Keith Rome

A Reliability Study of the Universal Goniometer, Fluid Goniometer, and Electrogoniometer for the Measurement of Ankle Dorsiflexion:

This study investigated the reliability of three goniometers, the universal, fluid, and electro-goniometers, in the measurement of ankle dorsiflexion. Intra- and interobserver reliability were assessed using 10 healthy volunteers and five observers. A standardized ankle position was used to measure full range of active dorsiflexion. Intraobserver reliability was assessed using one observer over two successive occasions. Interobserver reliability was assessed among five observers over five separate occasions. A one-factor analysis of variance to examine intraobserver reliability demonstrated no significant difference between each of the devices on the two occasions. A multifactorial analysis of variance demonstrated significant differences among observers and again among devices (P < 0.001). Secondary analysis for interdevice reliability demonstrated significant differences among the three devices (p<0.1). The study suggests that each device cannot be used reliably among observers or be used interchangeably, and clinical judgment based on angular changes of less than 10° are invalid if rigid protocols are not followed.

Vertical ground reaction forces in patients with unilateral plantar heel pain — a pilot study

Plantar heel pain (PHP) is a foot pathology commonly reported in both athletic and non-athletic populations. The etiology of PHP is complex and identification of risk factors associated with PHP is required to predict who is at increased risk of injury. Excessive plantar heel force and pressures are intrinsic risk factors that may play a contributing role in the development of PHP. Limited research, however, has been undertaken in terms of ground reaction forces associated with PHP. The aim of the study was to test the hypothesis that there were significant differences in the vertical ground reaction forces and loading rates at rearfoot contact between symptomatic and contra-lateral asymptomatic feet in 23 subjects diagnosed with unilateral PHP. The equipment consisted of a portable force plate using a 10-m modular walkway sampled at 200 Hz by an independent observer. Paired t-tests demonstrated no significant difference (P0.05) in the vertical ground reaction forces and loading rates between the symptomatic and contra-lateral asymptomatic feet. The results suggest that single risk factors such as vertical ground reaction force and loading rates do not contribute to PHP. The authors conclude that a model that incorporates a multi-factorial approach to risk factors may lead to a better understanding into the etiology and management of those individuals who suffer from heel pathologies.

Heel pad stiffness in runners with plantar heel pain

OBJECTIVE To evaluate significant differences in heel pad stiffness within a cohort of runners with diagnosed plantar heel pain and to explore the clinical importance of maximum heel pad stiffness values. DESIGN A cross-sectional design was used to quantify the heel pad stiffness of 166 runners with 33 diagnosed with plantar heel pain. BACKGROUND Palpation is still widely used to evaluate heel pad stiffness subjectively in everyday clinical practice. However, there is limited quantifiable data pertaining to heel pad stiffness measurements in runners and those with heel pain. METHODS A portable hand-held device measured force applied by a metal probe, and its displacement into the plantar surface of the heel pad. Non-linear modelling allowed curve coefficients b0 and b1 to be evaluated and was described by an exponential function using a non-linear regression equation. Exploratory analysis was used to describe a single-point approximation for clinical use. RESULTS An independent t-test demonstrated a statistically significant difference between the curve coefficient b1 (p<0.05). No significant difference was found for coefficient b0 between the plantar heel pain group and the non-plantar heel pain group (p>0.05). Exploratory analysis demonstrated maximum mean stiffness of 3.22 N/mm for the non-plantar heel pain group and 2.87 N/mm for the plantar heel pain-group, an 11% mean difference. CONCLUSION The results suggested that heel pad stiffness may be associated with plantar heel pain subjects. RELEVANCE Heel pad stiffness measurements may give a better insight into the mechanical properties of the heel pad in subjects with plantar heel pain.

Heel Pad Thickness—A Contributing Factor Associated with Plantar Heel Pain in Young Adults

Thirty-three runners were clinically diagnosed with plantar heel pain (PHP) and 107 runners were designated into a non-PHP group (NPHP). Cases were matched with a further control group of 64 subjects with regard to body mass index and age. A weight-bearing platform measured heel pad thickness by real-time ultrasound scanning. The results demonstrated a significant difference between the PHP and both the NPHP and control groups (P <0.05). The results also demonstrated that body mass index had a significant effect (P <0.05) on the heel pad thickness of all subjects, regardless of the heel pad group. The results from the current study, with some precaution, conclude that body mass index as such is not related to PHP in the athletic population. In the current study the observed differences of body mass index on heel pad thickness between the PHP and NPHP groups, and the similarity between the control group and NPHP subjects suggests other risk factors may play an important role in heel pad thickening and associated development of PHP.

Development of a clinical instrument to measure heel pad indentation.

