Foot Posture Index

TonyR · Sep 26, 2005

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Dear all

Please excuse this posting if you have no interest in the FPI, but I know there are many arena members who have used or seen the FPI in its developmental stages.

After a long gestation period the final, validated version of the Foot Posture Index is about to be published.
The pre-publication version of the Clinical Biomechanics paper is now available online at:
http://www.sciencedirect.com/science/journal/02680033

The instrument itself is being released into the public domain and the rest of the information you are likely to need is also available online at http://www.leeds.ac.uk/medicine/FASTER/FPI/index.htm

If you need any further information drop me an email.

Kind regards

Tony

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Dr Anthony Redmond
Arthritis Research Campaign Lecturer
School of Medicine, University of Leeds
Address for correspondence:
Academic Unit of Musculoskeletal Disease 2nd Floor, Chapel Allerton Hospital Harehills Lane, Leeds LS7 4SA Tel 0113 392 4914 (Office) Tel 0113 392 2297 (Gait lab) Fax 0113 392 4991 www.leeds.ac.uk/medicine/FASTER/
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admin · Nov 29, 2005

Congrat Tony, its no longer pre publication - its out:

Development and validation of a novel rating system for scoring standing foot posture: The Foot Posture Index
Anthony C. Redmonda, Jack Crosbiec and Robert A. Ouvrierb
Clinical Biomechanics
Volume 21, Issue 1 , January 2006, Pages 89-98

Introduction
The limitations of clinical methods for appraising foot posture are well documented. A new measure, the Foot Posture Index is proposed, and its development and validation described.

Methods
A four-phase development process was used: (i) to derive a series of candidate measures, (ii) to define an appropriate scoring system, (iii) to evaluate the validity of components and modify the instrument as appropriate, and (iv) to investigate the predictive validity of the finalised instrument relative to static and dynamic kinematic models. Methods included initial concurrent validation using Rose’s Valgus Index, determination of inter-item reliability, factor analysis, and benchmarking against three dimensional kinematic models derived from electromagnetic motion tracking of the lower limb.

Results
Thirty-six candidate components were reduced to six in the final instrument. The draft version of the instrument predicted 59% of the variance in concurrent Valgus Index scores and demonstrated good inter item reliability (Cronbach’s α = 0.83). The relevant variables from the motion tracking lower limb model predicted 58–80% of the variance in the six components retained in the final instrument. The finalised instrument predicted 64% of the variance in static standing posture, and 41% of the variance in midstance posture during normal walking.

Conclusion
The Foot Posture Index has been subjected to thorough evaluation in the course of its development and a final version is proposed comprising six component measures that performed satisfactorily during the validation process. The Foot Posture Index assessment is quick and simple to perform and allows a multiple segment, multiple plane evaluation that offers some advantages over existing clinical measures of foot posture.
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NewsBot · Jan 4, 2007

The Foot Posture Index: Rasch Analysis of a Novel, Foot-Specific Outcome Measure
Keenan A-M, Redmond AC, Horton M, Conaghan PG, Tennant A.
Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 1 , January 2007, Pages 88-93

Objective
To investigate the internal construct validity of a clinician-assessed measure of foot position, the Foot Posture Index (FPI), versions FPI-8 and FPI-6.

Design
Rasch analysis of baseline FPI scores from studies conducted during the development of the instrument.

Setting
A community-based and a hospital-based study, conducted at 2 institutions.

Participants
Measures were obtained from 143 participants (98 men, 45 women; age range, 8–65y).

Interventions
Not applicable.

Main Outcome Measures
Rasch analysis was undertaken using RUMM2020 software in order to evaluate the following properties of the FPI: unidimensionality of each item included in the FPI, the differential item functioning (DIF) of each item, and item and person separation indices.

Results
In the developmental draft of the instrument, the 8-item FPI-8 showed some misfit to the Rasch model (χ162 test=27.63, P=.03), indicating lack of unidimensionality. Two items were identified as problematic in the Rasch modeling: Achilles’ tendon insertion (Helbing’s sign), which showed illogical response ordering and “congruence of the lateral border of the foot,” which showed misfit, indicating that this item may be measuring a different construct (χ22 test=15.35, P<.01). All FPI-8 items showed an absence of DIF, and the person separation index (PSI) was good (PSI=.88). The revised FPI-6, which does not include the 2 problematic items, showed unidimensionality (χ122 test=11.49, P=.49), indicating a good overall fit to the model, and improvement over the preliminary version. With the removal of the 2 problematic items, there were no disordered thresholds; all items remained DIF free and all individual items displayed a good fit to the model. The person-separation index for the FPI was similar for both the 8-item (FPI-8=.880) and 6-item (FPI-6=.884) versions.

