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We aimed to investigate whether foot function and physical performance differ between women with and without bilateral painful hallux valgus (HV). Forty-four women with bilateral painful HV and forty-three controls were included. The Foot Function Index, American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joints Scale, and Manchester-Oxford Foot Questionnaire were used. The time while walking 10 m-walkway at maximum speed and ascending and descending ten stairs as fast as possible also single-limb stance time were measured. All self-reported and performance-based measures showed that women with HV had poorer foot function and physical performance than controls (p < 0.05). Women with mild HV had better self-reported foot function than those with moderate HV or severe HV (p < 0.05), but physical performance did not differ (p > 0.05). Women with bilateral painful HV exhibited poorer self-reported foot function and performance-based physical function than those without HV. Level III [ABSTRACT FROM AUTHOR]

A frontal plane metatarsal rotational (pronation) has been documented in a high percentage of hallux valgus patients. Pathoanatomical concepts leading to pronation are still debated. Nevertheless, there is no consensus on how to measure this component of the deformity. The aim of the present study was to compare three commonly used radiographic methods to measure the frontal plane deformity in hallux valgus deformity, such as 1. Round sign of the lateral edge of the first metatarsal head on anterior-posterior radiograph, 2. Non-weightbearing CT-scan and 3. Bernard's axial projection of the first metatarsal head. Afterwards, feet were dissected, and a direct measurement of the pronation was done. Our data showed that alpha angle measurements made through the Bernard's axial projection were closer with those obtained during the dissection compared to those made through the CT-scan. The main finding of our study is that osteoarthritic changes at the metatarso-sesamoid joint play an important role in severe hallux valgus cases. The proposed radiographic methods allow surgeons to verify whether rotation can be corrected during Hallux Valgus procedures and to determine which procedure may be the best for each patient. [ABSTRACT FROM AUTHOR]

Une prévalence élevée de troubles au pied rapportés chez les marcheurs de longue distance a été observée. Or, aucune documentation ne semble décrire comment se manifeste l'adaptation du pied à un volume soutenu de marche dans le temps. Le but de l'étude est de quantifier les modulations morpho-fonctionnelles du pied peu de jours après une période de marche au long cours. L'étude recense aussi les effets différenciés reliés au sexe, à la latéralité du membre inférieur (dominant vs non dominant) et à l'ampleur du trajet pédestre. Les données de 38 marcheurs-pèlerins (âge : 63,2 ± 7,8 ans ; 57,9 % de femmes ; IMC : 25,7 ± 3,8 kg/m2) ont été recueillies lors de trois collectes en laboratoire (C 1 , C 2 , C 3), intercalées d'une période de marche au long cours. La collecte initiale C 1 avait lieu à l'intérieur des 30 jours avant la marche. La collecte C 2 , tenue 5 à 10 jours après C 1 , servait à quantifier le changement minimal détectable (CMD) pour chaque variable dépendante. La collecte C 3 (de suivi) prenait place au maximum 10 jours après la marche. Quatre types de regroupement ont été formés selon les trajets pédestres réalisés : cohorte au long cours (parcours ≥ 250 km) [LC, n = 31], groupes court trajet (parcours de 200 à 450 km) [CT, n = 15], moyen trajet (parcours de 450 à 900 km) [MT, n = 10] et long trajet (parcours ≥ 900 km) [LT, n = 8]. L'étude de la cohorte LC sert à cibler les effets spécifiques au contexte de marche, la comparaison des groupes CT, MT, LT permet d'en dégager les effets associés au cumul de marche. Les analyses de variance traitent séparément les facteurs sexe et latéralité. Pour la cohorte LC, l'éventuelle différence significative (p ≤ 0,05) entre C 1 et C 3 doit aussi être confirmée par un changement moyen de la mesure qui soit d'une ampleur supérieure au seuil critique (valeur du CMD.n) pour que le changement soit considéré réel. Sept variables dépendantes sont testées : la longueur du pied et du pied tronqué, la largeur du pied aux têtes métatarsiennes, l'indice MVI, la hauteur du naviculaire et du dos du pied, et le ratio AHI. Une diminution significative de la longueur du pied (−0,8 ± 1,9 mm ; −0,34 % ; CMD.n = 0,7 mm) du côté du membre inférieur dominant (F 1,29 = 4,95 ; p = 0,034) a été observée entre C 1 et C 3 pour la cohorte LC. Dans la même cohorte, un effet d'interaction significatif a été noté pour la largeur du pied (F 1,29 = 4,64 ; p = 0,040) : chez l'homme, une augmentation significative (+1,4 ± 1,6 mm ; +1,35 % ; CMD.n = 0,7 mm) de C 1 à C 3 est observée, alors qu'une tendance opposée apparaît chez la femme. Ces effets sont considérés de réels changements induits par la marche, leur ampleur se chiffrant au-dessus des seuils critiques calculés. Les analyses considérant les groupes CT, MT, LT ne révèlent aucun effet relatif à l'ampleur des trajets pédestres. Cette étude montre que quelques dimensions morpho-fonctionnelles du pied sont finement impactées par la marche au long cours considérant les volumes de pratique rapportés. Les résultats mettent en lumière que le sexe et la dominance du membre inférieur sont à considérer pour décrire avec justesse les modulations au pied induites par la marche de longue durée. D'autres études sont indiquées pour mieux comprendre les mécanismes pathogéniques des troubles au pied rapportés par les marcheurs au long cours. A high prevalence of foot disorders reported in long-distance walkers has been observed. However, we found no documentation on how the foot adapts to a sustained walking volume over time. The aim of the study was to quantify the morpho-functional modulations of the foot shortly after a period of long-term walking. The study also investigates differential effects related to gender, lower limb laterality (dominant vs. non-dominant), and to the extent of the pedestrian path covered. Data from 38 pilgrim-walkers (age: 63.2 ± 7.8 years; 57.9% women; BMI: 25.7 ± 3.8 kg/m2) were collected during three lab data collection (C 1 , C 2 , C 3), interspersed with a long-term walk. The baseline data collection C 1 took place within 30 days before the walk. The C 2 data collection, held 5-10 days after C 1 , was used to quantify the minimum detectable change (MDC) for each dependent variable. The C 3 (follow-up) data collection took place up to 10 days after the walk. Four groups were formed based on the extent of the pedestrian routes covered: long-term cohort (path ≥ 250 km) [LT, n = 31], short-path group (path from 200 to 450 km) [SP, n = 15], medium-path group (path from 450 to 900 km) [MP, n = 10] and long-path group (path ≥ 900 km) [LP, n = 8]. Studying the LC cohort serves to target the effects specific to the walking context, while comparing groups SP, MP, LP allows the cumulative effects to be identified. Analyses of variance treat the factors gender and laterality separately. For the LC cohort, a possible of significant difference (P ≤ 0.05) between C 1 and C 3 must also be ratified by an average change in the measure that is greater than the critical threshold (MDC.n value) for the change to be considered real. Seven dependent variables are tested: foot length and truncated foot length, foot width at the metatarsal heads, MVI index, navicular height, dorsum of foot height and AHI ratio. A significant decrease in foot length (−0.8 ± 1.9 mm; −0.34% MDC.n = 0.7 mm) on the side of the dominant lower limb (F 1.29 = 4.95; P = 0.034) was observed between C 1 and C 3 for the LC cohort. In the same cohort, a significant interaction effect was noted for foot width (F 1.29 = 4.64; P = 0.040): in men, a significant increase (+1.4 ± 1.6 mm; +1.35%; MDC.n = 0.7 mm) from C 1 to C 3 is observed while a reverse trend appears in woman. These effects are considered real changes induced by walking: their magnitude being above the calculated critical thresholds. Analyses considering the SP, MP, LP groups showed no effect relative to the extent of the pedestrian routes covered. The changes observed in this study show that some morpho-functional dimensions of the foot are finely impacted by long-term walking considering the reported volumes of practice. Results highlight that the walker's gender and lower limb dominance should be considered to accurately describe the foot modulations induced by long-term walking. Further studies are indicated to better understand the pathogenic mechanisms of foot disorders reported by long-term walkers. [ABSTRACT FROM AUTHOR]

