Influence of Children's Foot Type on Their Physical Motor Performance.

BACKGROUND: This cross-sectional study aimed to determine whether normal, flat, or high-arched feet corresponded to better performance of certain motor tests in children. METHODS: One hundred eighty-seven children (mean ± SD age, 11.15 ± 1.24 years) were recruited and divided into three groups: 96 with normal feet, 54 with high-arched feet, and 37 with low-arched feet. Nine motor trials were selected to assess motor performance: standing long jump, standing triple jump from each foot, standing vertical jump, shuttle run 10 × 5 m, standing-start 20-m sprint, static balance, dynamic balance on a beam of an inverted gym bench, and agility circuit. RESULTS: There were no significant differences in the trial results between groups, although in eight of the nine trials participants in the high-arched group tended to perform better. Boys performed better than girls in all of the trials except those of balance. CONCLUSIONS: These results suggest that children with a certain foot type did not achieve better motor performance in the nine trials tested.

Sensitivity and specificity of a new test for thermographic evaluation of the foot in the diagnosis of diabetic peripheral polyneuropathy.

OBJECTIVE: This work determined the sensitivity, specificity, and predictive values of a test evaluating the thermal perception threshold to cold and heat and established a thermal interval with the participant's basal temperature in order to detect diabetic peripheral neuropathy in 172 people with diabetes, 86 with and 86 without diabetic neuropathy. DESIGN: This was a cross-sectional, diagnosis accuracy study. SETTING: This research was performed from January 2010 to February 2012 in Seville, Spain, and Córdoba, Spain. PARTICIPANTS: One hundred seventy-two people with diabetes, 86 with and 86 without diabetic neuropathy, were recruited to participate in the study. MAIN OUTCOME MEASURES: The thermal sensitivity was examined in the participants' feet with an instrument designed to assess thermal discrimination and sensitivity based on the Peltier principle. The skin temperature was recorded, and it was performed the following tests: (1) determining the thermal discrimination threshold, used to identify the lowest noticeable temperature difference, and (2) examining the thermal sensitivity, used to determine the absolute thermal threshold. The receiver operating characteristic curve technique was used to calculate the sensitivity, specificity, and predictive values. MAIN RESULTS: The area under the curve that showed the best sensitivities and specificities bilaterally was for the warm temperatures under the first and fifth metatarsal heads. In these zones, the temperature difference needed to predict whether a patient was neuropathic was 2°C. Sensitivities were greater than 75%, and the positive predictive values in all cases exceeded 60%. CONCLUSIONS: This technique enabled the authors to quantify the degrees of colder or warmer temperature differences that participants with diabetes (with and without neuropathy) needed to be able to detect a difference, with acceptable sensitivity, specificity, and predictive values.

The tarsal bone test: a basic test of health sciences students' knowledge of lower limb anatomy.

OBJECTIVES: The aim of the present study was to design an easy-to-use tool, the tarsal bone test (TBT), to provide a snapshot of podiatry students' basic anatomical knowledge of the bones of the lower limb. METHODS: The study included 254 podiatry students from three different universities, 145 of them were first-year students and 109 were in their fourth and final years. The TBT was administered without prior notice to the participants and was to be completed in 5 minutes. RESULTS: The results show that 97.2% of the subjects (n = 247) correctly labelled all tarsal bones, while the other 2.8% (n = 7) incorrectly labelled at least one bone, that was either the cuboid (7 times) or the navicular (6 times). Although only one fourth-year student inaccurately identified one bone, no significant differences in the distribution of the correct and incorrect responses were found between first and fourth-year students. CONCLUSIONS: The TBT seems to be a straightforward and easy-to-apply instrument, and provides an objective view of the level of knowledge acquired at different stages of podiatry studies.

Plantar fasciitis and its relationship with hallux limitus.

BACKGROUND: We sought to determine whether patients with plantar fasciitis have limited dorsiflexion in the first metatarsophalangeal joint and which type of foot, pronated or supinated, is most frequently associated with plantar fasciitis. METHODS: The 100 study participants (34 men and 66 women) were divided into two groups: patients with plantar fasciitis and controls. The Foot Posture Index and dorsiflexion of the first metatarsophalangeal joint were compared between the two groups, and a correlation analysis was conducted to study their relationship. RESULTS: In the plantar fasciitis group there was a slight limitation of dorsiflexion of the hallux that was not present in the control group (P < .001). Hallux dorsiflexion and the Foot Posture Index were inversely correlated (Spearman correlation coefficient, -0.441; P < .01). CONCLUSIONS: Participants with plantar fasciitis presented less hallux dorsiflexion than those in the control group, and their most common foot type was the pronated foot.

