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Abstract Background It is not uncommon for a person's foot posture and/or mobility to be assessed during a clinical examination. The exact relationship, however, between static posture and mobility is not known. Objective The purpose of this study was to determine the degree of association between static foot posture and mobility. Method The static foot posture and foot mobility of 203 healthy individuals was assessed and then analyzed to determine if low arched or "pronated" feet are more mobile than high arched or "supinated" feet. Results The study demonstrated that those individuals with a lower standing dorsal arch height and/or a wider standing midfoot width had greater mobility in their foot. In addition, those individuals with higher Foot Posture Index (FPI) values demonstrated greater mobility and those with lower FPI values demonstrated less mobility. Finally, the amount of foot mobility that an individual has can be predicted reasonably well using either a 3 or 4 variable linear regression model. Conclusions Because of the relationship between static foot posture and mobility, it is recommended that both be assessed as part of a comprehensive evaluation of a individual with foot problems.

Abstract Background Previous studies have suggested that increased plantar surface area, associated with pes planus, is a risk factor for the development of lower extremity overuse injuries. The intent of this study was to determine if a single or combination of foot anthropometric measures could be used to predict plantar surface area. Methods Six foot measurements were collected on 155 subjects (97 females, 58 males, mean age 24.5 ± 3.5 years). The measurements as well as one ratio were entered into a stepwise regression analysis to determine the optimal set of measurements associated with total plantar contact area either including or excluding the toe region. The predicted values were used to calculate plantar surface area and were compared to the actual values obtained dynamically using a pressure sensor platform. Results A three variable model was found to describe the relationship between the foot measures/ratio and total plantar contact area (R2 = 0.77, p < 0.0001)). A three variable model was also found to describe the relationship between the foot measures/ratio and plantar contact area minus the toe region (R2 = 0.76, p < 0.0001). Conclusion The results of this study indicate that the clinician can use a combination of simple, reliable, and time efficient foot anthropometric measurements to explain over 75% of the plantar surface contact area, either including or excluding the toe region.

Abstract Correction to McPoil TG, Cornwall MW, Medoff L, Vicenzion B, Fosberg K, Hilz D. Arch height change during sit-to-stand: an alternative for the navicular drop test. Journal of Foot and Ankle Research 2008; 1:3.

Abstract Background A study was conducted to determine the reliability and minimal detectable change for a new composite measure of the vertical and medial-lateral mobility of the midfoot called the foot mobility magnitude. Methods Three hundred and forty-five healthy participants volunteered to take part in the study. The change in dorsal arch height between weight bearing and non-weight bearing as well as the change in midfoot width between weight bearing and non-weight bearing were measured at 50% of total foot length and used to calculate the foot mobility magnitude. The reliability and minimal detectable change for the measurements were then determined based on the assessment of the measurements by three raters with different levels of clinical experience. Results The change in dorsal arch height between weight bearing and non-weight bearing, midfoot width between weight bearing and non-weight bearing, and the foot mobility magnitude were shown to have high levels of intra-rater and inter-rater reliability. Normative data are provided for the left and right feet of both the female (n = 211) and male (n = 134) subjects. Conclusion While the measurements of navicular drop and drift have been used as a clinical method to assess both the vertical and medial-lateral mobility of the midfoot, poor to fair levels of inter-rater reliability have been reported. The results of the current study suggest that the foot mobility magnitude provides the clinician and researcher with a highly reliable measure of vertical and medial-lateral midfoot mobility.

Abstract Background A study was conducted to determine the reliability and validity of a new foot mobility assessment method that utilizes digital images to measure the change in dorsal arch height measured at 50% of the length of the foot during the Sit-to-Stand test. Methods Two hundred – seventy five healthy participants participated in the study. The medial aspect of each foot was photographed with a digital camera while each participant stood with 50% body weight on each foot as well as in sitting for a non-weight bearing image. The dorsal arch height was measured at 50% of the total length of the foot on both weight bearing and non-weight bearing images to determine the change in dorsal arch height. The reliability and validity of the measurements were then determined. Results The mean difference in dorsal arch height between non-weight bearing and weight bearing was 10 millimeters. The change in arch height during the Sit-to-Stand test was shown to have good to high levels of intra- and inter-reliability as well as validity using x-rays as the criterion measure. Conclusion While the navicular drop test has been widely used as a clinical method to assess foot mobility, poor levels of inter-rater reliability have been reported. The results of the current study suggest that the change in dorsal arch height during the Sit-to-Stand test offers the clinician a reliable and valid alternative to the navicular drop test.

