Validity of 3 clinical techniques for the measurement of static foot posture in older people

STUDY DESIGN: Concurrent validity study. OBJECTIVES: To determine the validity of 3 clinical methods for assessing static foot posture in older people. BACKGROUND: Variations in the structure of the medial longitudinal arch are thought to influence lower extremity function; however, the validity of clinical measurements has not been fully established. METHODS AND MEASURES: Clinical measurements of arch index (AI), navicular height (NH), and Foot Posture Index (FPI) were performed on 95 subjects (31 men and 64 women), aged 62 to 94 years (mean +/- SD, 78.6 +/- 6.5 years). These clinical measurements were then correlated with 3 arch-related measurements from radiographs: navicular height (NHr), calcaneal inclination angle (CIA), and calcaneal first metatarsal angle (C1MA). RESULTS: All 3 clinical measures demonstrated significant associations with each of the radiographic parameters (P<.01). NH was highly correlated with NHr (Pearson r = 0.79), followed by C1MA (r = -0.53), and CIA (r = 0.44). The AI was highly correlated with the C1MA (r = 0.71) and CIA (r = -0.68), but only moderately correlated with NHr (r = 0.52). The FPI demonstrated weaker correlations with the radiographic parameters (NHr, r = 0.59; CIA, r = 0.36; C1MA, r = 0.42). CONCLUSION: Clinical measurements of AI, NH, and FPI provide valid information regarding the structure of the medial longitudinal arch; however, each test may reflect different aspects of arch structure. NH would appear to be the most useful clinical measure, as it is simple to perform and provides an accurate representation of the skeletal alignment of the medial longitudinal arch. Further refinement of the clinical measurement of NH is now required to improve its moderate intratester and intertester reliability.     

The association between foot posture,single leg balance and running biomechanics of the foot

ObjectivesA mal-aligned foot posture (high-arched and flat feet) and poor single leg balance ability have been separately associated with foot injuries during running. Therefore, clinicians assess these routinely. However, the extent to which foot posture and single-leg balance ability affect actual foot biomechanics during running is not known. This study aims to investigate the association of foot posture, single-leg balance ability, and foot biomechanics during running.MethodThis is a cross sectional study of sixty-nine participants who had their foot postures and single-leg balance ability assessed. The Foot Posture Index and Balance Error Scoring System were used. Their foot kinetics was measured as they ran on an instrumented treadmill and foot kinematics was processed using a 3D motion capture system. Multiple-regression was used to analyse the variance of foot biomechanics explained by foot posture and single-leg balance ability.ResultsFoot posture and single-leg balance ability were found to account significantly for the variance in rearfoot eversion (24%) and forefoot dorsiflexion (7%). Two regression equations were derived, where rearfoot eversion and forefoot dorsiflexion during running may be predicted.ConclusionFoot posture and single-leg balance ability can predict rearfoot eversion and forefoot dorsiflexion only during running. Based on the regression equations, individuals with the same foot posture but different single-leg balance ability may exhibit different foot kinematics. However, the angular differences are small. The equations may be useful for clinicians working in places where running gait analysis equipment are not readily accessible. Further studies with larger sample sizes are required to validate these equations. In addition, further studies are necessary to investigate the effect of these two variables under different running conditions e.g. with footwear and with orthoses.     

足姿指数(FPI):足部姿势及足踝功能的定量表达

足部姿势与足踝功能紧密相关,足姿异常影响足踝功能,导致各关节产生代偿性损伤,改变正常步态及身体姿势。足姿指数(FPI)将足部姿势量化,通过评分对足部姿势进行评估,能够全面、有效的反映足踝功能。本文查阅、分析国内外大量有关足姿指数研究的文献资料。根据可借鉴的数据和方法理论,结合足踝结构特征,确定了评价足部姿势及足踝功能的六项内容,并对足姿指数的研究提出建议与展望。     

Correlation between clinical outcome of surgically treated clubfeet and different radiological parameters

