A hypothesis for robust polarization vision: an example from the Australian imperial blue butterfly, Jalmenus evagoras.

The Australian lycaenid butterfly Jalmenus evagoras has iridescent wings that are sexually dimorphic, spectrally and in their degree of polarization, suggesting that these properties are likely to be important in mate recognition. We first describe the results of a field experiment showing that free-flying individuals of J. evagoras discriminate between visual stimuli that vary in polarization content in blue wavelengths but not in others. We then present detailed reflectance spectrophotometry measurements of the polarization content of male and female wings, showing that female wings exhibit blue-shifted reflectance, with a lower degree of polarization relative to male wings. Finally, we describe a novel method for measuring alignment of ommatidial arrays: by measuring variation of depolarized eyeshine intensity from patches of ommatidia as a function of eye rotation, we show that (a) individual rhabdoms contain mutually perpendicular microvilli; (b) many rhabdoms in the array have their microvilli misaligned with respect to neighboring rhabdoms by as much as 45 deg; and (c) the misaligned ommatidia are useful for robust polarization detection. By mapping the distribution of the ommatidial misalignments in eye patches of J. evagoras, we show that males and females exhibit differences in the extent to which ommatidia are aligned. Both the number of misaligned ommatidia suitable for robust polarization detection and the number of aligned ommatidia suitable for edge detection vary with respect to both sex and eye patch elevation. Thus, J. evagoras exhibits finely tuned ommatidial arrays suitable for perception of polarized signals, likely to match sex-specific life history differences in the utility of polarized signals.

Ancient Neotropical origin and recent recolonisation: Phylogeny, biogeography and diversification of the Riodinidae (Lepidoptera: Papilionoidea).

We present the first dated higher-level phylogenetic and biogeographic analysis of the butterfly family Riodinidae. This family is distributed worldwide, but more than 90% of the c. 1500 species are found in the Neotropics, while the c. 120 Old World species are concentrated in the Southeast Asian tropics, with minor Afrotropical and Australasian tropical radiations, and few temperate species. Morphologically based higher classification is partly unresolved, with genera incompletely assigned to tribes. Using 3666bp from one mitochondrial and four nuclear markers for each of 23 outgroups and 178 riodinid taxa representing all subfamilies, tribes and subtribes, and 98 out of 145 described genera of riodinids, we estimate that Riodinidae split from Lycaenidae about 96Mya in the mid-Cretaceous and started to diversify about 81Mya. The Riodinidae are monophyletic and originated in the Neotropics, most likely in lowland proto-Amazonia. Neither the subfamily Euselasiinae nor the Nemeobiinae are monophyletic as currently constituted. The enigmatic, monotypic Neotropical genera Styx and Corrachia (most recently treated in Euselasiinae: Corrachiini) are highly supported as derived taxa in the Old World Nemeobiinae, with dispersal most likely occurring across the Beringia land bridge during the Oligocene. Styx and Corrachia, together with all other nemeobiines, are the only exclusively Primulaceae-feeding riodinids. The steadily increasing proliferation of the Neotropical Riodininae subfamily contrasts with the decrease in diversification in the Old World, and may provide insights into factors influencing the diversification rate of this relatively ancient clade of Neotropical insects.

Evaluation of efficacy of prion reduction filters using blood from an endogenously infected 263K scrapie hamster model.

BACKGROUND: The P-Capt prion reduction filter (MacoPharma) removes prion infectivity in model systems. This independent evaluation assesses prion removal from endogenously infected animal blood, using CE-marked P-Capt filters, and replicates the proposed use of the filter within the UK Blood Services. STUDY DESIGN AND METHODS: Two units of blood, generated from 263K scrapie-infected hamsters, were processed using leukoreduction filters (LXT-quadruple, MacoPharma). Approximately 100 mL of the removed plasma was added back to the red blood cells (RBCs) and the blood was filtered through a P-Capt filter. Samples of unfiltered whole blood, the prion filter input (RBCs plus plasma and SAGM [RBCPS]), and prion-filtered leukoreduced blood (PFB) were injected intracranially into hamsters. Clinical symptoms were monitored for 500 ± 1 day, and brains were assessed for spongiosis and prion protein deposit. RESULTS: In Filtration Run 1, none of the 50 challenged animals were diagnosed with scrapie after inoculation with the RBCPS fraction, while two of 190 hamsters injected with PFB were infected. In Filtration Run 2, one of 49 animals injected with RBCPS and two of 193 hamsters injected with PFB were infected. Run 1 reduced the infectious dose (ID) by 1.467 log (>1.187 log and <0.280 log for leukoreduction and prion filtration, respectively). Run 2 reduced prion infectivity by 1.424 log (1.127 and 0.297 log, respectively). Residual infectivity was estimated at 0.212 ± 0.149 IDs/mL (Run 1) and 0.208 ± 0.147 IDs/mL (Run 2). CONCLUSION: Leukoreduction removed the majority of infectivity from 263K scrapie hamster blood. The P-Capt filter removed a proportion of the remaining infectivity, but residual infectivity was observed in two independent processes.

