Angela M. Evans

Reliability of the Foot Posture Index and Traditional Measures of Foot Position

Repeatable measures are essential for clinicians and researchers alike. Both need baseline measures that are reliable, as intervention effects cannot be accurately identified without consistent measures. The intrarater and interrater reliability of the new Foot Posture Index and current podiatric measures of foot position were assessed using a same-subject, repeated-measures study design across three age groups. The Foot Posture Index total score showed moderate reliability overall, demonstrating better reliability than most other current measures, although navicular height (normalized for foot length) was the single most reliable measure in adults. None of the tested measures exhibited adequate reliability in young children, and, with less-than-desirable reliability being demonstrated, most measures need to be interpreted accordingly when repeated measures are involved.

The foot posture index, ankle lunge test, Beighton scale and the lower limb assessment score in healthy children: a reliability study

BackgroundOutcome measures are important when evaluating treatments and physiological progress in paediatric populations. Reliable, relevant measures of foot posture are important for such assessments to be accurate over time. The aim of the study was to assess the intra- and inter-rater reliability of common outcome measures for paediatric foot conditions.MethodsA repeated measures, same-subject design assessed the intra- and inter-rater reliability of measures of foot posture, joint hypermobility and ankle range: the Foot Posture Index (FPI-6), the ankle lunge test, the Beighton scale and the lower limb assessment scale (LLAS), used by two examiners in 30 healthy children (aged 7 to 15 years). The Oxford Ankle Foot Questionnaire (OxAFQ-C) was completed by participants and a parent, to assess the extent of foot and ankle problems.ResultsThe OxAFQ-C demonstrated a mean (SD) score of 6 (6) in adults and 7(5) for children, showing good agreement between parents and children, and which indicates mid-range (transient) disability. Intra-rater reliability was good for the FPI-6 (ICC = 0.93 - 0.94), ankle lunge test (ICC = 0.85-0.95), Beighton scale (ICC = 0.96-0.98) and LLAS (ICC = 0.90-0.98). Inter-rater reliability was largely good for each of the: FPI-6 (ICC = 0.79), ankle lunge test (ICC = 0.83), Beighton scale (ICC = 0.73) and LLAS (ICC = 0.78).ConclusionThe four measures investigated demonstrated adequate intra-rater and inter-rater reliability in this paediatric sample, which further justifies their use in clinical practice.

Are foot posture and functional health different in children with growing pains

Background: The aim of the present paper was to investigate and compare findings of foot posture and functional health between groups of children aged 4–6 years with and without leg pain (described as “growing pains”). The null hypothesis: that there is no difference in measures of either foot posture or functional health between groups of children with and without leg pain.

The paediatric flat foot and general anthropometry in 140 Australian school children aged 7 - 10 years

BackgroundMany studies have found a positive relationship between increased body weight and flat foot posture in children.MethodsFrom a study population of 140 children aged seven to 10 years, a sample of 31 children with flat feet was identified by screening with the FPI-6. Basic anthropometric measures were compared between subjects with and without flat feet as designated.ResultsThe results of this study, in contrast to many others, question the association of flat feet and heavy children. A significant relationship between foot posture and weight (FPI (L) r = -0.186 (p < 0.05), FPI(R) r = -0.194 (p < 0.05), waist girth (FPI (L) r = -0.213 (p < 0.05), FPI(R) r = -0.228 (p < 0.01) and BMI (FPI (L) r = -0.243 (p < 0.01), FPI(R) r = -0.263 (p < 0.01) was identified, but was both weak and inverse.ConclusionsThis study presents results which conflict with those of many previous investigations addressing the relationship between childrens weight and foot posture. In contrast to previous studies, the implication of these results is that heavy children have less flat feet. Further investigation is warranted using a standardized approach to assessment and a larger sample of children to test this apparent contradiction.

The efficacy of nonsurgical interventions for pediatric flexible flat foot: a critical review.

Background: The pediatric flat foot frequently presents as a common parental concern in the health care setting. Foot orthoses are often used, yet benefits are uncertain and disputed, having been variably investigated. A recent Cochrane review cites limited evidence for nonsurgical interventions. This critical and structured review evaluates the effect of pediatric foot orthoses from assessment of the current literature. Methods: A systematic search of the following electronic databases: Medline, CINAHL, AMED, and SPORTDiscus, using an array of search terms. A further search was also performed on relevant reference listings. Inclusion criteria were peer-reviewed journal articles, publication date from 1970 onwards, in the English language. Exclusion criteria were surgery interventions, adult subjects, rigid flat foot, articles based on opinion. A structured Quality Index was used to evaluate the research quality of articles. Three reviewers independently assessed the studies with disputes resolved by majority consensus. Studies were then grouped according to the outcome measures used. Results: Thirteen articles, from an initial 429, met the criteria for quality evaluation. The mean Quality Index score was 35% (range: 13% to 81%), indicative of generally poor and varying methodological quality. Conclusions: The low quality of the studies negates definitive conclusions. Only 3/13 quality evaluations scored >50%; hence, evidence for efficacy of nonsurgical interventions for flexible pediatric flat feet is very limited. Future research needs validated foot type assessment, applicable outcome measures for the intervention, the use of control groups, allowance for independent effects of footwear, age range comparisons, larger samples, and prospective, longer follow-up. Clinical Relevance: There is very limited evidence for the efficacy of nonsurgical interventions for children with flexible flat feet. Clinicians need to consider the lack of good-quality evidence in their decision-making for the management of pediatric flat foot.

