Clinical measures of static foot posture do not agree

NewsBot · Dec 1, 2016

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Clinical measures of static foot posture do not agree
Ben Langley, Mary Cramp and Stewart C. Morrison
Journal of Foot and Ankle Research20169:45

Background
The aim of this study was to determine the level of agreement between common clinical foot classification measures.

Methods
Static foot assessment was undertaken using the Foot Posture Index (FPI-6), rearfoot angle (RFA), medial longitudinal arch angle (MLAA) and navicular drop (ND) in 30 participants (29 ± 6 years, 1.72 ± 0.08 m, 75 ± 18 kg). The right foot was measured on two occasions by one rater within the same test environment. Agreement between the test sessions was initially determined for each measure using the Weighted Kappa. Agreement between the measures was determined using Fleiss Kappa.

Results
Foot classification across the two test occasions was almost perfect for MLAA (Kw = .92) and FPI-6 (Kw = .92), moderate for RFA (Kw = .60) and fair for ND (Kw = .40) for comparison within the measures. Overall agreement between the measures for foot classification was moderate (Kf = .58).

Conclusion
The findings reported in this study highlight discrepancies between the chosen foot classification measures. The FPI-6 was a reliable multi-planar measure whereas navicular drop emerged as an unreliable measure with only fair agreement across test sessions. The use of this measure for foot assessment is discouraged. The lack of strong consensus between measures for foot classification underpins the need for a consensus on appropriate clinical measures of foot structure.
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Admin2 · Dec 1, 2016

Related Topics:
Other threads tagged with the Foot Posture Index
Other threads tagged with foot posture

mike weber · Dec 2, 2016

The use of Navicular drop test is discouraged:eek::eek:

It is one of the good tests to help determine the final shape of an device imho

NewsBot · Sep 11, 2019

The relationship between foot posture index and resting calcaneal stance position in elementary school students
YongjinChoaJin-WooParkaKiyeunNamb
Gait & Posture; 5 September 2019

Highlights
•Foot posture index (FPI) is a reliable test for foot position.
•Resting calcaneal stance position(RCSP) angle is widely used for pediatric flat foot.
•RCSP and FPI showed moderate correlations.
•Both FPI and RCSP can be used as important bio-mechanic evaluation tools.
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Background
Static foot assessment is commonly performed in clinical practice to classify foot type for prescribing therapeutic interventions. Foot posture index is known to be a reliable indicator for foot position. Resting calcaneal stance position angle is used widely to determine foot posture and manufacture orthoses for pediatric flat foot patients. However, the relationship between foot posture index and resting calcaneal stance position angle in elementary school students is currently unclear.

Research question
To investigate the relationship between foot posture index and resting calcaneal stance position angle in elementary school students.

Methods
Between January 2016 and December 2017, 208 elementary school students (average age, 10.3 years; range, 8-13 years) were enrolled for this study. All students were examined physically by one practitioner to measure foot posture index and resting calcaneal stance position angle. Age, gender, and body mass index were analyzed for factors associated with flat foot prevalence. This study was conducted as a retrospective comparative study. Associations between foot posture index and resting calcaneal stance position angle were determined by Pearson's correlation analysis.

Results and Significance
When measured by foot posture index and resting calcaneal stance position angle, the overall prevalence of flatfoot was 29% and 24% in the right foot and 26% and 23% in the left foot, respectively. Resting calcaneal stance position angle and foot posture index score showed moderate correlation in Pearson’s correlation analysis (left side foot: kappa value = 0.710; right side foot: kappa value = 0.704).

Conclusion
There is a moderate correlation between foot posture index and resting calcaneal stance position angle in elementary school students. Thus, both foot posture index with proven validity and reliability and resting calcaneal stance position widely used in the manufacture of insoles can be used as important biomechanical evaluation tools for feet in clinical settings.
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NewsBot · Sep 4, 2020

Reliability of Different Clinical Techniques for Assessing Foot Posture
MugeKirmizi et al
Journal of Manipulative and Physiological Therapeutics; 20 August 2020

Objective
The aim was to determine the interrater and intrarater reliability of navicular drop (NDP), navicular drift (NDT), and the Foot Posture Index-6 (FPI-6), and test–retest reliability of the static arch index (SAI) and dynamic arch index (DAI).