Influence of a metatarsus adductus foot type on plantar pressures during walking in adults using a pedobarograph.

Metatarsus adductus is a relatively common congenital foot deformity that is often unrecognized at birth. Thus, the adult foot with metatarsus adductus is prone to pathologic entities that have been theorized to result from lateral column overload. We present a descriptive study comparing plantar foot pressure distribution during gait in subjects with and without metatarsus adductus. A total of 65 subjects were recruited for the study: 28 subjects with and 37 subjects without metatarsus adductus. An EMED(®) pedobarograph was used to collect the data. The analysis of the peak pressure and pressure-time integral in each of the 8 regions of the plantar surface of the foot showed significant (p < .05) differences between each of the regions and a significant (p < .05) interaction effect between the 8 regions and the 2 groups. A series of independent Student's t tests were therefore performed to determine which of the plantar regions showed a significant difference between the 2 groups. The result of those t tests showed that the peak pressure and pressure-time integral were significantly different (p < .05) between the 2 groups for the "heel," "lateral midfoot," and "lateral forefoot." The results of the present study support the concept that during gait, the adult foot with metatarsus adductus has increased peak plantar pressures on the lateral side of the foot.

Association of Risk Factors with Receiving a Foot Check in People With Diabetes: NHANES 2013-2016.

AIMS: The American Diabetes Association (ADA) recommends annual foot examinations for those with diabetes. The factors related to who receives an annual examination is not completely understood. This study aims to identify factors that influence whether individuals with diabtes had their feet checked for sores or irritations. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES), were analyzed to determine the factors that influence whether an annual foot check was performed. RESULTS: Participants with abnormal A1C (> 6.5%) had higher odds of having their feet checked compared to those with a normal A1C (adjusted odds ratio [AOR] = 2.61; 95% confidence interval (CI): 1.28-5.30). The presence of retinopathy (AOR = 2.76; 95% CI:1.13-6.73) or kidney disease (AOR = 2.37; 95% CI:1.11-5.03) also increased the odds of a foot check. Finally, the number of risk factors for diabetic complications was significantly associated with having a foot check when modeled as a continuous variable (AOR = 1.36; 95% CI: 1.14-1.63). CONCLUSIONS: Whether an individual received an annual foot check for sores or irritations was influenced by the number of risk factors they had, especially an elevated A1C value, and the presence of retinopathy or kidney disease.

Cost-Effectiveness of Operative Versus Nonoperative Management of Patients With Intra-articular Calcaneal Fractures.