The goal of this study was to determine the relationship between the clinical outcome of surgically treated clubfeet and several radiological parameters. The talocalcaneal angle, talocalcaneal index, talo-first metatarsal angle and the calcaneo-first metatarsal angle were measured on anteroposterior and lateral radiographs of 54 children with 70 idiopathic clubfeet treated surgically between 2000 and 2004. Their age at surgery ranged from 4 to 23 months. These radiological parameters were compared with the clinical results. Follow-up was conducted after 24 to 69 months following surgery. Using the functional rating system of Laaveg and Ponseti, results were graded as excellent in 28.6% (20 feet), good in 40% (28 feet), fair in 17.1% (12 feet) and poor in 14.3% (10 feet). There was a statistically significant correlation between the clinical results and two angles: the talo-first metatarsal angle on the anteroposterior radiograph and the calcaneao-first metatarsal angle on the lateral radiograph. These two angles should be considered when designing an evaluation system of clubfeet.     

Reliability and normative values of the foot line test: a technique to assess foot posture

STUDY DESIGN: Test-retest reliability. OBJECTIVE: To examine the reliability and report normative values of a novel test, the foot line test (FLT), to describe foot morphology. BACKGROUND: Numerous foot examinations are performed each day, but most existing examination techniques have considerable limitations regarding reliability and validity. METHODS: One hundred thirty subjects with mean foot size 44 (41-50 European size) participated. Two examiners, blinded to each other's measurements, measured the right foot of the subjects twice and the left foot once. The position of the most medial aspect of the navicular in the mediolateral direction was projected vertically onto a piece of paper placed under the subject's foot, and compared to the position of the forefoot and hindfoot to obtain the FLT value. RESULTS: FLT values ranged from -8 to 14 mm, with a mean (+/-SD) of 3.7 +/- 3.4 mm. The intratester reproducibility reported by SEM was 0.8 mm for tester 1 and 0.9 mm for tester 2, while intertester SEM was 1.4 mm for the right foot and 1.3 mm for the left foot. The intrarater ICC was 0.95 for tester 1 and 0.94 for tester 2, while the interrater ICC was 0.86 (left foot) and 0.83 (right foot). There was no significant association between foot size and FLT values. CONCLUSION: The FLT is a reproducible technique to assess foot posture.     

不同压力负压闭式引流术对足踝部碾轧伤疗效分析

目的探讨高、中、低三种负压闭式引流（vacuum sealing drainage,VSD）术对足踝部碾轧伤治疗效果,并为足踝部碾轧伤治疗提供合适的VSD负压值。方法2008年10月-2010年3月,应用VSD高（-40．1—-60kPa）、中（-20．1--40kPa）、低（-16．6--20kPa）三种压力对足踝部碾轧伤进行治疗,观察不同负压梯度下患者的体温、引流量、局部微循环等变化。术后1个月和6个月分别进行Maryland足功能评分．并对评分结果进行统计学分析。结果本组27例术后随访6～12个月,完整随访24例,随访率78％：VSD三种压力治疗组在术后1个月差异无显著性（P〉0．01）,但术后6个月统计学分析差异有显著性（P〈0．01）。结论VSD技术是治疗足踝部碾轧伤的一种可靠、实用的方法,高（-40．1—-60kPa）负压力治疗组较其他两组可获得更好的足功能恢复。     

Clinical measures of static foot posture do not agree

Background

The aim of this study was to determine the level of agreement between common clinical foot classification measures.

Methods

Static foot assessment was undertaken using the Foot Posture Index (FPI-6), rearfoot angle (RFA), medial longitudinal arch angle (MLAA) and navicular drop (ND) in 30 participants (29?±?6 years, 1.72?±?0.08 m, 75?±?18 kg). The right foot was measured on two occasions by one rater within the same test environment. Agreement between the test sessions was initially determined for each measure using the Weighted Kappa. Agreement between the measures was determined using Fleiss Kappa.