Background: As a flexible and elastic structure, the dynamic morphometry of medial longitudinal arch remains to be an unresolved Issue for clinic. Here we introduce a new measurement named arch volume to describe the morphological changes of the medial longitudinal arch during weight-bearing and compare with present method for measuring MLA.Methods: 64 healthy participants were enrolled. And the dynamic arch morphology was measured under four weight bearing status with navicular height, arch area and arch volume, respectively.Results: With the increase of weight loading, the flattening or slightly deformation of medial longitudinal arch was observed by all method (p<0.05). However, as a 3D indicator, arch volume not only showed higher sensitivity than other method, but also provide visualization of MLA during loading changing.Conclusions: Compared with navicular height and arch area, arch volume has a significant advantage in describing arch morphological changes under different weight bearing status. [ABSTRACT FROM AUTHOR]

The surgical anatomy of the foot is complex. Understanding the approaches used to address pathology of the foot and ankle requires in-depth appreciation of the anatomy of the region. Each structure has a function and enables the foot to perform its requirements. Biomechanics in the foot can be understood by grasping key principles. Anatomy and biomechanics of the foot is a potential questioning point for candidates sitting final professional examinations in trauma and orthopaedic surgery. The aim of this article is to provide an appreciation of the surgical anatomy of the foot and the biomechanics at play in the area. Gait and the gait cycle will also be reviewed. [ABSTRACT FROM AUTHOR]

• Tech footwear linked to reduced foot muscle vs. barefoot. • Barefoot group shows significantly higher ankle dorsiflexion ROM. • No significant dynamic balance differences found between groups. Technological running shoes have become increasingly popular, leading to improvements in performance. However, their long-term effects on foot musculature and joint mobility have not been thoroughly studied. To compare the activation of the intrinsic foot muscles between runners wearing technological footwear and barefoot runners. Secondary objectives included assessing ankle dorsiflexion (DF) range of motion (ROM) and dynamic postural control in both groups. A cross-sectional study was conducted involving 22 technological footwear runners and 22 barefoot runners. Ultrasonography was used to measure the thickness of the plantar fascia (PF) and the quadratus plantae (QP), abductor digiti minimus (ADM), abductor hallucis (AH), and flexor hallucis longus (FHL) muscles. Ankle mobility and dynamic postural control were also recorded. Ultrasonography measurements showed statistically significant differences for PF thickness (mean difference [MD]: -0.10 cm; 95% CI: -0.13, -0.05 cm), QP cross-sectional area (CSA) (MD: -0.45 cm2; 95% CI: -0.77, -0.12 cm2), ADM CSA (MD: -0.49 cm2; 95% CI: -0.70, -0.17 cm2), and FHL thickness (MD: 0.82 cm; 95% CI: 0.53, 1.09 cm), with all measurements being lower in the group wearing technological footwear compared to the barefoot runners. Ankle DF ROM was also significantly greater for the barefoot runners (MD: -5.1°; 95% CI: -8.6, -1.7°). These findings suggest potential implications for the foot musculature and ankle mobility in runners using technological footwear. [ABSTRACT FROM AUTHOR]

Background: Ankle injuries are one of the most common musculoskeletal disorder. The purpose of this study was to analyze and describe the detailed anatomical arrangement and relationship of posterior ligaments of the ankle, especially de posteroinferior tibiofibular ligament (PITFL) and intermalleolar ligament (IML). Controversy exists in the previous literature regarding their morphology and denomination, as well as the relation with ankle injuries including posterior soft tissue impingement syndrome.Methods: Seventeen fresh-frozen cadaveric feet were used. The origins, insertions, ligament lengths, orientations with respect to relevant bony landmarks of the PITFL were evaluated.Results: PITFL was present in all anatomical specimens. It was formed by two independent components, the superficial and deep fibers. Their dimensions vary widely between specimens. The IML was located between the deep PITFL and posterior talofibular ligament. The shape varied from a thin fibrous band to a thick cordlike structure. The IML was evident in 82.4% of the ankles. In 28.6% of the cases, the posterior intermalleolar ligament was split into two bundles in the fibular insertion. In 14 ankles, three slips were found.Conclusion: Given the frequency of injury and increasing necessity for surgical intervention, a more comprehensive anatomic knowledge of the different ligaments is warranted, provide clinically pertinent quantitative data and improve the treatment of these lesions. [ABSTRACT FROM AUTHOR]

Background: Previous literature on the transverse head of adductor hallucis (AddH-T) has largely focused on muscle morphology. This data provides insight into muscle architecture, yet fails to inform it's functional implication during walking. The role of the AddH-T, which runs parallel to the distal transverse metatarsal arch, has never been studied using fine-wire EMG during locomotion.Research Question: The purpose of this study is to explain a novel method of recording fine-wire EMG of the adductor hallucis muscle of the foot, and secondly, to report phasic AddH-T muscle activity during level walking on hard and soft surfaces.Methods: Ultrasound-guided fine-wire EMG was recorded from the AddH-T of each foot, in ten asymptomatic young adults. Participants completed ten walking trials per experimental conditions (hard and soft surface). Ensemble averages were calculated from the time normalized linear-envelopes of each participant, and represented from 0 to 100 percent of the gait cycle.Results: Using the described ultrasound-guided fine-wire protocol, successful EMG signals were generated in 19 of 20 feet. When walking over hard or soft flooring, the AddH-T muscle has two bursts in EMG, occurring between 0-20 % and 50-65 % of the gait cycle. The magnitude of peak activity was often reduced at initial contact when walking over foam. 45 % of participants experienced a third burst in EMG activity at midstance, corresponding to 30-40 % of the gait cycle.Significance: This study has successfully explained a novel method of recording finewire electromyography (EMG) of the adductor hallucis (transverse head) muscle of the foot. Results suggest that the AddH-T stabilizes the forefoot at initial contact and toeoff, while further anchoring the hallux during propulsion. These results provide preliminary insight into the functional role of the AddH-T during human locomotion. [ABSTRACT FROM AUTHOR]

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

Background: Poor postural stability is associated with chronic ankle instability. Previous research showed an effect of foot type on postural stability. However, the specific effect of supinated feet remains unclear.Research Question: Our study aimed to assess the effect of foot type on postural stability, while taking potential confounding effects of body mass and body height into account.Methods: Forty-three healthy participants between 18 and 40 years old performed barefooted single leg stance tests with eyes open (EO) and closed (EC) on solid ground, and on a balance board (BB). Foot type was determined from pressure recordings during gait, using the arch index. Ground reaction forces were measured using a force plate. Outcome measures were Center of Pressure Velocity (COPV) divided by body height, and the Horizontal Ground Reaction Force (HGRF) divided by body mass. Generalized Estimating Equations models assessed the differences between supinated, normal and pronated feet during EO, EC and on a BB.Results: During EO an interaction between supinated feet and body mass showed an increase of COPV with 0.03 × 10-2 1/s per kilogram of mass relative to normal feet (p = .03). During EC this interaction was more pronounced with 0.22 × 10-2 1/s increase per kilogram mass (p < .01). The HGRF did not differ between foot types in any of the conditions.Significance: Supinated feet have a larger increase in COPV compared to normal feet with increasing mass when standing on solid ground during EO and EC. This indicates that people with supinated feet and a higher mass are less stable during single leg stance.Level Of Evidence: Level 3, associative study. [ABSTRACT FROM AUTHOR]

