Is a Three-component Video-based Version of the Foot Posture Index Valid for Assessing Pediatric Patients With Orthopaedic and Neurologic Foot Conditions?

BACKGROUND: The Foot Posture Index-6 (FPI6) is an assessment of foot position that can be useful for patients with orthopaedic complaints. The FPI6 rates six components of foot position from -2 to +2, resulting in a total score on a continuum between -12 (severe cavus or supination) to +12 (severe planus or pronation). The subscores are ratings made by the examiner and are subjective assessments of deformity severity. The FPI6 requires palpation of bony structures around the foot and therefore must be administered live during physical examination. Because it is sometimes impractical to perform these assessments live, such as for retrospective research, a valid and reliable video-based tool would be very useful. QUESTIONS/PURPOSES: This study examines a version of the FPI using three of the original six components to determine: (1) Are scores from the three-component version of the FPI (FPI3) associated with those from the original six-component version (FPI6)? (2) Is the three-component FPI3 as reliable as the original six-component FPI6? (3) Are FPI3 assessments done retrospectively from video as reliable as those done live? METHODS: A retrospective group of 155 participants (106 males; mean age 13 ± 4 years) was studied. All had undergone gait analysis including videotaping and in-person assessment using the FPI6. Ratings for three components (calcaneus inversion/eversion, medial arch congruence, and forefoot abduction/adduction) were extracted yielding an FPI3 score ranging from -6 to +6. The other three components of the FPI6 (talar head palpation, curves above and below the lateral malleolus, talonavicular joint bulge) were excluded from the FPI3. FPI6 and FPI3 scores and side-to-side asymmetry were compared for all participants and for diagnosis subgroups (cerebral palsy and Charcot-Marie-Tooth disease) using a Pearson correlation. Agreement for foot posture categorization between the FPI6 and FPI3 was assessed using weighted kappa. Intra- and interrater reliability of live and video-based assessments for the FPI3 and its components were examined using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. RESULTS: Scores from the FPI3 and FPI6 are highly associated with each other, suggesting the FPI3 is an adequate substitute for the FPI6. FPI6 and FPI3 scores (r = 0.98) and asymmetry (r = 0.96) were highly correlated overall and within the cerebral palsy (r = 0.98 for scores; r = 0.98 for asymmetry) and Charcot-Marie-Tooth (r = 0.96 for scores; r = 0.90 for asymmetry) subgroups (all p < 0.001). Agreement between the FPI6 and FPI3 was high for foot posture categorization (weighted agreement = 95%, weighted κ = 0.88; p < 0.001). Interrater reliability for live ratings was similar for FPI3 and FPI6 and high for both measures (ICC = 0.95 for FPI6 and 0.94 for FPI3; both p < 0.001). High reliability was seen in video versus live ratings for the FPI3 total score and each of its components regardless of whether they were performed by the same (ICC = 0.98) or different (ICC = 0.97) raters (both p < 0.001), and interrater reliability remained high when the FPI3 was scored from video recordings (ICC = 0.96; p < 0.001). CONCLUSION: The FPI3 is valid and reliable when done live or from video or by the same or different examiners. It is suitable for retrospective and multicenter research studies, provided videos are done using standardized protocols. Further research is recommended investigating possible ceiling and floor effects in patients with pathologic conditions.Level of Evidence Level III, diagnostic study.

In vivo non-contact regions of proximal scaphoid in six extreme wrist positions.

