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The measurements of subtalar joint neutral position and hindfoot range of motion have been shown to be unreliable. The first step in making these measurements is to determine the calcaneal bisection. This study examines the reliability of bisecting the calcaneus with digital linear calipers. Five trials on each of six cadavers resulted in a mean absolute angular difference of 0.60° (SD ±1.17°). These results were then compared with results from the typical visual method used clinically. Three raters each performed five trials on six cadavers. Visual bisection was more variable, with a mean absolute error of 3.61° (±3.13°). A mean error of 6° (±1°) is certainly possible when the heel is visually bisected. It was determined that the caliper bisection was a valid technique for bisection of the heel, but that clinical visual bisection was not. (J Am Podiatr Med Assoc 91(3): 121-126, 2001)
The Relationship Between Arch Height and Arch Flexibility
A Proposed Arch Flexibility Classification System for the Description of Multidimensional Foot Structure
Background:
The correlation between arch structure and injury may be related to the fact that foot structure influences foot function. Foot structure is often defined by arch height, although arch flexibility may be just as important to form a more complete description. We propose an arch flexibility classification system, analogous to arch height classification, and then use the classification system to examine the relationship between arch flexibility and arch height.
Methods:
Arch height index was calculated in 1,124 incoming military cadets, of whom 1,056 had usable data. By measuring arch height during both sitting and standing, a measurement of arch flexibility could also be calculated. These values were used to create five arch flexibility categories: very stiff, stiff, neutral, flexible, and very flexible. The distribution of arch flexibility types among arch height categories was statistically compared.
Results:
The goodness of fit test showed a disproportionate number of each arch flexibility type in each of the arch height categories (P < .01). The largest proportion of cavus feet was very stiff and the smallest proportion was very flexible. Conversely, the largest proportion of planus feet was very flexible and the smallest proportion was very stiff.
Conclusions:
The results of this research support the common belief that cavus feet tend to be very stiff and planus feet tend to be very flexible.
Background: Medial tibial stress syndrome is a common overuse injury in weightbearing, physically active individuals and in athletes. Most research associated with this condition is primarily based on static foot and lower-extremity measurements.
Methods: A cross-sectional design was used to assess a set of static and dynamic measurements to determine which anatomical factors (limb length, ankle dorsiflexion, first metatarsophalangeal joint extension, and arch height) and biomechanical factors (center-of-pressure excursion index, malleolar valgus index, and gait velocity) are associated with medial tibial stress syndrome.
Results: One-way analysis of variance models revealed that participants with medial tibial stress syndrome had significantly greater visual analog pain levels and slower gait velocity than noninjured controls (P = .05). No other significant differences were found between the two groups.
Conclusions: Further investigation of these and other factors can help health professionals develop better strategies for the prevention and clinical intervention of medial tibial stress syndrome. (J Am Podiatr Med Assoc 100(2): 121–132, 2010)
Lesser Proximal Interphalangeal Joint Arthrodesis
A Retrospective Analysis of the Peg-in-Hole and End-to-End Procedures
A retrospective study was performed to compare the prevalence of complications in peg-in-hole and end-to-end arthrodesis procedures. The authors reviewed 177 second, third, and fourth proximal interphalangeal joint fusions for the correction of hammer toe deformities in 85 patients from 1988 to 1998 at the Temple University School of Podiatric Medicine. The average age of the patients was 49 years. Sixteen percent (14) of the subjects were male and 84% were (71) female. Upon follow-up, the fourth digit was generally associated with a greater number of complications for the end-to-end and peg-in-hole procedures, with the second digit being the most common site of fusion. The prevalence of complications was evaluated using contingency table analysis and expressed as a percent of total complications (27%, the end-to-end group; 17%, the peg-in-hole group). A subset of complications deemed clinically relevant was also computed. Similarly, the prevalence of clinically relevant complications for the end-to-end (10%) and the peg-in-hole (9%) procedures was not statistically significant. Therefore, this study showed no statistically significant differences in the total or clinically relevant complications between end-to-end and the peg-in-hole arthrodesis procedures. (J Am Podiatr Med Assoc 91(7): 331-336, 2001)
Stability of the Offset V-Osteotomy
Test Jig Development and Saw Bone Model Assessment
In the offset V-bunionectomy used for hallux valgus repair, both the Kalish and the Vogler variations have a long dorsal arm, but the apex is more distal in the Kalish procedure. This study investigated the effect that pin orientation and location of the osteotomy apex have on weightbearing stability. The authors studied saw bone models that were loaded to failure in an Instron 4201 materials testing machine and, in addition, designed, fabricated, and used a unique jig assembly to help minimize data variability. Statistically significant differences were found between the surgical techniques and pin orientations: the Kalish osteotomy was stronger than the Vogler procedure, and in both osteotomies, the plantarly directed Kirschner wire orientation was stronger than the dorsally directed orientation. (J Am Podiatr Med Assoc 92(2): 82-89, 2002)
Background:
Clinical observations note that foot pain can be linked to contralateral pain at the knee or hip, yet we are unaware of any community-based studies that have investigated the sidedness of pain. Because clinic-based patient samples are often different from the general population, the purpose of this study was to determine whether knee or hip pain is more prevalent with contralateral foot pain than with ipsilateral foot pain in a population-based cohort.