Background: The flexor hallucis longus (FHL) muscle often has a tendinous slip with a variable number of branches. We aimed at developing the FHL branch test to determine the number of FHL branches.Methods: In anatomical validation study, 6 intact cadavers were used. The toe flexion angles were measured while the FHL and flexor digitorum longus (FDL) were manually pulled individually. For electrophysiological studies, 4 healthy men participated. The FHL was electrically stimulated, and electromyography (EMG) of the FHL and FDL were recorded during the FHL branch test.Results: The toe flexion angles' changes in the FHL pulling condition were equivalent with pulling FDL in toes with FHL branching. The electrical stimulation of the FHL produced similar flexion as the FHL branch test. EMG of the FHL was higher than FDL during the FHL branch test (p=0.036).Conclusions: The FHL branch test could be used to evaluate the number of FHL branches. [ABSTRACT FROM AUTHOR]

• Foot height is decreased in early stage of Parkinson's disease. • Clinician tend to judge gait based on walking speed and stride length. • 3D motion analysis can detect subclinical gait disturbance in Parkinson's disease. [ABSTRACT FROM AUTHOR]

The science of foot pressure studies the forces acting on the bottom and different regions of the foot along with the pressure exerted on the plantar surface with the interacting surface in contact. The information derived gave impact to human biomechanical assessment on body balance and ergonomics posture during gait. Various experiments designed at generating foot pressure data returns only with limited knowledge generated. Obviously, the procedure for experiment design needs to be properly understood from the foot morphology aspects; healthiness, footwear, surface in contact, load and forces impacts, and the foot sensitivity as well as the specification for the foot pressure. This paper reviews the proper preliminary experimental setups for foot pressure measurement analysis during static or dynamic gait. The strength and limitations of recent devices used and considerable variables are also discussed. The overall review explains that the comfortable natural gait in relation to the aspects of sensitivity, load, time duration, and stability are the standard considerations for plantar pressure experiments. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the reliability and reproducibility of three commonly used radiographic measures for plantar surface angles.Methods: The calcaneal angle (CA), calcaneal pitch angle (CPA), and length-height index (LHI) was measured by three independent examiners on two occasions on lateral foot radiographs. Intra- and inter-rater correlations were calculated using a general linear estimate model and post-hoc tests for repeated measures. Bland-Altman's plots with limits of agreement were used for observer differences in scores.Results: The intra-class correlations for the CA ranged from 0.91 to 0.94, for the CPA from 0.93 to 0.98, and for the LHI from 0.96 to 0.97. The inter-class correlations were 0.80 for CA, 0.83 for CPA and 0.93 for LHI.Conclusions: The results of this study strongly suggest that the length-height index was the most consistent and reliable measure for arch height.Level Of Evidence: Diagnostic Level II, validity. [ABSTRACT FROM AUTHOR]

Individuals with lateral ankle sprain and chronic ankle instability have impaired postural control and altered motor strategies during walking. However, little is known regarding foot mechanics during gait. The purpose of this study was to compare three-dimensional multisegmented ankle-foot kinematics during stance phase following gait-initiation in acute lateral ankle sprain (Ankle-sprain), chronic ankle instability (Chronic-instability), Coper, and Control groups. 80 recreationally-active individuals (Control: n = 22, Coper: n = 21, Ankle-sprain: n = 17, Chronic-instability: n = 20) participated. Three-dimensional kinematics of the hallux, medial forefoot, lateral forefoot, medial midfoot, lateral midfoot, and rearfoot on shank were collected during the stance phase following gait initiation using an electromagnetic motion capture system. The average joint excursions of 10 steps were normalized to 101 points and analyzed using Statistical Parametric Mapping ANOVA and post hoc t -tests comparing Coper, Ankle-sprain, or Chronic-instability versus Control groups. Secondary analysis was performed comparing Chronic-instability versus Coper groups. The Ankle-sprain group had up to 4.1° more rearfoot inversion during midstance (mean difference: 3.1°) from 42 to 49% of stance phase compared to healthy controls. The Chronic-instability group had up to 5.3° more rearfoot inversion (mean difference: 3.6°) from 34% to 91% of stance phase compared to controls. There were no further statistical differences found between Chronic-instability and Copers, other planes, or segments of the ankle-foot complex. Ankle-sprain and Chronic-instability groups demonstrated more rearfoot inversion compared to controls with no differences in midfoot or forefoot mechanics. Clinicians and researchers should include interventions that control inversion and increase eversion following lateral ankle sprain. • Individuals with recent ankle sprains had 4.1° more rearfoot inversion during midstance. • The chronic ankle instability group had 5.3° more rearfoot inversion in the latter half of stance. • There were no significant differences in midfoot or forefoot kinematics between groups. [ABSTRACT FROM AUTHOR]

The morphology of fossil footprints is the basis of vertebrate footprint ichnology. However, the processes acting during and after trace fossil registration which are responsible for the final morphology have never been precisely defined, resulting in a dearth of nomenclature. Therefore, we discuss the concepts of ichnotaphonomy, ichnostratinomy, taphonomy, biostratinomy, registration and diagenesis and describe the processes acting on footprint morphology. In order to evaluate the morphological quality of tetrapod footprints, we introduce the concept of morphological preservation, which is related to the morphological quality of footprints (M-preservation, acronym MP), and distinguish it from physical preservation (P-preservation, acronym PP), which characterizes whether or not a track is eliminated by taphonomic and diagenetic processes. M-preservation includes all the morphological features produced during and after track registration prior to its study, and may be divided into substages (ichnostratinomic, registrational, taphonomic, stratinomic, diagenetic). Moreover, we propose an updated numerical preservation scale for M-preservation. It ranges from 0.0 (worst preservation) to 3.0 (best preservation); intermediate values may be used and specific features may be indicated by letters. In vertebrate footprint ichnotaxonomy, we regard the anatomy-consistent morphology and to a lesser extent the trackway pattern as the only acceptable ichnotaxobases. Only footprints showing a good morphological preservation (grade 2.0–3.0) are useful in ichnotaxonomy, whereas ichnotaxa based on poor morphological preservation (grade 0.0–1.5) are considered ichnotaphotaxa (nomina dubia) characterized by extramorphologies. We applied the preservation scale on examples from the Palaeozoic to the present time, including three ichnotaphotaxa and 18 anatomy-consistent ichnotaxa/morphotypes attributed to several vertebrate footprint producers. Results indicate the utility, feasibility and suitability of this method for the entire vertebrate footprint record in any lithofacies, strongly recommending its use in future ichnotaxonomic studies. [ABSTRACT FROM AUTHOR]

Abstract Background A juvenile flexible flatfoot is a common abnormality during growth. For children with a pathological manifestation, subtalar extra-articular screw arthroereisis is a popular operative technique. Although this minimally invasive operation technique has been performed for >45 years, complications still occasionally occur. For this reason, we created this pilot study to investigate whether a two-dimensional (2D) gait analysis is able to identify functional movement deficits after surgery. Methods Fourteen children (27 ft) with a mean age of 12.38 years (SD, 1.40 years) were analyzed. Biomechanics were examined before and 4 weeks after surgery using a 2D gait analysis. For this purpose, the patients were filmed on a treadmill. In focus were static and dynamic recordings of the heel angle, rearfoot angle, and the leg axis angle. In addition, the step length and self-selected speed were measured. Findings After surgery rearfoot angle showed significant reduction (p < 0.001) from 12.49° to 3.63° under static conditions and from 12.65° to 4.58° under dynamic conditions. Heel angle responded similar (p < 0.001). There were no significant differences in self-selected speed or step length. Undoubtedly, gait analysis was able to identify intraindividual deficits, leading to a closer monitoring of five patients and an adjustment of the screw in one foot. Interpretation By means of the 2D gait analysis, we were able to show functional improvement after subtalar extra-articular screw arthroereisis. Nonetheless, we identified a few children who still had functional abnormalities. Certainly, it is unclear whether this additional examination is able to reveal all complications that would have occurred later. Highlights • The arthroereisis is a popular operation technique for juvenile flatfeet. • Since complications still occur a functional verification of surgical success may be beneficial. • The 2D gait analysis is able to identify the changes of the rear-foot angle after the surgery. • Problematic cases can be identified and further treatment can be initiated at an early stage. [ABSTRACT FROM AUTHOR]