Methods
Sixty healthy individuals were assessed for intrarater and test–retest reliability. From 60 participants, 30 individuals were assessed for interrater reliability. A digital caliper was used to measure NDP and NDT. Electronic pedography was used to calculate SAI and DAI. The FPI-6 was also performed. All assessments were performed on the dominant foot. The NDP, NDT, SAI, and DAI were repeated 3 times. The NDP and NDT were analyzed separately using both first measurement and the average, but the SAI and DAI were analyzed using only the average. The NDP, NDT, and FPI-6 were conducted by 2 raters to determine interrater reliability and were repeated by a single rater after 5 days from initial assessment to determine intrarater reliability. The SAI and DAI were also repeated after 5 days to determine test–retest reliability.

Results
Intrarater intraclass correlation coefficients (ICCs) were 0.934 and 0.970 for NDP, 0.724 and 0.850 for NDT, and 0.945 for FPI. Interrater ICCs were 0.712 and 0.811 for NDP, 0.592 and 0.797 for NDT, and 0.575 for FPI. Test–retest ICCs of the SAI and DAI were 0.850 and 0.876, respectively.

Conclusion
Navicular drop is relatively more reliable than other traditional techniques. Also, the FPI-6 has excellent intrarater reliability, but only moderate interrater reliability. The results can provide clinicians and researchers with a reliable way to implement foot posture assessment.
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NewsBot · Nov 16, 2020

Clinical Assessment of the Medial Longitudinal Arch in Children: Rater Agreement and Relationship to Objective Foot Arch Measurements
Andreas Stotz, Karsten Hollander, Christoph Heidt, Susanne Sehner & Astrid Zech
SN Comprehensive Clinical Medicine (2020)

The purpose of this study was to (1) investigate the agreement among clinical experts regarding the classification of the medial longitudinal arch in children and to (2) examine the relationship between the expert ratings and the static and dynamic foot arch measurements. Eleven foot experts were asked to identify foot arches of seventy-four children (mean ± SD age of 9.0 ± 1.81 years) using three categories (low, normal, and high arch). Additionally, dynamic footprint data of all children were captured with a pedobarographic platform. For static arch measurements, a specially constructed caliper was used to assess heel-to-toe length and dorsum height. Agreement among raters was determined using the kappa statistic. For comparisons between clinical rating and diagnostic systems, receiver operating characteristic (ROC) curves and ordinal logistic regression were calculated. The combined kappa score for all three arch types (0.422, 32.8%) shows borderline moderate agreement between raters. Area under the curves (AUC) values of the ROC curves ranging from 0.48 to 0.68 show poor relationship between quantitative and qualitative arch height measurements. The highest agreement was found for the dynamic arch index and foot experts’ ratings for low arched vs non-low arched feet (AUC = 0.68) and normal vs low arched feet (AUC = 0.67). The results of this study showed borderline moderate agreement among clinical experts in the clinical assessment of the medial longitudinal plantar arch in children. Also, only a poor relationship between the clinical foot arch assessments and the static and dynamic foot measurements was revealed. Further research is necessary to establish an accurate and consistent diagnostic system for the measurement of the medial longitudinal arch in children.
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NewsBot · Jan 9, 2021

Non-radiographic validity and reliability measures for assessing foot types: A systematic review
Aline C.Carrasco et al
Foot and Ankle Surgery; 6 January 2021

Highlights
•A classification, with standardized measures, to determine foot types is lacking.
•Studies present a wide variety of methods for classifying foot types.
•Static measures such as AHI, FPI, and SAI present valid and reliable normative value.
•These measures can be applied in clinical practice and for future research.
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Background
Foot type classification is well recognized in clinic al practice and orthopedic literature, a universally accepted classification or standardized measures to determine foot types are lacking. The objective of this study was to identify which non-radiographic assessment methods are considered valid and/or reliable for the classification of foot types.