Methods:
Framingham Foot Study participants (2002–2008) with information on foot, knee, and hip pain were included in this cross-sectional analysis. Foot pain was queried as pain, aching, or stiffness on most days. Using a manikin diagram, participants indicated whether they had experienced pain, aching, or stiffness at the hip or knee and specified the side of any reported pain. Sex-specific multinomial logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals for the association of foot pain with knee and hip pain, adjusting for age and body mass index.
Results:
In the 2,181 participants, the mean ± SD age was 64 ± 9 years; 56% were women, and the mean body mass index was 28.6. For men and women, bilateral foot pain was associated with increased odds of knee pain on any side (ORs = 2–3; P < .02). Men with foot pain were more likely to have ipsilateral hip pain (ORs = 2–4; P<.03), whereas women with bilateral foot pain were more likely to have hip pain on any side (OR = 2–3; P < .02).
Conclusions:
Bilateral foot pain was associated with increased odds of knee and hip pain in men and women. For ipsilateral foot and hip pain, men had a stronger effect compared with women.
Arch Height Index Measurement System
Establishment of Reliability and Normative Values
Background: The purposes of this study were 1) to determine the intrarater and interrater reliability of the arch height index measurement system device, 2) to establish population normative values for the arch height index in recreational runners, and 3) to compare arch height index values between the right and left feet and between genders.
Methods: Eleven subjects were used to establish intrarater and interrater reliability of the arch height index measurement system. This system was then used to measure the arch height index of 100 recreational runners.
Results: Measurements taken with the arch height index measurement system device exhibited high intrarater and interrater reliability. The mean ± SD arch height index of the recreational runners was 0.340 ± 0.030. Men had larger feet than women, but the arch height index between genders was similar.
Conclusions: The arch height index measurement system device is reliable to use between testers while simplifying the measurement procedure for recording the arch height index. The arch height index may be helpful in identifying potential structural factors that predispose individuals to lower-extremity injuries. (J Am Podiatr Med Assoc 98(2): 102–106, 2008)
Two randomized, double-blind, placebo-controlled studies assessed the analgesic efficacy of valdecoxib in patients with moderate-to-severe pain after bunionectomy. Study 1 (N = 374) assessed the efficacy of two regimens of valdecoxib on the day after surgery (valdecoxib, 40 mg, with a 20-mg redose [n = 127]; valdecoxib, 40 mg, with a placebo redose [n = 122]; and placebo/placebo [n = 125]), and study 2 (N = 478) examined the efficacy of two different multiple-dose regimens on postoperative days 2 through 5 (valdecoxib, 20 mg, twice daily [n = 160]; valdecoxib, 20 mg, once daily [n = 159]; and placebo [n = 159]). Valdecoxib provided significant pain relief and reduced the use of opioid rescue medication. This efficacy was accompanied by improved global scores, decreased pain interference with function, and increased patient satisfaction. (J Am Podiatr Med Assoc 96(5): 393–407, 2006)