INTRODUCTION: Fractures of the scaphoid are the most common carpal injuries, account for 80-90% of all carpal fractures. 5-15% nonunion of scaphoid fractures were reported even with adequate primary treatment, which probably progresses to osteoarthritic changes several decades later. Researches regarding to scaphoid physiological characteristic in vitro and in vivo and kinds of trials in clinical practice are being kept on going, which contribute much to our clinical practice. With the advancing wrist arthroscopy, 3D-print patient-specific drill guide, and intraoperative fluoroscopic guidance, dorsal approach (mini-invasive and percutaneous technique) is being popular, through which we can implant the screw in good coincidence with biomechanics and with less disturbing tenuous blood supply of the scaphoid. Investigating the noncontact area of the dorsal proximal scaphoid in different wrist positions can facilitate preoperatively estimating insert point of the screw. MATERIALS AND METHODS: Eight volunteers were recruited to accept CT scans in six extreme wrist positions. The images of DICOM mode were imput into the Mimics analytical system, the segmented scaphoid, lunate and radius were exported in mode of ASCII STL and were opened in the software of Geomagic studio. We created four planes based on anatomic markers on the surface of the radius and scaphoid to confine the proximal scaphoid to form the so-called non-contact regions. We measured and compared the areas in six targeted positions. RESULTS: Amidst six extreme wrist positions, area of the non-contact region in extreme dorsal extension (59.81 ± 26.46 mm2) was significantly the smallest, and it in extreme palmar flexion significantly was largest (170.51 ± 30.44 mm2). The non-contact regions increased in order of dorsal extension, supination, ulnar deviation, radial deviation, pronation and palmar flexion. As for two-group comparison, the non-contact region showed significantly larger (p < 0.05) in palmar flexion than the others except for in pronation individually, and in radial deviation (p < 0.05) than in dorsal extension. CONCLUSIONS: Sufficient space was available for the screw started from the dorsal approach despite the wrist positions.

Coxa pedis: can calcaneal pronation angle be considered a predictive sign of medial plantar arch overload?

PURPOSE: To assess whether a correlation between the calcaneal pronation angle and the presence of internal plantar arch overload signs (such as upper-medial spring ligament lesion, posterior tibial tendon tenosynovitis, etc.) could lead to a better understanding of coxa pedis pathology. MATERIAL AND METHODS: One hundred ankle MRIs of consecutive patients were retrospectively reviewed measuring the calcaneal pronation angle and either the presence or absence of internal plantar arch overload signs. Next, the association of overload signs with increasing pronation angle was evaluated to establish a cut-off point beyond which coxa pedis pathology could be defined. RESULTS: The tibial-calcaneal angle values in patients with and without effusion proved to be significantly different (p < 0.0001). The tibial-calcaneal angle values in patients with and without oedema also demonstrated a significant difference (p < 0.0056). Regarding posterior tibial tendon, a significant difference was found between the two groups (p < 0.0001). For plantar fascia enthesopathy, the result was borderline significant (p < 0.054). A linear correlation was found between the value of pronation angle and the extent of spring ligament injury (p < 0.0001). In contrast, no correlation with age was found. CONCLUSION: In conclusion, the literature associates medial longitudinal plantar arch overload with posterior tibial tendinopathy and spring ligament complex injuries. Our data show that both injuries are highly correlated with increased calcaneal pronation angle, which could be considered a predictive sign of internal plantar arch overload, prior to the development of the associated signs.

Anconeus and pronation: a palpatory and ultrasonographic study.

PURPOSE: Depending on its axis, pronation varies from the radius rotation around the steady ulna to the reciprocal adduction of the radius and abduction of the ulna. While there is no question that pronator teres is a central pronation agonist, anconeus's role is not settled. The current investigation comparing palpation and ultrasonography in these two muscles during pronation along the axis capitulum-second digit evolved from a serendipitous finding in a clinical anatomy seminar. METHODS: Single-hand palpation and two-transducer ultrasonography over anconeus and pronator teres were used on ten normal subjects to investigate their contraction during pronation around the capitulum-second digit axis. These studies were done independently and blind to the results of the other. The statistical analysis between palpation and ultrasonography was performed with Cohen's kappa coefficient and the χ2 test. RESULTS: On palpation, on resisted full pronation, anconeus contracted in 8/10 subjects and pronator teres in 10/10 subjects. Without resistance, the corresponding ratios were 5/10 and 9/10. On two-transducer ultrasonography, the comparable ratios were 7/10 and 10/10, and 3/10 and 10/10. A fair concordance (Cohen's kappa = 0.21) between palpation and ultrasonography in detecting the simultaneous status of anconeus and pronator teres during resisted full pronation. Anatomic dissection illustrated the elements involved. CONCLUSIONS: Plain palpation confirmed by ultrasonography showed the simultaneous contraction of anconeus and pronator teres during resisted pronation in most of the studied subjects. The study suggests that palpation can be helpful in directly studying muscle activity during movement.

Neuromechanical Differences between Pronated and Supinated Forearm Positions during Upper-Body Wingate Tests.