OBJECTIVE: To assess the costs, health gains, and cost-effectiveness of operative versus nonoperative treatment of calcaneal fractures over a 5-year time horizon from both US societal and payer perspectives. METHODS: The societal perspective analysis included both direct medical costs and costs for missed work, whereas the health care payer perspective analysis included only direct medical costs associated with treatment and complications. A decision tree simulation model was developed to estimate the direct medical and indirect costs (2018 US$) and quality-adjusted life-years (QALYs) for treatment of patients sustaining intra-articular calcaneal fractures fixed with an extensile lateral approach. Direct medical costs were obtained from a large US health care system in Utah, Intermountain Healthcare, and indirect costs from the literature. Utility and probability parameters were also derived from the literature. Parameter uncertainty was explored using both one-way and probabilistic sensitivity analysis. RESULTS: From a US societal perspective, operative treatment costs less ($35,110 vs. $39,870) and yielded more QALYs (3.89 vs. 3.51) over 5 years compared with nonoperative treatment. At a willingness-to-pay threshold of $50,000 per QALY, operative fixation had an 89% probability of being cost-effective. From a health care payer perspective, operative management remained cost-effective as the incremental cost-effectiveness ratio is below the willingness-to-pay threshold of $50,000/QALY. CONCLUSION: From both US societal and health care payer perspectives, operative treatment of displaced intra-articular calcaneal fractures utilizing an extensile lateral approach is cost-effective at commonly accepted willingness-to-pay thresholds compared with nonoperative treatment over a 5-year time horizon. Patient variability may impact cost-effectiveness and should be explored in future research. LEVEL OF EVIDENCE: Economic Level III. See Instructions for Authors for a complete description of levels of evidence.

Tibial and calcaneal coupling during walking in those with chronic ankle instability.

BACKGROUND: It is estimated that nearly 2 million individuals sprain their ankle each year in the US. A majority of these are recurrent injuries, which often results in chronic ankle instability. To better understand the cause of instability, previous research has looked at the coupling or coordination between leg and foot motion during locomotion. RESEARCH QUESTION: Determine the coupling between the tibia and the calcaneus during the stance phase of walking in those without a history of ankle instability compared to those with either moderate or severe instability. METHODS: Fifty-four individuals between the age of 18-30 years (15 males; 39 females) participated in this study. Each participant's history of ankle sprains and score on the Cumberland Ankle Instability survey was used to assign them to either a no, moderate or severe instability group. Electromagnetic sensors attached to the tibia and calcaneus recorded three-dimensional movement of their tibia and calcaneus during the stance phase of barefoot over ground walking. The kinematic data was referenced to the subject's standing position and time normalized to each subject's stance phase duration. The relative phase (RP) angle and RP variability between tibia internal/external rotation and calcaneal inversion/eversion motion was then calculated. A one-way analysis of variance test was used to determine if significant differences existed between the three groups of subjects on mean RP angle or variability. An alpha level of .05 was used to determine statistical significance. RESULTS: A significant increase in RP angle and variability was found during the mid-stance phase of walking for those with severe ankle joint instability compared to those with moderate or no instability. SIGNIFICANCE: The observed decreased coordination and increased coupling variability observed for those with severe ankle instability suggests either residual ligamentous damage, inadequate sensorimotor control, or both.

The 3-m Backwards Walk and Retrospective Falls: Diagnostic Accuracy of a Novel Clinical Measure.

BACKGROUND AND PURPOSE: Several measures of fall risk have been previously developed and include forward walking, turning, and stepping motions. However, recent research has demonstrated that backwards walking is more sensitive at identifying age-related changes in mobility and balance compared with forward walking. No clinical test of backwards walking currently exists. Therefore, this article describes a novel clinical test of backwards walking, the 3-m backwards walk (3MBW), and assessed whether it was associated with 1-year retrospective falls in a population of healthy older adults. Diagnostic accuracy of the 3MBW was calculated at different cutoff points and compared with existing clinical tests. METHODS: This study was a retrospective cohort study including residents of a retirement community without a history of neurological deficits. Demographics, medical history, and falls in the past year were collected, and clinical tests included the 3MBW and the Timed Up and Go (TUG), the 5 times sit-to-stand, and the 4-square step test. Frequency distributions and t tests compared baseline characteristics of people who reported falling with people who did not. Diagnostic accuracy (sensitivity and specificity) was calculated for a series of cutoffs for the 3MBW, the TUG (≥8, 10, and 13.5 seconds), 5 times sit-to-stand (≥12 and ≥15 seconds), and 4-step square test (>15 seconds). Receiver operating curve analyses were used to define 3MBW optimal cutoffs, and the difference between the overall area under the curve (AUC) was statistically tested. SPSS 24.0 and MedCalc 17.1 were used for all analyses. RESULTS AND DISCUSSION: Fifty-nine adults with a mean (SD) age of 71.5 (7.6) years participated, with 25 people reporting falls in the past year. The mean (SD) time for the 3MBW was 4.0 (2.1) seconds. People who fell had a significantly slower 3MBW time (4.8 vs 3.5 seconds for people who did not fall, P = .015), but not a significantly slower 4-step square test (9.5 vs 8.1 seconds, P = .056), TUG (9.3 vs 8.0 seconds, P = .077), and 5 times sit-to-stand (12.5 vs 10.3 seconds, P = .121). The highest overall AUC for any measure was for the 3MBW at 3.5 seconds (0.707, 95% confidence interval = 0.570-0.821; sensitivity = 74%, specificity = 61%), which was significantly higher than the TUG at 8 seconds (AUC = 0.560, P = .023) and 13.5 seconds (AUC = 0.528, P = .011), the 4-step square test (AUC = 0.522, P = .004), but not significantly higher than the TUG at 10 seconds (P = .098) and the 5 times sit-to-stand at 12 (P = .092) or 15 seconds (P = .276). On the 3MBW, more than 75% of people who were faster than 3.0 seconds did not report any falls, and 94% of people who did not report falling were faster than 4.5 seconds. Of the people who were slower than 4.5 seconds, 81% reported falling. CONCLUSIONS: In a study of healthy older adults, the 3MBW demonstrated similar or better diagnostic accuracy for falls in the past year than most commonly used measures. People walking faster than 3.0 seconds on the 3MBW were unlikely to have reported falling, whereas people slower than 4.5 seconds were very likely to have reported falling. Further validation of the 3MBW in prospective studies, larger samples, and clinical populations is recommended.