Abstract Objective The purpose of this study was to evaluate the correlation among the navicular drop test, the arch angle, the Staheli index and the Chippaux-Smirak index. The reliability and the correlation among the footprint parameters were also estimated. Methods A cross-sectional study (n = 86; 59.3% women; 27.8 years, standard deviation: 4.8 years) was carried out. The navicular drop test was evaluated and footprint parameters using a plantar pressure platform were recorded in the dominant foot. Pearson correlation coefficients, intraclass correlation coefficient, standard error of measurement, and minimum detectable change were calculated. Results Both intrarater and interrater reliability were excellent for all the parameters evaluated (intraclass correlation coefficients > 0.880). Statistically significant correlations existed between the navicular drop test and footprints parameters (arch angle = 0,643; Staheli index = 0.633; Chippaux-Smirak index = 0.614). The footprint parameters had excellent correlation with each other (0.838-0.881). The navicular drop test and the footprint parameters studied were reproducible and thus had excellent reliability. Conclusion The correlations obtained between the navicular drop test and the footprint parameters evaluated were good. The navicular drop test appears to be a reproducible, valid, and simple test for evaluating medial longitudinal arch height, having fewer disadvantages than using footprint parameters. [ABSTRACT FROM AUTHOR]

Objective: To perform an MR imaging-anatomical correlation to elucidate the anatomy of muscles, tendons, and ligaments about the hallux as seen on MR imaging.Materials and Methods: Four fresh and 4 embalmed cadaver specimens were used for this study. The embalmed specimens and one fresh specimen were dissected by three investigators. The fresh specimens were preserved deep frozen. They were thawed and imaged with a 3 T MR system. Proton density weighted images were obtained. The specimens were refrozen and sectioned with a band saw into 3 mm thick slices.Results: Musculotendinous structures were equally well seen in the fresh and embalmed specimens. The capsular ligaments could best be studied in the fresh specimens. Proximal to the sesamoids the following muscle and tendon anatomy was delineated: the abductor hallucis tendon inserted on the medial sesamoid bone together with the medial belly of the flexor digitorum brevis; the adductor hallucis (transverse and oblique heads) inserted on the lateral sesamoid together with the lateral head of the flexor hallucis brevis. At the level of the sesamoid bones and distally, the ligaments making up the plantar plate were delineated, including the presesamoid band, the flexor hallucis longus pulley, the sesamometatarsal ligaments, the sesamophalangeal ligaments, and the capsular ligaments.Conclusion: MRI allows for accurate assessment of the complex anatomy of the hallux. At the level proximal to the sesamoids the muscle and tendon insertions are well demonstrated. At the level of the sesamoids and distally, the ligaments making up 'the plantar plate' are well demonstrated. [ABSTRACT FROM AUTHOR]

Objective: Barefoot impressions collected from crime scenes can be used in forensic analysis. The reliability of the measurement method employed during comparison of these foot impressions is paramount to prevent incorrect conclusions being made. A number of methods of obtaining measurements from barefoot impressions have been described in the research literature; however there has been no comprehensive review of their reliability. Therefore, the aim of this systematic review was to determine the reliability of measurements used to describe footprint morphology obtained from static and dynamic barefoot impressions.Methods: Four electronic databases were searched from inception to 23 November 2017. Eligible studies were required to report either the test-retest, intra or inter-rater reliability of measurements taken from barefoot impressions for the purposes of identification or classification of foot morphology. Methodological quality was assessed using the COSMIN checklist.Results: Eleven studies were identified that reported the reliability of 10 measurements (Reel method, arch index, Chippaux-Smirak index, footprint angle, Staheli index, contact area, Martirosov's K index, toe score and metatarsal ridge-to-toe measurement). High intra-rater reliability has been established for the Reel method (ICC=0.98-0.99), arch index (ICC=0.96-0.99), Chippaux-Smirak index (ICC=0.98-0.99), footprint angle (ICC=0.97-0.98), Staheli index (ICC=0.98-0.99) and footprint index (ICC=0.96-0.97). High inter-rater reliability has been established for the Reel method (ICC=0.99) and footprint angle (ICC=0.99). Overall methodological quality was rated as 'Poor' to 'Fair'.Conclusion: The measurement developed by Reel et al. has both its intra- and inter-rater reliability established to be high. However, the findings of this review were unable to inform a recommendation of one specific technique based on reliability data due to a small body of research at this time. Furthermore, there is a lack of data on the reliability of footprint measurement and comparison techniques in real-world scenarios. Overall, the findings regarding reliability of the techniques covered in this systematic review are to be interpreted with caution due to the methodological quality of reliability testing conducted within the included studies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the characteristics of biomechanical and clinical measurements in relation to the knee adduction moment when wearing a standard shoe and a shoe design for individuals with knee osteoarthritis (Flex-OA).Methods: Kinematic and kinetic data were collected from thirty-two healthy individuals (64 knees) using a ten camera motion analysis system and four force plates. Subjects performed 5 walking trials under the two conditions and the magnitude of individuals' biomechanical responses where explored in relation to the clinical assessment of the Foot Posture Index, hip rotation range, strength of hip rotators, and active ankle-foot motion, all of which have been described as possible compensation mechanisms in knee osteoarthritis.Results: Significant reductions in the first peak of the knee adduction moment (KAM) during stance phase (9.3%) were recorded (p<0.0001). However, despite this difference, 22 of 64 knees showed either no change or an increased KAM, indicating a non-response or negative-response to the Flex-OA shoe. Significant differences were observed between the responder and non-responder subgroups in the hip rotation range ratio (p=0.044) and the hip rotators strength ratio (p=0.028).Conclusion: Significant differences were seen in clinical assessments of hip rotation range and hip rotator strength between responders and non-responders using a cut-off of 0.02Nm/kg change in the KAM. [ABSTRACT FROM AUTHOR]

Introduction/aim: Foot structure has been implicated as a risk factor of numerous overuse injuries, however, the mechanism linking foot structure and the development of soft-tissue overuse injuries are not well understood. The aim of this study was to identify factors that could predict foot function during walking.Methods: A total of eleven variables (including measures of foot structure, anthropometry and spatiotemporal gait characteristics) were investigated for their predictive ability on identifying kinematic, kinetic and energetic components of the foot. Three-dimensional motion capture and force data were collected at preferred walking speed on an instrumented treadmill. Mechanical measures were subsequently assessed using a custom multi-segment foot model in Opensim. Factors with significant univariate associations were entered into multiple linear regression models to identify a group of factors independently associated with the mechanical measures.Results: Although no model could be created for any of the kinematic measures analysed, approximately 46% and 37% of the variance in the kinetic and energetic measures were associated with three or two factors respectively. Arch-height ratio, foot length and step width were associated with peak subtalar joint (STJ) moment, while greater STJ negative work was correlated to a low arch-height ratio and greater foot mobility.Conclusion: The models presented in this study suggest that the soft-tissue structures of a flat-arched, mobile foot are at a greater risk of injury as they have greater requirements to absorb energy and generate larger forces. However, as these associations are only moderate, other measures may also have an influence. [ABSTRACT FROM AUTHOR]

Maintaining balance is vitally important in everyday life. Investigating the effects of individual foot muscle morphology on balance may provide insights into neuromuscular balance control mechanisms. This study aimed to examine the correlation between the morphology of foot muscles and balance performance during single-leg standing. Twenty-eight recreational runners were recruited in this study. An ultrasound device was used to measure the thickness and cross-sectional area of three intrinsic foot muscles (abductor hallucis, flexor digitorum brevis and quadratus plantae) and peroneus muscles. Participants were required to perform 30s of single-leg standing for three trials on a force plate, which was used to record the center of pressure (COP). The standard deviation of the amplitude and ellipse area of the COP were calculated. In addition, stabilogram diffusion analysis (SDA) was performed on COP data. Pearson correlation coefficients were computed to examine the correlation between foot muscle morphology and traditional COP parameters as well as with SDA parameters. Our results showed that larger abductor hallucis correlated to smaller COP sway, while larger peroneus muscles correlated to larger COP sway during single-leg standing. Larger abductor hallucis also benefited open-loop dynamic stability, as well as supported a more efficient transfer from open-loop to closed loop control mechanisms. These results suggest that the morphology of foot muscles plays an important role in balance performance, and that strengthening the intrinsic foot muscles may be an effective way to improve balance. [ABSTRACT FROM AUTHOR]