Arm-cycling is a versatile exercise modality with applications in both athletic enhancement and rehabilitation, yet the influence of forearm orientation remains understudied. Thus, this study aimed to investigate the impact of forearm position on upper-body arm-cycling Wingate tests. Fourteen adult males (27.3 ± 5.8 years) underwent bilateral assessments of handgrip strength in standing and seated positions, followed by pronated and supinated forward arm-cycling Wingate tests. Electromyography (EMG) was recorded from five upper-extremity muscles, including anterior deltoid, triceps brachii lateral head, biceps brachii, latissimus dorsi, and brachioradialis. Simultaneously, bilateral normal and propulsion forces were measured at the pedal-crank interface. Rate of perceived exertion (RPE), power output, and fatigue index were recorded post-test. The results showed that a pronated forearm position provided significantly (p < 0.05) higher normal and propulsion forces and triceps brachii muscle activation patterns during arm-cycling. No significant difference in RPE was observed between forearm positions (p = 0.17). A positive correlation was found between seated handgrip strength and peak power output during the Wingate test while pronated (dominant: p = 0.01, r = 0.55; non-dominant: p = 0.03, r = 0.49) and supinated (dominant: p = 0.03, r = 0.51; don-dominant: p = 0.04, r = 0.47). Fatigue changed the force and EMG profile during the Wingate test. In conclusion, this study enhances our understanding of forearm position's impact on upper-body Wingate tests. These findings have implications for optimizing training and performance strategies in individuals using arm-cycling for athletic enhancement and rehabilitation.

Pronator quadratus preserving versus pronator quadratus dissecting approaches in volar plate fixation of distal radius fractures: a systematic review of comparative studies.

PURPOSE: To compare pronator quadratus preserving (PQ-P) approaches with PQ dissecting (PQ-D) approaches in volar plate fixation of distal radius fractures (DRFs). METHODS: Three databases were searched on March 10th, 2024. The authors adhered to the PRISMA and R-AMSTAR guidelines and Cochrane Handbook for Systematic Reviews. Data on demographics, fracture classifications, patient reported outcome measures (PROMs), range of motion, radiographic parameters, and complications were extracted. RESULTS: Thirteen studies with a total of 1007 fractures were included. Two of three studies reported lower DASH scores in the PQ-P group between 6 weeks and 3 months postoperative, however no studies reported lower scores in the PQ-P group after 3 months. Three of three studies reported significantly lower VAS scores at 6 weeks postoperative, however no studies reported significant differences after 6 months. Only one of six studies reported significantly greater flexion, extension, and pronation in the PQ-P group. One of four studies reported greater radial deviation in the PQ-P group, while there were no differences in supination or ulnar deviation. One of ten and one of six studies reported greater volar tilt and ulnar variance or radial length, respectively, in the PQ-P group. CONCLUSION: There is not sufficient evidence supporting the utility of PQ-P approaches over conventional PQ-D approaches for volar plate fixation of DRFs, especially at long-term follow-ups (3+ months). There may be short term benefits with PQ-P approaches, specifically with regards to PROMs in the short-term (< 6 weeks), however there is limited high-quality evidence supporting these findings. LEVEL OF EVIDENCE: Level III.

Intra- and Inter-Examiner Reliability of the Viladot Method in Children.

OBJECTIVE: The aim of this study was to evaluate the interexaminer and intraexaminer reliability of classification with the Viladot method of plantar impression obtained by means of a footprinting mat. METHODS: Footprints were taken from 40 participants using a footprinting mat. The images were subjected to analysis by 3 independent examiners. To investigate intraexaminer reliability, the analysis was repeated by 1 of the examiners 1 week later. RESULTS: Excellent intraexaminer reliability was found (κ = 1.0; 95% confidence interval [CI], 0.77-1.0; P < .00). For interexaminer reliability, in the right foot high concordance was found for typical feet (κp = 0.76; 95% CI, 0.58-0.93; P < .00) and excellent concordance for cavus feet and flat feet (respectively: κp = 0.86; 95% CI, 0.68-1.0; P < .00; and κp = 0.81; 95% CI, = 0.63-0.99; P < .00). In the left foot high concordance was observed between the 3 evaluators for typical feet and cavus feet (respectively: κp = 0.75; 95% CI, 0.57-0.93; P < .00; and κp = 0.69; 95% CI, 0.51-0.87; P < .00) and excellent concordance for flat feet (κp = 1.0; 95% CI, 0.82-1.0; P < .00). CONCLUSION: The Viladot method is reliable for analyses involving 1 or more examiners, presenting excellent intraexaminer reliability and high to excellent interexaminer reliability. The Viladot method is a reliable (replicable and consistent) instrument, that is, its repeated application to the same subject produces similar results.

