Adrienne Hunt

Three-dimensional kinematics of the rearfoot during the stance phase of walking in normal young adult males

Three-dimensional video analysis was used to quantify three-dimensional motion of the rearfoot in 14 normal young adult males during the stance phase of walking. A stringent calibration procedure enabled standardization of the neutral position of the rearfoot. Surface markers were placed on the calcaneus and lower tibia, and a joint coordinate system was used to determine the relative displacement between the calcaneus and lower leg as representative of rearfoot motion. Confirmation was made of the assumption of a mechanical coupling between the rearfoot displacements of abduction/adduction and eversion/inversion. However, there were several findings which contrasted with commonly held assumptions. For example, the rearfoot was found to evert gradually, rather than rapidly, from heel contact to just prior to heel rise. Also the conventional descriptions of the composite movements of pronation and supination were not applicable to rearfoot movement in this study, and it was therefore concluded that pronation and supination are not valid descriptors of three-dimensional rearfoot motion during the stance phase of walking.

Effective orthotic therapy for the painful cavus foot : a randomized controlled trial

Patients with a cavus or high-arched foot frequently experience foot pain, which can lead to significant limitation in function. Custom foot orthoses are widely prescribed to treat cavus foot pain. However, no clear guidelines for their construction exist, and there is limited evidence of their efficacy. In a randomized, single-blind, sham-controlled trial, the effect of custom foot orthoses on foot pain, function, quality of life, and plantar pressure loading in people with a cavus foot type was investigated. One hundred fifty-four participants with chronic musculoskeletal foot pain and bilateral cavus feet were randomly assigned to a treatment group receiving custom foot orthoses (n = 75) or to a control group receiving simple sham insoles (n = 79). At 3 months, 99% of the participants provided follow-up data using the Foot Health Status Questionnaire. Foot pain scores improved more with custom foot orthoses than with the control (difference, 8.3 points; 95% confidence interval [CI], 1.2 to 15.3 points; P = .022). Function scores also improved more with custom foot orthoses than with the control (difference, 9.5 points; 95% CI, 2.9 to 16.1 points; P = .005). Quality-of-life data favored custom foot orthoses, although differences reached statistical significance only for physical functioning (difference, 7.0 points; 95% CI, 1.9 to 12.1 points; P = .008). Plantar pressure improved considerably more with custom foot orthoses than with the control for all regions of the foot (difference, ‐3.0 N . s/cm 2 ; 95% CI, ‐3.7 to ‐2.4 N . s/cm 2 ; P < .001). In conclusion, custom foot orthoses are more effective than a control for the treatment of cavus foot pain and its associated limitation in function. (J Am Podiatr Med Assoc 96(3): 205-211, 2006)

Medial Longitudinal Arch of the Foot: Stationary Versus Walking Measures

We describe the characteristics of the medial longitudinal arch (MLA) of the right foot in 19 healthy men while sitting/partial bodyweight, standing/full bodyweight, and during the stance phase of walking. Three measurements were selected as representative of the MLA, including: height of the arch, length of the arch, and supranavicular angle. Mean values were calculated in three dimensions for each measure in the sitting and standing conditions and for the minimum value of each measure in the walking condition. Patterns measured during walking had high association (r = 0.999) and could be related to phases of stance. In the stationary conditions, the MLA varied significantly (P <0.001). No significant relationship of arch height, arch length, or supranavicular angle was found between sitting and standing or between stationary and walking conditions. It was concluded that none of the static variables could be used to predict others and that static measures of the MLA do not predict the dynamic motion of the MLA. The MLA may not be a reasonable indicator of behavior or motion of the foot.

Extrinsic Muscle Activity, Foot Motion and Ankle Joint Moments During the Stance Phase of Walking

This study examined stance phase foot kinematics, kinetics and electromyographic (EMG) activity of extrinsic muscles of 18 healthy males. Three-dimensional kinematic and kinetic data were obtained via video analysis of surface markers and a force plate. Ankle joint moments are described about orthogonal axes in a segmental coordinate system. Kinematic data comprise rearfoot and forefoot motion, described about axes of a joint coordinate system, and medial longitudinal arch height. Surface EMG was obtained for tibialis anterior, soleus, gastocnemius medialis and lateralis, peroneus longus and peroneus brevis and extensor digitorum longus. It was concluded that the demands on the controlling muscles are greatest prior to foot flat and after heel rise. Tibialis anterior restrained rearfoot plantarflexion from heel contact to 10% stance, and eversion between 10% stance and footflat. Activity in peroneus longus was consistent with its role in causing eversion after heel contact, then as a stabiliser of the forefoot after heel rise. Activity in peroneus brevis suggested a role in restraining lateral rotation of the leg over the foot, late in stance.

Static measures of calcaneal deviation and arch angle as predictors of rearfoot motion during walking

Clinicians commonly assess static alignment of the foot with the assumption that it is predictive of its movement during walking and the risk of injury. This study investigated the relationship between clinical measures of calcaneal deviation and medial arch angle in standing and three-dimensional rearfoot movement during the stance phase of walking in 19 young healthy males. Correlations were performed among the variables of maximum eversion, maximum abduction, the range of inversion-eversion and the range of abduction-adduction. The only significant correlation was between calcaneal deviation and maximum eversion (r = 0.46, p < 0.05). We concluded that the static measures of calcaneal deviation and medial arch angle are limited in their ability to predict three-dimensional rearfoot movement during walking in asymptomatic people.