Hallux abductus interphalangeus in normal feet, early-stage hallux limitus, and hallux valgus.

BACKGROUND: Excessive deviation of the distal phalanx in abduction frequently occurs in advanced stages of hallux rigidus but not in hallux valgus. Therefore, theoretically there should be no significant differences in the hallux interphalangeal angle (HIPA) between individuals with normal feet, those with hallux valgus, and those with mild hallux limitus. The objective of the present study was thus to determine if significant differences in HIPA exist in the early stages of hallux valgus or hallux limitus deformities. METHODS: The hallux interphalangeal angle was measured in three groups of participants: a control group with normal feet (45 participants), a hallux valgus group (49 participants), and a hallux limitus group (48 participants). Both of the pathologies were at an early stage. A dorsoplantar radiograph under weightbearing conditions was taken for each individual, and measurements (HIPA and hallux abductus angle [HAA]) were taken using AutoCAD (Autodesk Inc, San Rafael, California) software. Intergroup comparisons of HIPA, and correlations between HIPA, HAA, and hallux dorsiflexion were calculated. RESULTS: The comparisons revealed no significant differences in the values of HIPA between any of the groups (15.2 ± 5.9 degrees in the control group, 15.5 ± 3.9 degrees in the hallux valgus group, and 16.15 ± 4.3 in the hallux limitus group; P  =  0.634). The Pearson correlation coefficients in particular showed no correlation between hallux dorsiflexion, HAA, and HIPA. CONCLUSIONS: For the study participants, there were similar deviations of the distal phalanx of the hallux with respect to the proximal phalanx in normal feet and in feet with the early stages of the hallux limitus and hallux valgus deformities.

Angular position of the cleat according to torsional parameters of the cyclist's lower limb.

OBJECTIVE: The aim of this work was to study the relationship of torsional and rotational parameters of the lower limb with a specific angular position of the cleat to establish whether these variables affect the adjustment of the cleat. DESIGN: Correlational study. SETTING: Motion analysis laboratory. PARTICIPANTS: Thirty-seven male cyclists of high performance. INTERVENTIONS: The variables studied of the cyclist's lower limb were hip rotation (internal and external), tibial torsion angle, Q angle, and forefoot adductus angle. MAIN OUTCOME MEASURES: The cleat angle was measured through a photograph of the sole and with an Rx of this using the software AutoCAD 2008. The variables were photograph angle (photograph), the variable denominated cleat-tarsus minor angle, and a variable denominated cleat-second metatarsal angle (Rx). Analysis included the intraclass correlation coefficient for the reliability of the measurements, Student's t test performed on the dependent variables to compare side, and the multiple linear regression models were calculated using the software SPSS 15.0 for Windows. RESULTS: The Student's t test performed on the dependent variables to compare side showed no significant differences (P = 0.209 for the photograph angle, P = 0.735 for the cleat-tarsus minor angle, and P = 0.801 for the cleat-second metatarsal angle). Values of R and R2 for the photograph angle model were 0.303 and 0.092 (P = 0.08), the cleat/tarsus minor angle model were 0.683 and 0.466 (P < 0.001), and the cleat/second metatarsal angle model were 0.618 and 0.382, respectively (P < 0.001). CONCLUSIONS: The equation given by the model was cleat-tarsus minor angle = 75.094 - (0.521 × forefoot adductus angle) + (0.116 × outward rotation of the hips) + (0.220 × Q angle).

Effectiveness of neuromuscular stretching with symmetrical biphasic electric currents in the cavus foot.

