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.
•The medial plantar structures appear to be the major contributors to static foot posture.•Plantar fascia is the main contributor among the plantar structures.•Plantar muscles have less contribution ...on static foot posture.
The plantar foot muscles and plantar fascia differ between different foot postures. However, how each individual plantar structure contribute to foot posture has not been explored. The purpose of this study was to investigate the associations between static foot posture and morphology of plantar foot muscles and plantar fascia and thus the contributions of these structures to static foot posture.
A total of 111 participants were recruited, 43 were classified as having pes planus and 68 as having normal foot posture using Foot Posture Index assessment tool. Images from the flexor digitorum longus (FDL), flexor hallucis longus (FHL), peroneus longus and brevis (PER), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB) and abductor hallucis (AbH) muscles, and the calcaneal (PF1), middle (PF2) and metatarsal (PF3) regions of the plantar fascia were obtained using a Venue 40 ultrasound system with a 5–13 MHz transducer.
In order of decreasing contribution, PF3 > FHB > FHL > PER > FDB were all associated with FPI and able to explain 69% of the change in FPI scores. PF3 was the highest contributor explaining 52% of increases in FPI score. Decreased thickness was associated with increased FPI score. Smaller cross sectional area (CSA) in FHB and PER muscles explained 20% and 8% of increase in FPI score. Larger CSA of FDB and FHL muscles explained 4% and 14% increase in FPI score respectively.
The medial plantar structures and the plantar fascia appear to be the major contributors to static foot posture. Elucidating the individual contribution of multiple muscles of the foot could provide insight about their role in the foot posture.
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.
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.
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.
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).
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.
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.
•Plantar pressure measurements can be considered as a diagnostic tool for detection of flat foot.•Medial foot parameters are the most significant to differentiate flat foot.•Static arch index and medial foot surface have more sensitivity and specificity for detecting flat feet.
•Radiologic severity of knee OA is associated with supinated foot posture.•Varus alignment in knee OA is related to pronated foot posture.•Clinical severity in knee OA is associated with supinated ...foot posture.
There are many contributors of knee osteoarthritis including the postural abnormalities of the adjacent joints. The relationship between foot posture and the clinical-radiological parameters of knee osteoarthritis is poorly understood.
Is foot posture related to the clinical and radiological parameters in patients with knee osteoarthritis?
Patients diagnosed with primary clinical and radiographic medial tibiofemoral knee osteoarthritis were included in the study. Anteroposterior knee radiographs were staged by using the Kellgren-Lawrence grading system. Computer-based measurements of the medial joint space width (mJSW), condylar angle, anatomical axis angle, tibial plateau angle and condylar plateau angle were performed on digital anteroposterior knee radiographs. The Western Ontario and Mc Master University Osteoarthritis Index (WOMAC) questionnaire was used to assess pain and the functional status of the patients. Foot posture was assessed by the Foot Posture Index (FPI) system and feet were categorized into three (pronated, neutral and supinated).
The study included 150 patients (150 knees and feet at one side) with a mean age of 61.2 ± 10.1 years. In terms of foot posture groups; percentages for supination, neutral and pronation were 22.66%, 68.66% and 8.66%, respectively. In the group with supinated FPI; WOMAC total score, pain and function subscale scores were higher (p < 0.001), mJSW was narrowed (p = 0.038) and the condylar plateau angle was increased (p = 0.009). In the FPI pronation group; anatomic axis angle values were found to change in the varus direction (p = 0.012).
The potential postural dysfunction of the foot should be taken into consideration during the assessment and/or management of a patient with knee osteoarthritis.
The French version of the 6-item Foot Posture Index (FPI-6) can be used in clinical practice in French-speaking countries
Intra- and inter-rater reliability of total FPI score are excellent
We ...provide minimal detectable change value for clinical interpretation (1.58 to 1.82)
The 6-item Foot Posture Index (FPI-6) is a reliable tool for the evaluation of foot deformities. Our aim was to translate and cross-culturally validate the FPI-6 for use in French-speaking countries and to determine the intra-rater and inter-rater reliability of the French version.