Conclusions
The original FPI-8 showed significant mismatching to the model. The 2 items in the FPI-8 that were identified as problematic in clinical validation studies were also found to be contributing to the lack of fit to the Rasch model. The finalized 6-item instrument showed good metric properties, including good individual item fit and good overall fit to the model, along with a lack of differential item functioning. This analysis provides further evidence for the validity of the FPI-6 as a clinical instrument for use in screening studies and shows that it has the potential to be analyzed using parametric strategies.
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NewsBot · Oct 27, 2009

Video based analysis of dynamic midfoot function and its relationship with Foot Posture Index scores.
Nielsen RG, Rathleff MS, Moelgaard CM, Simonsen O, Kaalund S, Olesen CG, Christensen FB, Kersting UG.
Gait Posture. 2009 Oct 23. [Epub ahead of print]

INTRODUCTION: Various studies have demonstrated significant as well as non-significant relationships between static evaluation of foot posture and injury likelihood. Therefore, the relationship of static and dynamic measures needs to be established as in clinical settings time consuming dynamic methods are often not feasible.

PURPOSE: Assess reliability of a new method to quantify midfoot movement and validate the use of Foot Posture Index (FPI) classification as predictor of dynamic foot function during walking.

METHOD: Foot type was classified using FPI in 280 randomly selected adult participants (mean age 43.4 years). A Video Sequence Analysis (VSA) system was used to quantify midfoot kinematics during walking. Navicula drop (DeltaNH) and minimal navicula height (NHL) were compared with FPI. RESULTS: The Intraclass Correlation Coefficients (ICC) for DeltaNH and NHL ranged from 0.65 to 0.95 with a coefficient of repeatability of 1.4mm for DeltaNH and 4.5mm for NHL. System precision was estimated at 0.99mm for DeltaNH and 3.18mm for NHL. DeltaNH was significantly positively correlated with FPI scores while NHL decreased with increasing FPI. However, the FPI model predicted only 13.2% of the variation in DeltaNH and 45% of the variation in NHL during walking (p<0.001).

CONCLUSION: The VSA was proven as a reliable and precise method to quantify midfoot kinematics. FPI scores and individual components of the FPI show strong statistical relationships to dynamic measures but individual predictions remain questionable. Dynamic midfoot measures are recommended for clinical foot assessments.
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NewsBot · May 14, 2013

Normative values for the foot posture index between right and left foot: A descriptive study
Torben Rokkedal-Lausch, Majbritt Lykke, Martin Serup Hansen, Rasmus Oestergaard Nielsen
Gait & Posture Article in Press

Highlights
•We quantified foot posture index (FPI) scores in both feet among 930 subjects.
•Differences in FPI scores between right and left foot were calculated.
•Normative and asymmetrical ranges for the difference in FPI score were established.
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Abstract

Background
The foot posture index (FPI) is a commonly used method to quantify standing foot posture. No normative data have, however, been presented to establish the range of a normal difference and asymmetrical differences between FPI score in the right foot and in the left foot.

Purpose
The purpose of the present study was to establish normative values for the difference between the FPI scores across the two feet.

Methods
Among 930 healthy adults, FPI score was quantified in both feet. Difference between the two feet was calculated as FPI score on the right foot minus the FPI score on the left foot. Based on a normal distribution of the differences, asymmetry was defined as values below or above one standard deviation (SD) from the mean. Severe asymmetry was below and above ±2SD from the mean. Normal difference was defined as the range between ±1SD.

Results
A reference range for normal difference in FPI score between left foot and right foot was −2 to +2. Asymmetry scores ranged from −2 to −4 and +2 to +4, while severe asymmetry was <−4 and >4.

Conclusion
Normative values for the difference between FPI scores in right foot and left foot have been presented from a large sample of healthy adults. These normative values can be used to identify a normal difference or an asymmetrical difference in foot posture across feet in one individual.
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NewsBot · Sep 16, 2013

Inter- and intra-rater reliability of the Foot Posture Index-6 and Weight Bearing Lunge Test
Hijnen, R.
Faculty of Medicine Theses (2013)

Background Running is a health-promoted activity that contributes to increasing levels of physical activity. Besides the positive effects, running also has a high injury risk. In the prevention of running related injuries (RRIs) the identification of risk factors is essential. Abnormalities in foot posture and range of motion of the ankle have previously been associated with RRIs in the lower extremities. These characteristics of the ankle may be risk factors and require clinical measurement. The Foot Posture Index-6 (FPI-6) and Weight Bearing Lunge Test (WBLT) are clinical measures of foot posture and dorsalflexion of the ankle. However, uniformity lacks about the reliability of the FPI-6 and WBLT. Aim The aim of this study was to examine the inter- and intra-rater reliability of the FPI-6 and the WBLT in healthy adults.

