduced in children with autism under all anatomical masks, which was caused by plano-valgus deformity. Differences were also observed in joint angles and moments during gait cycle. Some of the results can be a source of important information about gait patterns in autistic children. Any exercise treatment prescribed for autistic children should focus on changing the patterns of plantar pressure distribution, which would be similar to patterns of typical children. However, the exercise treatment cannot be generalized due to the high inter-subject variability in children with autism.
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Affiliation(s)
- JOLANTA PAUK
- Faculty of Mechanical Engineering, Bialystok University of Technology, Wiejska 45C, 15-351 Bialystok, Poland
- Glenrose Rehabilitation Hospital, 10230 111 Avenue Northwest, Edmonton, AB T5G 0B7, Canada
| | - NINA ZAWADZKA
- Special Care and Educational Center for Children and Youth with Autism, Pulaskiego 96, 15-338 Bialystok, Poland
| | | | - PAWEL GODLEWSKI
- Bialystok University of Technology, Wiejska 45C, 15-351 Białystok, Poland
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Gijon-Nogueron G, Montes-Alguacil J, Alfageme-Garcia P, Cervera-Marin JA, Morales-Asencio JM, Martinez-Nova A. Establishing normative foot posture index values for the paediatric population: a cross-sectional study. J Foot Ankle Res 2016; 9:24. [PMID: 27468312 PMCID: PMC4962378 DOI: 10.1186/s13047-016-0156-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 07/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Foot Posture Index (FPI) is an observational tool designed to measure the position of the foot. Its reliability is well established, and it provides normative reference values for the general population. However, this is not so for the paediatric population. The aim of this study is to determine FPI reference values in childhood, taking into account age and gender. METHODS This cross-sectional study included 1,762 school children (863 boys and 899 girls) aged 6-11 years, from Málaga, Granada and Plasencia (Spain). In every case, FPI measurements were obtained for both feet by two experienced podiatrists. A descriptive analysis was then conducted and the percentiles of the variables determined, with a significance level of P < 0.05. RESULTS The consolidated FPI results for the sample population produced mean values of 3.74 (SD 2.93) points for the right foot and 3.83 (SD 2.92) for the left. The 50th percentile was 4 points for both genders and for both feet, except for the right foot among the girls, which was slightly lower, at 3 points. The 85th percentile, which is considered to represent the boundary between the normal and the pronated foot among children, was 6 points, uniformly among the subjects. CONCLUSIONS As a normative FPI value for the paediatric population, we recommend the 50th percentile, i.e. 4 points, for children, of both genders, aged 6 years. This value progressively falls with age, to 3 FPI points for children aged 11 years. The 85th percentile for the pronated foot and the 4th percentile for the supinated foot can be considered the pathological boundary.
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