THE EFFECT of KINESIO TAPE® on STATIC FOOT POSTURE, PLANTAR PRESSURE, and REARFOOT MOTION in INDIVIDUALS with PRONATED FEET.

BACKGROUND: Kinesio Tape® (KT) is an elastic therapeutic tape that is applied to the skin for treatment of sport-related injuries. Its application has been purported to facilitate the neuromuscular system, thus altering skeletal muscle activity to increase joint range of motion and improve performance. Due to its proposed therapeutic effect, KT may benefit individuals with excess foot pronation in order to decrease pain and improve function. Unfortunately, current research regarding the ability of KT to alter foot biomechanics is limited. PURPOSE: The purpose of this study was to determine if the application of KT to the ankle and lower leg would alter static foot posture, plantar pressure, and foot motion during walking in individuals with foot pronation. STUDY DESIGN: Prospective Cohort Study. METHODS: Thirty participants (10M/20F) were recruited for this study. Each participant had their dorsal arch height and midfoot width measured prior to the application of the KT. In addition, their dynamic rearfoot eversion and plantar pressure was recorded during walking using an electrogoniometer and plantar pressure system. After these measurements were collected, KT was applied to their right foot and lower leg in order to attempt to facilitate activity in the posterior tibialis muscle. After applying the tape, the above measurements were repeated. RESULTS: None of the variables measured were statistically significantly different between the pre-test and post-test. CONCLUSION: Application of KT did not result in a change in static foot posture, plantar pressure, and frontal plane rearfoot motion during walking. As such, KT cannot be recommended as a treatment for reducing excessive foot pronation where such a goal would be beneficial. LEVEL OF EVIDENCE: Level 3.

Short-term Effects of Manual Therapy in Patients After Surgical Fixation of Ankle and/or Hindfoot Fracture: A Randomized Clinical Trial.

