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Foot Posture Index

Discussion in 'Biomechanics, Sports and Foot orthoses' started by amcgrail, Aug 15, 2007.

  1. amcgrail

    amcgrail Member


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    What are peoples experiences and feelings on using the Foot Posture Index as an instrument to quantify standing foot posture? As descibed by Redmond et al (2006) Clinical Biomechanics 21: 89-98.

    Am interested in any feedback.

    Regards,

    Aidan
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. caseytm99

    caseytm99 Member

    It is a good additional tool to traditional assessment methods. It provides an additional evidence base which can be referenced if necessary.

    The Interpod DVD by Craig Payne uses the FPI with good effect and I have used it for quick foot analysis when deciding if a full biomechanical assessment is needed.

    Mike
     
  4. amcgrail

    amcgrail Member

    Thanks Mike.

    Regards,

    Aidan
     
  5. Kenva

    Kenva Active Member

    I was just wondering, looking at the FPI used on the assessment form at La Trobe, why they use an 8 criteria FPI.
    Isn't the latest version a 6 criteria FPI?
    greetings
    Ken
     
  6. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    uuuummmm..... ???? probably because we have not got around to changing it yet?
     
  7. Personally, I think the foot posture index is a great way to quantify foot appearance, especially for scientific research studies, since it allows feet to have their basic shape quantified in a repeatable fashion to classify them into foot shape subgroups for study. However, I do not think the foot posture index measurements gives the clinician much useful information they couldn't make by just looking briefly at the feet in a weightbearing fashion. In other words, the foot posture index is too generalized and not functional enough regarding specific mechanical pathologies for my liking clinically. I would rather know where the STJ axis spatial location is, if the foot is maximally pronated, how the foot functions in gait and what their forefoot to rearfoot relationship is than knowing what the patient's foot posture index is. However, with all that aside, hats off to Anthony Redmond for having the foresight to create a measurement system that allows us to better classify feet for scientific study.
     
  8. amcgrail

    amcgrail Member

    Thanks for your response Kevin.

    Regards


    Aidan

    Aidan McGrail MSc, BHSc, DPodM, SRCh, MSCh
    Clinical Musculoskeltal Podiatrist
    Department of Foot Health
    Guys & St. Thomas’ Hosptal
    London SE1
     
  9. amcgrail

    amcgrail Member

    Thanks for your response Kevin.

    Regards


    Aidan

    Aidan McGrail MSc, BHSc, DPodM, SRCh, MSCh
    Clinical Musculoskeletal Podiatrist
    Department of Foot Health
    Guys & St. Thomas’ Hospital
    London SE1
     
  10. Kenva

    Kenva Active Member

    Craig didn't mean anything by it...absolutely don't want to push you to work even harder as you do now...:eek:
     
  11. Josh Burns

    Josh Burns Active Member

    On the contrary Kevin, translating the research on the Foot Posture Index (FPI) to the clinical environment, enables to the podiatrist to:

     Identify triathletes with cavus feet (FPI < -2) at risk of injury and intervene to prevent subsequent pathology (Burns J. Keenan AM. Redmond A. Foot type and overuse injury in triathletes. Journal of the American Podiatric Medical Association. 95(3):235-41, 2005).

     Identify and intervene in those at greatest risk of injury in adolescent indoor soccer players (FPI < +2) and those with lowest playing ability (FPI > +6) (Cain LE. Nicholson LL. Adams RD. Burns J. Foot morphology and foot/ankle injury in indoor football. Journal of Science & Medicine in Sport 10(5):311-9, 2007).

     Understand the strong relationship between foot posture (FPI -9 to +12) and ankle range of motion when assessing and treating ankle equinus (Burns J. Crosbie J. Weight bearing ankle dorsiflexion range of motion in idiopathic pes cavus compared to normal and pes planus feet. Foot. 15(2): 91-4, 2005).

     Target therapy at muscle imbalance in patients with Charcot-Marie-Tooth disease and pes cavus (FPI < -2) (Burns J. Redmond A. Ouvrier R. Crosbie J. Quantification of muscle strength and imbalance in neurogenic pes cavus, compared to health controls, using hand-held dynamometry. Foot & Ankle International 26(7):540-4, 2005).

     Implement the most appropriate orthotic therapy for patients with painful cavus foot (FPI < -2) (Burns J. Crosbie J. Hunt A. Ouvrier R. Effective orthotic therapy for the painful cavus foot: a randomized controlled trial. Journal of the American Podiatric Medicine Association 96(3): 2005-211, 2006).

    As a clinical researcher, my primary goal is to communicate and translate podiatric research into clinical practice. This is obviously a give and take relationship with clinicians who should try to embrace the good research being conducted and feedback to researchers about how it helps or hinders patient care.

    Kind regards

    Joshua Burns PhD, B App Sc (Pod) Hons
    Podiatrist and NHMRC Australian Clinical Research Fellow
    Institute for Neuromuscular Research, The Children's Hospital at Westmead
    Faculty of Medicine, The University of Sydney, Australia
     
  12. Josh:

    Thanks for your informative posting on the research on the FPI. I realize that the FPI is helpful in research....I believe I stated that very clearly earlier.

    However, Josh, specific to my original statement, could you provide specific examples of how certain numerical values of the FPI would help the clinician determine how to manage a few common mechanical pathologies of the foot that the experienced clinician couldn't otherwise gather by visually inspecting the feet for 5-10 seconds while the patient was in relaxed bipedal stance.

    In other words, does the clinician need to have a numerical value of the FPI to treat the patient effectively? I know the answer to this one, since I have been treating patients with foot orthoses effectively for over 20 years without the use of the FPI. However, what does the FPI give the clinician in terms of improving his/her clinical outcomes, in your opinion??
     
