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Best test for measuring rearfoot range of motion and/or position?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by stevenurse, Nov 16, 2010.

  1. stevenurse

    stevenurse Member

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    As part of my dissertation I am looking at the relationship between rearfoot range of motion or position (I havent completely decided yet) and wondered if any of the esteemed brains on here could advise the best option and the most reliable test to use. So far I'm thinking of measuring position and using the rcsp/ncsp test to give me the results...any thoughts?

    Many thanks guys,
  2. Griff

    Griff Moderator

    What is your research question Steve?
  3. Steve it´s been shown to very unreliable to measure NCSP and RCSP from day to day and person to person. There are many studies if you do a lit review.

    The next question that must be asked why are you even looking at these measurements, what clinical significance do they play ?

    Just some thoughts.
  4. David Smith

    David Smith Well-Known Member

    So your hypothesis might be "There is no relationship between NCSP and RCSP"

    And your results might show that there is a greater STJ range of motion from NCSP to RCSP in those subjects that had an NCSP within a certain range of angular position relative to vertical calcaneus.

    This might rely on being able to take reliable double blinded data of the two positions and the relative displacement.

    As proposed earlier and reported by these researchers, that may be difficult.

    Reliability of two instruments in the measurement of closed chain subtalar joint positions

    H. B. Menz, and A-M. Keenan
    Division of Podiatry, La Trobe University, Bundoora, Victoria, Australia

    Available online 8 June 2004.
    Abnormal motion of the subtalar joint has often been implicated as a major contributing factor to lower limb pathology. However, the techniques used to assess this joint have not been adequately evaluated. The purpose of this study was to evaluate the inter- and intra-tester reliability of measuring neutral calcaneal stance position and resting calcaneal stance position using the gravity angle finder and a digital goniometer which has been specifically designed and manufactured by one of the authors. Two testers measured the neutral calcaneal stance position and resting calcaneal stance position of ten healthy volunteer participants (seven females, three males, mean age 21) using each device to establish both inter- and intra-tester reliability. The results indicated that inter- and intra-tester rearfoot measurement using both instruments had poor reliability (as evidenced by standard error of measurement values ranging from ± 3.7 to ± 8.5). Rearfoot measurement using the angle finder and a digital goniometer is unreliable and produces values with questionable clinical application. In light of such poor reliability, the validity of measuring frontal plane heel bisections to indicate subtalar joint position must also be seriously questioned.
    Article Outline

    Regards Dave
    Last edited: Nov 16, 2010
  5. stevenurse

    stevenurse Member

    I should have been more clear with my title. The full title is something along the lines of "is there a relationship in rearfoot position/ROM and lower limb, non contact injuries in amateur footballers?"
  6. efuller

    efuller MVP

    The first part of the study is to figure out if your measurement is reliable/ repeatable. I will predict that you cannot measure a heel bisection repeatably becasue of variance in "drawing" the line on the heel, skin mobility relative to the bone and then measurement error with lining your measurement device with the line representing the bone.

    The second part of the study is to figure out if your measurement has any correlation with injury.

    I think that what people were looking at with calcaneal eversion is actually looking at frontal plane position of the heel, in stance, relative to the leg. Specifically does the heel sit under the leg or to one side or the other. This might correlate with STJ axis position in the frontal plane or it might correlate with knee abduction moments or some other factor that would effect tissue stress. Testing the relative positoin of the heel to the leg (maleoli) would be interesting, but you would have to be careful with paralax problems. (The measurment would change depending on the angle you viewed it at.

    Just some thoughts.

  7. Griff

    Griff Moderator


    As Dave, Mike and Eric have mentioned, the reliability of most anthropometric measurements are generally poor. That said it shouldn't put you off researching them, but it does mean you have to run repeatability (test-retest) stats as part of your project.

    Also, is this a batchelors or a masters thesis? The time frame you have will directly affect how easy it would be to investigate your above title and what the most appropriate methodology may be. (Sample size will also be important).

    Don't let any of this put you off, but they are considerations which need to be made prior to planning any research project.

  8. stevenurse

    stevenurse Member

    Thanks guys, im a third year BSc student so the project is part of my dissertation. The sample size I have already is around 20 subjects.
  9. Griff

    Griff Moderator


    When looking at 'relationships' the methodology will dictate how the conclusions can be interpreted. Imagine the ways you could structure this study:

    • [1]Take 20 footballers and measure their rearfoot position (lets assume for now you have shown you can do that repeatably). Ask them what injuries they have had in the past. Try to find a correlation between rearfoot position and previous injury patterns.

    • [2]Take 20 footballers who all have history of a particular injury (e.g. lateral ankle inversion sprains). Measure their rearfoot position (lets assume for now you have shown you can do that repeatably). Try to find a correlation between the injury you are investigating and rearfoot position.

    • [3]Take 20 footballers who are uninjured. Measure their rearfoot position (lets assume for now you have shown you can do that repeatably). Follow them for a season and see what injuries (if any) they develop.

    These are different types of study (retrospective, cross-sectional, prospective) and as you can imagine, as far as 'ideal' goes then a prospective study [3] is generally thought to be best as it is the only one which would suggest 'causation'.

    However, as it is a BSc project, (which I assume has to be submitted in June 2011) that gives you 7 months. This is not long enough to perform a prospective study. Other considerations are the sample size (n=20). It is probably not large enough to make any firm conclusions from (read up on statistical power), and there is generally an attrition rate when performing research, so if you start with 20, you'll be lucky to end with more than 17 at a guess. However at undergrad level it is probably about as good as it will get so not that much you can do about it.

    Clearly you are keen on football, and have an interest in foot mechanics. Maybe there is another way you can study these variables with the time/resources that you have? Investigating injury will be difficult to do. As Eric said though, whatever measurement you decide to do (foot posture index, calcaneal eversion, navicular drift, navicular drop, LAA etc etc) you will have to perform reliability studies before you do anything - so that would be where to first focus you attention.
  10. Pod on sea

    Pod on sea Active Member

    It's a long-shot but...
    To increase your sample size and get some results in your time frame you could contact the club Physio/Sports science lead at a number of professional clubs and find out if you could do an injury survey then 'measure' their academy players? If the staff are willing, it could be more useful than the current study you are proposing.
  11. Griff

    Griff Moderator

    Professional clubs are very protective of their squads - you'd get very few that said yes. And I'm not sure how 'useful' a cross-sectional study like this would be in any case.

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