University Education and the Physiotherapy Professional

Summary The growth and development of physiotherapy is influenced significantly by the professional abilities and potential of its new graduates. Physiotherapy graduates need to have skills and attributes relevant to their day-to-day practice to enable them to be confident and competent. They also need skills and attributes that will enable them to adapt to changes and develop professionally. It could be assumed that physiotherapists are well equipped for their future role, because, as well as gaining discipline-specific technical competence, as university graduates they are expected to have generic skills and attributes in such areas as communication, thinking, learning, teamwork, research, evaluation and problem solving. However, possession of these generic university-education skills does not, alone, provide a guarantee of competence in the workplace. The education process must equip graduate physiotherapists for professional survival in a health care environment in which the funding and organisation of health care are changing. This paper examines the need for the profession and its educators to review current teaching in physiotherapy. It explores curriculum and teaching strategies that could be implemented to foster required skills and attributes in its newest graduates to ensure that they meet the needs of the community, thereby facilitating the ongoing development of the profession.

Occupational Therapists' Perceptions of Their Undergraduate Preparation for the Workplace:

The health care environment is undergoing rapid change. This has major implications for health science education programmes. The extent to which university education prepares graduates for the requirements of the workplace has become an important issue in the health science literature. The present study investigated the perceptions of 144 graduate occupational therapists regarding the adequacy of their undergraduate education at the University of Sydney in equipping them for the workplace. The findings indicated that occupational therapy graduates perceived significant gaps between the knowledge and skills gained during their undergraduate course and those required in the workplace, particularly in the areas of communication with other health professionals and the general public, knowledge of the health industry and workplace management. This paper considers the implications of workplace requirements and expectations for the occupational therapy course curricula.

Inter-Tester Reliability and Precision of Manual Muscle Testing and Hand-Held Dynamometry in Lower Limb Muscles of Children with Spina Bifida

Reliability and measurement precision of manual muscle testing (MMT) and hand-held dynamometry (HHD) were compared for children with spina bifida. Strength measures were obtained of the hip flexors, hip abductors, and knee extensors of 20 children (10 males, 10 females; mean age 9 years 10 months; range: 5 to 15 years) by two experienced physical therapists and a student physical therapist. Inter-tester reliability [ICC(2,1)] for HHD varied from 0.76 to 0.83, indicating excellent reliability for the three muscle groups. Inter-tester reliability for MMT was 0.75 for the hip abductor muscle group, indicating good reliability, and 0.37 to 0.40 for the remaining muscle groups. The minimum detectable change was 15N for HHD and 1 scale unit of a 0 to 5 MMT scale. The results suggest a situation-specific solution to the question of which method to use. To detect small strength changes over time in children with spina bifida, MMT should be used when the child has insufficient strength to move the limb against gravity; otherwise, HHD should be used.

Effect of foot morphology on center-of-pressure excursion during barefoot walking

BACKGROUND The path of the center of pressure during walking varies among individuals by deviating to a greater or lesser extent toward the medial or lateral border of the foot. It is unclear whether this variance is systematic and is affected by foot posture. The aim of this study was to explore the relationship between foot morphology and center-of-pressure excursion during barefoot walking. METHODS Pressure data were collected from 83 participants whose foot type had been classified as supinated, normal, or pronated according to the Foot Posture Index. Three center-of-pressure variables were analyzed: medial excursion area, lateral excursion area, and total excursion area. RESULTS Across the spectrum of foot types, we found that the more supinated a participants foot posture, the larger the area of lateral center-of-pressure excursion, and, conversely, the more pronated the foot posture, the smaller the area of lateral center-of-pressure excursion. Furthermore, the supinated foot type had a relatively larger center-of-pressure total excursion area, and the pronated foot type had a relatively smaller center-of-pressure total excursion area. CONCLUSIONS These results indicate the importance of assessing foot posture when measuring center of pressure and may help explain regional differences in pain and injury location among foot types.

Effect of thong style flip-flops on children's barefoot walking and jogging kinematics.

BackgroundThong style flip-flops are a popular form of footwear for children. Health professionals relate the wearing of thongs to foot pathology and deformity despite the lack of quantitative evidence to support or refute the benefits or disadvantages of children wearing thongs. The purpose of this study was to compare the effect of thong footwear on children’s barefoot three dimensional foot kinematics during walking and jogging.MethodsThirteen healthy children (age 10.3 ± 1.6 SD years) were recruited from the metropolitan area of Sydney Australia following a national press release. Kinematic data were recorded at 200 Hz using a 14 camera motion analysis system (Cortex, Motion Analysis Corporation, Santa Rosa, USA) and simultaneous ground reaction force were measured using a force platform (Model 9281B, Kistler, Winterthur, Switzerland). A three-segment foot model was used to describe three dimensional ankle, midfoot and one dimensional hallux kinematics during the stance sub-phases of contact, midstance and propulsion.ResultsThongs resulted in increased ankle dorsiflexion during contact (by 10.9°, p; = 0.005 walk and by 8.1°, p; = 0.005 jog); increased midfoot plantarflexion during midstance (by 5.0°, p; = 0.037 jog) and propulsion (by 6.7°, p; = 0.044 walk and by 5.4°, p;= 0.020 jog); increased midfoot inversion during contact (by 3.8°, p;= 0.042 jog) and reduced hallux dorsiflexion during walking 10% prior to heel strike (by 6.5°, p; = 0.005) at heel strike (by 4.9°, p; = 0.031) and 10% post toe-off (by 10.7°, p; = 0.001).ConclusionsAnkle dorsiflexion during the contact phase of walking and jogging, combined with reduced hallux dorsiflexion during walking, suggests a mechanism to retain the thong during weight acceptance. Greater midfoot plantarflexion throughout midstance while walking and throughout midstance and propulsion while jogging may indicate a gripping action to sustain the thong during stance. While these compensations exist, the overall findings suggest that foot motion whilst wearing thongs may be more replicable of barefoot motion than originally thought.