Jill Ferrari

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

BackgroundReliability is an integral component of clinical assessment and necessary for establishing baseline data, monitoring treatment outcomes and providing robust research findings. In the podiatric literature traditional measures of foot assessment have been shown to be largely unreliable. The Foot Posture Index (FPI-6) is a clinical tool used in the assessment of foot and to date, there is limited research published which evaluates the reliability of this tool in children and adolescents.MethodThirty participants aged 5 - 16 years were recruited for the research. Two raters independently recorded the FPI-6 score for each participant.ResultsAlmost perfect agreement between the two raters was identified following weighted kappa analysis (Kw = 0.86).ConclusionThe FPI-6 is a quick, simple and reliable clinical tool which has demonstrated excellent inter-rater reliability when used in the assessment of the paediatric foot.

Size and shape differences between male and female foot bones: Is the female foot predisposed to hallux abducto valgus deformity?

This study introduces a new technique to measure bone size and shape. A three-dimensional laser scan was taken of the talus, navicular, medial cuneiform, and first metatarsal from 107 skeletons of known age and sex. The bones were analyzed for differences in bone morphology between the sexes and the ability of each bone to contribute to the adducted position of the first metatarsal. Linear measurements showed that male bones were larger than female bones. Measurements of articular surfaces suggested that female bones had the potential for more movement to occur in the direction of adduction, possibly resulting in the female first metatarsal being more adducted than that in the male skeleton. Such differences may underlie the predisposition of the female foot to develop hallux valgus deformity.

The Shape of the Metatarsal Head as a Cause of Hallux Abductovalgus

The curvature of the 1st metatarsal head was evaluated on 100 radiographs by calculating the functional angle of the joint surface. This measure of curvature varied positively with the degree of hallux abductovalgus (HAV). Using measures of correlation it was found that in males, the association was linear (r2=0.39, p<0.001). In females, a linear relationship was identified only after logarithmic transformation of the data (r2=0.25, p<0.001). Comparison of the functional angle between males and females showed a significant difference (t=−5.03, df=98, p<0.001).

Foot pressure measurement differences between boys and girls with reference to hallux valgus deformity and hypermobility.

Background: Previous studies that compared foot pressures in boys and girls found that girls had greater peak pressures under the hallux than did boys. Only one of these studies considered plantar pressure measurements in children. The purpose of the study was to investigate the effect of gender on foot pressure measurements in children. Methods: This is a comparative study using the F-Scan pressure platform (F-Mat; Texscan® Boston, MA) on a sample of children attending a podiatric clinic. Pressure measurements and temporal parameters were measured in 61 children between the ages of 5 and 16 years. Associations between joint hypermobility and hallux valgus angle also were investigated. Results: Girls were found to have significantly greater peak pressure under the hallux, faster timing of heel contact to first metatarsal head loading, and a more medially placed center of pressure trajectory. No associations were found between these significant variables and hypermobility scores or hallux valgus angle. Conclusion: The results indicate that there are differences in pressure measurements between boys and girls, but the reasons for these remain unclear. Differences in pressure measurements in the feet of boys and girls may be useful in establishing the cause of foot pathologies for which a prevalence has been shown in boys or girls, such as hallux valgus deformity, which is known to be more frequent in females of all ages.

Relationship between proximal articular set angle and hallux abducto valgus.

A study of radiographs from 50 males and 50 females was undertaken to determine whether a relationship existed between the proximal articular set angle and the hallux abductus angle. Gender differences in the relationship were also investigated. The normal range for the proximal articular set angle was -2.6 degrees to 8.6 degrees, with a mean of 5 degrees. There was no significant difference in the mean values between males and females. A positive linear correlation between the proximal articular set angle and hallux abducto valgus deformity was found (R(2) = 0.52), suggesting that an increased lateral tilt of the metatarsal head is one of the factors that lead to hallux abducto valgus deformity. The relationship between proximal articular set angle and hallux abducto valgus deformity was similar in males and females and did not account for the increased hallux deformity seen in females.

Assessment of gait characteristics and orthotic management in children with Developmental Coordination Disorder: Preliminary findings to inform multidisciplinary care

Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder characterised by impaired motor co-ordination and awkward gait. Despite self-reported findings of pes planus and joint hypermobility in children with DCD, there is little objective evidence regarding the clinical management of the foot in children with DCD. The aims of this research were to report clinical findings of foot posture and lower limb hypermobility in children with DCD and to evaluate the impact of foot orthoses on spatio-temporal gait parameters. Children with DCD were recruited into the study. Participants were randomly assigned to an intervention group who received foot orthoses at the start of their rehabilitation programme or to a second group who received foot orthoses at the end of their intervention programme. Foot posture was assessed with the Foot Posture Index and lower limb hypermobility assessed with the Lower Limb Assessment Score. The effect of foot orthoses was evaluated through assessment of spatio-temporal gait characteristics at baseline and post-rehabilitation programme. Fourteen children were recruited (mdn age 7.5 years) with nine children assigned to the group receiving orthoses early (mdn age 8 years) and five children assigned to the post-rehabilitation orthoses group (mdn age 6.5 years). A pes planus foot posture (FPI score=8) and lower limb hypermobility (LLAS score=11) were observed. Changes in spatio-temporal gait parameters failed to reach significance (p>.012) following orthotic invention but demonstrated a trend towards a decreased cadence and increased double support duration. Despite non-significant findings this work offers preliminary support for podiatric intervention in the rehabilitation of children with DCD. Further work is required to understand the biomechanics of gait in children with DCD and appreciate the role of podiatry as a component of multidisciplinary care.

