Search Results
Radiologic Morphology of the Calcaneus
A Study of Radiologic Angles in a Pediatric Population
Background:
The Fowler-Philip, calcaneal pitch, and total calcaneal angles define the radiologic morphology of the rearfoot. We studied these angles in healthy adolescents.
Methods:
We studied 141 feet. Patients with inflammatory or traumatic injuries were excluded. The mean participant age was 11.5 years. The Fowler-Philip, calcaneal pitch, and total calcaneal angles were measured on lateral weightbearing radiographs. The statistics included descriptive, sample size (α=0.05 and β=0.20), the Student t test, and analysis of variance; P < .05 was considered significant.
Results:
The samples were 141 and 35 radiographs for the Fowler-Philip and calcaneal pitch angles, respectively. Ninety percent, 25.1%, and 97.4% of the adolescents had normal Fowler-Philip, calcaneal pitch, and total calcaneal angles, respectively. In addition, 9.9%, 74.9%, and 2.6% of the values were outside the reference ranges, respectively. The Fowler-Philip angle decreased and the calcaneal pitch angle increased significantly with age (P = .0005). The total calcaneal angle did not change with age (P = .65).
Conclusions:
The mean angle values in a pediatric population did not differ from those in adults. We found a high percentage of calcaneal pitch angles outside the reference range. Age influenced the Fowler-Philip and calcaneal pitch angles but not the total calcaneal angle. (J Am Podiatr Med Assoc 103(1): 32–35, 2013)
Background: A few studies have investigated the relationship between foot posture measures and plantar pressure parameters, but no study has investigated the correlation of foot posture measures with all primary parameters consisting of contact area (CA), maximum force (MF), and peak pressure (PP). We aimed to determine the relationship of the Foot Posture Index-6 (FPI-6) and navicular drop (ND) with plantar pressure parameters during static standing and preferred walking.
Methods: Seventy people were included. Navicular drop and the FPI-6 were used to assess foot posture. Plantar pressure parameters including CA, MF, and PP were recorded by a pressure-sensitive mat during barefoot standing and barefoot walking at preferred speed. All assessments were repeated three times and averaged. Pearson correlation coefficients below 0.300 were accepted as negligible and higher ones were interpreted.
Results: Navicular drop was moderately correlated with dynamic CA under the midfoot and second metatarsal; also, the FPI-6 was moderately correlated with dynamic CA under the midfoot (0.500 < r < 0.700). The other interpreted correlations were poor (0.300 < r < 0.500). Both measures were correlated with dynamic CA under the second and third metatarsals; dynamic CA and MF under the midfoot; and static CA, MF, and PP under the first metatarsal and hallux (P < .01). Navicular drop was also correlated with dynamic MF under the first metatarsal and dynamic CA under the fourth metatarsal (P < .01). Furthermore, ND was correlated with static CA and PP under the second metatarsal and static PP under the fifth metatarsal (P < .01). The FPI-6 was also correlated with dynamic MF and PP under the hallux (P < .01).
Conclusions: The correlations between foot posture measures and plantar pressure variables are poor to moderate. The measures may be useful in the clinical assessment of medial forefoot problems related to prolonged standing and midfoot complaints related to high force during walking. Furthermore, the FPI-6 may provide valuable data regarding hallux complaints related to the high loads during walking.
The foot postures of 39 subjects were evaluated for excessive pronation by means of six static weightbearing and five nonweightbearing measurements, and two types of footprint indexes. Visual evidence of windlass function was recorded by video. Chi-square analysis revealed that excessive pronation does not affect the establishment of the windlass mechanism. The position of the forefoot relative to the rearfoot, subtalar joint axis position, and navicular drift/foot length ratio were significantly associated with dynamic windlass function. These results suggest that selected static measurements may have value in predicting some aspects of dynamic foot function during the propulsive phase of the gait cycle. (J Am Podiatr Med Assoc 91(5): 245-250, 2001)
Background:
Measurement of weightbearing ankle dorsiflexion (DF) passive range of motion (PROM) has been suggested as a way to estimate ankle kinematics during gait; however, no previous study has demonstrated the relationship between ankle DF during gait and ankle DF PROM with knee extension. We examine the relationship between maximum ankle DF during gait and nonweightbearing and weightbearing ankle DF PROM with knee extension.