  13. Josh Burns

    Josh Burns Active Member

    Dear Kevin,
    I agree with you that an experienced clinician may not see value in the FPI. I believe the FPI gives a foot morphology framework for early career podiatrists and those with limited biomechanical knowledge and experience. We don't yet know what the implications of each particular score on the 25-point scale are in terms of pathology risk and intervention success. However, in time a clinical algorithm of injury risk and treatment selection may come with instruments such as the FPI.

    Kind regards

    Joshua Burns PhD, B App Sc (Pod) Hons
    Podiatrist and NHMRC Australian Clinical Research Fellow
    Institute for Neuromuscular Research, The Children's Hospital at Westmead
    Faculty of Medicine, The University of Sydney, Australia
     
  14. admin

    admin Administrator Staff Member

  15. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    One of my frustrations as an educator is how often students look at a foot and tell me its OK; when I look at it, I see a very pronated foot. Our solution has been to get the students to use the FPI ---- as it breaks each element of what is a pronated foot down into its components (eg arch height; medial bulging; calc angle; etc) ----- all of a suddent they then start seeing what I see.

    One of my frsutrations in reading some foot orthotic research is that we have no idea if participants actually needed foot orthotics or not. The solution would be for researchers to report the FPI of the participants (in the same way they report the weight, age, etc). We use the FPI as part of our inclusion criteria. That way readers of the research can judge for themselve the results based on if they do or do not accept the inclusion criteria.
     
  16. poppet

    poppet Active Member

    ah a light has come on!

    i am about to embark on my final year research and have been trawling this site for enlightenment.

    my proposed area of research is along the lines of whether obesity is a sgnificant predisposing factor in the development of pathologies such as plantar fascitis. the exact question etc is still in its embryonic stage but i was thinking of inclusion criteria and how i was going to design the method. my thoughts were to use f-scan or similar but after reading somemore, realised that this would be difficult to get acurrate results due to individual subject foot type. then came the light bulb moment! what about if i used the FPI as part of my inclusion criteria so as to exclude that variable?
    does this seem viable and does anyone have any other thoughts on this subject matter?

    poppet
     
  17. Admin2

    Admin2 Administrator Staff Member

  18. poppet

    poppet Active Member

    thank you for that...yes it was one of my first 'reads' in this area...i agree with Kevin in that it seemed a well written paper. i appreciatet that papers are often used for peer use/review but the language for those of us 'starting out' is often complex and confusing. this paperi understood and could therefore, critically evaluate. great!

    i would appreciate any other personal thoughts on this work also, but journals are great to.

    poppet
     
  19. ely

    ely Member

    I like the FPI because it's quick and easy and rather just saying "pronated" or "supinated" or whatever all the cool kids do, it's really quick to do AND write up, and indicates how you came to your conclusion as to "foot type". Good for following progression as well e.g. flexible pes planus in children.
     
  20. lcp

    lcp Active Member

    Gday everyone, i know this is a reasonably old thread, but just a quick question. Which of the original 8 factors of the FPI were dropped to make it 6?
    Thanks
    Paul
     
  21. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    FPI-6 consists of: talar head palpation; curves above and below lateral malleoli; inversion/eversion of calc; bulge in TNJ region; congruence of medial arch; abd/add of forefoot on rearfoot.

    FPI-8 consisted of: talar head palpation; curves above and below lateral malleoli; inversion/eversion of calc; bulge in TNJ region; congruence of medial arch; abd/add of forefoot on rearfoot; helbings sign; congruence of the lateral border of the foot
     
  22. lcp

    lcp Active Member

    Great, thanks for the reply Craig.
    Paul
     
  23. Admin2

    Admin2 Administrator Staff Member

  24. JFAR

    JFAR Active Member

    Normative values for the Foot Posture Index

    Anthony C Redmond , Yvonne Z Crane and Hylton B Menz

    Journal of Foot and Ankle Research 2008, 1:6doi:10.1186/1757-1146-1-6

    Published: 31 July 2008

    Abstract (provisional)

    Background
    The Foot Posture Index (FPI) is a validated method for quantifying standing foot posture, and is being used in a variety of clinical settings. There have however been no normative data available to date for comparison and reference. This study aimed to establish normative FPI reference values.

    Methods
    Studies reporting FPI data were identified by searching online databases. Nine authors contributed anonymised versions of their original datasets comprising 1648 individual observations. The datasets included information relating to centre, age, gender, pathology (if relevant), FPI scores and body mass index (BMI) where available. FPI total scores were transformed to interval logit scores as per the Rasch model and normal ranges were defined. Comparisons between groups employed t-tests or ANOVA models as appropriate and data were explored descriptively and graphically.

    Results
    The main analysis based on a normal healthy population (n = 619), confirmed a slightly pronated foot posture is the normal position at rest (mean back transformed FPI raw score = +4). A 'U' shaped relationship existed for age, with minors and older adults exhibiting significantly higher FPI scores than the general adult population (F = 51.07, p < 0.001). There was no difference between the FPI scores of males and females (2.3 versus 2.5; t = -1.44, p = 0.149). No relationship was found between the FPI and BMI. Systematic differences from the adult normals were confirmed in patients with neurogenic and idiopathic cavus (F = 216.981, p < 0.001), indicating some sensitivity of the instrument to detect a posturally pathological population.

    Conclusions
    A set of population norms for children, adults and older people have been derived from a large sample. Foot posture is related to age and the presence of pathology, but not influenced by gender or BMI. The normative values identified may assist in classifying foot type for the purpose of research and clinical decision making.
     
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