Abstract
BackgroundThe aim of this study was to determine the level of agreement between common clinical foot classification measures.MethodsStatic foot assessment was undertaken using the Foot Posture Index (FPI-6), rearfoot angle (RFA), medial longitudinal arch angle (MLAA) and navicular drop (ND) in 30 participants (29 ± 6 years, 1.72 ± 0.08 m, 75 ± 18 kg). The right foot was measured on two occasions by one rater within the same test environment. Agreement between the test sessions was initially determined for each measure using the Weighted Kappa. Agreement between the measures was determined using Fleiss Kappa.ResultsFoot classification across the two test occasions was almost perfect for MLAA (Kw = .92) and FPI-6 (Kw = .92), moderate for RFA (Kw = .60) and fair for ND (Kw = .40) for comparison within the measures. Overall agreement between the measures for foot classification was moderate (Kf = .58).ConclusionThe findings reported in this study highlight discrepancies between the chosen foot classification measures. The FPI-6 was a reliable multi-planar measure whereas navicular drop emerged as an unreliable measure with only fair agreement across test sessions. The use of this measure for foot assessment is discouraged. The lack of strong consensus between measures for foot classification underpins the need for a consensus on appropriate clinical measures of foot structure.
Highlights
The aim of this study was to determine the level of agreement between common clinical foot classification measures
The level of agreement for foot classification based on each measure across the two test sessions was almost perfect for the Foot Posture Index (FPI-6) (Kw = .92) and medial longitudinal arch angle (MLAA) (Kw = .92), moderate for the rearfoot angle (RFA) (Kw = .6) and fair for navicular drop (ND) (Kw = .4) (Table 1)
FPI-6 = foot posture index, RFA = rearfoot angle, MLAA = medial longitudinal arch angle, ND = navicular drop, Kf = Fleiss Kappa statistic intricacies with navicular tuberosity and sub-talar joint palpation are factors which pose challenges and, as an independent measure, the findings from this study suggest that patients may be misclassified with this measurement and as such the purpose of the measure is challenged
Summary
The aim of this study was to determine the level of agreement between common clinical foot classification measures. Static foot assessment is a common approach in clinical practice for classifying foot type with a view to identifying possible aetiological factors relating to injury and prescribing therapeutic interventions [1, 2] This approach is underpinned by a contextual model of the foot whereby structural alignment, or position of the foot, is used to infer characteristics of dynamic foot function, and theoretically establish injury mechanisms leading to pathology [3,4,5]. Significant correlations were reported between Arch Index and navicular drift during single leg stance (r = .43, p = .029) These studies have all included footprint based tools and the majority have included radiographic measures. Information of this kind may in turn help to develop a more standardised approach to static foot classification
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