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- Author or Editor: Jose M. Castillo x
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Background: The aim of this study is to confirm whether the absolute and relative lengths of the first metatarso-digital segment is greater than normal in incipient hallux limitus deformity.
Methods: In a sample of 144 dorsoplantar radiographs under weightbearing conditions (94 of normal feet and 50 of feet with a slightly stiff hallux), measurements were made of the relative first metatarsal protrusion, the length and width of the first metatarsal and of the proximal phalanx of the hallux, the length of the distal phalanx of the hallux, and the total length of the hallux.
Results: There were significant differences between the two types of feet in the relative first metatarsal protrusion, the width of the first metatarsal, the length and width of the proximal phalanx of the hallux, the length of the distal phalanx, and the total length of the hallux.
Conclusion: The size of the first metatarso-digital segment could be implicated in the development of hallux limitus deformity. (J Am Podiatr Med Assoc 97(6): 460–468, 2007)
Background: Orthotic devices are used to help children progressively acquire a more physiologic walking pattern.
Methods: To determine the effect of an orthotic device with an out-toeing wedge along with a physiologic shoe as treatment for in-toed gait, angle of gait was measured in 48 children aged 3 to 14 years with in-toed gait. The following comparisons were made: angle of gait in children unshod versus children shod without treatment, angle of gait in children shod without treatment versus children shod plus orthoses, and angle of gait in children unshod versus children shod plus orthoses.
Results: Using a correctly fitting shoe increased the angle of gait in a nonsignificant manner, but a significant increase was revealed in the comparison of the angle of gait in children unshod versus children under treatment. The results showed that the behavior in boys and girls was similar to that in the total sample. Regarding side, the corrective effect of the orthotic device was similar in the two feet. However, the data showed a greater corrective effect of the shoe in the right foot.
Conclusions: Orthotic devices with out-toeing wedge combined with correctly fitting shoes, as well as shoes alone, are useful tools in the treatment of in-toed gait in children. (J Am Podiatr Med Assoc 100(6): 472–478, 2010)
Distance Between the Malleoli and the Ground
A New Clinical Method to Measure Leg-Length Discrepancy
Background:
The aim of this work is to introduce a useful method for the clinical diagnosis of leg-length inequality: distance between the malleoli and the ground (DMG).
Methods:
A transversal observational study was performed on 17 patients with leg-length discrepancy. Leg-length inequality was determined with different clinical methods: with a tape measure in a supine position from the anterior superior iliac spine (ASIS) to the internal and external malleoli, as the difference between the iliac crests when standing (pelvimeter), and as asymmetry between ASISs (PALpation Meter [PALM]; A&D Medical Products Healthcare, San Jose, California). The Foot Posture Index (FPI) and the navicular drop test were also used. The DMG with Perthes rule (perpendicular to the foot when standing), the distance between the internal malleolus and the ground (DIMG), and the distance between the external malleolus and the ground were designed by the authors.
Results:
The DIMG is directly related to the traditional ASIS–external malleolus measurement (P = .003), the FPI (P = .010), and the navicular drop test (P < .001). There are statistically significant differences between measurement of leg-length inequality with a tape measure, in supine decubitus, from the ASIS to the internal malleolus, and from the ASIS to the external malleolus.
Conclusions:
This new method (the DMG) is useful for diagnosing leg-length discrepancy and is related to the ASIS–external malleolus measurement. The DIMG is significantly inversely proportional to the degree of pronation according to the FPI. Conversely, determination of leg-length discrepancy with a tape measure from the ASIS to the malleoli cannot be performed interchangeably at the level of the internal or external malleolus.
Background: The practice of flamenco dance involves great biomechanical demands, comparable with a high-performance sport. The technical movements of the footwork tap, the jumps, and the turns increase the prevalence of injuries and pathologic disorders of the foot and lower limb. Limited research has examined adaptation of the foot posture and dorsiflexion of the ankle in flamenco dancing. Therefore, the aim of this study was to evaluate whether the practice of flamenco dancing produces modifications in the ankle’s dorsiflexion range of motion, Foot Posture Index, or pronation.
Methods: A cross-sectional observational study with intentional sampling was performed with 26 individuals (52 feet) in two groups: professional female flamenco dancers (n = 13) and nondancers (n = 13). The participants were assessed in a single session for ankle dorsiflexion, foot pronation (navicular drop test), and foot posture (Foot Posture Index).
Results: Significant differences were found between the two groups for left foot Foot Posture Index (P = .007) and right foot navicular drop test (P = .006).
Conclusions: The results of this study indicate that flamenco dancing can produce modifications in the Foot Posture Index and foot pronation versus nondancers. Further research is required.
Background
Excessive deviation of the distal phalanx in abduction frequently occurs in advanced stages of hallux rigidus but not in hallux valgus. Therefore, theoretically there should be no significant differences in the hallux interphalangeal angle (HIPA) between individuals with normal feet, those with hallux valgus, and those with mild hallux limitus. The objective of the present study was thus to determine if significant differences in HIPA exist in the early stages of hallux valgus or hallux limitus deformities.