The modulation of walking speed results in adaptations to the lower limbs which can be quantified using mechanical work. A 6 degree-of-freedom (DOF) power analysis, which includes additional translations as compared to the 3 DOF (all rotational) approach, is a comprehensive approach for quantifying lower limb work during gait. The purpose of this study was to quantify the speed-related 6 DOF joint and distal foot work adaptations of all the lower extremity limb constituents (hip, knee, ankle, and distal foot) in healthy individuals. Relative constituent 6 DOF work, the amount of constituent work relative to absolute limb work, was calculated during the stance and swing phases of gait. Eight unimpaired adults walked on an instrumented split-belt treadmill at slow, moderate, and typical walking speeds (0.4, 0.6, and 0.8 statures/s, respectively). Using motion capture and force data, 6 DOF powers were calculated for each constituent. Contrary to previously published results, 6 DOF positive relative ankle work and negative relative distal foot work increased significantly with increased speed during stance phase ( p < 0.05). Similar to previous rotational DOF results in the sagittal plane, negative relative ankle work decreased significantly with increased speed during stance phase ( p < 0.05). Scientifically, these findings provide new insight into how healthy individuals adapt to increased walking speed and suggest limitations of the rotational DOF approach for quantifying limb work. Clinically, the data presented here for unimpaired limbs can be used to compare with speed-matched data from limbs with impairments. [ABSTRACT FROM AUTHOR]

Objective: Medial longitudinal Arch Height is synonymous with classifying foot type and conversely foot function. Detailed knowledge of foot anthropometry is essential in the development of ergonomically sound footwear. Current Footwear design incorporates a direct proportionate scaling of instep dimensions with those of foot length. The objective of this paper is to investigate if a direct proportional relationship exists between human arch height parameters and foot length in subjects with normal foot posture.Method: A healthy convenience sample of 62 volunteers was recruited to participate in this observational study. All subjects were screened for normal foot health and posture. Each subject's foot dimensions were scanned and measured using a 3D Foot Scanner. From this foot length and arch height parameters were obtained. Normalised ratios of arch height with respect to foot length were also calculated. The arch height parameters and the normalised arch ratios were used interchangeably as the dependent variables with the foot length parameters used as the independent variable for Simple Linear Regression and Correlation.Results: Analysis of foot length measures demonstrated poor correlation with all arch height parameters.Conclusion: No significant relationships between arch height and foot length were found. The predictive value of the relationship was found to be poor. This holds significant implications for the current method of proportionate scaling of footwear in terms of fit and function to the midfoot region for a normative population. [ABSTRACT FROM AUTHOR]

Plantar pressure analysis is widely used in the assessment of foot function. In order to assess regional loading, a mask is applied to the footprint to sub-divide it into regions of interest (ROIs). The most common masking method is based on geometric features of the footprint (GM). Footprint masking based on anatomical landmarks of the foot has been implemented more recently, and involves the integration of a 3D motion capture system, plantar pressure measurement device, and a multi-segment foot model. However, thorough validation of anatomical masking (AM) using pathological footprints has not yet been presented. In the present study, an AM method based on the Oxford Foot Model (OFM) was compared to an equivalent GM. Pressure footprints from 20 young healthy subjects (HG) and 20 patients with clubfoot (CF) were anatomically divided into 5 ROIs using a subset of the OFM markers. The same foot regions were also identified by using a standard GM method. Comparisons of intra-subject coefficient of variation (CV) showed that the OFM-based AM was at least as reliable as the GM for all investigated pressure parameters in all foot regions. Clinical relevance of AM was investigated by comparing footprints from HG and CF groups. Contact time, maximum force, force-time integral and contact area proved to be sensitive parameters that were able to distinguish HG and CF groups, using both AM and GM methods However, the AM method revealed statistically significant differences between groups in 75% of measured variables, compared to 62% using a standard GM method, indicating that the AM method is more sensitive for revealing differences between groups. [ABSTRACT FROM AUTHOR]

The purpose of this clinical note is to describe the performance of the Lunar Achilles Insight device in assessing bone quality at the calcaneus in 142 children between the ages of 5 and 11 y accessing healthcare in Johannesburg, South Africa. We observed an asymmetric bimodal distribution in speed of sound (SOS). The minor mode consisted of unusually high SOS values (≥1625 m/s), which were primarily observed among children with foot size <19 cm and height <119 cm. Cortical regions of the bone may have been inadvertently included in the region of interest for smaller feet, causing unusually high SOS values. The unusually high SOS values indicate that the validity of SOS in this device, as it is currently used for measuring bone quality in young children, is questionable. Future studies using this device in young children should develop new methodology to account for smaller foot size. [ABSTRACT FROM AUTHOR]

Purpose: Describe age-related differences in women's foot shape using a wide range of measurements and ages.Study Design: Cross-sectional, observational study.Main Outcome Measurements: Six foot-shape measurements of each foot: foot lengths, ball widths, ball circumferences, low instep circumferences, high instep circumferences, and heel instep circumference.Results: 168 women from 20 to over 80 years of age, divided into seven age categories, were included. Older women had significantly greater foot-shape measurements, even after adjusting for Body Mass Index. Ball widths increased 3.1-4.0mm per decade, ball circumferences 5.6-7.4mm per decade, high instep circumferences 0.4-4.8mm per decade, and heel instep circumferences 1.8-1.9mm per decade. Ball widths, ball circumferences, and left high instep circumference plateaued in the 70-75 years-of-age category, and decreased in the oldest age category. For low instep circumference, age did not prevail significantly over Body Mass Index. Foot length was not associated with age.Conclusion: This study described women's progressive foot-shape changes with age. The findings provide a better understanding of foot-shape changes, mainly found in the forefoot. It demonstrates that for a good fit, shoe design for older adults and for younger adults should differ. [ABSTRACT FROM AUTHOR]

The spring (plantar calcaneonavicular) ligament complex connects the calcaneus and navicular bone of the foot and serves as the primary static stabilizer of the medial longitudinal arch of the foot. In this article, we describe the normal anatomy of the spring ligament complex, illustrate 3T magnetic resonance imaging appearances in its normal and abnormal states, and discuss the pathological associations with relevant case examples. [ABSTRACT FROM AUTHOR]

Background: Flexible flatfoot, as the most prevalent foot deformity in pediatric population still has no standardized strategy for its management hence some orthopedic surgeons have the tendency to use orthotic devices. The objective of this study is to evaluate whether orthotic shoes effect the natural course of the developing medial longitudinal arch in children diagnosed with moderate flexible flatfoot.Methods: Fourty-five children (33 boys and 12 girls) with moderate flexible flatfoot were enrolled in this study. They were followed up for 34.6 ± 10.9 months (24-57 months). Patients in group 1 were treated with corrective shoes whereas group 2 was left untreated. Patients were evaluated according to; general joint laxity, arch index, lateral talo-first metatarsal (TM), talo-horizontal (TH), calcaneal pitch (CP), lateral and anterior talocalcaneal (TC) angles.Results: Although there was a significant decrease in general laxity in both groups, decrease of laxity percentage was not significant between groups (p = 0.812). TM, TH and anterior TC angles were found to be decreased in groups whereas there was no difference between group 1 and 2. The arch index was found to be correlated with TM and TH angles in both groups (p = 0.004, p = 0.013).Conclusions: Corrective shoes for flexible flatfoot was found not effective on development of foot arches. Therefore, they should be limited only for selected cases. [ABSTRACT FROM AUTHOR]