BACKGROUND: Pes cavus is a structural deformity in which the increased plantar arch can lead to greater metatarsal verticality with the consequent excess of pressure under the forefoot zone (especially the metatarsal zone), causing pain and significant loss of functional capacity. We sought to determine whether neuromuscular stretching with symmetrical rectangular biphasic currents can reduce the pressure supported by this zone. METHODS: This prospective, nonrandomized, longitudinal, analytical, and experimental controlled trial included 34 patients with pes cavus. Pedobarometric measurements were made using the footscan USB Gait Clinical System platform considering the toes and metatarsal heads, forefoot, midfoot, and hindfoot before and after performing stretching using a Med Tens 931 electrotherapy device. The measurements were repeated 7 days after the application. RESULTS: With the Student t test for paired samples, we showed that there was a significant decline in metatarsal pressure (P < .001) in the zones of the first (P = .045) and third (P = .01) metatarsals and that this reduction was maintained 1 week after the plantar stretching. CONCLUSIONS: Plantar stretching with symmetrical rectangular biphasic currents is effective for the prevention and treatment of pes cavus metatarsalgia caused by excessive pressure.

Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis.

BACKGROUND: The aim of this study was to determine whether tightness of the posterior muscles of the lower extremity was associated with plantar fasciitis. METHODS: A total of 100 lower limbs of 100 subjects, 50 with plantar fasciitis and 50 matching controls were recruited. Hamstring and calf muscles were evaluated through the straight leg elevation test, popliteal angle test, and ankle dorsiflexion (knee extended and with the knee flexed). All variables were compared between the 2 groups. In addition, ROC curves, sensitivity, and specificity of the muscle contraction tests were also calculated to determine their potential predictive powers. RESULTS: Differences between the 2 groups for the tests used to assess muscular shortening were significant (P < .001) in all cases. The straight leg elevation test and ankle dorsiflexion with the knee extended presented respective sensitivities of 94% and 100% and specificities of 82% and 96% as diagnostic tests for the participants in this study. CONCLUSION: Tightness of the posterior muscles of the lower limb was present in the plantar fasciitis patients, but not in the unaffected participants. CLINICAL RELEVANCE: The results of this study suggest that therapists who are going to employ a stretching protocol for treatment of plantar fasciitis should look for both hamstring as well as triceps surae tightness. Stretching exercise programs could be recommended for treatment of plantar fasciitis, focusing on stretching the triceps surae and hamstrings, apart from an adequate tissue-specific plantar fascia-stretching protocol. LEVEL OF EVIDENCE: Level III, case control study.

The short-term effect of custom-made foot orthoses in subjects with excessive foot pronation and lower back pain: a randomized, double-blinded, clinical trial.

STUDY DESIGN: randomized, double-blinded, clinical trial. BACKGROUND: Low back pain is one of the commonest disorders affecting the back. The literature reflects how over time excessive pronation of the foot has become to be recognized as linked to chronic low back pain, and how the problem can evolve for the better with the use of compensating foot orthoses. OBJECTIVES: The main objective of this study is to answer the question of whether the use of a certain type of custom-made foot orthosis alleviates low back pain. MATERIAL AND METHODS: In a sample of 51 participants with excessive subtalar pronation and chronic low back pain (43 women and 8 men), the effect of custom-made foot orthoses in low back pain was studied. The study design was a randomized, double-blinded, clinical trial with two groups: experimental, treated with the custom-made foot orthoses, and control, treated with a placebo. Low back pain was evaluated by a visual analog scale for pain and Oswestry's Disability Index Questionnaire for lower back pain at two moments--on the day of inclusion in the study and after 4 weeks of treatment. RESULTS: The evolution of the low back pain showed significant differences in the experimental group, showing a significant reduction of pain and disability (p < 0.001, visual analog scale; p < 0.001, Oswestry's Index). CONCLUSIONS: In the sample studied, the use of custom-made foot orthoses to control foot pronation had a short-term effect in reduction of perceived low back pain.

Effect of custom-made foot orthoses in female hallux valgus after one-year follow up.

