Alternative techniques for the clinical assessment of foot pronation.

Clinical measurement is a fundamental component of podiatric biomechanics. However, recent research has seriously questioned the reliability and validity of the commonly used approaches to clinical measurement of foot posture. A reevaluation of foot-morphology measurement is therefore warranted. This article discusses alternative clinical techniques of measuring foot type reported in the literature (arch height, footprint indices, the valgus index, and navicular drop) that may prove to be superior to the commonly used podiatric measurement system. On the basis of a critical evaluation of the literature, it would appear that arch height and footprint indices are invalid as means of categorizing foot morphology, while the valgus index and navicular drop offer a number of benefits over traditional frontal-plane measurements. An additional clinical measurement suggested by the author, navicular "drift," is also introduced. The advantages, disadvantages, and clinical application of each of these approaches are discussed in detail.

[1]  B. Maslen,et al.  Radiographic study of skin displacement errors in the foot and ankle during standing. , 1994, Clinical biomechanics.

[2]  R. Donatelli,et al.  Biomechanical foot orthotics: a retrospective study. , 1988, The Journal of orthopaedic and sports physical therapy.

[3]  Functional foot orthoses for athletic injuries. A retrospective study. , 1985 .

[4]  E. Welton.  The Harris and Beath Footprint: Interpretation and Clinical Value , 1992, Foot & ankle.

[5]  M. J. Muêller,et al.  Navicular drop as a composite measure of excessive pronation. , 1993, Journal of the American Podiatric Medical Association.

[6]  R. Harris,et al.  The short first metatarsal; its incidence and clinical significance. , 1949, The Journal of bone and joint surgery. American volume.

[7]  E. Kreighbaum,et al.  Analysis of selected alignment of the lower extremity related to the shin splint syndrome. , 1979, Journal of the American Podiatry Association.

[8]  B. Joseph,et al.  The influence of footwear on the prevalence of flat foot. A survey of 1846 skeletally mature persons. , 1995, The Journal of bone and joint surgery. British volume.

[9]  P. Cavanagh,et al.  The arch index: a useful measure from footprints. , 1987, Journal of biomechanics.

[10]  Benno M. Nigg,et al.  Footprint Parameters as a Measure of Arch Height , 1992, Foot & ankle.

[11]  D A Nawoczenski,et al.  Measurement of the medial longitudinal arch. , 1995, Archives of physical medicine and rehabilitation.

[12]  D. J. Morton,et al.  Structural factors in static disorders of the foot , 1930 .

[13]  T G McPoil,et al.  Evaluation and management of foot and ankle disorders: present problems and future directions. , 1995, The Journal of orthopaedic and sports physical therapy.

[14]  A. Belli,et al.  Relationship between rearfoot and forefoot orientation and ground reaction forces during running. , 1996, Medicine and science in sports and exercise.

[15]  H. Hlavac.  Differences in x-ray findings with varied positioning of the foot. , 1967, Journal of the American Podiatry Association.

[16]  T. Worrell,et al.  Reliability of open and closed kinetic chain subtalar joint neutral positions and navicular drop test. , 1993, The Journal of orthopaedic and sports physical therapy.

[17]  B. Nigg,et al.  Effects of arch height of the foot on ground reaction forces in running. , 1992, Medicine and science in sports and exercise.

[18]  Michael J. Mueller,et al.  Reliability of a diabetic foot evaluation. , 1989, Physical therapy.

[19]  Hicks Jh.  The mechanics of the foot: II. The plantar aponeurosis and the arch , 1954 .

[20]  V. Kalen,et al.  Relationship Between Adolescent Bunions and Flatfeet , 1988, Foot & ankle.

[21]  R. Betts,et al.  The relationships between footprints, foot pressure distributions, rearfoot motion and foot function in runners , 1992 .

[22]  B. Nigg,et al.  Effects of arch height of the foot on angular motion of the lower extremities in running. , 1993, Journal of biomechanics.

[23]  M. L. Root,et al.  Normal and abnormal function of the foot , 1977 .