Background: The objectives of the study were to evaluate the safety of hypothetical arthroscopic portals from talonavicular joint and to evaluate their reproducibility and enforceability.Methods: 19 cadaveric feet were marked and four arthroscopic portals were made (medial, dorsomedial, dorsolateral and lateral). The specimens were dissected in layers and the distances between neurovascular structures and the trocars were measured.Results: Medial and dorsomedial portals were in average 8.3 and 8.7, respectively, to the saphenous vein and nerve. Dorsolateral portal was in average 8.1mm to the deep peroneal nerve and dorsalis pedis artery, and 9.1mm to the medial dorsal cutaneous branch of the superficial peroneal nerve. Lateral portal was in average 12.3mm to the intermediate dorsal cutaneous branch of the superficial peroneal nerve.Conclusion: Tested portals shown to have a good safety margin for the foot neurovascular deep dorsal structures and an acceptable safety margin for the superficial neurovascular structures. [ABSTRACT FROM AUTHOR]

Background: The list of indications of posterior ankle endoscopy is expanding and includes various soft tissue and bony pathologies of the posterior ankle. Some of the indications, e.g. release of frozen ankle, debridement of posteromedial soft tissue impingement of the ankle and debridement or fixation of the posteromedial osteochondral lesion of the talus, require approach to the posterior ankle medial to the flexor hallucis longus tendon. The purpose of this study was to assess the risk of injury to the posterior tibial neurovascular bundle during posterior ankle endoscopy.Methods: Fourteen fresh frozen foot and ankle specimens were used. A metal rod was inserted into the posteromedial, posterolateral and modified posteromedial portals and touched the medial border of the posterolateral talar tubercle and the posteromedial corner of the ankle mortise in turn. The neurovascular bundle and FHL tendon were examined for any kink.Results: The neurovascular bundle was kinked in all specimens (100%) with the rod at the posteromedial corner of the ankle mortise through the posteromedial portal and was kinked in 11 specimens (79%) with the rod through the modified posteromedial portal. The neurovascular bundle was kinked in 1 specimen (7%) with the rod through the posterolateral portal.Conclusions: The neurovascular bundle was at risk during instrumentation of the posteromedial ankle through the posteromedial portal but was safe through the posterolateral portal. [ABSTRACT FROM AUTHOR]

Foot pressure ulcers are a common complication of diabetes because of patient's lack of sensitivity due to neuropathy. Deep pressure ulcers appear internally when pressures applied on the foot create high internal strains nearby bony structures. Monitoring tissue strains in persons with diabetes is therefore important for an efficient prevention. We propose to use personalized biomechanical foot models to assess strains within the foot and to determine the risk of ulcer formation. Our workflow generates a foot model adapted to a patient's morphology by deforming an atlas model to conform it to the contours of segmented medical images of the patient's foot. Our biomechanical model is composed of rigid bodies for the bones, joined by ligaments and muscles, and a finite element mesh representing the soft tissues. Using our registration algorithm to conform three datasets, three new patient models were created. After applying a pressure load below these foot models, the Von Mises equivalent strains and “cluster volumes” (i.e. volumes of contiguous elements with strains above a given threshold) were measured within eight functionally meaningful foot regions. The results show the variability of both location and strain values among the three considered patients. This study also confirms that the anatomy of the foot has an influence on the risk of pressure ulcer. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to evaluate the accuracy and the intrarater reliability of arch angle (AA), Staheli Index (SI), and Chippaux-Smirak Index (CSI) obtained from ink and pressure platform footprints. Methods We obtained AA, SI, and CSI measurements from ink pedigraph footprints and pressure platform footprints in 40 healthy participants (aged 25.65 ± 5.187 years). Intrarater reliability was calculated for all parameters obtained using the 2 methods. Standard error of measurement and minimal detectable change were also calculated. A repeated-measure analysis of variance was used to identify differences between ink and pressure platform footprints. Intraclass correlation coefficient and Bland and Altman plots were used to assess similar parameters obtained using different methods. Results Intrarater reliability was >0.9 for all parameters and was slightly higher for the ink footprints. No statistical difference was reported in repeated-measure analysis of variance for any of the parameters. Intraclass correlation coefficient values from AA, SI, and CSI that were obtained using ink footprints and pressure platform footprints were excellent, ranging from 0.797 to 0.829. However, pressure platform overestimated AA and underestimated SI and CSI. Conclusions Our study revealed that AA, SI, and CSI were similar regardless of whether the ink or pressure platform method was used. In addition, the parameters indicated high intrarater reliability and were reproducible. [ABSTRACT FROM AUTHOR]

The purpose of this study was to observe effects of wearing textured insoles and clinical compression socks on organisation of lower limb interceptive actions in developing athletes of different skill levels in association football. Six advanced learners and six completely novice football players (15.4±0.9years) performed 20 instep kicks with maximum velocity, in four randomly organised insoles and socks conditions, (a) Smooth Socks with Smooth Insoles (SSSI); (b) Smooth Socks with Textured Insoles (SSTI); (c) Compression Socks with Smooth Insoles (CSSI) and (d), Compression Socks with Textured Insoles (CSTI). Reflective markers were placed on key anatomical locations and the ball to facilitate three-dimensional (3D) movement recording and analysis. Data on 3D kinematic variables and initial ball velocity were analysed using one-way mixed model ANOVAs. Results revealed that wearing textured and compression materials enhanced performance in key variables, such as the maximum velocity of the instep kick and increased initial ball velocity, among advanced learners compared to the use of non-textured and compression materials. Adding texture to football boot insoles appeared to interact with compression materials to improve kicking performance, captured by these important measures. This improvement in kicking performance is likely to have occurred through enhanced somatosensory system feedback utilised for foot placement and movement organisation of the lower limbs. Data suggested that advanced learners were better at harnessing the augmented feedback information from compression and texture to regulate emerging movement patterns compared to novices. [ABSTRACT FROM AUTHOR]

Background Overweight and obesity are increasing in prevalence. However, despite reports of poor foot health, the influence of obesity and overweight on adult foot morphology has received limited attention. The objective of this work is to accurately and appropriately quantify the foot morphology of adults who are overweight and obese. Methods The foot morphology of 23 healthy weight (BMI = 22.9 kg.m − 2 ), overweight (27.5 kg.m − 2 ) and obese (32.9 kg.m − 2 ) age (60 years) matched males was quantified using a 3D scanner (all size UK 9). Data analysis computed normalised (to foot length) standard anatomical measures, and widths, heights and circumferences of 31 evenly spaced cross-sections of right feet. Findings Anatomical measures of foot, ball and heel width, ball and heel circumference and ball height were all greater in the obese group than the healthy weight ( P < 0.05). Cross-sectional measures were significantly wider than the healthy group for the majority of measures from 14 to 67% ( P = 0.025–1.000) of heel-to-toe length. Also, the obese group had significantly higher midfoot regions ( P = 0.024–0.025). This increased foot height was not evident from anatomical measures, which were not sensitive enough to detect dimensional differences in this foot region. Interpretation Feet of obese adults differ from healthy and overweight individuals, notably they are wider. Data needs to avoid reliance upon discrete anatomical landmarks to describe foot morphology. In the obese, changes in foot shape do not coincide with traditional anatomical landmarks and more comprehensive foot shape data are required to inform footwear design. [ABSTRACT FROM AUTHOR]