Methods:
Forty physically active individuals (mean ± SD age, 21.63 ± 1.73 years) participated in this study. Ankle DF PROM with knee extension was measured in the nonweightbearing and weightbearing conditions; maximum ankle DF during gait was assessed using a three-dimensional motion analysis system. The relationship between each variable was calculated using the Pearson product moment correlation coefficient, and the difference in ankle DF PROM between the nonweightbearing and weightbearing conditions was analyzed using a paired t test.
Results:
The weightbearing measurement (r = 0.521; P < .001) for ankle DF PROM showed a greater correlation with maximum ankle DF during gait than did the nonweightbearing measurement (r = 0.245; P = .029). Ankle DF PROM was significantly greater in the weightbearing than in the nonweightbearing condition (P < .001) despite a significant correlation between the two measurements (r = 0.402; P < .001).
Conclusions:
These findings indicate that nonweightbearing and weightbearing measurements of ankle DF PROM with knee extension should not be used interchangeably and that weightbearing ankle DF PROM with the knee extended is more appropriate for estimating ankle DF during gait.
Medial Tibial Stress Syndrome (Tibial Fasciitis)
A Proposed Pathomechanical Model Involving Fascial Traction
Although medial tibial stress syndrome is one of the most common lower-extremity overuse injuries, its pathomechanics remain controversial. Two popular theories have been proposed to account for this condition: tibial bending and fascial traction. This article evaluates the role of fascial traction in medial tibial stress pathomechanics. We hypothesized that with contraction of the deep leg flexors tension would be imparted to the tibial fascial attachment at the medial tibial crest. We also speculated that circumferential straps would dampen tension directed to the medial tibial crest. The amount of strain present in the tibial fascia adjacent to its distal medial tibial crest insertion during loading of the leg was investigated as a descriptive laboratory pilot study using three fresh cadaver specimens. Strain in the distal tibial fascia was measured using strain gauges placed in the fascia at its medial tibial crest insertion. As tension on the posterior tibial, flexor digitorum longus, and soleus tendons increased, strain in the tibial fascia increased in a consistent linear manner (P < .0001). We conclude that fascial tension may play a role in the pathomechanics of medial tibial stress syndrome. The tenting effect of the posterior tibial, flexor digitorum longus, and soleus tendons caused by muscle contraction exerts a force on the distal tibial fascia that is directed to its tibial crest insertion. Circumferential straps provided no dampening effect on tension directed to the medial tibial crest. (J Am Podiatr Med Assoc 97(1): 31–36, 2007)
Background: A study was conducted to determine whether the longitudinal arch angle can be used to predict dynamic foot posture during running.
Methods: Seventeen healthy, experienced runners participated in the study. The static longitudinal arch angle was determined from a digital image of the medial aspect of each subject’s feet obtained in relaxed standing posture. For the dynamic phase, subjects were asked to walk across a 12-m walkway and then to run across a 25-m runway while the medial aspect of each foot was videotaped. The longitudinal arch angle was digitized from the video images at midstance in walking and at midsupport while running for five trials per extremity.
Results: The longitudinal arch angle obtained in relaxed standing posture was highly predictive of dynamic foot posture at midstance in walking (r 2 = 0.854) and at midsupport while running (r 2 = 0.846).
Conclusions: The static measurement of longitudinal arch angle is highly predictive of dynamic foot posture during walking and running. The longitudinal arch angle measured in relaxed standing posture significantly contributed to explaining more than 85% of the variance associated with the longitudinal arch angle position at midstance during walking and at midsupport while running. These results seem to validate use of the longitudinal arch angle as part of the foot and ankle physical examination. (J Am Podiatr Med Assoc 97(2): 102–107, 2007)
Background: Previous two-dimensional kinematic studies that assessed the effect of foot orthoses on rearfoot motion have yielded mixed results regarding whether control of rearfoot motion is related to symptom relief.