Methods Participants were 19 healthy adults (mean age: 47 years, SD 18 years; 7 male and 12 females). For inter-rater reliability, two raters independently examined the participants with the FPI-6 and with the WBLT. For intra-rater reliability, one of the two raters re-examined the same participants one week later. To determine the inter- and intra-rater reliability of both instruments, intraclass correlation coefficients (ICC) were calculated. To be able to compare results with other studies Cohen’s Kappa’s were performed in addition to the ICCs.

Results For the FPI-6, ICC values were 0.496 and 0.860 for inter- and intra-rater reliability, respectively. For the WBLT-distance to wall ICCs were 0.893 and 0.963 for inter- and intra-rater reliability, respectively. For WBLT-grades, ICCs were 0.622 and 0.859 for inter- and intra-rater reliability, respectively.

Conclusion For FPI-6 and for WBLT inter-rater reliability was good to excellent, intra-rater reliability was excellent for both FPI-6 and WBLT. These instruments can be considered useful for measuring potential risk factors in clinical practice.
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NewsBot · Sep 27, 2013

The Foot Posture Index
Anthropometric Determinants and Influence of Sex
Raquel Sánchez Rodríguez, PhD*, Alfonso Martínez Nova, PhD*, Elena Escamilla Martínez, PhD*, Beatriz Gómez Martín, PhD*, Rodrigo Martínez Quintana, PhD† and Juan Diego Pedrera Zamorano, PhD*
J Am Podiatr Med Assoc 103(5): 400–404, 2013

Background: The Foot Posture Index (FPI) quantifies foot posture on the basis of six criteria. Although the male foot is longer and broader than the female foot, limited evidence exists about the differences in foot posture between the sexes and which are its biological and anthropometric determinants. We sought to evaluate possible sex differences in the FPI and the determinants influencing foot posture.

Methods: In 400 individuals (201 men and 199 women), the FPI was determined in the static bipedal stance and relaxed position. The FPI was obtained as the sum of the scores (−2, −1, 0, 1, or 2) given to each of six criteria. A multiple regression model was constructed of the overall FPI against age, weight, height, body mass index, and foot size.

Results: The mean ± SD FPI was 2.0 ± 4.3 overall, 1.6 ± 4.5 for men, and 2.4 ± 4.1 for women, with the difference being nonsignificant (P = .142). The neutral posture was the most frequent (57.3%). A greater proportion of women had neutral and pronated feet, and a greater proportion of men had supinated and highly supinated feet, with the differences being nonsignificant (P = .143). Foot size, height, and body mass index together explained 10.1% of the overall FPI value (P < .001).

Conclusions: The most frequent posture was neutral with a certain degree of pronation, with no differences in FPI values between men and women. Participants with larger foot sizes had higher FPI values, whereas taller and heavier participants had lower FPI values.
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NewsBot · May 3, 2014

INTRA-RATER AND INTER-RATER RELIABILITY OF THE FIVE IMAGE-BASED CRITERIA OF THE FOOT POSTURE INDEX-6.
Terada M, Wittwer AM, Gribble PA.
Int J Sports Phys Ther. 2014 Apr;9(2):187-194.