BACKGROUND: Subtalar joint hyperpronation plays a fundamental role in the development of hallux valgus (HV). Foot orthotics have used to treat this condition and are aimed at preventing progression of the deformity. OBJECTIVES: The aim of this study was to determine if the use of custom-made foot orthotics for 12 months prevented the advancement of HV in women. STUDY DESIGN: Prospective trial, using a repeated-measures design. METHODS: Fifty-four women with mild to moderate HV were divided into two groups: the experimental group used custom-made foot orthoses, and the control group used no treatment. First intermetatarsal (IMA) and hallux abductus (HAA) angles were measured at the beginning of the study and after 12-months follow up. Inter-group comparisons were made of these angles at both times of measurement, and intra-group comparisons between the two times of measurement. RESULTS: The initial HAA was similar in both groups (19.92 ± 4.25 degrees for the control group, 20.55 ± 5.10 degrees for the experimental group; p = 0.392), and also the IMA (10.56 ± 2.45 degrees for the control group, 10.86 ± 2.33 for the experimental group; p = 0.618) There were no significant differences in the follow-up values of these angles (p = 0.395 and p = 0.288, respectively). There were no significant intra-group differences in the comparisons of the initial and follow-up angles. CONCLUSIONS: HV did not have a significantly slower evolution in participants of the experimental group compared with controls. Custom-made orthoses appear to have no effect in the evolution of mild and moderate HV during a 12 month period. Clinical relevance Subtalar joint hyperpronation plays a fundamental role in the development of hallux valgus. Conservative management typically involves the use of foot orthotics which is aimed at preventing the progress of the condition. The use of foot orthotics however should be used as a long term management strategy (beyond 12 months).

Hallux interphalangeal joint range of motion in feet with and without limited first metatarsophalangeal joint dorsiflexion.

BACKGROUND: This work was designed to assess the degree of correlation between hallux interphalangeal joint and first metatarsophalangeal joint dorsiflexion and to compare the mobility of the hallux interphalangeal joint between participants with and without limited first metatarsophalangeal joint dorsiflexion (hallux limitus). METHODS: Dorsiflexion of the hallux interphalangeal joint was measured in 60 normal feet and in 60 feet with hallux limitus to find correlations with first metatarsophalangeal joint dorsiflexion with the Spearman correlation coefficient and a simple linear regression equation. In addition, movement of the hallux interphalangeal joint was compared between normal and hallux limitus feet with the Mann-Whitney U test. RESULTS: Significant differences were found between the groups in mean ± SD interphalangeal joint dorsiflexion (control group: 1.17° ± 2.50° ; hallux limitus group: 10.65° ± 8.24° ; P < .001). A significant inverse correlation was found between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion (ρ = -0.766, P < .001), and the regression equation from which predictions could be made is the following: hallux interphalangeal joint dorsiflexion = 27.17 - 0.381 × first metatarsophalangeal joint dorsiflexion. CONCLUSIONS: Hallux interphalangeal joint dorsiflexion was greater in feet with hallux limitus than in normal feet. There was a strong inverse correlation between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion.

Effect of curettage after segmental phenolization in the treatment of onychocryptosis: a randomized double-blind clinical trial.

BACKGROUND: Segmental phenolization for the treatment of onychocryptosis has a number of disadvantages, resulting from the cauterization of the tissue, including delayed healing and prolonged drainage. Although one may expect excision or curettage of the cauterized tissue after phenolization to benefit the healing process, these simple procedures have not been suitably studied. OBJECTIVE: To examine the effect of curettage primarily on cicatrization or healing time and secondarily on postoperative bleeding. MATERIALS AND METHODS: Fifty-one patients (80 feet) with stage I or IIa onychocryptosis according to the classification of Mozena were enrolled in this randomized, double-blind, parallel-group, controlled clinical trial. A total of 137 phenolizations were performed on affected folds of ingrowing hallux nails. Each hallux was randomly assigned to one of two groups (experimental [phenolization with curettage]; control [phenolization alone]). RESULTS: Curettage reduced healing time (7.49 ± 1.76 days vs 12.38 ± 3.01 days; p = .001), increased postoperative bleeding (p < .001), led to lower rates of infection (p = .01), and increased postoperative pain (p = .028). CONCLUSION: Curettage of the cauterized tissue after segmental phenolization reduces healing time.

Hallux limitus and its relationship with the internal rotational pattern of the lower limb.