Background: The differences at the attachment site of peroneus brevis (PB) to the fifth metatarsal bone is important in terms of the forces exerted on the bone and hence the mechanism of fractures involving this structure. In this study, we investigated the anatomical properties of PB at the insertion site to the base of fifth metatarsal bone, its possible intertendinous connections with peroneus tertius (PT) and their possible effects on the fracture occurrence at the bony attachment site.Methods: The length and the width of PB tendons at their mid- and end-points were measured and classified according to the insertion types. Besides, the length and the width of the base of fifth metatarsal bone were assessed. The slips extending from the PB tendons and their relationship with PT were also evaluated. The data was compared statistically with each other and between the right and left sides.Results: The length of PB tendon was measured 79.57±15.40mm on the right side; 81.48±14.31mm on the left. The width of PB tendon at the mid-point was 4.46±0.80mm on the right side; 4.42±0.94mm on the left. The width of the tendon at its insertion point was measured 14.85±3.40mm and 15.16±3.42mm on the right and left sides respectively. PB was divided into three types according to its attachment to base of fifth metatarsal bone (5thMB). Type I, Type II and Type III were observed at the rates of 59.5%, 28.6% and 11.5% respectively. It was observed that the slips to the bone were extending more commonly from PB than from PT and that the large majority of them were single having their insertions on the base of the proximal phalanx of the fifth toe.Conclusions: Knowing the width and insertional types of PB aids in understanding the mechanism of fractures at the site of bony attachment. The existence of slips may help the surgeon in the procedures involving PB or the lateral side of the forefoot. [ABSTRACT FROM AUTHOR]

Background: Discrepancies observed between clinical findings and a weightbearing foot X-ray might be caused by a patients' positioning. This study's main objective was to determine the effect of a subjects' posture on the osseous relations of the foot.Methods: Anatomical markers were placed on the skin of the foot of 17 subjects. A plantar pressure plate assessed the percentage weight on the foot and weight distribution over the foot. Medial longitudinal foot angles were derived from the markers and compared between the 10 postures. The effect of percentage weight and weight distribution on the foot angles was determined by multiple regression analysis.Results: The foot angles were significantly affected by the postures. The multiple regression analysis revealed the weight on the foot and the mediolateral weight distribution over the foot as important factors for the foot angles.Conclusion: A subjects posture significantly influences the osseous relations in the foot. [ABSTRACT FROM AUTHOR]

Integration of patient-specific biomechanical measurements into the design of therapeutic footwear has been shown to improve clinical outcomes in patients with diabetic foot disease. The addition of numerical simulations intended to optimise intervention design may help to build on these advances, however at present the time and labour required to generate and run personalised models of foot anatomy restrict their routine clinical utility. In this study we developed second-generation personalised simple finite element (FE) models of the forefoot with varying geometric fidelities. Plantar pressure predictions from barefoot, shod, and shod with insole simulations using simplified models were compared to those obtained from CT-based FE models incorporating more detailed representations of bone and tissue geometry. A simplified model including representations of metatarsals based on simple geometric shapes, embedded within a contoured soft tissue block with outer geometry acquired from a 3D surface scan was found to provide pressure predictions closest to the more complex model, with mean differences of 13.3 kPa (SD 13.4), 12.52 kPa (SD 11.9) and 9.6 kPa (SD 9.3) for barefoot, shod, and insole conditions respectively. The simplified model design could be produced in <1 h compared to >3 h in the case of the more detailed model, and solved on average 24% faster. FE models of the forefoot based on simplified geometric representations of the metatarsal bones and soft tissue surface geometry from 3D surface scans may potentially provide a simulation approach with improved clinical utility, however further validity testing around a range of therapeutic footwear types is required. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore load transference with weight increase in children after 3-year follow-up and to identify the mechanism of force transference in feet with the weight changes. Totally 147 children (82 boys and 65 girls) in Shandong, China, which were selected from a database of 836 Chinese children, completed a plantar pressure measurement, and were followed-up for 3 years. Data of pressure parameters were recorded by Footscan® plate system. An algorithm was designed to quantify the plantar force transference with the weight increase. The results indicated that when children increase their weight from normal to overweight and obese, load transference mainly occurred from forefoot and midfoot to the heel. When children increase their weight from overweight to obese, plantar load not only transferred to the metatarsal, but also concentrated to the midfoot. [ABSTRACT FROM AUTHOR]

Subtalar hyperpronation and ankle dorsiflexion restriction have been theoretically associated with Achilles tendinopathy (AT). However, evidence to support these associations is lacking. To compare foot alignment and ankle dorsiflexion range of motion (ROM) between the symptomatic and non-symptomatic limbs of individuals with unilateral AT. And to verify whether differences exist between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain, structure, and symptom severity. Sixty-three participants with unilateral AT underwent a bilateral evaluation of pain during tendon palpation, symptom severity, tendon thickening, tendon neovascularization, ankle dorsiflexion ROM, and foot posture alignment [foot posture index (FPI), navicular drop, navicular drift, and longitudinal arch angle (LAA)]. Side and group comparisons were made using t-tests and correlations were evaluated using the Pearson test. There were no differences between the symptomatic and non-symptomatic limbs regarding foot posture alignment. Specifically, non-significant negligible differences were observed between limbs regarding FPI [mean difference (MD)=-0.23; 95% confidence interval (CI)=-0.70, 0.25), navicular drop (MD=0.58 mm; 95%CI=-0.25, 1.43), navicular drift (MD=0.16 mm; 95%CI=-0.77, 1.09), and LAA (MD=0.30º; 95%CI=-1.74, 2.34). There was no difference between limbs regarding ankle dorsiflexion ROM. However, lower ankle dorsiflexion was associated with worse symptom severity (r = 0.223). Finally, no difference was observed between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain or structure. Static foot alignment measures do not seem to be clinically relevant in patients with AT. Smaller ankle dorsiflexion ROM, however, was associated with greater symptom severity in this population. • Individuals with Achilles tendinopathy (AT) and symptomatic pronated feet did not differ from individuals with AT and symptomatic neutral/supinated feet in terms of tendon pain, structure, or symptom severity. • The symptomatic and non-symptomatic limbs of individuals with unilateral AT had no differences in terms of foot alignment, evaluated by static measures. • Pronated foot posture was not more prevalent in individuals with AT when compared to neutral/supinated foot postures. • Smaller ankle dorsiflexion range of motion was associated with greater symptom severity and may be relevant for this population. • Static foot alignment measures do not seem to be clinically relevant in patients with AT. [ABSTRACT FROM AUTHOR]

Introduction: It has been shown that doctors in Emergency Departments (EDs) have inconsistent knowledge of musculoskeletal anatomy. This is most likely due to a deficiency in focused musculoskeletal modules at undergraduate level in medical school. The aims of this study were to evaluate the knowledge of final year medical students on foot anatomy and common foot and ankle pathology as seen on radiographs. Methods: Final year medical students were asked to complete our short examination on a handout. The handout was anonymous and non-mandatory. There were four images. The first image is the anatomical section and the remaining images are the pathological section. Results: All 235 students responded. 57% were females. For the identification of the normal bones of the foot as shown on an X-ray, the average score for the group was 2.69 (out of a maximum of 6) {SD 1.67}7. Only 8.3% achieved a 6/6 or 100% grade i.e. recognising all six bones correctly. A further 8.3% achieved 5/6 (83%). 8.3% failed to correctly identify any bone seen on the X-ray, a corresponding score of 0. Discussion: This quick test showed normal anatomy of the foot and common pathology. One would expect final year medical students to be familiar with, especially two weeks before their finals in surgery. The curriculum should address the paucity of time spent in educating students in foot and ankle pathology. [ABSTRACT FROM AUTHOR]

The biomechanics of distance running are studied in relation to both understanding injury mechanisms and improving performance. Kinematic methods must be used to identify the stance phase of running when data are recorded during running on a standard treadmill or outside the laboratory. Recently, a focus on foot strike patterns has emerged in the field. Thus, there is a need for a kinematic method to identify foot contact that is equally effective for both rearfoot and non-rearfoot strike patterns. The purpose of this study was to determine whether a new kinematic method could accurately determine foot contact during running in both rearfoot and non-rearfoot strikers. Overground gait data were collected at on 22 runners, 11 with a rearfoot strike pattern and 11 with a non-rearfoot strike pattern. Data were processed to identify foot contact from: vertical ground reaction force, two previously published kinematic methods, and our new kinematic method. Limits of agreement were used to determine bias and random error of each kinematic method compared to ground reaction force onset. The new method had comparable random error at 200 Hz sampling frequency (5 ms per frame) to the previous methods (7 frames vs 6–9 frames) and produced the same offset for both strike patterns (3 frames), while the existing methods had different offsets for different strike patterns (4 or 7 frames). Study findings support use of this new method, as it can be applied to all running strike patterns without adjusting the frame offset, simplifying data processing. [ABSTRACT FROM AUTHOR]