PURPOSE/BACKGROUND:
The Foot Posture Index-6 (FPI-6) is considered a simple quantification tool to assess static foot alignment. Palpation of the foot is required for assessment of one of the six criteria that comprise the FPI-6; the remaining five criteria may be evaluated using still-frame photographs. Using only the image-based criteria may allow multiple clinicians to evaluate large groups of patients quickly. Reliability using only these five image-based criteria has not been established. The purposes of the current study were to establish the inter- and intra-rater reliability using five image-based criteria from the Foot Posture Index-6 (FPI-6) as well as to examine the agreement between the raters in identifying foot type using the composite five FPI scores.
METHODS:
Forty participants (23 females, 17 males; 23.67 ± 8.49 years; 64.59 ± 14.43 kg; 166.07 ± 11.79 cm) volunteered for this study. An investigator took three photos with a digital camera of the medial longitudinal arch, posterior ankle, and of the talonavicular joint approximately 45° from the posterior calcaneus for both right and left feet. Two investigators assessed the five image-based criteria of the FPI-6 for both feet of 40 participants on three occasions separated by a day. Inter-and intra-rater reliability were assessed with Intraclass Correlation Coefficients (ICC3,2). The amount of agreement for classification of foot posture type between the two raters was assessed with Cohen's kappa coefficient. Significance was set a priori at P < 0.05.
RESULTS:
The inter-rater reliability was poor to moderate for all three sessions (ICC3,2 = 0.334-0.634). For the foot posture classification, the amount of agreement between two raters was poor for left (κ= 0.12) and right (κ= 0.19) feet. The intra-rater reliability was excellent for left (ICC3,2=0.956) and right feet (ICC3,2=0.959).
CONCLUSIONS:
Excellent intra-rater and poor to moderate inter-rater reliability was found using only the five image-based criteria of the FPI-6. However, the classification of foot posture did not improve the amount of agreement between raters. Therefore, caution is needed when interpreting FPI scores from five image-based criteria.
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NewsBot · Feb 16, 2015

Normal Values of the Foot Posture Index in a Young Adult Spanish Population.
Gabriel Gijon-Nogueron, Raquel Sanchez-Rodriguez, Eva Lopezosa-Reca, Jose Antonio Cervera-Marin, Rodrigo Martinez-Quintana, and Alfonso Martinez-Nova
Journal of the American Podiatric Medical Association: January 2015, Vol. 105, No. 1, pp. 42-46.

Background: Although the appearance of foot or lower-limb pathologies is etiologically multifactorial, foot postures in pronation or supination have been related to certain diseases such as patellofemoral syndrome and plantar fasciitis. The objective of the present study was to determine the normal values of foot posture in a healthy young adult Spanish sample, and to identify individuals at risk of developing some foot pathology.

Methods: The Foot Posture Index (FPI) was determined in a sample of 635 (304 men, 331 women) healthy young adults (ages 18–30 years). The FPI raw score was transformed into a logit score, and a new classification was obtained with the mean ± 2 SD to identify the 5% of the sample with potentially pathologic feet.

Results: The normal range of the FPI was −1 to +6, and FPI values from +10 to +12 and −6 to −12 could be classified as indicating potentially pathologic feet. The women's logit FPI (0.50 ± 1.4, raw FPI +3) was higher than the men's (0.25 ± 1.6, raw FPI +2), with the difference being significant (P = 0.038). No statistically significant differences were found between body mass index groups (P = 0.141).

Conclusions: The normal FPI range goes from just one point of supination to a certain degree of pronation (+6). The identification of 35 individuals with potentially pathologic feet may help in the implementation of a preventive plan to avoid the appearance of foot disorders.
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NewsBot · Jun 25, 2016

Inexperienced examiners and the Foot Posture Index: a reliability study
Patrick McLaughlin et al
Manual Therapy; 21 June 2016

Highlights
•The FPI-6 is reliable when used by novice examiners
•Experience, even limited, in musculoskeletal assessment is of benefit
•The reliable use of the FPI-6 is not restricted to podiatrists
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The Foot Posture Index (FPI-6) is a reliable (experienced examiners) assessment tool used in clinical practice to classify foot posture. No work has been completed to determine the reliability of the FPI-6 between novice examiners. Therefore, the aim was to determine the inter-examiner reliability of the FPI-6 using two novice examiners (graduate level osteopathy students). The FPI-6 was used to classify the feet of 83 students recruited as part of a larger study. Data were collected simultaneously by both examiners, but there was no communication between them. The scoring system provided by the FPI-6 manual was used to assess all feet. Collated data were assessed between examiners for reliability based on raw, transformed and foot type scores. The inter-examiner reliability was high for both left (ICC2,1=0.86) and right (ICC2,1=0.85) feet for the novice examiners. When data were assessed based on foot type classification the examiners agreed on 76% of the left feet and 82% of the right feet with Kappa values of 0.73 and 0.72 respectively. The FPI-6 is a robust clinical tool that can be reliably utilised by inexperienced clinicians.
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NewsBot · Jul 27, 2016

Establishing normative foot posture index values for the paediatric population: a cross-sectional study
Gabriel Gijon Nogueron, Jesus Montes-Alguacil, Pilar Alfageme-Garcia, Jose Antonio Cervera-Marin, Jose Miguel Morales-Asencio and Alfonso Martinez-Nova
Journal of Foot and Ankle Research20169:24

Background
The Foot Posture Index (FPI) is an observational tool designed to measure the position of the foot. Its reliability is well established, and it provides normative reference values for the general population. However, this is not so for the paediatric population. The aim of this study is to determine FPI reference values in childhood, taking into account age and gender.

