Varus foot alignment and hip conditions in older adults.

NewsBot · Sep 1, 2007

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Varus foot alignment and hip conditions in older adults.
Gross KD, Niu J, Zhang YQ, Felson DT, McLennan C, Hannan MT, Holt KG, Hunter DJ.
Arthritis Rheum. 2007 Aug 30;56(9):2993-2998

OBJECTIVE: Mechanical strain on the hip can result from varus malalignment of the foot. This study was undertaken to explore the cross-sectional relationship between varus foot alignment and hip conditions in a population of older adults.

METHODS: The Framingham Osteoarthritis Study cohort consists of a population-based sample of older adults. Within this sample, we measured forefoot and rearfoot frontal plane alignment using photographs of a non-weight-bearing view of both feet of 385 men and women (mean age 63.1 years). Each foot segment was categorized according to the distribution of forefoot and rearfoot alignment among cases of ipsilateral hip pain, trochanter tenderness, hip pain or tenderness, and total hip replacement (THR). The relationship of foot alignment to these conditions was examined using logistic regression and generalized estimating equations, adjusting for age, body mass index, sex, and physical activity.

RESULTS: The mean +/- SD rearfoot varus alignment was 0.7 +/- 5.5 degrees, and the mean +/- SD forefoot varus alignment was 9.9 +/- 9.9 degrees. Subjects in the highest category of forefoot varus alignment had 1.8 times the odds of having ipsilateral hip pain (P for trend = 0.06), 1.9 times the odds of having hip pain or tenderness (P for trend < 0.01), and 5.1 times the odds of having undergone THR (P for trend = 0.04) compared with those in the lowest category. No significant associations were found between rearfoot varus alignment and any hip conditions.

CONCLUSION: Forefoot varus malalignment may be associated with ipsilateral hip pain or tenderness and THR in older adults. These findings have implications for treatment, since this risk factor is potentially modifiable with foot orthoses.
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Craig Payne · Sep 1, 2007

Subjects in the highest category of forefoot varus alignment had 1.8 times the odds of having ipsilateral hip pain (P for trend = 0.06), 1.9 times the odds of having hip pain or tenderness (P for trend < 0.01), and 5.1 times the odds of having undergone THR (P for trend = 0.04)
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Why do I have a hard time believing that? Will get a full copy of the paper Monday and investigate further.

Craig Payne · Sep 2, 2007

OK .... just got the full paper ..... and my response is to quote my good friend Homer Simpson .... 'duh!' :confused:

Here is what they did to measure foot alignment:

Forefoot and rearfoot
alignment was measured using a digital photograph taken
while the subject lay in the prone position. Positioning of the
legs and ankles followed a strict protocol and was performed
by a single trained examiner who was blinded with regard to
the study question. The medial malleoli were aligned with the
inferior edge of an examination table and the legs were fixed in
neutral rotation so that the posterior aspect of the calcanei was
uppermost. A maximum allowable distance of 16.5 cm between
the sagittal midline of the body and each lateral malleolus was
marked on the table. The examiner brought both ankles to
neutral dorsiflexion (0 degrees) using gentle thumb pressure
over the third metatarsal head. The subject maintained both
feet in this position while a single digital photograph, using a
PowerShot camera (Canon, Lake Success, NY), was obtained
from above. The camera remained fixed to the wall throughout
the study in order to ensure consistent positioning.
Rearfoot alignment was defined by the angle between
a vertical bisection of the calcaneus and a horizontal reference
line drawn across the inferior edge of the examination table
(Figure 1). Forefoot alignment was defined by the angle
between the same horizontal reference line and a line connecting
the first and fifth metatarsal heads (7) (Figure 1). A single
investigator (KDG), who was blinded with regard to outcome
status, used Canvas software, version 9.0.3 (ACD Systems,
Vancouver, British Columbia, Canada) to measure the alignment
of each foot segment to the nearest 0.1 degree. Measurements
of varus alignment were recorded as positive values,
while measurements of valgus alignment were assigned negative
values.
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Looking at the figures, the feet were just hanging over the edge of exam table and NOT loaded or placed in STJ neutral!. The vary definition of forefoot varus is that its LOADED!!! And even if it was loaded are the authors even aware that there is a difference, by definition, between forefoot varus and forefoot supnatus.

The concluding sentence of this study said: Forefoot varus malalignment may be associated with ipsilateral hip pain or tenderness and THR in older adults, whereas it would have been more appropriate to say Those whose foot when unloaded in a non-weightbearing position assumed a more varus position and may be associated with ipisilateral hip pain...

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