Up until recently severe foot defects have been underestimated and amputation considered the treatment of choice. Inadequate treatment of foot defects is generally responsible for impaired deambulation resulting in physical and psychological handicap to the patient and producing a negative impact on social life. Foot reconstruction represents a recent advancement but is still a great challenge to the plastic surgeon; indeed the absence of a comprehensive anatomical classification of foot defects makes sharing clinical experiences difficult, slowing down the progress in this field. We report a single surgeon experience on a consecutive series of 47 complex foot reconstructions performed on 45 patients with microvascular free flaps over a 27-year period. A retrospective review of the cases was performed, a detailed analysis of the defects is presented and possible solutions debated so as to outline the key points in the diagnosis and treatment of foot defects. In the decision making process, soft tissue defect location, dimension, and functional relevance have proven to be as important as the exact definition of the bone defect. A new anatomical classification scheme for composite defects of the foot, involving both bone and soft tissue, is proposed in order to allow for a correct evaluation of the wound and an easier identification of the ideal treatment. [ABSTRACT FROM AUTHOR]

Running is one of the most accessible physical activities and running with and without footwear has attracted extensive attention in the past several years. In this study 18 habitually male unshod runners and 20 habitually male shod runners (all with dominant right feet) participated in a running test. A Vicon motion analysis system was used to capture the kinematics of each participant's lower limb. The in-shoe plantar pressure measurement system was employed to measure the pressure and force exerted on the pressure sensors of the insole. The function of a separate hallux in unshod runners is analyzed through the comparison of plantar pressure parameters. Owing to the different strike patterns in shod and unshod runners, peak dorsiflexion and plantarflexion angle were significantly different. Habitually shod runners exhibited a decreased foot strike angle (FSA) under unshod conditions; and the vertical average loading rate (VALR) of shod runners under unshod conditions was larger than that under shod conditions. This suggests that the foot strike pattern is more important than the shod or unshod running style and runners need to acquire the technique. It can be concluded that for habitually unshod runners the separate hallux takes part of the foot loading and reduces loading to the forefoot under shod conditions. The remaining toes of rearfoot strike (RFS) runners function similarly under unshod conditions. These morphological features of shod and unshod runners should be considered in footwear design to improve sport performance and reduce injury. [ABSTRACT FROM AUTHOR]

Objectives A multidisciplinary team developed an evidence-based guideline for the management of foot burns occurring in diabetic patients that included transcutaneous oxygen measurements (TCOM) and application of hyperbaric oxygen therapy (HBOT) to selected patients. This report represents an evaluation of preliminary TCOM/HBOT data. Methods This is a retrospective review of patients with diabetes mellitus (DM) who were admitted to a single American Burn Association (ABA) verified burn center for the treatment of foot burns. Patients were treated via the guideline if they were over the age of 16, admitted for the initial care of burns involving the feet between 4/01/2012 and 7/22/2013, and had a known or new diagnosis of DM. Results Eighteen patients were treated according to the guideline, 14 men and 4 women. Average age was 54 years + 14.78. Average BMI was 30.63 + 6.34. Median burn size was 0.88% TBSA (median partial thickness of 1% and median full thickness of 0.5%). The average HbA1c was 9.08 + 2.42. Seven patients received pre-operative HBOT, two received post-operative HBOT and three patients healed their wounds with HBOT alone. Average hospital length of stay was 13.39 days + 9.94 and was significantly longer for the group receiving HBOT. Admission HbA1c was not a predictor of the need for HBOT . Conclusions While TCOM/HBOT therapy has not been widely applied to the management of diabetic foot burns, the use of an evidence-based guideline incorporating TCOM/HBOT can provide a systematic way to evaluate the patients’ microcirculation and ability to heal burns of the foot. The incorporation of TCOM determination and application of HBOT in selected patients with DM and burns of the feet warrant continued study. [ABSTRACT FROM AUTHOR]

Objective: This study sought to use high-resolution ultrasound to measure changes in plantar fascia thickness as a result of tissue creep generated by walking and running. Methods: Independent samples of participants were obtained. Thirty-six walkers and 25 runners walked on a treadmill for 10 minutes or ran for 30 minutes, respectively. Standardized measures of the thickness of the plantar fascia were obtained in both groups using high-resolution ultrasound. Results: The mean thickness of the plantar fascia was measured immediately before and after participation. The mean plantar fascia thickness was decreased by 0.06 ± 0.33 mm SD after running and 0.03 ± 0.22 mm SD after walking. The difference between groups was not significant. Conclusion: Although the parameters of this study did not produce significant changes in the plantar fascia thickness, a slightly higher change in the mean thickness of the plantar fascia in the running group deserves further investigation. [ABSTRACT FROM AUTHOR]

Background Lateral foot wedges represent a biomechanical intervention aimed at reducing medial knee loads. However, the effects of varying wedge amounts on biomechanical variables and orthotic comfort have not been systematically studied. Further, arch height may influence the comfort of laterally wedged devices. Therefore, the primary purpose of this study was to examine the effect of incrementally increasing lateral wedge amounts on knee adduction moment parameters and subjective comfort. The secondary purpose was to relate arch height measures to the comfort of the devices. Methods Twenty-five healthy subjects underwent three-dimensional instrumented gait analysis testing using seven inclinations of lateral wedging (0°, 2°, 4°, 6°, 8°, 10°, 12°). Subjects reported comfort level for each orthotic condition. Arch heights were measured in standing and sitting, and rigidity index and stiffness were calculated. Findings The knee adduction moment decreased with wedge amounts up to 6°, but more aggressive amounts did not yield additional reductions. Comfort ratings did not change from baseline until wedge amounts exceeded 8°. In addition, arch height measures, arch rigidity index and stiffness did not relate to the comfort of the orthotic device regardless of the wedge amount. Interpretation Knee adduction moment decreased with mild wedge amounts while maintaining comfort. Wedge amounts greater than 6° yielded little additional mechanical benefit and amounts greater than 8° compromised comfort. It appears that 4°–6° of lateral wedging are optimal in regard to desirable biomechanical change and comfort level in healthy individuals. [ABSTRACT FROM AUTHOR]

As 3-dimensional (3D) motion-capture for clinical gait analysis continues to evolve, new methods must be developed to improve the detection of gait cycle events based on kinematic data. Recently, the application of principal component analysis (PCA) to gait data has shown promise in detecting important biomechanical features. Therefore, the purpose of this study was to define a new foot strike detection method for a continuum of striking techniques, by applying PCA to joint angle waveforms. In accordance with Newtonian mechanics, it was hypothesized that transient features in the sagittal-plane accelerations of the lower extremity would be linked with the impulsive application of force to the foot at foot strike. Kinematic and kinetic data from treadmill running were selected for 154 subjects, from a database of gait biomechanics. Ankle, knee and hip sagittal plane angular acceleration kinematic curves were chained together to form a row input to a PCA matrix. A linear polynomial was calculated based on PCA scores, and a 10-fold cross-validation was performed to evaluate prediction accuracy against goldstandard foot strike as determined by a 10 N rise in the vertical ground reaction force. Results show 89-94% of all predicted foot strikes were within 4 frames (20 ms) of the gold standard with the largest error being 28 ms. It is concluded that this new foot strike detection is an improvement on existing methods and can be applied regardless of whether the runner exhibits a rearfoot, midfoot, or forefoot strike pattern. [ABSTRACT FROM AUTHOR]