Results

Foot classification across the two test occasions was almost perfect for MLAA (Kw?=?.92) and FPI-6 (Kw?=?.92), moderate for RFA (Kw?=?.60) and fair for ND (Kw?=?.40) for comparison within the measures. Overall agreement between the measures for foot classification was moderate (Kf?=?.58).

Conclusion

The findings reported in this study highlight discrepancies between the chosen foot classification measures. The FPI-6 was a reliable multi-planar measure whereas navicular drop emerged as an unreliable measure with only fair agreement across test sessions. The use of this measure for foot assessment is discouraged. The lack of strong consensus between measures for foot classification underpins the need for a consensus on appropriate clinical measures of foot structure.

     

Assessment of foot movement

A method of assessing foot movement suitable for use in clinical practice is presented. The method assesses the component of movement in the horizontal plane which is produced by rotating the calcaneum about the axis of the subtalar joint.     

Correlation of unilateral urolithiasis with sleep posture

PURPOSE: Recurrent stone formers commonly present with calculi on the same side and the etiology of recurrent unilateral urolithiasis is unclear. Despite comprehensive metabolic evaluations, many patients will not be readily categorized into a treatable group. Data from the literature support that sleep posture may result in alterations of renal hemodynamics. We investigate the correlation of sleep posture with unilateral urinary stone formation. MATERIALS AND METHODS: A prospective study of 110 patients with recurrent unilateral nephrolithiasis was conducted. A questionnaire was used to evaluate patient sleep posture. Right or left side down and rotisserie-like sleep postures were defined. The side of stone formation was correlated with sleep posture using chi-square test. RESULTS: Of the patients 93 slept consistently with 1 side in a dependent position and the side of stone was identical to the dependent sleep side in 76% (p = 0.008). The positive predictive values of right and left side down sleep posture for formation of ipsilateral calculi were 82% and 70%, respectively. CONCLUSIONS: Although the exact pathophysiology of the association between sleep posture and recurrent unilateral stone disease remains to be elucidated, sleep posture may alter renal hemodynamics during sleep and promote stone formation. This observation needs further investigation and should be factored into the evaluation and prevention of unilateral urinary stone disease.     

颈后路内固定手术方式的选择与术后疗效的相关性分析

目的通过比较颈后路椎弓根钉(CPS)及侧块螺钉(LMS)内固定术后疗效,探讨两种术式选择的临床意义。方法 2009-02-2012-02,回顾性分析63例多节段脊髓型颈椎病(M-CSM)患者。A组M-CSM患者共31例,行后路减压CPS固定。其中,男23例,女8例;年龄42-70岁,平均57.0岁。B组M-CSM患者共32例,行后路减压LMS固定。其中,男21例,女11例;年龄45-68岁,平均56.8岁。患者常规行颈椎CT、MRI、X线(正侧、过伸过屈位)检查,分析比较患者术前、术后、随访时临床症状、颈椎曲度(CI)、轴性症状(AS)评分。结果随访时间24~48个月,平均36个月。临床症状采用JOA评分比较,A组康复率(62.1±25.2)%,B组(61.6±24.8)%,经分析无统计学意义(P0.05)。A组CI变化率为(1.6±1.1)%,B组(3.6±2.1)%,经比较其变化差异有统计学意义(P0.05)。A组发现明显AS比例12.9%,B组31.2%,差异有统计学意义(P0.05)。A组未发现内固定并发症;B组患者2年随访时发现3例侧块螺钉松动现象,占比9.4%。结论颈后路手术采用椎弓根钉内固定对维持颈椎稳定性作用更为显著,亦减少明显AS发生率。提示临床制定颈后路手术方案应充分结合下颈椎解剖结构,周全考虑安全性、操作性、手术习惯等因素,选择恰当的颈后路固定方式。     

The relationship between foot posture index,ankle equinus,body mass index and intermetatarsal neuroma

Background

The main purpose of this study was to investigate the presence of an association between intermetatarsal neuroma and foot type, as measured by the Foot Posture Index. The study also examined whether there was a relationship between foot type and the interspace affected with intermetatarsal neuroma, and whether ankle equinus or body mass index had an effect.