Method
A systematic database search was performed. Only cross-sectional studies that performed reliability and/or validity analysis of non-radiographic methods were included. To evaluate the risk of bias, the Critical Appraisal Tool (CAT) was used to evaluate the measurement properties of objective clinical methods.

Results
Twenty-six studies were included. The results of reliability and validity, in general, demonstrated high scores, but, inconsistencies were related to the variability of the measurements, heterogeneity of the methods used to determine reliability and validity, and lack of parameters for classifying foot types, which resulted in few elements to determine which method of foot type evaluation is valid and reliable.

Conclusion
Given the Intraclass Correlation Coefficient and CAT results and the presence of normative values, the static measurements of the “Arch Height Index”, “Foot Posture Index”, and “Staheli Arch Index” can be suggested to classify foot types.
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NewsBot · May 13, 2021

Accuracy of the flexible flatfoot measurement in a Paediatric Population. Results of a cross-sectional study
Žukauskas, Saidas;Barauskas, Vidmantas
Medicina : Abstracts accepted for the International Scientific Conference on Medicine organized within the frame of the 79th International Scientific Conference of the University of Latvia : [23-24 April], Riga, Latvia / Editor-in-Chief Edgaras Stankevičius. Kaunas ; Basel : LSMU ; MDPI, 2021, vol. 57, suppl. 1

Background. Flatfoot is a common posture in children’s feet. The posture of the foot depends on age, and the time when the longitudinal arch is formed is not yet known precisely. Mostly, non-dynamic assessment of children’s feet is performed in clinical practice to classify foot posture and excluding pathological feet. This includes: visual assessment, anthropometric measurements (resting calcaneal stance position angle (RCSP), Navicular Drop Test (ND)), Foot Posture Index (FPI-6), various footprint-based analyses (Chippaux-Smirak Index (CSI), Staheli Arch Index (SI), etc.) and radiological examinations – calcaneal pitch angle (CP), talocalcaneal angle (TCA), lateral first metatarsal angle (TMA). However, there is no concensus in clinical practice and researcher’s community as to whether FPI-6, ND, RCSP, SI, CSI or X-ray measurements and clinical measurements could be used as a best clinical, radiological measuring tools for paediatric flat foot. Aim. To investigate the relationship between the 6-item version of the foot posture index and other clinical, foot anthropometric, radiological measurements for foot position in children at 5–8 years. Methods. A total of 300 participants with a mean age of 6.4 ± 1.14 years were enrolled in the study. Children were examined physically, clinically, radiologically to measure Foot Posture Index and Navicular Drop Test, resting calcaneal stance position angle, Chippaux-Smirak Index, Staheli Index, calcaneal pitch angle, talocalcaneal angle, lateral first metatarsal angle. Tibial torsions, internal rotation of hip as an indirect method of femoral anteversion and Beighton Scale were analysed for factors associated with flat foot prevalence. Results. The study included children with normal and flexible flat feet. Statistical analysis showed a significant FPI score correlation with other parameters (SI, CSI, RCSP, ND, CP, TMA, TCA showed strong and moderate correlat[...]
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NewsBot · Apr 5, 2022

Investigation of the Relationships Among Clinical Measures of Foot Posture in Individuals with and Without Pronated Foot
Muge Kirmizi, Mehmet Alphan Cakiroglu, Yesim Salik Sengul, Ata Elvan, Ibrahim Engin Simsek, Salih Angin
J Am Podiatr Med Assoc. 2021 Dec 15;111(6)

Background: Many indirect clinical techniques have been developed to assess foot posture; however, there is relatively little research investigating the relationships among these techniques. We investigated the relationships among the most commonly used clinical measures of foot posture-Foot Posture Index-6 (FPI-6), navicular drop (NDP), navicular drift (NDT), and static and dynamic arch indices (SAI and DAI)-in individuals with normal foot posture and those with pronated foot.

Methods: Sixty-three individuals with FPI-6 scores of 0 to 12 were included. A digital caliper was used to measure NDP and NDT; SAI and DAI were measured by electronic pedobarography. Assessments were applied on the dominant foot. Pearson correlation coefficients were calculated to determine the relationships among measures. Participants were classified into two groups, pronated foot (n = 33) and normal foot posture (n = 30), based on FPI-6 scores, providing a multisegmental and multiplanar assessment. The independent-samples t test was used to compare groups regarding NDP, NDT, SAI, and DAI.

