Rolf Scharfbillig

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.

Sever's Disease: What Does the Literature Really Tell Us?

BACKGROUND Severs disease is typical of many musculoskeletal conditions where observational annotations have slowly been accepted as fact with the passing of years. Acceptance of these nontested observations means that health professionals seeking information on this condition access very low-level evidence, mainly being respectable opinion or poorly conducted retrospective case series. METHODS A comprehensive review of the literature was undertaken gathering available articles and book references relating to Severs disease. This information was then reviewed to present what is actually known about this condition. RESULTS Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition. CONCLUSION The level of evidence for most of what we purport to know about Severs disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment.

Sever’s disease—Does it effect quality of life?

BACKGROUND Severs disease is a condition which has been described inconsistently in the literature with respect to pathology, aetiology and management. In particular, the impact of this condition has been overlooked, probably because it is usually self-limiting. METHOD This study used a prospective comparative design study to determine the impact of Severs disease on the quality of life of its sufferers. RESULTS Three scales--Happiness, Satisfaction with symptoms and Pain/comfort scale--from the POSNA musculoskeletal questionnaire showed significant differences between the symptomatic and control groups. CONCLUSION Although the condition may resolve with time, these results show that it has a considerable impact on childrens lives.

Measurement of foot dorsiflexion: a modified Lidcombe template.

The Lidcombe template was introduced in 1991 for the nonweightbearing assessment of ankle joint dorsiflexion, and it has shown excellent reliability in impaired and unimpaired adult populations. We discuss limitations of the original template and test the reliability of a modified apparatus in an adolescent population. Intrarater and interrater reliability were assessed for 14 children (28 limbs) aged 7 to 14 years, returning intraclass correlation coefficient (1,1) results of greater than 0.99 for both aspects of reliability.

Sever's disease: a prospective study of risk factors.

BACKGROUND Severs disease, also known as calcaneal apophysitis, is thought to be an inflammation of the apophysis of the heel, which is open in childhood. This condition has been commented on and looked at in a retrospective manner but has not been examined systematically. We assembled the most commonly cited theoretical causative models identified from the literature and tested them to determine whether any were risk factors. METHODS Children with Severs disease were compared with a similarly aged nonsymptomatic population to determine whether identifiable risk factors exist for the onset of Severs disease. Areas raised in the literature and, hence, compared were biomechanical foot malalignment, as measured by Root et al-type foot measurements and the Foot Posture Index; ankle joint dorsiflexion, measured with a modified apparatus; body mass index; and total activity and types of sport played. RESULTS Statistically significant but small odds ratios were found in forefoot to rearfoot determination and left ankle joint dorsiflexion. CONCLUSIONS This study suggests that there is no evidence to support that weight and activity levels are risk factors for Severs disease. The statistically significant but clinically negligible odds ratio (0.93) on the left side for decreased ankle joint dorsiflexion and statistically significant and clinically stronger odds ratio bilaterally for forefoot to rearfoot malalignment suggest that biomechanical malalignment is an area for further investigation.

The typically developing paediatric foot: how flat should it be? A systematic review

BackgroundAll typically developing children are born with flexible flat feet, progressively developing a medial longitudinal arch during the first decade of their lives. Whilst the child’s foot is expected to be flat, there is currently no consensus as to how flat this foot should be. Furthermore, whilst feet are observed to decrease in flatness with increasing age, it is not known how flat they should be at each age increment. The objective of this systematic review is to define the postural characteristics of the ‘typically’ developing paediatric foot.MethodsThe PRISMA protocol was applied to compare all data currently published describing the typical development of the paediatric foot. The Epidemiological Appraisal Instrument (EAI) was used to assess the risk of bias of the included studies.ResultsThirty four epidemiological papers pertaining to the development of the paediatric foot were graphically compared. Sixteen different foot posture assessments were identified of which footprint based measures were the most reported outcome.ConclusionFirstly, the use of the term normal in relation to foot posture is misleading in the categorisation of the paediatric foot, as indeed a flat foot posture is a normal finding at specific ages. Secondly, the foot posture of the developing child is indeed age dependent and has been shown to change over time. Thirdly, no firm conclusion could be reached as to which age the foot posture of children ceases to develop further, as no two foot measures are comparable, therefore future research needs to consider the development of consensus recommendations as to the measurement of the paediatric foot, using valid and reliable assessment tools.