Methods
The hallux interphalangeal angle was measured in three groups of participants: a control group with normal feet (45 participants), a hallux valgus group (49 participants), and a hallux limitus group (48 participants). Both of the pathologies were at an early stage. A dorsoplantar radiograph under weightbearing conditions was taken for each individual, and measurements (HIPA and hallux abductus angle [HAA]) were taken using AutoCAD (Autodesk Inc, San Rafael, California) software. Intergroup comparisons of HIPA, and correlations between HIPA, HAA, and hallux dorsiflexion were calculated.
Results
The comparisons revealed no significant differences in the values of HIPA between any of the groups (15.2 ± 5.9 degrees in the control group, 15.5 ± 3.9 degrees in the hallux valgus group, and 16.15 ± 4.3 in the hallux limitus group; P = 0.634). The Pearson correlation coefficients in particular showed no correlation between hallux dorsiflexion, HAA, and HIPA.
Conclusions
For the study participants, there were similar deviations of the distal phalanx of the hallux with respect to the proximal phalanx in normal feet and in feet with the early stages of the hallux limitus and hallux valgus deformities.
Background: The foot is the main element of artistic creation in flamenco dancing. At the professional level, the foot undergoes high musculoskeletal demands, predisposing the development of podiatric pathologic disorders in this group. The principal objective of this study was to determine the most common foot lesions in professional female flamenco dancers.
Methods: In a cross-sectional observational study of 44 female professional flamenco dancers, the participants completed a short questionnaire about their demographic features, number of hours danced per week, and years of professional activity. Any foot lesions presented by the participant were also recorded.
Results: Some type of pathologic foot condition was noted in 75% of the women, with a particularly high prevalence of hallux abducto valgus (61.4%), hypermobility of the first ray (43.2%), claw toe (40.9%), and varus fifth toe (37.5%) compared with the general population. No significant differences in the presence of pathologic disorders of the foot were found according to the time dedicated to dance or the years of professional activity.
Conclusions: Female flamenco dancers in this study had a high prevalence of podiatric medical problems: some kind of pathologic abnormality of the foot was present in 75% of the participants. Hallux abducto valgus, claw toe, and hypermobility of the first ray were the most common pathologic disorders observed.
Background
Sports have a strong influence on current society. Foot posture has been postulated to be a risk factor for overuse injuries; however, the link between foot posture and injuries is unclear. This study aimed to determine whether children with pronated feet become more fatigued after participating in sports tests than those with normal feet.
Methods
One hundred five children aged 10 to 12 years (mean ± SD age, 10.46 ± 0.78 years) participated in the sports tests, which were aerobic-type resistance exercises with six stations at which each child remained for 30 sec. The posture of the foot was evaluated via the Foot Posture Index and the plantar footprint via the arch index and the Clarke angle before and after aerobic-type resistance exercises. Perceived tiredness was evaluated with the Pictorial Children's Effort Rating Table (PCERT) and whether there was pain during or after physical activity.
Results
The variables used to measure foot posture and the plantar arch changed more in the pronated feet, suggesting that the feet undergo more pronation after physical exercise. The neutral feet obtained a mean ± SD PCERT score of 5.46 ± 1.89 and the pronated feet a score of 7.60 ± 1.92.
Conclusions
Children with pronated feet showed more fatigue and foot pain during and/or after physical exercise than those with neutral feet. Foot type could be responsible for the lack of enthusiasm of children toward undertaking healthy activities, and this problem might be solved via appropriate orthopedic treatment.
Background:
This study compares different lower-limb length measurements using tests of lower-limb upright full-length radiography and anteroposterior radiography of load-bearing hips.
Methods:
Forty-seven consecutive individuals aged 17 to 61 years (mean ± SD, 31.47 ± 11.42 years) voluntarily took part in the study; 23 (48.9%) were women and 24 (51.1%) were men. All individuals presenting a difference of 5 mm or greater between both lower limbs quantified with a tape measure were included. All of the participants signed an informed consent form to take part in the study. Two anteroposterior load-bearing radiographs were taken: one of the hip and an upright full-length radiograph of the lower limbs. Lower-limb–length discrepancy was quantified by taking different reference points. Interobserver and intraobserver reliability was assessed for each radiographic measurement. Any correlation between the different measurements were also verified.
Results:
Interobserver and intraobserver reliability was high for all of the measurements because the intraclass correlation was greater than 0.75 in all of the cases. There was a strong and positive correlation between the different measurements because when performing bivariate correlations with the Pearson correlation coefficient, positive values close to 1 were found.
Conclusions:
In this study, the different reference points reported in the upright full-length radiograph in addition to the hip radiographs are useful for assessing lower-limb–length discrepancy. The results showed that there is a correct correlation between the different measurements.