Results: We found a high correlation between NDP and FPI-6 (r = 0.754) and between NDP and NDT (r = 0.778) (all P < .001). A moderate correlation was found between NDT and FPI-6 (r = 0.599) and between DAI and SAI (r = 0.519) (all P < .001). A negligible correlation was found between NDP and DAI (r = 0.268; P = .033). Furthermore, NDP, NDT, and DAI values were higher in individuals with pronated foot compared with those with normal posture (P < .001 for NDP and NDT; P = .022 for DAI), whereas SAI values were not (P = .837).

Conclusions: These results suggest that there are moderate-to-strong relationships among FPI-6, NDP, and NDT and between SAI and DAI. The NDP, NDT, and DAI are suitable for the classification of foot posture based on FPI-6 scores. This study can guide clinicians and researchers to associate the foot posture measures with each other.
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NewsBot · Jul 17, 2022

Validity of a simple footprint assessment board for diagnosing the severity of flatfoot: a prospective cohort study
Seikai Toyooka et al
BMC Musculoskelet Disord. 2021 Mar 18;22(1):285. doi: 10.1186/s12891-021-04154-3.

Background: A simple, non-quantitative, and cost-effective diagnostic tool would enable the diagnosis of flatfoot without need for specialized training. A simple footprint assessment board that investigates which toe the cord passes through from the centre point of the heel to the most lateral point of the medial contour of the footprint has been developed to assess flatfoot. The purpose of this study was to verify the validity of a simple footprint assessment board for flatfoot.

Methods: Thirty-five consecutive patients with foot pain, foot injury, or any associated symptoms who underwent computed tomography (CT) were analysed prospectively. At the time of the CT scan, a footprint analysis using a simple footprint assessment board was performed. The navicular index, tibiocalcaneal angle, and calcaneal inclination angle were evaluated by CT to assess flat feet. These three criteria were compared to those evaluated with the simple footprint assessment board by regression analysis. In addition, the same analysis was conducted separately for young, middle-aged, and older patients in order to investigate each age group.

Results: The navicular index and tibiocalcaneal angle generally decreased as the score of the simple footprint assessment board increased. Calcaneal inclination angle generally increased as the score of the simple footprint assessment board increased. As the scores of the simple footprint assessment board decreased by approaching the great toe, the navicular index and tibiocalcaneal angle were higher and calcaneal inclination angle was lower, which is indicative of a higher likelihood of flatfoot. The scores derived from the simple footprint assessment board was correlated with these three criteria measured by CT, not only when the result of simple footprint assessment board was set as a non-continuous variable but also when the result was set as a continuous variable. The results of the age-stratified survey were similar for all groups.

Conclusions: The findings of this study suggest that a simple footprint assessment board can be potentially useful to detect flatfoot.
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NewsBot · Aug 11, 2022

Analysis of skeletal characteristics of flat feet using three-dimensional foot scanner and digital footprint
Tomoko Yamashita et al
Biomed Eng Online. 2022 Aug 9;21(1):56

Background: Flat feet increase the risk of knee osteoarthritis and contribute to frailty, which may lead to worse life prognoses. The influence of the foot skeletal structure on flat feet is not yet entirely understood. Footprints are often used to evaluate feet. However, footprint-based measurements do not reflect the underlying structures of feet and are easily confounded by soft tissue. Three-dimensional evaluation of the foot shape can reveal the characteristics of flat feet. Therefore, foot shape evaluations have garnered increasing research interest. This study aimed to determine the correlation between the three-dimensional (3D) features of the foot and the measurement results of footprint and to predict the evaluation results of flat feet from the footprint based on the 3D features. Finally, the three-dimensional characteristics of flat feet, which cannot be revealed by footprint, were determined.