Methods
This cross-sectional study included 1,762 school children (863 boys and 899 girls) aged 6?11 years, from M?laga, Granada and Plasencia (Spain). In every case, FPI measurements were obtained for both feet by two experienced podiatrists. A descriptive analysis was then conducted and the percentiles of the variables determined, with a significance level of P < 0.05.

Results
The consolidated FPI results for the sample population produced mean values of 3.74 (SD 2.93) points for the right foot and 3.83 (SD 2.92) for the left. The 50th percentile was 4 points for both genders and for both feet, except for the right foot among the girls, which was slightly lower, at 3 points. The 85th percentile, which is considered to represent the boundary between the normal and the pronated foot among children, was 6 points, uniformly among the subjects.

Conclusions
As a normative FPI value for the paediatric population, we recommend the 50th percentile, i.e. 4 points, for children, of both genders, aged 6 years. This value progressively falls with age, to 3 FPI points for children aged 11 years. The 85th percentile for the pronated foot and the 4th percentile for the supinated foot can be considered the pathological boundary.
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Griff · Jul 28, 2016

NewsBot said: ↑

Establishing normative foot posture index values for the paediatric population: a cross-sectional study
Gabriel Gijon Nogueron, Jesus Montes-Alguacil, Pilar Alfageme-Garcia, Jose Antonio Cervera-Marin, Jose Miguel Morales-Asencio and Alfonso Martinez-Nova
Journal of Foot and Ankle Research20169:24
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I'll admit I've only skim read the paper but I'm confused; this was a study collecting data from subjects with no pain or injury (that was actually stated in their inclusion/exclusion criteria) - so how can there be a comment made about the 'pathological boundary'?

Craig Payne · Jul 28, 2016

Griff said: ↑

I'll admit I've only skim read the paper but I'm confused; this was a study collecting data from subjects with no pain or injury (that was actually stated in their inclusion/exclusion criteria) - so how can there be a comment made about the 'pathological boundary'?
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It was based on the assumption that is widely used in medicine that approx 2SD from the population mean is "pathological" or outside the normal range; ie normal =+/1 2SD from population mean

That was the problem with the Nielsen et al (2013) study

In the last couple of yrs of Boot Camps I have asked participants who are familiar with the FPI, what their cut of point is and NONE of them agree with the above and Nielsen's cut off point.

Houston .... we have a problem.

William Fowler · Jul 28, 2016

Surely it meaningless. You can have a foot with a low FPI and high supination resistance that is pathological. You can have a foot with a high FPI and low supination resistance that is not pathological.

Craig Payne · Jul 28, 2016

William Fowler said: ↑

Surely it meaningless. You can have a foot with a low FPI and high supination resistance that is pathological. You can have a foot with a high FPI and low supination resistance that is not pathological.
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Of course. That is at the heart of the:

Craig Payne said: ↑

Houston .... we have a problem.
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You can have a foot with 'perfect' alignment or normal FPI that will be pathological if the loads are high enough (and not just supination resistance as there are other high 'loads').

There are plenty of feet with very high FPI's (ie 'overpronated') that never get symptoms .... one assumption could be that loads are low and that is why they do not get symptoms.

In recent Boot Camps I have been banging on about joint moment and lever arms as being a key determinant of tissue loads at any particular volume of activity.... and those lever arms/joint moments are not related to FPI.

Griff · Jul 28, 2016

In Gaussian terms I guess they'd just be called 'outliers'. We all know that is not consistently predictive of pathology...

Ricko · Jul 29, 2016

Craig Payne said: ↑

Of course. That is at the heart of the:You can have a foot with 'perfect' alignment or normal FPI that will be pathological if the loads are high enough (and not just supination resistance as there are other high 'loads').

There are plenty of feet with very high FPI's (ie 'overpronated') that never get symptoms .... one assumption could be that loads are low and that is why they do not get symptoms.

In recent Boot Camps I have been banging on about joint moment and lever arms as being a key determinant of tissue loads at any particular volume of activity.... and those lever arms/joint moments are not related to FPI.
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Craig, can this not be the basis for a new grad to 'hang their hat on' whilst concurrently developing their clinical experience in determining axis and loads? ie use it as just another bit of quantitative data to throw into the melting pot to make some informed decisions?