The paediatric flat foot proforma (p-FFP): improved and abridged following a reproducibility study

BackgroundConcern about a childs flat foot posture is a common reason for frequent clinical consultations for an array of health care and medical professionals. The recently developed paediatric flatfoot clinical-care pathway (FFP) has provided an evidence based approach to diagnosis and management. The intra and inter-rater/measurer reliability of the FFP has been investigated in this study.MethodsFrom a study population of 140 children aged seven to 10 years, a sample with flat feet was identified by screening with the Foot posture index (FPI-6). Subjects who scored ≥ 6 on the FPI-6 for both feet became the studys flat foot sample. A same subject, repeated measure research design was used for this study which examined the reliability of the FFP in 31 children aged seven to 10 years, as rated by three examiners.ResultsApproximately half of the items of the FFP showed less-than-desirable inter-rater reliability, arbitrarily set at the conventional 0.7 level (intra-class correlations). Removal of the unreliable items has produced a shorter; more relevant instrument designated the paediatric flat foot proforma (p-FFP).ConclusionThe p-FFP is a reliable instrument for the assessment and resulting treatment actions for children with flat feet. Findings indicate that the simplified p-FFP is a reproducible instrument for the clinical assessment of flat foot in mid-childhood.

Sagittal plane range of motion of the pediatric ankle joint : A reliability study

Measurement of ankle dorsiflexion is a routine part of the podiatric examination of children, yet the reliability of this measure is largely unknown in healthy individuals. This study assessed the intrarater and interrater reliability of the first and second resistance levels of sagittal ankle range of motion in 4- to 6-year-old children. The results show that measures of ankle dorsiflexion in children are highly variable among examiners, and, in general, gastrocnemius range of motion is more reliable than soleal range of motion.

A review of the Ponseti method and development of an infant clubfoot program in Vietnam.

BACKGROUND The Feet for Walking clubfoot project from Australia formally introduced the Ponseti technique in Vietnam in 2004 and is based at the Da Nang Orthopedic and Rehabilitation Centre in central Vietnam. METHODS We provide an initial overview of the management of infant clubfoot deformity using the nonsurgical Ponseti method. RESULTS Early indicators of the outcome of implementing this clubfoot project are largely positive but also require ongoing review. Further analyses of the use of the Ponseti method (or obstacles preventing the same) following training of personnel is underway. CONCLUSIONS Recent research has improved and refined the technique that must now be both appreciated and incorporated by clinicians. This technique is used across the world in both developed and developing countries and is universally regarded as the best management method for clubfoot deformities.

Podiatric Medical Applications of Posterior Night Stretch Splinting

Podiatric physicians encounter many conditions, especially in sports medicine, that involve pain in the vicinity of the rearfoot or lower leg. These conditions are often associated with ankle equinus and may affect either child or adult sports participants. A review of the literature and clinical experience identify posterior night stretch splinting as an effective adjunct in the treatment of persistent symptomatic plantar fasciitis, negating the need for corticosteroid injections, further protracted pain, or surgery. This article reviews clinical cases in which night stretch splinting was used for a variety of diagnoses. Further research is needed into its efficacy for conditions other than plantar fasciitis.

Measuring the paediatric foot—a criterion validity and reliability study of navicular height in 4-year-old children

Abstract Background : Fundamental to clinical measures are the concepts of validity and reliability. This study addresses these issues in the paediatric foot which has been less investigated in terms of clinical assessment than the adult foot. The measure of navicular height (NH; usually normalised for foot length) has been studied to ascertain its value as a clinical measure in a sample of young children. Objective : To determine the criterion validity and reliability of NH as a clinical foot measure in young children. Method : Sonography was utilised to assess the accuracy of the examiners skin palpation of the navicular which is required for the measure of NH to be valid. A same subject repeated measures design was used for the reliability component of this study. Results : The results indicate that individual examiners can achieve good reliability and demonstrate low measurement error for the measure of NH (ICC=0.69–0.84) but agreement between examiners was not demonstrated (ICC=0.23). Sonographic imaging showed that NH was largely an invalid measure although again varied between the two examiners. Conclusion : This study indicates that the use of NH as a clinical measure of the foot in 4-year-old children is dubious. Examiner experience and the developing navicular morphology may be relevant influences.