BACKGROUND: The aims of this study were to determine whether individuals with mild hallux limitus show a diminished capacity of internal rotation of the lower limb compared with those without hallux limitus and whether individuals with mild hallux limitus show an increased foot progression angle. METHODS: In 80 study participants (35 with normal feet and 45 with mild hallux limitus), the capacity of internal rotation of the lower limb (internal rotational pattern), hallux dorsiflexion, and the foot progression angle were measured. The values for internal rotational pattern and foot progression angle were compared between the two study groups, and the correlations between these variables were studied. RESULTS: The capacity of internal rotation of the lower limb was significantly lesser in patients with mild hallux limitus (P < .0001). There was no significant difference in foot progression angle between the two groups (P = .115). The Spearman correlation coefficient was 0.638 (P < .0001) for the relationship between internal rotational pattern and hallux dorsiflexion. CONCLUSIONS: Patients with mild hallux limitus had a lesser capacity of internal rotation of the lower extremity than did individuals in the control group. The more limited the internal rotational pattern of the lower limb, the more limited was hallux dorsiflexion. The foot progression angle was similar in both groups.

Benefits of custom-made foot orthoses in treating patellofemoral pain.

BACKGROUND: Patellofemoral pain is one of the most common disorders affecting the knee. Forefoot varus and excessive subtalar pronation can be associated with patellofemoral pain. Foot orthotics may produce an improvement in symptoms. OBJECTIVES: The aim of this study was to test whether patellofemoral pain is improved after four weeks of using custom-made foot orthoses. STUDY DESIGN: Clinical trial without control group. METHODS: Twenty-one subjects with patellofemoral pain were given custom-made foot orthoses (2-mm thick polypropylene and 4-mm thick polyethylene foam liner of 45 shore A hardness). Patellofemoral pain was evaluated with a visual analogue scale before applying the treatment, and at two weeks and four weeks follow-up. At the two-week check-up, a forefoot varus posting was added to the orthoses. RESULTS: Improvements in patellofemoral pain was significant in all comparisons: initial pain with pain at the two-week check-up (P < 0.001), initial pain with pain at four weeks (P < 0.001), and pain at two weeks with pain at four weeks (P < 0.001). The effect size was large in all comparisons. CONCLUSION: For the participants in this study, the custom-made foot orthoses were found to be an effective conservative treatment to reduce the symptoms of patellofemoral pain.

Orthotic devices with out-toeing wedge as treatment for in-toed gait in children.

BACKGROUND: Orthotic devices are used to help children progressively acquire a more physiologic walking pattern. METHODS: To determine the effect of an orthotic device with an out-toeing wedge along with a physiologic shoe as treatment for in-toed gait, angle of gait was measured in 48 children aged 3 to 14 years with in-toed gait. The following comparisons were made: angle of gait in children unshod versus children shod without treatment, angle of gait in children shod without treatment versus children shod plus orthoses, and angle of gait in children unshod versus children shod plus orthoses. RESULTS: Using a correctly fitting shoe increased the angle of gait in a nonsignificant manner, but a significant increase was revealed in the comparison of the angle of gait in children unshod versus children under treatment. The results showed that the behavior in boys and girls was similar to that in the total sample. Regarding side, the corrective effect of the orthotic device was similar in the two feet. However, the data showed a greater corrective effect of the shoe in the right foot. CONCLUSIONS: Orthotic devices with out-toeing wedge combined with correctly fitting shoes, as well as shoes alone, are useful tools in the treatment of in-toed gait in children.

Metatarsal protrusion angle: values of normality.

BACKGROUND: We performed an adaptation of the system of evaluation of metatarsal protrusion described by Oller in 1994 to study the metatarsal parabola group. METHODS: The system of measurement was applied to the five metatarsals of 169 normal feet (72 feet of women and 97 feet of men) according to the inclusion criteria established. RESULTS: The mean +/- SD metatarsal protrusion angle with respect to the second ray in women was 87.49 degrees +/- 5.48 degrees for metatarsal I, 70.00 degrees +/- 5.74 degrees for metatarsal III, 63.47 degrees +/- 4.17 degrees for metatarsal IV, and 56.38 degrees +/- 3.27 degrees for metatarsal V. In men, the values were 85.30 degrees +/- 6.75 degrees for metatarsal I, 68.00 degrees +/- 6.72 degrees for metatarsal III, 60.56 degrees +/- 4.61 degrees for metatarsal IV, and 54.13 degrees +/- 3.75 degrees for metatarsal V. The comparative analysis between women and men showed significant differences (P < .05) for all of the values of metatarsal protrusion. CONCLUSIONS: The comparative analysis between women and men indicates a possible difference between the anthropometric values of these variables in humans, suggesting a possible repercussion on the biomechanical patterns by sex.