BACKGROUND: Patients with surgical fixation of ankle and/or hindfoot fractures often experience decreased range of motion and loss of function following surgery and postsurgical immobilization, yet there is minimal evidence to guide care for these patients. OBJECTIVES: To assess whether manual therapy may provide short-term improvements in range of motion, muscle stiffness, gait, and balance in patients who undergo operative fixation of an ankle and/or hindfoot fracture. METHODS: In this multisite, double-blind randomized clinical trial, 72 consecutive patients who underwent open reduction internal fixation of an ankle and/or hindfoot fracture and were receiving physical therapy treatment of exercise and gait training were randomized to receive either impairment-based manual therapy (manual therapy group) or a sham manual therapy treatment of light soft tissue mobilization and proximal tibiofibular joint mobilizations (control group). Participants in both groups received 3 treatment sessions over 7 to 10 days, and outcomes were assessed immediately post intervention. Outcomes included ankle joint range of motion, muscle stiffness, gait characteristics, and balance measures. Group-by-time effects were compared using linear mixed modeling. RESULTS: There were no significant differences between the manual therapy and control groups for range of motion, gait, or balance outcomes. There was a significant difference from baseline to the final follow-up in resting gastrocnemius muscle stiffness between the manual therapy and control groups (-47.9 N/m; 95% confidence interval: -86.1, -9.8; P = .01). There was no change in muscle stiffness for the manual therapy group between baseline and final follow-up, whereas muscle stiffness increased in the control group by 6.4%. CONCLUSION: A brief course of manual therapy consisting of 3 treatment sessions over 7 to 10 days did not lead to better short-term improvement than the application of sham manual therapy for most clinical outcomes in patients after ankle and/or hindfoot fracture who were already being treated with exercise and gait training. Our results, however, suggest that manual therapy might decrease aberrant resting muscle stiffness after ankle and/or hindfoot surgical fixation. LEVEL OF EVIDENCE: Therapy, level 2. J Orthop Sports Phys Ther 2019;49(5):310-319. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8864.

Heel pain--plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association.

The Heel Pain-Plantar Fasciitis Guidelines link the International Classification of Functioning, Disability, and Health (ICF) body structures (Ligaments and fascia of ankle and foot, and Neural structures of lower leg) and the ICF body functions (Pain in lower limb, and Radiating pain in a segment or region) with the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD) health condition (Plantar fascia fibromatosis/Plantar fasciitis). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) prognosis, (3) interventions provided by physical therapists, and (4) assessment of outcome for common musculoskeletal disorders.

Reliability of the modified Foot Posture Index.

BACKGROUND: The Foot Posture Index (FPI) has been advocated as a simple and convenient tool to assess static foot posture in a clinical setting. Although published studies have indicated that the FPI has good intrarater reliability and moderate interrater reliability, these studies were conducted on a previous version of the tool that used eight criteria to score a patient's foot posture. The revised tool has only six criteria (FPI-6). The purpose, therefore, of this study was to investigate the intrarater and interrater reliability of the revised version of the FPI. METHODS: Three different raters used the FPI-6 to twice evaluate 92 feet from 46 individuals. RESULTS: Intrarater reliability was high but interrater reliability was only moderate. In addition, using the raw score generated by the FPI-6 to classify feet into one of five categories did not improve agreement between raters. CONCLUSIONS: The FPI-6 should be used with extreme caution and may actually have limited value, especially from a research perspective.

Use of antipronation taping to determine foot orthoses prescription: a case series.

In order to determine if the use of antipronation taping could be used to direct foot orthoses prescription, seven high school athletes with lower extremity or foot pain caused by overuse stress were taped for 3 days during practice sessions. A visual pain scale and the Foot and Ankle Ability Measure sports subscale were used to monitor pain and function improvement caused by taping. If the taping was effective, foot orthotics were fabricated and posted according to the change in foot posture created by the tape. After wearing the foot orthotics for 4 weeks, all athletes reported a substantial short-term (4-week) reduction in pain and an increase in function. The results of this case series indicate that changes in foot posture created by taping can be used to guide foot orthosis prescription.

Prediction of dynamic foot posture during running using the longitudinal arch angle.

BACKGROUND: A study was conducted to determine whether the longitudinal arch angle can be used to predict dynamic foot posture during running. METHODS: Seventeen healthy, experienced runners participated in the study. The static longitudinal arch angle was determined from a digital image of the medial aspect of each subject's feet obtained in relaxed standing posture. For the dynamic phase, subjects were asked to walk across a 12-m walkway and then to run across a 25-m runway while the medial aspect of each foot was videotaped. The longitudinal arch angle was digitized from the video images at midstance in walking and at midsupport while running for five trials per extremity. RESULTS: The longitudinal arch angle obtained in relaxed standing posture was highly predictive of dynamic foot posture at midstance in walking (r(2) = 0.854) and at midsupport while running (r(2) = 0.846). CONCLUSIONS: The static measurement of longitudinal arch angle is highly predictive of dynamic foot posture during walking and running. The longitudinal arch angle measured in relaxed standing posture significantly contributed to explaining more than 85% of the variance associated with the longitudinal arch angle position at midstance during walking and at midsupport while running. These results seem to validate use of the longitudinal arch angle as part of the foot and ankle physical examination.