Methods

In total, 100 participants were recruited from The University of Western Australia’s Podiatry Clinic, 68 of whom were diagnosed with inter-metatarsal neuroma from 2009 to 2015. There were 32 control participants recruited from 2014 to 2015. The age of subjects was recorded, as were weight and height, which were used to calculate body mass index. The foot posture index and ankle dorsiflexion were measured using standard technique. Independent t-tests and Kruskal-Wallis tests were used to compare differences in foot posture index, body mass index and ankle dorsiflexion between the inter-metatarsal neuroma and control groups. Multivariable logistic regression was also used to model relationships for outcome.

Results

The 68 intermetatarsal neuroma subjects had a mean age of 52 years (range 20 to 74 years) and comprised of 56 females and 12 males. The 32 control subjects had a mean age of 49 years (range 24 to 67 years) with 26 females and six males. There were no significant differences between the control and the intermetatarsal neuroma groups with respect to the mean foot posture index scores of the left and right foot (p?=?0.21 and 0.87, respectively). Additionally no significant differences were detected between the affected intermetatarsal neuroma interspace and foot posture index (p?=?0.27 and 0.47, respectively). There was no significant difference in mean body mass index between the intermetatarsal neuroma (26.9?±?5.7) and control groups (26.5?±?4.1) (p?=?0.72). There was, however, a significant difference in mean ankle dorsiflexion between the intermetatarsal neuroma and control groups (p?<?0.001 for both feet). Logistic regression models, adjusted for age, sex, foot posture index and body mass index estimated that the odds of having an intermetatarsal neuroma in the right foot increased by 61% (OR 1.61; 95% CI 1.32–1.96) with each one degree reduction of ankle dorsiflexion, and in the left foot by 43% (OR 1.43; 95% CI 1.22–1.69).

Conclusion

No relationships were found between foot posture index and body mass index with intermetatarsal neuroma, or between foot posture index and the interspaces affected. However, a strong association was demonstrated between the presence of intermetatarsal neuroma and a restriction of ankle dorsiflexion.

     

Ultrasound evaluation of the quadriceps muscles in pronated foot posture

ObjectiveThe main goal of this study was to investigate the size of all portions of the quadriceps muscles in individuals with pronated foot posture compared to normal foot posture using ultrasound imaging.DesignTwenty nine females with pronated foot posture and 29 age-, body weight-, body height-matched females with normal foot posture were recruited from university communities. The muscle thicknesses of the rectus femoris (RF), vastus medialis (VM), vastus medialis oblique (VMO), vastus lateralis (VL) and vastus intermedius (VI) were measured using ultrasound imaging.ResultsThe thicknesses of the RF and VMO were significantly smaller in individuals with pronated foot posture compared to normal foot posture (p < 0.05). No significant differences were observed in the VM, VL, and VI muscle thicknesses in both groups.ConclusionBased on the results of the present study, it seems that besides the foot and lower leg muscles, an integrated assessment of proximal knee muscles, especially quadriceps, is required in individuals with pronated foot posture.     

Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot

Achilles tenotomy is a recognised step in the Ponseti technique for the correction of idiopathic congenital talipes equinovarus in most percutaneous cases. Its use has been limited in part by concern that the subsequent natural history of the tendon is unknown. In a study of 11 tendons in eight infants, eight tendons were shown to be clinically intact and ten had ultrasonographic evidence of continuity three weeks after tenotomy. At six weeks after tenotomy all tendons had both clinical and ultrasonographic evidence of continuity.     

Compression therapy: effects of posture and application techniques on initial pressures delivered by bandages of different physical properties.