Metatarsus adductus angle in male and female feet: normal values with two measurement techniques.

BACKGROUND: The literature contains several techniques for calculating metatarsal adductus angle. Most common systems use the fourth metatarsal cuboid joint and the fifth metatarsal cuboid joint. Although both systems are quite different, normal values of metatarsus adductus angle have not been established with each system of measurement. METHODS: Two hundred six radiographic images of feet in dorsoplantar projection were used to measure the metatarsus adductus angle using two different reference points: the joint between the fourth metatarsal and the cuboid and the joint between the fifth metatarsal and the cuboid. RESULTS: Comparison of the results of the two measurement techniques showed significant differences (P < .05). The values of the metatarsus adductus angle also showed significant differences in men versus women (P < .05). The reliability of the measurements was checked by using an intra- and inter-evaluator test performed by two evaluators. CONCLUSION: Data showed the reliability of both systems of measurement, although significant differences in the metatarsal adductus angle mean value were found using these systems of measurement in the same foot. On the other hand, significant differences were found in mean values of metatarsus adductus angle between male and female feet.

Length of the sesamoids and their distance from the metatarsophalangeal joint space in feet with incipient hallux limitus.

BACKGROUND: We designed this study to verify whether the sesamoids of the first metatarsal head are longer than normal in feet with incipient hallux limitus, and whether feet with incipient hallux limitus are in a more proximal than normal sesamoid position. METHODS: In a sample of 183 dorsoplantar radiographs under weightbearing conditions (115 of normal feet and 68 of feet with slightly stiff hallux), measurements were made of the length of both the medial and the lateral sesamoids and of the distance between these bones to the distal edge of the first metatarsal head. These variables were compared between the normal and the hallux limitus feet. The relationship between these variables and the hallux dorsiflexion was also studied. RESULTS: We found significant differences between the two types of foot in the medial and lateral sesamoid lengths, but no significant difference in the distance between the sesamoids to the distal edge of the first metatarsal. A poor-to-moderate inverse correlation was found between hallux dorsiflexion and medial sesamoid length and between hallux dorsiflexion and lateral sesamoid length. CONCLUSIONS: The length of the sesamoid bones of the first metatarsal head could be implicated in the development of the hallux limitus deformity.

Length of the first metatarsal and hallux in hallux valgus in the initial stage.

The aim of this study was to confirm whether the length of the first metatarsal and the length of the hallux are greater than normal in the initial phase of the hallux valgus deformity. In a sample of 152 radiographs (98 of normal feet and 54 of incipient hallux valgus feet), the length of the first metatarsal and the hallux was measured according to methods previously described. Comparisons were made between normal and hallux valgus feet, and between male and female feet. The results show significant differences between the two groups in the first metatarsal (P<0.0001) and hallux (P<0.001). In the male feet, these differences are more marked (when comparing the length of the hallux between the female hallux valgus feet and the female normal feet, P>0.05). This indicates that in men with hallux valgus, the excess in length of the first metatarso-digital segment is greater than in women that develop this deformity, at least in its initial phase. According to these results, the size of the first metatarso-digital segment could be involved in the development of the hallux valgus deformity.

Radiographic study of the size of the first metatarso-digital segment in feet with incipient hallux limitus.

BACKGROUND: The aim of this study is to confirm whether the absolute and relative lengths of the first metatarso-digital segment is greater than normal in incipient hallux limitus deformity. METHODS: In a sample of 144 dorsoplantar radiographs under weightbearing conditions (94 of normal feet and 50 of feet with a slightly stiff hallux), measurements were made of the relative first metatarsal protrusion, the length and width of the first metatarsal and of the proximal phalanx of the hallux, the length of the distal phalanx of the hallux, and the total length of the hallux. RESULTS: There were significant differences between the two types of feet in the relative first metatarsal protrusion, the width of the first metatarsal, the length and width of the proximal phalanx of the hallux, the length of the distal phalanx, and the total length of the hallux. CONCLUSION: The size of the first metatarso-digital segment could be implicated in the development of hallux limitus deformity.