Hip-Focused Neuromuscular Exercise Provides Immediate Benefits in Foot Pronation and Dynamic Balance: A Sham-Controlled Cross-Over Study.

CONTEXT: Knowledge on how to utilize a kinetic chain approach in foot and ankle rehabilitation is important. OBJECTIVE: The aim of this study was to investigate the immediate effects of hip-focused neuromuscular exercise on foot pronation and single-leg neuromuscular control. DESIGN: Cross-over study. SETTING: University laboratory. PARTICIPANTS: This cross-over study included 44 asymptomatic volunteers with foot pronation. INTERVENTIONS: All participants performed (1) a hip-focused neuromuscular exercise and (2) a sham exercise in randomized order. MAIN OUTCOME MEASURES: Foot pronation was assessed by the navicular drop test, and lower-extremity neuromuscular control was assessed by the Modified Star Excursion Balance Test and frontal plane projection angle during single-leg squat before and after the experiments. RESULTS: Navicular drop test scores were significantly lower after the hip-focused neuromuscular exercise than after the sham exercise (mean difference [95% CI] = 2.84 [-1.08 to 6.77], P = .003). Modified Star Excursion Balance Test scores in the anterior (P = .008), posteromedial (P = .04), and posterolateral (P < .001) directions were significantly increased after hip-focused neuromuscular exercise. No statistically significant condition × time interaction was found for the frontal plane projection angle (P > .05). However, a main effect of time (P = .003) indicated that less dynamic knee valgus occurred during single-leg squat after both experiments. CONCLUSIONS: Hip-focused neuromuscular exercise produced immediate alterations in foot pronation and dynamic balance. Thus, the hip-focused neuromuscular exercise may be used to control foot posture in foot rehabilitation integrated with a kinetic chain approach and could be an effective prevention and treatment strategy.

The effects of forearm position and contraction intensity on cortical and spinal excitability during a submaximal force steadiness task of the elbow flexors.

Elbow flexor force steadiness is less with the forearm pronated (PRO) compared with neutral (NEU) or supinated (SUP) and may relate to neural excitability. Although not tested in a force steadiness paradigm, lower spinal and cortical excitability was observed separately for biceps brachii in PRO, possibly dependent on contractile status at the time of assessment. This study aimed to investigate position-dependent changes in force steadiness as well as spinal and cortical excitability at a variety of contraction intensities. Thirteen males (26 ± 7 yr; means ± SD) performed three blocks (PRO, NEU, and SUP) of 24 brief (~6 s) isometric elbow flexor contractions (5, 10, 25 or 50% of maximal force). During each contraction, transcranial magnetic stimulation or transmastoid stimulation was delivered to elicit a motor-evoked potential (MEP) or cervicomedullary motor-evoked potential (CMEP), respectively. Force steadiness was lower in PRO compared with NEU and SUP (P ≤ 0.001), with no difference between NEU and SUP. Similarly, spinal excitability (CMEP/maximal M wave) was lower in PRO than NEU (25 and 50% maximal force; P ≤ 0.010) and SUP (all force levels; P ≤ 0.004), with no difference between NEU and SUP. Cortical excitability (MEP/CMEP) did not change with forearm position (P = 0.055); however, a priori post hoc testing for position showed excitability was 39.8 ± 38.3% lower for PRO than NEU at 25% maximal force (P = 0.006). The data suggest that contraction intensity influences the effect of forearm position on neural excitability and that reduced spinal and, to a lesser extent, cortical excitability could contribute to lower force steadiness in PRO compared with NEU and SUP.NEW & NOTEWORTHY To address conflicting reports about the effect of forearm position on spinal and cortical excitability of the elbow flexors, we examine the influence of contraction intensity. For the first time, excitability data are considered in a force steadiness context. Motoneuronal excitability is lowest in pronation and this disparity increases with contraction intensity. Cortical excitability exhibits a similar pattern from 5 to 25% of maximal force. Lower corticospinal excitability likely contributes to relatively poor force steadiness in pronation.

Foot structure and lower limb function in individuals with midfoot osteoarthritis: a systematic review.