Are spatiotemporal gait characteristics reliable outcome measures in children with developmental coordination disorder

Purpose: To evaluate the reliability of spatiotemporal gait parameters used in the clinical evaluation of children with developmental coordination disorder (DCD). Methods: Participants recruited were asked to ambulate across a 4.5-meter GAITRite walkway (CIR Systems, Inc, Havertown, Pennsylvania) at a self-selected walking speed. The spatiotemporal parameters recorded for both limbs were: velocity (cm/sec), stance phase duration (%), swing phase duration (%), stride length (cm), double support duration (%), and single support duration (%). Results: Intraclass correlation coefficient values attained in this study ranged from 0.24 to 0.73, with good reliability achieved for one parameter (cadence = 0.73), and moderate reliability for step length (0.55–0.58), stride length (0.57–0.61), and double support duration (0.56–0.59). Conclusion: The findings from this study indicate that the clinical evaluation of spatiotemporal gait parameters in children with DCD can yield reliable data for some parameters but further work on this is warranted.

Chronic recurrent multifocal osteomyelitis: the prevalence of lower-limb and foot involvement.

BACKGROUND Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory condition. The lesions are reported to present most frequently in the long bones. This study aimed to review the presenting features of CRMO in a cohort of children diagnosed as having CRMO and to compare the level of agreement between the clinical and published diagnostic criteria. METHODS A case notes review was undertaken of patients with a clinical diagnosis of CRMO. Patients were younger than 16 years at the time of diagnosis. Features were identified in each patient that agreed or disagreed with the published diagnostic criteria. The location of bone lesions in the lower limb at onset and disease progression was recorded. RESULTS A total of 37 patients were included. There was a high prevalence in white individuals. Agreement with the diagnostic criteria of Jansson et al and El-Shanti and Ferguson was poor, with levels of agreement of 40.5% and 43%, respectively, and low kappa scores (κ = 0.07 and 0.09, respectively). The lower limb was affected in 49% of patients at onset and in 72% overall. CONCLUSIONS This study presents one of the largest published cohorts of pediatric patients with CRMO and also presents racial/ethnic group data that have not previously been reported in other studies. Despite being a condition considered to affect the metaphysis of long bones, the ankle area and foot bones were also frequently affected. The agreement between the clinical diagnosis and the published diagnostic criteria was weak.

Patient perceptions of foot disability in Juvenile Idiopathic Arthritis: a comparison of the juvenile arthritis foot disability index and the Oxford ankle foot questionnaire for children

BackgroundThe Juvenile Arthritis Foot Disability Index (JAFI) and the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) are two region-specific paediatric outcome tools that measure the impact on well-being in children with foot pathology. The aim of this study was to establish the level of agreement between the JAFI and the OxAFQ-C in a group of children diagnosed with Juvenile Idiopathic Arthritis (JIA).MethodsChildren with JIA accessed the questionnaire via a website. The OxAFQ-C questionnaire and the JAFI questionnaire were combined into one document consisting of 42 statements with Likert-scale responses. A further question regarding duration of disease was added. On completion, the web-linked questionnaire was returned by e-mail.ResultsThirty five participants were included. Individual domain and composite score analysis was undertaken. The JAFI participation domain was compared to the OxAFQ-C school domain and showed no significant difference between the median scores of each participant (z = -1.33, p = 0.181). The JAFI activity and the OxAFQ-C physical domains were compared and showed that a significant difference between the median scores existed (z = -4.29, p < 0.001). Agreement between the two PROMs was tested using Bland Altman Levels of Agreement based upon the percentage summed composite scores. Levels of agreement between the scores were considered to be poor based on the Bland Altman plot, despite a low mean difference in scores (mean difference = -3.88, SD of difference = 9.93, p = 0.027). Pearson correlation was undertaken to measure the relationship between the summed composite score and disease duration. No relationship was found (JAFI: r = -0.08, p = 0.672; OxAFQ-C: r = 0.037, p = 0.871).ConclusionsThis study has shown that despite some agreement between the individual domains, overall there is poor agreement between the OxAFQ-C and the JAFI percentage summed composite scores. The study is not able to determine if one score is superior to the other but both scores could be of value when used in this population.

Self-reporting on foot health status in children

Background Clinicians involved in the management of children with chronic conditions are encouraged to utilise self-report outcome measures to inform clinical management and ensure patient preferences are considered throughout care provision. The use of self-report measures in the paediatric patient is not without challenges and alternative parent/proxy responders are often considered more appropriate. Despite this, the validity of parent/proxy responders reporting on behalf of children can be challenged and further work evaluating concordance between children and parents/proxy raters is needed. Through use of a foot-specific patient reported outcome measure in girls with Turner syndrome, the aim of this study was to measure agreement between children and parent/proxy responders for self-reporting on foot health.