Influence of foot posture on the functioning of the windlass mechanism.

The absence of a functioning windlass mechanism may delay re-supination of the foot during locomotion and put excess stress on the mid-tarsal joint and soft tissues of the foot. The purpose of this study was to describe the foot posture of individuals that have an impaired or absent windlass mechanism. Forty-seven individuals (34 females and 13 males) with a mean age of 26 years were recruited to participate in this study. The Foot Posture Index was used to visually assess the posture of both feet. In addition, a digital gauge was used to measure dorsal arch height and midfoot width in bilateral resting standing. Dorsal arch height and mid-foot width were also measured in non-weight bearing. Finally, for those individuals without a functioning windlass mechanism, the amount of medial wedging needed to restore its function was measured. Subjects with an "absent" or "impaired" windlass mechanism had a mean Foot Posture Index of +6.8 (sd=2.5) compared to +2.5 (sd=3.1) for those with a functioning windlass mechanism. A series of independent t-tests showed that individuals without a functioning windlass mechanism had a more pronated foot posture, a lower dorsal arch height and a wider mid-foot width compared to those that had a functioning windlass mechanism. Finally, an average medial wedge of 5.1mm (sd=2.1) was able to produce a functioning windlass mechanism in those individuals that previously lacked one.

CAN RUNNERS PERCEIVE CHANGES IN HEEL CUSHIONING AS THE SHOE AGES WITH INCREASED MILEAGE?

BACKGROUND: For those runners who utilize footwear and have a rearfoot strike pattern, the durability of the midsole heel region has been shown to deteriorate as shoe mileage increases. PURPOSE: The purpose of this study was threefold: 1) to determine if the runner can self-report changes in heel cushioning properties of the midsole after an extended period of distance running, 2) to determine if force and plantar pressures measured in the heel region of the midsole using a capacitance sensor insole change after running 640 km, and 3) to determine if a durometer could be used clinically to objectively measure changes in the hardness of the material in the heel region of the midsole. STUDY DESIGN: Cross-sectional Study. METHODS: Fifteen recreational runners voluntarily consented to participate and were provided with a new pair of running shoes. Each participant's running style was observed and classified as having a rearfoot strike pattern. Inclusion criteria included running at least 24 km per week, experience running on a treadmill, no history of lower extremity congenital or traumatic deformity, or acute injury six months prior to the start of the study. The ability of each participant to self-perceive changes in shoe cushioning, comfort and fit was assessed using the Footwear Comfort Assessment Tool (FCAT). In-shoe plantar pressures and vertical forces were assessed using a capacitance sensor insole while runners ran over a 42-meter indoor runway. A Shore A durometer was used to measure the hardness of the midsole in the heel region. All measures were completed at baseline (zero km) and after running 160, 320, 480, and 640 km. In addition to descriptive statistics, a repeated measures analysis of variance was used to determine if the FCAT, pressures, forces, or midsole hardness changed because of increased running mileage. RESULT: While plantar pressures and vertical forces were significantly reduced in the midsole heel region, none of the runners self-reported a significant reduction in heel cushioning based on FCAT scores after running 640 km. The use of a durometer provided an objective measure of the changes in the heel region of the midsole that closely matched the reductions observed in pressure and force values. CONCLUSION: The results indicated that runners who have a rearfoot strike pattern will have a 16% to 33% reduction in the amount of cushioning in the heel region of the midsole after running 480 km. Although there were significant reductions in heel cushioning, the experienced recreational runners in this study were not able to self-perceive these changes after running 640 km. In addition, the use of a durometer provides a quick and accurate way to assess changes in the hardness of the heel region of the midsole as running mileage increases. LEVEL OF EVIDENCE: 3, Controlled laboratory study.

The influence of first ray mobility on forefoot plantar pressure and hindfoot kinematics during walking.