Moisturisers for the treatment of foot xerosis: a systematic review

BackgroundXerosis, literally dryness of the skin, of the foot is a common condition encountered clinically, which can lead to discomfort and predisposition to infection. Currently, there are no evidence-based recommendations on which moisturiser formulations best alleviate xerotic symptoms. The aim of this review was to guide clinical practice in the treatment of primary and diabetes related foot xerosis, by identifying from the existing literature the most effective ingredient or formulation of topical treatments for symptoms of primary foot xerosis in the general population.MethodsA systematic review of published experimental trials was undertaken. Only studies pertaining to primary xerosis, classified within levels II – IV of the NHRMC hierarchy were reviewed. EMBASE, AMED, Cochrane, MEDLINE, CINAHL, Ageline and SCOPUS were searched using relevant search terms and keywords and pearling of reference lists was undertaken. Studies were evaluated for methodological quality using a critical appraisal tool. Individual active ingredients were identified from all studies, along with observed reported outcomes. A narrative synthesis was then conducted.ResultsA total of 22 experimental studies were included, from which 12 different active ingredients were identified. Study literature consisted of mainly comparative studies against other active interventions or controls, or pre-post-tests and was of a poor-to-moderate methodological quality as assessed by the Epidemiological Appraisal Instrument. Urea was the most researched active ingredient (14 studies), with ammonium lactate being next (7 studies).ConclusionsNo conclusive recommendations were possible due to wide variation in study quality, methodologies and outcome measures. A synthesis of available literature suggests that treatments containing urea as a primary active ingredient have been the most researched. The poor quality of literature generally, however, precludes recommendation of any active ingredient over another.

The effect of footwear and foot orthoses on transverse plane knee motion during running – A pilot study

OBJECTIVES This study aimed to determine the immediate effects of footwear and foot orthoses on transverse plane rotation of the knee joint during the stance phase of jogging gait. DESIGN An experimental, within subjects, repeated measures design. METHODS Three-dimensional knee kinematics were estimated in the transverse plane by surface-mounted markers as 14 asymptomatic participants ran in four randomised conditions; neutral shoe, neutral shoe with customised orthoses, neutral shoe with prefabricated orthoses, and a stability shoe. Peak internal/external rotation joint angles and ranges of motion (ROM) during loading response, midstance and propulsion were determined. Immediate subjective comfort was also recorded for each condition using a 100 mm visual analogue scale. RESULTS Significant main effects of condition were observed for all outcomes except transverse plane knee ROM during loading response (p < 0.05). All significant differences occurred between the stability shoe and another condition, with less knee internal rotation in the stability shoe (mean differences ranged between 1.7° and 6.1°) (p < 0.05). The neutral shoe with prefabricated orthoses was reported as more uncomfortable than all other testing conditions. CONCLUSIONS The stability shoe reduced peak knee internal rotation throughout stance phase of jogging more than any other condition. Importantly, it was subjectively as comfortable as the other conditions. These results identify the ability for footwear alone to induce immediate proximal kinematic effects. The use of the kinematic theory behind foot orthoses therapy is also questioned.

Correlation of a non-weight bearing foot position to the neutral calcaneal stance position in an adult population

It is speculated that as a crucial foot anthropometry, longer instep circumference in OFF group was found as a consequence of the increase of midfoot width. Therefore, small variations in foot morphology must be incorporated to the last design to meet the comfort and functionality requirements of specialized shoe for obese children with flatfoot. The results of the study indicated a greater force–time integral beneath the midfoot region of obese children with flatfoot, which implied a potential higher risk for midfoot injuries than obese children with normal arch foot. We can speculate that collapse of arch structure deteriorates the plantar load condition of obese children with flatfoot during walking. Obese children with flatfoot could be at an increased risk for midfoot injuries such as stress fractures. The significantly decreased pressure–time integral and force–time integral for obese children with flatfoot beneath the fifth metatarsal. These results were in line with the previous literature which indicated that individuals with a flat foot could be at a lower risk for lateral column metatarsal stress fractures (Chuckpaiwong, Nunley, Mall, & Queen, 2008).

Available and proposed foot measures in terms of reliability, validity and applicability on an adult population: a systematic review

For the prescription of foot orthoses that effectively manage malalignment, reliable and accurate measurements are necessary (Elveru et al., 1988). Foot biomechanics currently utilizes a method introduced by Root et al. (1971) of assessing the level of deformity in comparison to an ‘ideal’ position. This position is known as the Neutral Calcaneal Stance Position (NCSP), requiring the subtalar joint (STJ) being in its neutral position. The NCSP is then compared to a Resting Calcaneal Stance Position (RCSP) allowing abnormalities to be determined (Root et al., 1971). Due to the STJ neutral being a subjective, theoretical position, the authors have identified concerns with the reliability and validity of this approach (McPoil & Hunt, 1995; Menz, 1998). Subsequently, alternative and modified techniques have been proposed to improve this approach due to the implications posed on clinical and research practice (Elveru et al., 1988; Evans et al., 2003; Smith-Oricchio & Harris, 1990). Alternative techniques have included the Foot Posture Index (FPI), proposed by Redmond, Crosbie, and Ouvrier (2006), to classify foot type in a resting position. The Navicular Drop Test, proposed by Brody (1982), assesses arch height difference from ‘ideal’ to resting positions, to determine sagittal plane motion. A similar assessment, navicular drift, assesses the transverse motion (Menz, 1998). McPoil et al. (2008, 2009) proposed the foot mobility magnitude (FMM). By assessing dorsal arch height (DAH) and midfoot width (MFW) in a non-weightbearing (NWB) and RCSP position, the vertical and medial– lateral mobility of the midfoot is quantified (McPoil et al. 2008; McPoil et al. 2009). With the numerous techniques of foot assessment accessible to clinicians and researchers within the literature, there is a potential to confront the Root paradigm and provides a reliable and validated alternative. Purpose of the study