Craig Payne · Jul 29, 2016

Ricko said: ↑

Craig, can this not be the basis for a new grad to 'hang their hat on' whilst concurrently developing their clinical experience in determining axis and loads? ie use it as just another bit of quantitative data to throw into the melting pot to make some informed decisions?
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It is a bit of information; but we have to constantly be critical of what and why we collect any information for. Theoretically, any information we collect has to have the potential to alter clinical decision making. If any information that is collected does not factor into the clinical decision making process, then why collect it?

Petcu Daniel · Aug 4, 2016

Craig Payne said: ↑

It was based on the assumption that is widely used in medicine that approx 2SD from the population mean is "pathological" or outside the normal range; ie normal =+/1 2SD from population mean

That was the problem with the Nielsen et al (2013) study

In the last couple of yrs of Boot Camps I have asked participants who are familiar with the FPI, what their cut of point is and NONE of them agree with the above and Nielsen's cut off point.

Houston .... we have a problem.
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I found the same assumption used in the presentation""Forces Acting in the Forefoot During Normal Gait ?A Clinical Application"( http://novel.de/pdf/extra/WyssCh.pdf ). In the slide no. 45 the clinical approach is based on "more than 2 standard deviation >> pathologically" and the case simulation indications seems to be based on it. How correct could be this ?

Daniel

NewsBot · Sep 26, 2017

THE FOOT POSTURE INDEX BETWEEN ELITE ATHLETIC AND SEDENTARY COLLEGE STUDENTS
Yi-Liang Kuo, Yves Shen-Feng Liu
KINESIOLOGY Vol 49, No 2 (2017)

Sports participation may lead to musculoskeletal adaptation and alter foot posture; however, the effect of high impact sports on foot posture has not fully been understood yet. The purpose of this study was to investigate the difference in foot posture between elite collegiate athletes participating in high impact sports and sedentary college students using the Foot Posture Index (FPI). Foot postures of 30 elite collegiate athletes of high impact sports and 30 sedentary controls were observed in standing and evaluated using the 6-item FPI. The FPI-6 score for the athletic group was statistically significantly higher than that for the sedentary group (z=−2.282, p=.022). Participation in high impact sports can be associated with a more pronated foot posture; however, most college students, whether athletic or sedentary, had normal feet as categorized by the FPI-6.
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NewsBot · Apr 16, 2021

Foot Posture Index Reference Values among Young Adults in Saudi Arabia and Their Association with Anthropometric Determinants, Balance, Functional Mobility, and Hypermobility
Khalid A Alahmari et al
Biomed Res Int. 2021 Mar 28

Background: The foot posture index (FPI) is a valid, reliable, and multidimensional method for determining foot posture in a wide range of clinical settings. To date, no normative data of healthy young adults in Saudi Arabia have been available for comparison and reference. Hence, this study is aimed at establishing the FPI reference values, gender, and side differences of FPI and their association with anthropometric determinants, balance, functional mobility, and hypermobility.

Methods: FPI was assessed in 581 (291 men and 290 women) healthy young adults aged 18-25 years. The FPI range was obtained for both feet as the sum of the scores (-2, -1, 0, 1, and 2) given to each criterion: (-1 to -12) supinated foot, (0 to +5) neutral foot, and (+6 to +12) pronated foot. The study furthermore assessed the balance using a near tandem balance test, functional mobility by stair ascent and descent test, and joint hypermobility via the Beighton scale.

Results: The average FPI score was 2.76 ± 5.23 for all subjects, 2.98 ± 5.02 for men and 2.55 ± 5.43 for women. Neutral foot posture was most frequent in this study (52.9%). A higher proportion of women had pronated (21.0%) and supinated (11.7%) feet than men which were 16.8% and 10.3%, respectively. This study also confirmed that side differences were found to be significant (p value < 0.001), whereas gender differences were significant only in the normal, pronated, and supinated foot groups.

Conclusion: The most common foot posture in both genders was ranged from neutral to slight pronation. We also found a correlation between balance with FPI in the supinated and hypersupinated foot groups, functional mobility with FPI of pronated and supinated foot groups, and joint hypermobility with FPI of the hyperpronated foot group.
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Foot posture index and plantar pressures

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Foot posture index

Foot posture index versus navicular drop

Inter-rater reliability of the Foot Posture Index (FPI-6) in the assessment of the paediatric foot

Foot Posture Index and orthoses

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