OBJECTIVE: To define the pressures and gradients achieved by different bandages when applied by alternative bandaging techniques. METHODS: An experienced bandager applied six bandages to the same leg of a volunteer using three application techniques. Pressure measurements were taken at the ankle, gaiter, calf and upper calf in three postures. RESULTS: All bandages gave consistent pressures with all standard deviations falling below 7 mmHg. The percentage increase in pressure from resting leg to standing was inversely related to bandage elasticity. Pressures were similar at the upper calf among the bandages for each application technique in each posture (differences <10 mmHg). Small differences in pressure among the bandages (4-15 mmHg) occurred at the ankle for the resting leg with a reduction in pressure between 6 and 63% at the upper calf compared to the ankle. These differences in ankle pressure were more marked on sitting (differences 15-18 mmHg) and standing (differences 15-27 mmHg), which resulted in substantial differences in gradients. CONCLUSIONS: Striking variations in pressures and gradients were observed between bandages of different physical properties applied using alternative application techniques. In order to achieve clinical benefits without tissue damage, it is essential that the therapist appreciates how a bandage will react with a specific application technique.     

Talonavicular joint coverage and bone morphology between different foot types

This study explored three dimensional (3D) talonavicular joint (TNJ) coverage/orientation and bone morphology to reveal parameters that could classify and identify predispositions to cavus and planus feet. 3D models of 65 feet from 40 subjects were generated from computed tomography images classified as pes cavus, neutrally aligned, or asymptomatic/symptomatic pes planus. We calculated the talar and navicular overlap (TNJ coverage). We also measured orientation of the navicular, morphological parameters of the talus and navicular, and angular position of the talar head to body. Pes cavus showed significantly less talonavicular coverage (58 ± 2% talus and 86 ± 2% navicular) compared to asymptomatic pes planus (63 ± 2% and 95 ± 2%) and neutrally aligned feet (98 ± 2% navicular), and significantly more navicular dorsiflexion and adduction relative to the talus (p < 0.0083). The talar head in cavus feet was inverted relative to the body compared to planus feet (p < 0.0083). For symptomatic pes planus, significant abduction was measured for the navicular relative to the talus and the talar head was plantar flexed relative to the body (p < 0.0083). The talar head in planus feet was everted relative to the body compared to neutrally aligned feet. Both intrinsic (bone morphology) and extrinsic (bone position) differences exist in groups of feet described as cavus and planus. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:958–966, 2014.     

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 5.1 mm (sd = 2.1) was able to produce a functioning windlass mechanism in those individuals that previously lacked one.     

不同脑灌注成像方法的临床应用及其比较

近年来,许多影像学检查方法相继被用于脑灌注成像,但各有优势及劣势。本文对这些检查方法的原理、技术要求、临床应用、优缺点的比较及研究进展进行综述。     

良性前列腺增生症组织形态学及临床相关因素分析

目的 :探讨良性前列腺增生症 (BPH)临床参数与其组织学改变的关系 ,以指导临床治疗方法的选择。方法 :应用 HE染色和 Masson染色结合计算机辅助图像分析的方法 ,对 30例 BPH前列腺组织构成成分和 5例正常前列腺组织进行了形态学的定量分析。结果 :1BPH前列腺组织中上皮、腺腔、结缔组织和平滑肌的面积百分比分别是 14.87%± 5 .90 %、 2 2 .5 4%± 6 .99%、2 4.6 0 %± 7.78%和 37.98%± 9.33%。间质∶上皮为 (5 .30±3.78)∶ 1,平滑肌∶间质为 (0 .6 1± 0 .12 )∶ 1。 2随着腺体重量的增加 ,上皮面积百分比增加 (P <0 .0 1) ,平滑肌面积百分比下降 (P <0 .0 5 )。 3 BPH前列腺组织标本中的平滑肌面积百分比与 IPSS呈明显正相关 (P <0 .0 1)。结论 :1BPH的前列腺以间质增生为主 ,且间质中的平滑肌增生更为突出。2 BPH患者的 IPSS与 BPH的组织成分之间存在一定的关系 ,对临床患者的治疗选择有指导意义。