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.

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 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.

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.

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.

The amount of rearfoot motion used during the stance phase of walking.

The purpose of this study was to determine the proportion of available passive frontal plane rearfoot motion that is used during the stance phase of walking. Data were collected from 40 healthy, asymptomatic volunteer subjects (20 men and 20 women) aged 23 to 44 years. Passive inversion and eversion motion was measured in a non-weightbearing position by manually moving the calcaneus. Dynamic rearfoot motion was referenced to a vertical calcaneus and tibia and was measured using a three-dimensional electromagnetic motion-analysis system. The results indicated that individuals used 68.1% of their available passive eversion range of motion and 13.2% of their available passive inversion range of motion during walking. The clinical implication of individuals' regularly operating at or near the end point of their available rearfoot eversion range of motion is discussed.

Plantar Pressure and Gait Symmetry in Individuals with Fractures versus Tendon Injuries to the Hindfoot.

BACKGROUND: The intent of this study was to determine whether differences in function, walking characteristics, and plantar pressures exist in individuals after operative fixation of an intra-articular calcaneal fracture (HFX) compared with individuals with operative repair of an Achilles tendon rupture (ATR). METHODS: Twenty patients (ten with HFXs and ten with ATRs) were recruited approximately 3.5 months after operative intervention. All of the participants completed the Lower Extremity Functional Scale and had their foot posture assessed using the Foot Posture Index. Walking velocity was assessed using a pressure mat system, and plantar pressures were measured using an in-shoe sensor. In addition to between-group comparisons, the involved foot was compared with the uninvolved foot for each participant. RESULTS: There were no differences in age, height, weight, or number of days since surgery between the two groups. The HFX group had lower Lower Extremity Functional Scale scores, slower walking velocities, and different forefoot loading patterns compared with the ATR group. The involved limb of both groups was less pronated. CONCLUSIONS: The results indicate that individuals with an HFX spend more time on their involved limb and walk slower than those with an ATR. Plantar pressures in the HFX group were higher in the lateral forefoot and lower in the medial forefoot and in the ATR group were symmetrically lower in the forefoot.

Reliability of visual measurement of forefoot alignment.

BACKGROUND: The purpose of this study was to determine the interrater reliability of visual rating of forefoot frontal plane deformities among clinicians with different training. METHODS: Thirty individuals (16 men and 14 women) between the ages of 22 and 52 years of age participated in the study. None of the patients had a history of congenital deformity, pain, or trauma in the lower extremities during the 6 months before the study. Three clinicians of different educational backgrounds and experience visually evaluated each of the patients and rated forefoot alignment. None of the clinicians knew the rating assigned by either of the other two clinicians. RESULTS: The results of this study showed that two of the clinical raters agreed 61.7% of the time, but neither of them agreed with the third clinician more than 15% of the time. CONCLUSION: This study indicates that the commonplace method of visually rating forefoot frontal plane deformities is unreliable and of questionable clinical value.

Reliability and validity of center-of-pressure quantification.

The purpose of this study was to determine the reliability and validity of two center-of-pressure quantification methods. One hundred five individuals (33 men and 72 women) with a mean age of 26.7 years participated in phase 1 of the study. Two measures of the center-of-pressure pattern, the lateral-medial area index and the lateral-medial force index, were calculated from plantar pressure data collected on all subjects. Between-trial reliability of the two measurements was assessed using intraclass correlation coefficients. In phase 2, frontal plane motion of the rearfoot was recorded in 30 individuals. Pearson correlation coefficients were then calculated between the two center-of-pressure indices and the magnitude of rearfoot eversion obtained from each subject during walking. Intraclass correlation coefficient values ranged from 0.374 to 0.889 for the lateral-medial area index and from 0.215 to 0.905 for the lateral-medial force index. Pearson correlation coefficients between the two center-of-pressure indices and the rearfoot kinematic variables ranged from 0.050 to 0.165. The lateral-medial area index and the lateral-medial force index may have adequate between-trial reliability but are not related to the magnitude of frontal plane rearfoot eversion during the stance phase of walking.

Motion of the calcaneus, navicular, and first metatarsal during the stance phase of walking.

One hundred fifty-three subjects between the ages of 18 and 41 years (mean age, 26.2 years) with no history of congenital or traumatic deformity or foot problems walked along a 6-m walkway while the angular and linear displacement of the tibia, calcaneus, navicular, and first metatarsal was measured by means of an electromagnetic motion analysis system. Three-dimensional movement of the calcaneus relative to the tibia, of the navicular relative to the calcaneus, and of the first metatarsal relative to the navicular during the stance phase of gait was calculated. The results of this study provide information on, and an understanding of, how the calcaneus, navicular, and first metatarsal function during the stance phase of normal human walking.

Reliability and validity of clinically assessing first-ray mobility of the foot.

The objective of the present study was to determine the amount of agreement among three clinicians in the clinical assessment of dorsal mobility of the foot's first ray and the agreement between their assessments and that of a mechanical device designed to quantify first-ray mobility. Sixty feet from 30 individuals evaluated clinically by three health-care professionals were classified as having a hypomobile, normal, or hypermobile first ray. The amount of first-ray dorsal mobility of each participant's foot was then measured using a device specifically constructed for that purpose. The results of this study show generally poor agreement among the three clinicians on whether a foot should be classified as having hypomobility, hypermobility, or normal mobility of the first ray. The amount of agreement with the quantitative device was poor for two of the clinicians and moderate for the third clinician.

The effect of exercise and time on the height and width of the medial longitudinal arch following the modified reverse-6 and the modified augmented low-dye taping procedures.

PURPOSE/BACKGROUND: No evidence exits regarding the magnitude of the change in foot posture following the "modified reverse-6" (MR6) taping procedure, either alone or in combination with the "low-dye" (LD) taping technique. The purpose of this study was to investigate the change in the height and width of the midfoot after application of the MR6 and the MR6 plus the LD (MR6+LD) taping technique and determine how long those changes last. METHODS: Eleven individuals (2 female and 9 male) were recruited for this study and were tested under each of two experimental conditions, the MR6 and the MR6+LD taping technique. The order of testing for the two conditions was randomly determined. For each condition, the height and width of the midfoot at 50% of each subject's foot length was initially measured and then again immediately following the application of the tape. These measurements were repeated four hours later immediately prior to running two miles on a treadmill, again immediately after running, and finally after another four hours. RESULTS: The dorsal arch height increased significantly with both the MR6 and MR6+LD taping, but only the MR6+LD remained statistically greater after four hours, a bout of exercise and again at the end of the day. The mean width of the midfoot significantly decreased with both taping procedures. The change in the width of the midfoot remained significantly decreased in both taping conditions after exercise and throughout the day. CONCLUSIONS: Both taping procedures are able to significantly change the height and width of the medial longitudinal arch of the foot, but the change lasted longer when the two taping procedures were combined. LEVELS OF EVIDENCE: Level 3, Prospective Cohort Study.