Methods: A total of 403 individuals (40-89 years) participated in this study. The proposed system was developed to identify seven skeletal features that were expected to be associated with flat feet. The loads on the soles of the feet were measured in a static standing position and with a digital footprint device. Specifically, two footprint indices were calculated: the Chippaux-Smirak index (CSI) and the Staheli index (SI). In the analysis, comparisons between male and female measurement variables were performed using the Student's t test. The relationships between the 3D foot features and footprint index parameters were determined by employing the Pearson correlation coefficient. Multiple linear regression was utilized to identify 3D foot features that were strongly associated with the CSI and SI. Foot features identified as significant in the multivariate regression analysis were compared based on a one-way analysis of variance (ANOVA) with Tukey's post hoc test.

Results: The CSI and SI were highly correlated with the instep height (IH) and navicular height (NH) of the 3D foot scanning system and were also derived from multiple regression analysis. In addition to the NH and IH, the indicators of the forefoot, transverse arch width, and transverse arch height were considered. In the flat foot group with CSI values above 62.7%, NH was 13.5% (p < 0.001) for males and 14.9% (p = 0.01) for females, and the axis of the bone distance was 5.3% (p = 0.05) for males and 4.9% (p = 0.10) for females. In particular, for CSI values above 62.7% and NH values below 13%, the axis of the bone distance was large and the foot skeleton was deformed.

Conclusions: Decreased navicular bone height could be evaluated with the 3D foot scanning system even when flat feet were not detected from the footprint. The results indicate that the use of quantitative indices for 3D foot measurements is important when evaluating the flattening of the foot.
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NewsBot · Jul 6, 2023

Establishing concurrent validity between Chippaux-smirak index and foot posture index in asymptomatic flatfoot individuals: A correlation study
Dhanvi Jarsania, Bhavana Gadhavi
Source

Purpose: There are various methods used to assess flat foot in the individuals. Foot posture index is a qualitative as well as a quantitative tool for assessing flat foot. Chippaux-smirak index is a quantitative method that can be calculated using the ink foot prints. Both of them are reliable methods but foot posture index is very commonly used. Thus, there arises a need to replace foot posture index with a new tool which is purely quantitative. To establish concurrent validity between Chippaux-smirak index and foot posture index (FPI-6) in asymptomatic flatfoot individualsParticipants: The estimated sample size using G*power (version 3.1.9.2) was 138 participants. A total of 140 participants of Parul university, Vadodara, Gujarat between the age group of 18-25yrs with no history of pain or injury within last one year were assessed for asymptomatic flatfoot. Methods: The Chippaux-smirak index and foot posture index-6 were used to evaluate all individuals for asymptomatic flat foot. Participants were characterised as having flat foot if their Chippaux-smirak index and foot posture index-6 score were equal to or greater than 45% and 6+ to 12+ respectively. Results: The Chippaux-smirak index and the foot posture index have a Pearson correlation value of 0.652 (p<0.001). This indicates that there is a moderate positive correlation among the two indices. Conclusion: As there is a moderate positive correlation of Chippaux-smirak index with foot posture index, it can be used to assess the foot posture in asymptomatic flat foot individuals. Implications: Chippaux-smirak index can be used as a substitute method for quantifying the foot posture.
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NewsBot · Jul 20, 2023

Relationships of three arch height indices related to
different foot lengths between sitting and standing
postures
Hsin-Hung Tu
Source

Arch height index (AHI) between sitting and standing is an important reference in
assessing foot mobility and foot classification in podiatry clinic. The relationships of
three types of AHIs related to different foot lengths in sitting and standing postures are
desired to be investigated in clinical applications. The purpose of this study is to
investigate the relationships of three arch height indices (AHIs) calculated from total foot
length, medial ball length and lateral ball length between sitting and standing postures
and to examine the performances of them. Three AHIs of right feet of 150 subjects,
including 83 males and 67 females, were measured using 3D foot scanner with an
accuracy level of 0.05 cm in sitting and standing postures in this study. The results
showed that three AHIs were significantly different from each other, and had the same
performances between sitting and standing postures. AHI values in the sitting posture
were all larger than those in the standing posture, and AHI-MBL has a better explaining
power on AHI-TFL than AHI-LBL on AHI-TFL in both postures. The time and priority
of using these three AHIs in evaluating foot types with normality and deformity were
suggested.
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