[24]  J. H. Hicks.  The mechanics of the foot. IV. The action of muscles on the foot in standing. , 1956, Acta anatomica.

[25]  David W. Polly,et al.  Consistency of Visual Assessments of Arch Height among Clinicians* , 1994, Foot & ankle international.

[26]  H J Hillstrom,et al.  Foot type biomechanics. comparison of planus and rectus foot types. , 1996, Journal of the American Podiatric Medical Association.

[27]  J. Hamill,et al.  Relationship between selected static an dynamic lower extremity measures , 1989 .

[28]  J. M. Rothstein.  Measurement in physical therapy , 1985 .

[29]  Leslie W. Irwin,et al.  A Study of the Tendency of School Children to Develop Flat-Footedness , 1937 .

[30]  J. M. Rothstein,et al.  Goniometric reliability in a clinical setting. Subtalar and ankle joint measurements. , 1988, Physical therapy.

[31]  Orthotic survey. Preliminary results. , 1993, Journal of the American Podiatric Medical Association.

[32]  R. Benink.  The constraint-mechanism of the human tarsus. A roentgenological experimental study. , 1985, Acta orthopaedica Scandinavica. Supplementum.

[33]  J A Coplan,et al.  Rotational motion of the knee: a comparison of normal and pronating subjects. , 1989, The Journal of orthopaedic and sports physical therapy.

[34]  M I Root,et al.  Biomechanical examination of the foot. , 1973, Journal of the American Podiatry Association.

[35]  R. F. Ker,et al.  The spring in the arch of the human foot , 1987, Nature.

[36]  C. Denegar,et al.  Risk factors for anterior cruciate ligament injury in high school and college athletes. , 1994, Journal of athletic training.

[37]  H. Menz,et al.  The measurement of gait parameters from footprints , 1995 .

[38]  Matthew J Young,et al.  Arch index as a predictor of arch height , 1997 .

[39]  A. Delitto,et al.  Visual assessment of foot type and relationship of foot type to lower extremity injury. , 1991, The Journal of orthopaedic and sports physical therapy.

[40]  Hylton B. Menz,et al.  Clinical hindfoot measurement: a critical review of the literature , 1995 .

[41]  T G McPoil,et al.  Relationship between three static angles of the rearfoot and the pattern of rearfoot motion during walking. , 1996, The Journal of orthopaedic and sports physical therapy.

[42]  O. Svensson,et al.  Kinematics of the Ankle/Foot Complex—Part 2: Pronation and Supination , 1989, Foot & ankle.

[43]  M Aström,et al.  Alignment and joint motion in the normal foot. , 1995, The Journal of orthopaedic and sports physical therapy.

[44]  Colin E. Thomson,et al.  An investigation into the reliability of the valgus index and its validity as a clinical measurement , 1994 .

[45]  Hylton B. Menz,et al.  Measurement of gait parameters from footprints: a reliability study , 1997 .

[46]  B. A. Harris,et al.  Interrater reliability of subtalar neutral, calcaneal inversion and eversion. , 1990, The Journal of orthopaedic and sports physical therapy.

[47]  Bowers Kd,et al.  Incidence of Hyperpronation in the ACL Injured Knee: A Clinical Perspective. , 1992 .

[48]  Thomas W Kernozek,et al.  Foot placement angle and arch type: effect on rearfoot motion. , 1990, Archives of physical medicine and rehabilitation.

[49]  J. Hiss,et al.  Functional foot disorders , 1949 .

[50]  The K-square: a new biomechanical measuring device for the foot and ankle. , 1979 .

[51]  Brody Dm,et al.  Techniques in the evaluation and treatment of the injured runner. , 1982 .

[52]  T. Worrell,et al.  Two measurement techniques for assessing subtalar joint position: a reliability study. , 1994, The Journal of orthopaedic and sports physical therapy.

[53]  W. Wallace,et al.  The Significance of Pes Planus in Juvenile Hallux Valgus , 1992, Foot & ankle.