Plantar heel pain (PHP) is a common condition managed by physical therapists that can, at times, be difficult to treat. Management of PHP is complicated by a variety of pathoanatomic features associated with PHP in addition to several treatment approaches with varying efficacy. Although clinical guidelines and clinical trial data support a general approach to management, the current literature is limited in case-specific descriptions of PHP management that addresses unique combinations of pathoanatomical, physical, and psychosocial factors that are associated with PHP. Purpose: The purpose of this case series is to describe physical therapist decision-making of individualized multimodal treatment for PHP cases presenting with varied clinical presentations. Treatment incorporated clinical guidelines and recent evidence including a combination of manual therapy, patient education, stretching, resistance training, and neurodynamic interventions. A common clinical decision-making framework was used to progress individualized treatment from a focus on symptom modulation initially to increased load tolerance of involved tissues and graded activity. In each case, patients met their individual goals and demonstrated clinically meaningful improvements in pain, function, and global rating of change that were maintained at the 1–2-year follow-up. Implications: This case series provides details of physical therapist management of a variety of PHP clinical presentations that can be used to complement clinical practice guidelines in the management of PHP. [ABSTRACT FROM AUTHOR]

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

Background: Clinicians are interested in the foot strike pattern (FSP) in runners because of the suggested relationship between the strike pattern and lower extremity injury. Purpose: The purpose of this study was to assess the ability of collegiate cross-country runners and recreational runners to self-report their foot strike pattern during running. Study Design: Cross-sectional Study Methods: Twenty-three collegiate cross-country and 23 recreational runners voluntarily consented to participate. Inclusion criteria included running at least 18 miles per week, experience running on a treadmill, no history of lower extremity congenital or traumatic deformity, or acute injury three months prior to the start of the study. All participants completed a pre-test survey to indicate their typical foot strike pattern during a training run (FSPSurvey). Prior to running, reflective markers were placed on the posterior midsole and the vamp of the running shoe. A high-speed camera was used to film each runner in standing and while running at his or her preferred speed on a treadmill. The angle between the vector formed by the two reflective markers and the superior surface of the treadmill was used to calculate the foot strike angle (FSA). To determine the foot strike pattern from the video data (FSPVideo), the static standing angle was subtracted from the FSA at initial contact of the shoe on the treadmill. In addition to descriptive statistics, percent agreement and Chi square analysis was used to determine distribution differences between the video analysis results and the survey. Results: The results of the chi-square analysis on the distribution of the FSPSurvey in comparison to the FSPVideo were significantly different for both the XCRunners (p < .01; Chi-square = 8.77) and the REC Runners (p < .0002; Chi-square = 16.70). The cross-country and recreational runners could correctly self-identified their foot strike pattern 56.5% and 43.5% of the time, respectively. Conclusion: The findings of this study suggest that the clinician cannot depend on an experienced runner to correctly self-identify their FSP. Clinicians interested in knowing the FSP of a runner should consider performing the two-dimensional video analysis described in this paper. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background: The posture of the foot has been implicated as a factor in the development of running-related injuries. A static measure of foot posture, such as the longitudinal arch angle (LAA), that can be easily performed and is predictive of the posture of the foot at midsupport while running could provide valuable information to enhance the clinician's overall evaluation of the runner. Purpose: The purpose of this study was to determine if the LAA, assessed in relaxed standing, could predict the posture of the foot at midsupport while running on a treadmill. Study Design: Cross-sectional Study Methods: Forty experienced runners (mean age 26.6 years) voluntarily consented to participate. Inclusion criteria included running at least 18 miles per week, previous experience running on a treadmill, no history of lower extremity congenital or traumatic deformity, or acute injury three months prior to the start of the study. Each runner had markers placed on the medial malleolus, navicular tuberosity, and medial aspect 1st metatarsal head of both feet. A high speed camera (240 Hz) was used to film both feet of each runner in standing and while running on a treadmill at their preferred speed. The LAA in standing and at mid-support while running was determined by angle formed by two lines drawn between the three markers with the navicular tuberosity serving as the apex. The LAA in midsupport was determined using the mean of the middle five running trials. Results: The levels of intra-rater and inter-rater reliability for the dynamic LAA were excellent. The results of the t-tests indicated that mean values between the left and right foot were not significantly different for the standing or running LAA. The results of the t-tests between male and female runners were also not significantly different for standing or running LAA. The Pearson correlation between standing and running LAA for all 80 feet was r = 0.95 (r² = 0.90). Conclusions: The standing LAA was found to be highly predictive of the running LAA at midsupport while running. Approximately 90% of the variance associated with foot posture at midsupport in running could be explained by the standing LAA. [ABSTRACT FROM AUTHOR]