Cross-cultural adaptation was performed according to guidelines. Two clinicians assessed the FPI-6 in 52 asymptomatic individuals. We evaluated intra- and inter-rater reliability with the intraclass correlation coefficients (ICC), correlations (p-value < 0.05) and Bland-Altman plots. Standard error of measurement (SEM) and minimum detectable change (MDC
95
) were determined.
For the cross-cultural adaptation, we modified several items of the FPI-6 user guide and added footnotes to ensure correct interpretation. ICC of the total FPI-6 scores were 0.94 to 0.96 for the intra- and inter-rater reliability for dominant and non-dominant lower limb. Correlations were significant (p < 0.001); r 0.88 to 0.92. Total score SEM was 0.68 to 0.78 and MDC
95
was 1.58 to 1.82.
Intra- and inter-rater reliability of this French version of the FPI-6 was excellent for the total score and good to excellent for each item. The French FPI-6 can be used in French-speaking countries. The identification of SEM and MDC scores is useful for clinical interpretation.
This study aimed to determine the effectiveness of gluteus maximus versus gluteus medius muscle strengthening exercises on the navicular drop (ND), balance, and foot posture index (FPI 6) among ...athletes with over-pronated feet. A pre-post experimental study design with a total of 54 athletes with bilateral over-pronated feet were randomly assigned into group A (n=18), group B (n=18), and group C (n=18). Medial longitudinal arch height (MLA) was assessed with the Navicular Drop Test, the static and dynamic balance was determined with the stork stance test (SST) and modified Star Excursion Balance Test, and Foot Posture was assessed with Foot Posture Index 6. Multivariate Repeated measures ANOVA was used to analyze the effects of gluteus maximus versus gluteus medius muscle strengthening and short foot exercises. At four weeks, the gluteus medius along with short foot exercises (group B) showed significantly less ND and FPI 6 while showing more excellent SST and modified SEBT than the gluteus maximus muscle strengthening along with short foot exercises (group A) and control group (group C). These results suggest that adding gluteus medius muscle strengthening exercises to short foot exercises (SFE) was more effective in supporting the medial longitudinal arch and improving balance than performing SFE alone.
Objetivo: Realizar una revisión sobre la herramienta clínica de clasificación de la postura del pie en estática, Índice de Postura del Pie, para una mejor comprensión de su uso y aplicabilidad. ...Método: Revisión bibliográfica sobre el “Foot Posture Index”. Fueron consultados un total de 48 trabajos entre artículos de revista, libros y tesis doctorales. Se descartaron 18, por no cumplir los criterios de inclusión propuestos. Resultados: Se han utilizado 30 textos en castellano e inglés, en los que se relaciona el Índice de Postura del Pie, su fiabilidad en poblaciones diversas y su uso en el mundo de las Ciencias del Deporte. Conclusiones: El Índice de Postura del Pie es una herramienta fácil, fiable, y validada científicamente. Queda demostrada su aplicabilidad en todo tipo de poblaciones, sin existir limitaciones ante situaciones patológicas del miembro inferior. Existen datos que avalan su uso como predictor de lesiones, así como, para la mejora de las aptitudes del deportista.
The objective of this study was to establish the accuracy of the resting calcaneal stance position (RCSP) for the assessment of flat foot (FF) in children, aligned to the validity of the foot posture ...index (FPI). The RCSP cut-off point was explored, in context of both FF prevalence and the relationship between FF and body weight. A total of 205 healthy children, aged 5 to 10 years, participated in a cross-sectional study. Correlation was performed between RCSP and FPI. ROC curve technique was calculated to assess differentiation between groups. A score equal to or greater than 7 on the FPI was used as the ‘gold standard’ for analysis. The correlation between FPI and RCSP was significant (
r
= 0.63;
p
< 0.01). The discrimination score on the ROC curve (6 points/degrees) shows that the model can be used to identify FF through RCSP, with a sensitivity of 67% and specificity of 85% returned.