OBJECTIVE: To determine how foot structure and lower limb function differ between individuals with and without midfoot osteoarthritis (OA). DESIGN: Electronic databases were searched from inception until May 2020. To be eligible, studies needed to (1) include participants with radiographically confirmed midfoot OA, with or without midfoot symptoms, (2) include a control group of participants without radiographic midfoot OA or without midfoot symptoms, and (3) report outcomes of foot structure, alignment, range of motion or any measures of lower limb function during walking. Screening and data extraction were performed by two independent assessors, with disagreements resolved by a third independent assessor. The methodological quality of included studies was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: A total of 1,550 records were screened by title and abstract and 11 met the inclusion criteria. Quantitative synthesis indicated that individuals who had midfoot OA had a more pronated foot posture, greater first ray mobility, less range of motion in the subtalar joint and first metatarsophalangeal joints, longer central metatarsals and increased peak plantar pressures, pressure time integrals and contact times in the heel and midfoot during walking. Meta-analysis could not be performed as the data were not sufficiently homogenous. CONCLUSIONS: There are several differences in foot structure and lower limb function between individuals with and without midfoot OA. Future research with more consistent case definitions and detailed biomechanical models would further our understanding of potential mechanisms underlying the development of midfoot OA.

Interlimb differences in coordination of rapid wrist/forearm movements.

We have previously proposed a model of motor lateralization that attributes specialization for predictive control of intersegmental coordination to the dominant hemisphere/limb system, and control of limb impedance to the non-dominant system. This hypothesis was developed based on visually targeted discrete reaching movement made predominantly with the shoulder and elbow joints. The purpose of this experiment was to determine whether dominant arm advantages for multi-degree of freedom coordination also occur during continuous distal movements of the wrist that do not involve visual guidance. In other words, are the advantages of the dominant arm restricted to controlling intersegmental coordination during discrete visually targeted reaching movements, or are they more generally related to coordination of multiple degrees of freedom at other joints, regardless of whether the movements are discrete or invoke visual guidance? Eight right-handed participants were instructed to perform alternating wrist ulnar/radial deviation movements at two instructed speeds, slow and fast, with the dominant or the non-dominant arm, and were instructed not to rotate the forearm (pronation/supination) or move the wrist up and down (flexion/extension). This was explained by slowly and passively moving the wrist in each plane during the instructions. Because all the muscles that cross the wrist have moment arms with respect to more than one axis of rotation, intermuscular coordination is required to prevent motion about non-instructed axes of rotation. We included two conditions, a very slow condition, as a control condition, to demonstrate understanding of the task, and an as-fast-as-possible condition to challenge predictive aspect of control, which we hypothesize are specialized to the dominant controller. Our results indicated that during as-fast-as-possible conditions the non-dominant arm incorporated significantly more non-instructed motion, which resulted in greater circumduction at the non-dominant than the dominant wrist. These findings extend the dynamic dominance hypothesis, indicating that the dominant hemisphere-arm system is specialized for predictive control of multiple degrees of freedom, even in movements of the distal arm and made in the absence of visual guidance.

Analysis of the crosstalk in mechanomyographic signals along the longitudinal, lateral and transverse axes of elbow flexor muscles during sustained isometric forearm flexion, supination and pronation exercises.

OBJECTIVE: To analyse the influence of muscle fibre axis on the degree of crosstalk in mechanomyographic (MMG) signals during sustained isometric forearm flexion, pronation and supination exercises performed at 80% maximum voluntary contraction (MVC) at an elbow joint angle of 90°. METHODS: MMG signals in longitudinal, lateral and transverse directions of muscle fibres were recorded from the elbow flexors of twenty-five male subjects using triaxial accelerometers. Cross-correlation coefficients were used to quantify the degree of crosstalk in all nine possible pairs of fibre axes, all muscle pairs and all exercises. RESULTS: MMG root mean square (RMS) was statistically significant among the fibre axes (p<0.05, η2=0.17- 0.34) except for biceps brachii and brachioradialis in supination and brachialis in flexion. Overall mean crosstalk values in the three muscle pairs (biceps brachii & brachialis, brachialis & brachioradialis and brachioradialis & biceps brachii) were found to be 6.09-52.17%, 4.01-61.42% and 2.16-51.85%, respectively. Crosstalk values showed statistical significance among all nine axes pairs (p<0.05, η2=0.16-0.51) except for biceps brachii & brachialis during pronation. The transverse axes pair generated the lowest mean crosstalk values (2.16-9.14%). CONCLUSION: MMG signals recorded using accelerometers from the transverse axes of muscle fibres in the elbow flexors are unique and yield the least amount of crosstalk.