OBJECTIVE To provide an accurate, reliable, non-invasive, portable instrument to measure heel pad indentation in a clinical setting. DESIGN A novel instrument was applied to assess heel pad indentation. BACKGROUND For the lack of quantitative biomechanical tools for in vivo assessment, palpation is used to evaluate heel pad stiffness subjectively in everyday clinical practice. Furthermore, previous studies have evaluated heel pad stiffness using non-portable instrumentation. METHODS Cylindrical probe was attached to an electronic force gauge unit that passed through a Perspex plate for placement on heel pad. Displacement of the plate was connected to a linear variable differential transformer. A laptop PC allowed for portability and storage of data. An exponential curve described the force-displacement data. Ten healthy subjects (mean 21. 7; SD, 1.7 years) were assessed on ten separate occasions. The procedure was standardised for subject position and placement. RESULTS Accuracy and reliability of each device component was established. An intraclass correlation (2,1) of 0.90 and 0.88 demonstrated curve coefficients b1 and b0 respectively. A paired t-test demonstrated no significant difference between the left and right foot coefficients. CONCLUSION The results demonstrated that each system component could be measured accurately and reliable. Reproducible results were obtained over separate occasions. The study has described a method to analyse the force-displacement curve. RelevanceThe development of a hand-held device may help the clinician to assess heel pad stiffness in the clinical setting. Heel pad stiffness may be associated in the development of plantar heel pain in athletes.

Reliability of weight-bearing heel pad thickness measurements by ultrasound

OBJECTIVE: To evaluate the intra- and inter-operator reliability of measuring weightbearing heel pad thickness in healthy subjects. BACKGROUND: Heel pad thickness has been reported to be an important factor in determining stresses observed in healthy as well as pathological feet. To date no published data are available on inter- and intra-operator variation in sonographic heel pad thickness measurements in adults. METHOD: bilateral heel pad thickness was measured in 10 adult subjects, with no history of plantar heel pain, by two experienced operators, on two separate occasions. Limits of agreement for three replicate measurements by each ultrasonographer and for replicate measurements were determined. RESULTS: Replicate heel pad thickness measurements in 95% of cases differ by less than 0.39 mm, and the magnitude of variations is similar when measurements are made by either single or different ultrasonographers, and were similar for right and left heel pad thickness measurements. Between scan measurements demonstrated a coefficient of variation of 3.2%. CONCLUSION: Weightbearing heel pad thickness measurements by ultrasound using a standardised technique in normal adult feet are reasonably reliable. RELEVANCE: Heel pad thickness can be measured reliably. Heel pad thickness may be an important predictor in the cause of ulceration in diabetics, and a potential risk factor in plantar pain affecting athletes. Further work assessing the heel pad in pathological conditions and athletes merits further study.

Effect of subject position on the reliability of measurement of active ankle joint dorsiflexion

Abstract The aim of this study was to compare the intratester reliability of goniometry for measurements of active ankle joint dorsiflexion (AJDF) using three subject positions. These positions were supine, prone (knee extended) and sitting (knee flexed). Twenty-six healthy subjects (mean age 42.3 years) were measured on two separate occasions (mean interval 7.85 days). The prone position produced the lowest measurements (mean 6.5°, SD 4.6°) and the sitting position produced the greatest measurements (mean 11.7°, SD 6.0°). An ANOVA two-factor within subjects was undertaken to test the hypothesis that there was no significant difference in the reliability of the three positions to measure AJDF ( P A post hoc test concluded that there were significant differences between prone and sitting ( P P

A short-term study of shock-attenuation in different sock types

A study was undertaken to demonstrate whether there was a significant difference in shock attenuating effect between different sock types and barefoot walking over a period of 72 h. Five different sock types were tested: cotton socks, wool cushion sole sports socks, acrylic cushion sole hiking socks, double layer cotton socks and towelling cushion sole sports socks. A treadmill and shockmeter were used for the trials and the same subject participated throughout the study. The results demonstrated that the wool cushion sole sports sock and the acrylic cushion sole hiking sock demonstrated a significantly increased shock attenuation (P < 0.05, 95% confidence interval) compared to barefoot walking. The cotton sock, double layer cotton sock and towelling cushion sole sock did not demonstrate a significant difference in shock attenuation. Limited research has been undertaken to investigate the shock attenuating effects of socks. The authors believe that the recent developments in sock production and technology merits further research.

Reliability of walking speed in podiatric patients

Abstract The walking speed of 44 podiatry patients, divided by gender and stratified by age (60–69 and 70+ years), was measured on two occasions, 7 days apart. Infra-red thermal detectors with electronic stop-watches were placed at either end of a 14-m walkway. All subjects wore specially designed cold heat packs to detect heat. They walked along a carpeted walkway at the self-selected speeds of free, slow and fast, wearing a pair of their own shoes. No significant difference in walking speed from one week to the next was found in any of the age groups, except in the 60- to 69-year-old males at free speed (P