Conclusion
: The results of this study indicate the role of RCSP for simple, accessible and quick screening of paediatric FF. This is especially pertinent for non-podiatric healthcare professional without specialised paediatric foot knowledge.
What is Known:
• Most children develop a normal arch quickly, and flat feet usually resolve on their own between 2 and 6 years of age.
• The measurement used to diagnose flat foot in children must be accurate, consistent, and valid to characterize the standard foot position. The Resting Calcaneal Stance Position (RCSP) is another widely used measure to evaluate the position of the flat foot in children.
What is New:
• The RCSP cut-off point 6 shows a sensitivity of 67% and a specificity of 85% thanks to the FPI as the Gold standard.
• The RCSP is useful for health professionals who are not specialised in pediatric foot health. The RCSP is useful to detect flat foot in children.
Objective
To assess test-retest reliability and correlation of weight-bearing (WB) and non-weight-bearing (NWB) cone beam CT (CBCT) foot measurements and Foot Posture Index (FPI)
Materials and ...methods
Twenty healthy participants (age 43.11±11.36, 15 males, 5 females) were CBCT-scanned in February 2019 on two separate days on one foot in both WB and NWB positions. Three radiology observers measured the navicular bone position. Plantar (ΔNAV
plantar
) and medial navicular displacements (ΔNAV
medial
) were calculated as a measure of foot posture changes under loading. FPI was assessed by two rheumatologists on the same two days. FPI is a clinical measurement of foot posture with 3 rearfoot and 3 midfoot/forefoot scores. Test-retest reproducibility was determined for all measurements. CBCT was correlated to FPI total and subscores.
Results
Intra- and interobserver reliabilities for navicular position and FPI were excellent (intraclass correlation coefficient (ICC) .875–.997). In particular, intraobserver (ICC .0.967–1.000) and interobserver reliabilities (ICC .946–.997) were found for CBCT navicular height and medial position.
Interobserver reliability of ΔNAV
plantar
was excellent (ICC .926 (.812; .971); MDC 2.22), whereas the ΔNAV
medial
was fair-good (ICC .452 (.385; .783); MDC 2.42 mm). Using all observers’ measurements, we could calculate mean ΔNAV
plantar
(4.25±2.08 mm) and ΔNAV
medial
(1.55±0.83 mm). We demonstrated a small day-day difference in ΔNAV
plantar
(0.64 ±1.13mm;
p
<.05), but not for ΔNAV
medial
(0.04 ±1.13mm;
p
=n.s.).
Correlation of WBCT (WB navicular height - ΔNAV
medial
) with total clinical FPI scores and FPI subscores, respectively, showed high correlation (
ρ
: −.706;
ρ
: −.721).
Conclusion
CBCT and FPI are reliable measurements of foot posture, with a high correlation between the two measurements.
Introduction: Human foot posture is highly variable among healthy individuals and ranges from flat- to high-arched. Considering the hypothesized link between foot posture and lower extremity injury, ...static foot posture is frequently assessed in the clinical setting, with a belief that this may provide indications for biomechanical interventions (e.g. foot orthoses). The Foot Posture Index (FPI) is a validated method for quantifying standing foot posture. Navicular drop test is used in evaluating the amount of pronation in runner’s foot. However, studies need to be done to identify if the tools used to measure Foot posture and stability can be correlated and used to predict the outcome of other with the help of one score. Aims & objective: To identify the correlation of FPI-6 and NDT with Functional Ankle Stability in Running Male Athletes. Method: 60 running athletes were included in the study. FPI-6 and NDT were calculated for each athlete to measure the foot posture along with Side-hop test to analyze the functional ankle stability. Results: FPI- 6, NDT, Functional Ankle Stability using side hop test were calculated of both the feet. We found there is significant correlation between the FPI- 6, NDT and Side Hop Test. Conclusion: Results show that there is significant correlation between Navicular Drop Test with Functional Ankle Stability in Running Male Athletes. And there is significant correlation between Foot Posture Index-6 and Functional Ankle Stability in Running Male Athletes.
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