BACKGROUND: Hypomobility and hypermobility of the first ray have been implicated in the literature as a primary cause of mechanical foot problems because of proposed obligatory and compensatory movements. Despite these theoretical links, research is sparse regarding the effect on kinematic and plantar pressure patterns as a result of altered first ray mobility. The purpose of this study was to determine whether hypomobility or hypermobility of the first ray alters hindfoot kinematics or the distribution of plantar pressures during walking. METHODS: The magnitude of dorsal first ray mobility in 82 individuals was measured and then classified as being hypomobile, normal, or hypermobile. The plantar pressure under the first and second metatarsal heads, as well as hindfoot kinematics during walking, were then compared between the three categories of first ray mobility. RESULTS: The results of this study indicate that those feet with a hypomobile first ray had significantly decreased plantar force and pressure values under the first metatarsal compared to the second metatarsal. In addition, feet with a hypomobile first ray showed significantly more hindfoot eversion compared to those with either normal or hypermobile first rays. CONCLUSION: The results of this study do not support the common theoretical implications of altered mobility of the first ray related to plantar pressure and hindfoot kinematics.

Use of plantar contact area to predict medial longitudinal arch height during walking.

A study was conducted to determine whether plantar surface contact area measures calculated from footprints collected during walking can be used to predict the height of the medial longitudinal arch. Thirty healthy women participated in the study. Arch height was determined by the distance from the navicular tuberosity to the floor and by the "bony" arch index. Dynamic plantar surface contact area was recorded using a pressure platform as the subjects walked across a 12-m walkway. The arch index and the total plantar surface contact area were determined from the pressure sensor data. The results indicated that plantar surface contact area could be used to estimate only approximately 27% of the height of the medial longitudinal arch as determined by navicular tuberosity height and the bony arch index. These findings demonstrate the inability of the clinician to predict the vertical height of the medial longitudinal arch on the basis of the amount of foot plantar surface area in contact with the ground during walking.

Characteristics of US-Licensed Foreign-Educated Physical Therapists.

BACKGROUND: Foreign-educated physical therapists are often viewed as one possible solution to the current shortage of physical therapists, yet there is very little research regarding these individuals. OBJECTIVE: The purpose of this study was to describe those physical therapists who are licensed in the United States but who were educated in another country. This description includes their country of education, their employment patterns, and the reasons they decided to emigrate and work as a physical therapist in the United States. DESIGN: A cross-sectional survey was conducted. METHODS: An electronic survey was sent to all physical therapists currently licensed in the United States who had been educated in another country. Those who had been licensed within the last 5 years are reported. RESULTS: The results of the survey indicated that the typical foreign-educated physical therapist is female, aged 32.2 years, and was born and trained in either the Philippines or India. A majority of foreign-educated physical therapists obtained their first license in New York, Michigan, Illinois, Texas, or Florida. The most common reasons cited as to why a particular jurisdiction was chosen for initial employment were "recruiter recommendation," "family, spouse, partner, or friends," "ease of the licensure process," and "ability to secure a visa sponsor." A majority of foreign-educated physical therapists in this study initially worked in a skilled nursing facility, a long-term care or extended care facility, or a home health setting. LIMITATIONS: Only those foreign-educated physical therapists licensed within the last 5 years are reported. CONCLUSIONS: This study is the first to report on foreign-educated physical therapists in the United States. The findings of this study will provide important and useful information to others dealing with physical therapy professional and workforce issues.

Use of the longitudinal arch angle to predict dynamic foot posture in walking.

To determine whether differences exist in the longitudinal arch angle based on sex or extremity, the longitudinal arch angle was assessed in 21 men and 21 women using a digital image of the medial aspect of each subject's feet. The image was obtained with the subject in relaxed standing posture and in maximum internal rotation of the lower leg. To determine whether the longitudinal arch angle could be used to predict dynamic foot posture during walking, 50 different subjects were asked to walk across a 6-m walkway while the medial aspect of each foot was videotaped. The longitudinal arch angle was digitized from digital images obtained at midstance for three walking trials. No differences in the longitudinal arch angle were found based on sex or extremity. The longitudinal arch angles obtained in the static positions of relaxed standing posture and maximum internal rotation were highly predictive of dynamic foot posture at midstance during walking. Relaxed standing posture and maximum internal rotation significantly contributed to explaining more than 90% of the variance associated with the longitudinal arch angle position at midstance during walking. These results validate use of the longitudinal arch angle as part of the foot and ankle physical examination.