Does foot mobility affect the outcome in the management of patellofemoral pain with foot orthoses versus hip exercises? A randomised clinical trial.

OBJECTIVES: To test (i) if greater foot pronation (measured as midfoot width mobility) is associated with better outcomes with foot orthoses treatment, compared with hip exercises and (ii) if hip exercises are superior to foot orthoses, irrespective of midfoot width mobility. METHODS: A two-arm parallel, randomised superiority clinical trial was conducted in Australia and Denmark. Participants (18-40 years) were included who reported an insidious onset of knee pain (≥6 weeks duration); ≥3/10 numerical pain rating, that was aggravated by activities (eg, stairs, squatting, running). Participants were stratified by midfoot width mobility (high ≥11 mm change in midfoot width) and site, randomised to foot orthoses or hip exercises and blinded to objectives and stratification. Success was defined a priori as much better or better on a patient-perceived 7-point scale at 12 weeks. RESULTS: Of 218 stratified and randomised participants, 192 completed 12-week follow-up. This study found no difference in success rates between foot orthoses versus hip exercises in those with high (6/21 vs 9/20; 29% vs 45%, respectively) or low (42/79 vs 37/72; 53% vs 51%) midfoot width mobility. There was no association between midfoot width mobility and treatment outcome (Interaction effect p=0.19). This study found no difference in success rate between foot orthoses versus hip exercises (48/100 vs 46/92; 48% vs 50%). CONCLUSION: Midfoot width mobility should not be used to help clinicians decide which patient with patellofemoral pain might benefit most from foot orthoses. Clinicians and patients may consider either foot orthoses or hip exercises in managing patellofemoral pain. TRIAL REGISTRATION NUMBER: ACTRN12614000260628.

Is There Any Association Between Foot Posture and Lower Limb-Related Injuries in Professional Male Basketball Players? A Cross-Sectional Study.

BACKGROUND: Several studies have shown that foot posture is related to the incidence of ankle sprains in athletes and in nonathletic populations, but this association has not previously been considered in basketball players. This study investigates the relationship between foot posture and lower limb injuries in elite basketball players. DESIGN AND METHOD: Two hundred twenty participants were recruited as a convenience sample. The players had a mean age of 22.51 ± 3.88 years and a body mass index of 23.98 ± 1.80. The players' medical records were accessed from the preceding 10 years, and injuries were recorded according to their location (knee, foot, and/or ankle). In addition, the Foot Posture Index (FPI) was scored for each player, and their playing positions were noted. RESULTS: An average FPI score of 2.66 was obtained across all players, with guards presenting a significantly lower average FPI of -0.48 (P < 0.001) compared with the rest of playing positions, indicating a more supinated foot. However, center players presented an average FPI of 5.15 (P < 0.001), indicating a more pronated foot. The most common injuries observed were lateral ankle sprain (n = 214) and patellar tendinopathy (n = 126). Patellar tendinopathy was more common in supinated feet (30.08%) compared with 20.7% and 19.8% in pronated and neutral feet, respectively. CONCLUSIONS: The most common lower limb injuries observed in basketball players were lateral ankle sprain and patellar tendinopathy. Patellar tendinopathy was more commonly associated with the supinated feet. Guard players tended to have a more supinated foot, whereas centers presented a more pronated foot.

Intra- and intersession reliabilities of the flexor carpi radialis H-reflex while sitting with forearm pronation.

Purpose: The flexor carpi radialis H-reflex recordings were more robust when the participants were in a sitting position with forearm pronation than with forearm supination. The reliability of flexor carpi radialis recordings obtained with the participant in sitting posture with forearm supination is well established. However, similar reliability utilizing a sitting posture with forearm pronation has not been established. The purpose of this study was to establish the intra and intersession reliabilities of flexor carpi radialis H-reflex recordings acquired with the participants in a sitting with forearm pronation.Materials and methods: The flexor carpi radialis maximum H-reflex amplitude and latency were recorded unilaterally in twenty participants. The forearm was positioned in either a supination or a pronation position on two separate days. Four traces were recorded, and the intraclass correlation coefficients were calculated.Results: The intrasession intraclass correlation coefficients of the four traces of the flexor carpi radialis H-reflex amplitude during pronation on days 1 (0.96) and 2 (0.94) were more consistent than those acquired during supination on days 1 (0.78) and 2 (0.93). The intersession intraclass correlation coefficients of the average traces of the flexor carpi radialis H-reflex amplitude during pronation between days 1 and 2 were more consistent (0.9) than those during supination (0.55).Conclusions: The flexor carpi radialis H-reflex recordings acquired with the participant in a sitting position are more reliable with forearm pronation than with supination within and between sessions. These results should encourage clinicians and researchers to use this position when examining the neuromuscular function of the upper extremities in healthy individuals and those with neuromuscular disorders.