Methods: We sought to determine the effect of foot orthoses on rearfoot motion and to correlate these changes with the degree of symptom improvement in 22 individuals with excessive rearfoot pronation (17 women and 5 men; mean ± SD age, 44.3 ± 16.7 years; mean ± SD weight, 74.9 ± 15.9 kg). Two-dimensional motion-analysis software was used to assess frontal plane rearfoot motion with and without foot orthoses. The mean ± SD Foot Posture Index of the left foot was 8.83 ± 3.54 and of the right foot was 9.22 ± 3.64). The pain and function subscales of the Foot Health Status Questionnaire were then used to determine the degree of symptom relief associated with the orthoses at baseline and 4 weeks later.
Results: Orthoses had a small but statistically significant effect on rearfoot motion, although no significant correlations were found between differences in rearfoot motion with and without foot orthoses and the improvements demonstrated in the Foot Health Status Questionnaire subscales of pain and function.
Conclusions: The effect of orthoses on frontal plane rearfoot motion is considered small and probably insufficient to account for the extent of symptom reduction found in this study. Other parameters of orthotic function, such as kinetic and neuromechanical variables, should be further investigated. (J Am Podiatr Med Assoc 97(3): 207–212, 2007)
An ideal postoperative shoe should be comfortable to wear and protect the foot during recovery from surgery or injury. Protection is assumed to be related to peak pressure and force-time integral under the foot. This study compared a commonly used postoperative shoe with a new postoperative shoe that incorporates a rigid sole with an 11° rocker bottom. The new postoperative shoe significantly reduced peak pressures on the forefoot by 20%. The amount of pressure and force-time integral reduction is compared with other values found in the literature for various shoe modifications. Indications for rocker-bottom shoes are also explored. (J Am Podiatr Med Assoc 91(10): 501-507, 2001)
Background
Vitamin D is an essential vitamin that targets several tissues and organs and plays an important role in calcium homeostasis. Vitamin D deficiency is common, particularly at higher latitudes, where there is reduced exposure to ultraviolet B radiation. We reviewed the role of vitamin D and its deficiency in foot and ankle pathology.
Methods
The effects of vitamin D deficiency have been extensively studied, but only a small portion of the literature has focused on the foot and ankle. Most evidence regarding the foot and ankle consists of retrospective studies, which cannot determine whether vitamin D deficiency is, in fact, the cause of the pathologies being investigated.
Results
The available evidence suggests that insufficient vitamin D levels may result in an increased incidence of foot and ankle fractures. The effects of vitamin D deficiency on fracture healing, bone marrow edema syndrome, osteochondral lesions of the talus, strength around the foot and ankle, tendon disorders, elective foot and ankle surgery, and other foot and ankle conditions are less clear.
Conclusions
Based on the available evidence, we cannot recommend routine testing or supplementation of vitamin D in patients with foot and ankle pathology. However, supplementation is cheap, safe, and may be of benefit in patients at high risk for deficiency. When vitamin D is supplemented, the evidence suggests that calcium should be co-supplemented. Further high-quality research is needed into the effect of vitamin D in the foot and ankle. Cost-benefit analyses of routine testing and supplementation of vitamin D for foot and ankle pathology are also required.
Background:
Plantar pressure measurement is effective for assessing plantar loading and can be applied to evaluating foot performance. We sought to explore the characteristics of plantar pressures in elite sprinters and recreational runners during static standing and walking.
Methods:
Arch index (AI) values, regional plantar pressure distributions (PPDs), and footprint characteristics were examined in 80 elite sprinters and 90 recreational runners using an optical plantar pressure measurement system. Elite sprinters' pain profiles were examined to evaluate their most common pain areas.
Results:
In recreational runners, AI values in males were in the normal range and in females were high arch type. The AI values were significantly lower in elite sprinters than in recreational runners. In elite sprinters, particularly males, the static PPD of both feet was higher at the medial metatarsal bone and the lateral heel and lower at the medial and lateral longitudinal arches. Elite male sprinters' PPD of both feet was mainly transferred to the medial metatarsal bone and decreased at the lateral longitudinal arch and the medial heel during the midstance phase of walking. The lateral knee joint and biceps femoris were the most common sites of musculoskeletal pain in elite sprinters.
Conclusions:
Elite sprinters' AI values could be classified as high arches, and their PPD tended to parallel the features of runners and high-arched runners. These findings correspond to the profile of patellofemoral pain syndrome (PFPS)–related plantar pressure. The pain profiles seemed to resonate with the symptoms of high-arched runners and PFPS. A possible link between high-arched runners and PFPS warrants further study.