Age, Sex, Body Mass Index, and Laterality in the Foot Posture of Adolescents: A Cross Sectional Study.

OBJECTIVE: To investigate the relationship between the right and left foot posture in terms of body mass index (BMI), sex, and age in adolescents aged 10 to 14. METHODS: A total of 1400 adolescents were included. For assessment, the Foot Posture Index (FPI-6) was used. Each foot was assessed and ranked as supinated, normal, or pronated by the sum of the FPI-6 criteria. Each criterion was scored on a scale of -2 to +2, with negative for supinated and positive for pronated posture. A linear mixed model with repeated measures was used for statistical analysis. RESULTS: Sex, BMI, and right and left foot are associated with FPI-6. The total score attributed for male sex (ß = 0.29, P = .04) and the left foot (ß = 0.73, P < .001) was higher (male right foot: mean ± standard deviation [SD], 3.09 ± 2.84, male left foot: 3.76 ± 2.80; female right foot: mean ± SD, 2.28 ± 2.61, female left foot: 3.45 ± 2.66; laterality for left foot: mean ± SD, 3.55 ± 2.71, laterality for right foot: mean ± SD, 2.82 ± 2.7). On the other hand, the correlation coefficient for the BMI was negative (ß = -0.08, P = < .001), which means that the higher the BMI the lower the score attributed to the FPI-6. CONCLUSIONS: The FPI-6 is positively related to the male sex and the left foot-that is, the predicted score is higher, so the feet tend to present with a tendency to pronation. Although BMI is associated with FPI-6, it was not possible to establish a relationship between high BMI and pronation of the feet.

In vivo changes in length of elbow collateral ligaments during pronation and supination on an outstretched arm.

PURPOSE: This study investigated the length changes of the anterior bundle of the medial collateral ligament (AMCL) and the lateral ulnar collateral ligament (LUCL) in forearm pronation and supination under axial load in vivo. METHODS: Six healthy volunteers (2 males and 4 females, the average age of 44.6 years) were included in the study. CT scan of elbow joints was obtained at positions of forearm pronation and supination before and after load with the elbow extension. Mimics, Geomagic Studio, 3-matic Medical and Geometry Sketchpad were used to reconstruct three-dimensional models and analyze length changes of AMCL and LUCL. The AMCL and LUCL were divided, respectively, to three parts: the medial part, the middle part and the lateral part. RESULTS: Our results showed the length of the medial and middle parts of the AMCL significantly decreased from pronation to supination without load (0.46 mm, P < 0.05 and 0.43 mm, P < 0.05). With load, the length of the medial part and the middle of the AMCL significantly decreased from pronation to supination (0.62 mm, P < 0.05 and 0.44 mm P < 0.05). However, the length of the LUCL almost remained static for the forearm pronation and supination regardless of the axial load. CONCLUSION: The results showed that tension of the AMCL increases in forearm pronation, and increased tension on the ligament during impact may pave the way to injury. The AMCL of elbow may be easier to be injured in forearm pronation.

Doctor, when can I drive? - Range of functional ankle motion during driving.

BACKGROUND: Driving a motor vehicle needs a specific joint mobility and yet only limited knowledge exists regarding the necessary ankle range of motion. The goal of this study is to characterize the sequence and range of ankle motion. METHODS: The arc of plantarflexion/dorsiflexion and supination/pronation was recorded in the right and left ankle using electrogoniometers while thirty laps were driven by fifteen healthy participants around a course in a manual transmission car with a left sided steering wheel. The driver was required to perform the following maneuvers during each lap: (I) Vehicle acceleration and gear change, (II) Sudden evasion, (III) Routine turning, (IV) Rapid turning, (V) Vehicle acceleration followed by emergency braking. RESULTS: Driving required the right ankle to plantarflex 13±9 and dorsiflex 22±7 while supinating 15±7 degrees and pronating minimally. The left ankle plantarflexed 19±10and dorsiflexed 17±10 while supinating 15±7 degrees and pronating minimally. The right ankle dorsiflexed significantly more (p=0.00), and yet the left ankle had a significantly higher maximum plantarflexion and range of plantarflexion/dorsiflexion (p=0.00). Emergency braking resulted in a significantly higher maximum plantarflexion as well as plantarflexion/dorsiflexion range when compared to other maneuvers. CONCLUSION: This study describes the range of ankle motion identified to drive a car with a manual transmission and a left-sided steering wheel. The right and left ankle exhibit different arcs of motion during driving. This knowledge may assist when evaluating a patient's driving capability. Further studies are needed to investigate whether movement restrictions impair driving. LEVEL OF EVIDENCE: Basic science study.

Can short-term effectiveness of anti-pronation taping predict the long-term outcomes of customized foot orthoses: developing predictors to identify characteristics of patients with plantar heel pain likely to benefit from customized foot orthoses.

BACKGROUND: Foot orthoses are widely used to manage plantar heel pain (PHP). However, the evidence concerning the effect of foot orthoses on PHP is not conclusive. The study aims to identify the characteristics of patients with PHP likely to achieve a positive outcome after customized foot orthoses and to verify the concept that patients who respond positively to anti-pronation taping would achieve a positive prognosis after wearing foot orthoses for six months. METHODS: This is a prospective observational cohort study. Seventy-four patients with PHP underwent a baseline examination and received anti-pronation taping to their painful feet. The taping effects on pain and function were assessed at the 7-day follow-up visit. Then, all patients received an intervention for their PHP with customized foot orthoses for six months. Outcome was assessed with a numeric pain rating scale, the patient-specific functional scale, the foot function index, and the global rating of perceived change. Significant reduction of pain, increase of function, and perception of a meaningful improvement were considered a positive response. RESULTS: Of 74 patients, 49 had a positive response to the customized foot orthosis treatment. Five predictors were identified: (1) the average pain intensity decreased by over 1.5 points with taping, (2) the range of ankle plantarflexion > 54 degrees, (3) the strength of ankle plantarflexors on the symptomatic side was equal to or stronger than that on the other side, (4) the range of hip internal rotation < 39 degrees, and (5) the range of hip external rotation > 45 degrees. The presence of three or more predictors increased the rate of achieving positive outcome from 66 to 89%. CONCLUSIONS: The predictors of customized foot orthosis outcome in patients with PHP are related to several physical measures of a lower extremity. Findings of the study can be used to screen and select patients with PHP for foot orthosis intervention. Moreover, patients who respond positively to anti-pronation taping would also benefit from the customized foot orthoses. However, since there was no control group in the current study, it is inappropriate to draw conclusions about the effectiveness of the foot orthoses treatment. TRIAL REGISTRATION: The trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12617000119392 ).

The biomechanical difference between running with traditional and 3D printed orthoses.

Running-related injuries have been associated with excessive foot pronation and high vertical loading rates. Traditional plaster-molded (TPM) foot orthoses are commonly prescribed to minimize these atypical biomechanical patterns. Recently, 3D printed (3DP) orthoses have become popular, yet the functional difference between these two types of orthoses remains unknown. Therefore, this study compared running biomechanics and perceived comfort during treadmill running in three orthotic conditions: 3DP orthoses, TPM orthoses, and a no-orthoses control condition (CON). Thirteen female asymptomatic runners with excessive foot pronation were recruited. Rearfoot eversion angle and velocity (at initial contact and peak) during stance, vertical loading rates, and perceived comfort were compared. Results showed lower peak rearfoot eversion angles during running with TPM (p=0.001, d=0.38) or 3DP orthoses (p=0.002, d=0.24) than CON. No differences were observed in other biomechanical parameters among the three conditions (p>0.05). Running with TPM (p≤0.001, d=1.74-1.82) and 3DP orthoses (p<0.003, d=1.06-1.34) resulted in better perceived comfort in "medial-lateral control" and "heel cushioning" than CON. There were no statistical differences in all parameters between TPM and 3DP orthoses. The present findings indicate improved comfort during running with TPM or 3DP orthoses, which hinted 3DP orthoses could be a viable alternative to TPM orthoses for clinical practice.