Ankle Characteristics Research Articles

Foot and Ankle Characteristics of Children with an Idiopathic Toe-Walking Gait

Idiopathic toe-walking (ITW) in children has been associated with ankle equinus. Although equinus has been linked to foot deformity in adults, there has been limited investigation of the impact of equinus on structural foot change in children. We used the weightbearing lunge test and the six-item version of the Foot Posture Index (FPI-6) to evaluate the weightbearing foot and ankle measures of children with an ITW gait and to compare these with their age-matched peers. Sixty 4-to 6-year-old children were grouped into ITW (n = 30) and non-toe-walking (n = 30) cohorts using a validated ITW tool. Ankle range of motion was determined with weightbearing lunge tests. The FPI-6 was calculated during weightbearing stance. There was a highly significant difference in the weightbearing lunge test measures between the ITW cohort and the non-toe-walking cohort. The FPI-6 comparison was not significant. The straight-leg lunge test had a statistically significant relationship with the FPI-6 in the ITW cohort. Children with an ITW gait demonstrated reduced flexibility at the ankle joint but similar weightbearing foot posture compared with non-toe-walking children, showing that for children 4 to 8 years old, an ITW gait affects the available ankle dorsiflexion but seems to have a limited effect on weightbearing foot posture as measured by the FPI-6.

Correlation between Foot and Ankle Characteristics with Functional Abilities and Balance among South Indian Geriatrics

Objective: The aim of the study was to find the correlation between foot and ankle characteristics with functional abilities and balance among south Indian geriatrics. Methodology: Sixty elderly people residing in an old age home were taken for test of Foot & Ankle characteristics, Balance and functional ability. Foot & Ankle characteristics were tested across five domains: Foot posture was tested by foot posture index, ankle flexibility was measured by modified version of Lunge test, foot deformity was tested by the grading exercised by the photographs, foot strength was measured by Paper grip test and foot sensation was tested by Semmens- weinsten aesthesiometer.. Balance and Functional ability were tested by standing balance test, sit to stand , 8foot and go test and walking speed. Results: The correlation value between Foot posture with standing balance test, sit to stand test, 8-foot up and go test, gait speed are -0.027, -0.097, 0.048, 0.05 respectively.The correlation value between Ankle flexibility with Standing balance test, Sit to stand test, 8-foot up and go test, Gait speed are -0.023, -0.134, -0.169, -0.261 respectively. The correlation value between Hallux valgus deformity (HVD)with Standing balance test, Sit to stand test, 8-foot up and go test, Gait speed are -0.153, 0.011, -0.075, -0.099 respectively.The correlation value between Paper grip test1 (PGT1)with Standing balance test, Sit to stand test, 8-foot up and go test, Gait speed are 0.735, -0.367, 1.374, 1.133 respectively.The correlation value between Foot sensation(FS) with Standing balance test, Sit to stand test, 8-foot up and go test, Gait speed are -0.007, 0.052, -0.272, -0.206 respectively. Conclusion: This study proves that Foot and Ankle characteristics strongly correlate with the Balance and Functional ability in geriatric population.

The foot and ankle characteristics in children with idiopathic toe walking gait

Background Idiopathic toe walking (ITW) has been associated with ankle equinus, and while equinus has been linked with foot deformity in adults, there has been limited investigation on its impact on structural foot change in children. This study used the weight bearing lunge (WBL) test and Foot Posture Index-6 (FPI-6) to evaluate the foot and ankle measures of children with an ITW gait. Methods Sixty children between the ages of four and eight years were grouped into an ITW (N=30) and a non-toe walking (NTW) (N=30) cohort. The ankle range of movement and FPI-6 was calculated during appropriate weight–bearing test and stance. Results There was ah ighly significant difference in the WBL test measures between the ITW cohort and the NTW cohort. The FPI-6 comparison was not significant. The WBL test was also not predictive of an abnormal FPI-6 in the ITW cohort. Conclusion These results demonstrate that ITW gait style impacts only on the available dorsiflexion at the ankle. The WBL measure may be utilised within the clinical setting to guide and monitor treatment interventions.

Consequences of Pediatric Obesity on the Foot and Ankle Complex

Anthropometric status can influence gait biomechanics, but there is relatively little published research regarding foot and ankle characteristics in the obese pediatric population. We sought to compare the structural and functional characteristics of the foot and ankle complex in obese and non-obese children. Twenty healthy children (ten obese and ten normal weight) were recruited for a cross-sectional research study. Anthropometric parameters were measured to evaluate active ankle dorsiflexion, arch height (arch height index, arch rigidity index ratio, and arch drop), foot alignment (resting calcaneal stance position and forefoot-rearfoot alignment in unloaded and loaded positions), and foot type (malleolar valgus index). Independent t tests determined significant differences between groups for all assessed parameters. Statistical significance was set at P < .0125. Compared with non-obese participants, obese participants had significantly greater arch drop (mean ± SD: 5.10 ± 2.13 mm versus 2.90 ± 1.20 mm; P =.011) and a trend toward lower arch rigidity index ratios (mean ± SD: 0.92 ± 0.03 versus 0.95 ± 0.02; P = .013). In addition, obese participants had significantly less active ankle dorsiflexion at 90° of knee flexion versus non-obese participants (mean ± SD: 19.57 ± 5.17 versus 29.07 ± 3.06; P < .001). No significant differences existed between groups for any other anthropometric measurements. The decreased active ankle dorsiflexion in the obese group can increase foot contact for a longer period of the stance phase of gait. Obese participants also presented with a more flexible foot when bearing weight.

Foot and ankle characteristics of children with an idiopathic toe walking gait

Background: Idiopathic toe-walking (ITW) in children has been associated with ankle equinus. Although equinus has been linked to foot deformity in adults, there has been limited investigation of the impact of equinus on structural foot change in children. We used the weightbearing lunge test and the six-item version of the Foot Posture Index (FPI-6) to evaluate the weightbearing foot and ankle measures of children with an ITW gait and to compare these with their age-matched peers. Methods: Sixty 4-to 6-year-old children were grouped into ITW (n = 30) and non–toe-walking (n = 30) cohorts using a validated ITW tool. Ankle range of motion was determined with weightbearing lunge tests. The FPI-6 was calculated during weightbearing stance. Results: There was a highly significant difference in the weightbearing lunge test measures between the ITW cohort and the non–toe-walking cohort. The FPI-6 comparison was not significant. The straight-leg lunge test had a statistically significant relationship with the FPI-...

Clinical Predictors of Foot Orthoses Efficacy in Individuals with Patellofemoral Pain

There is emerging evidence that foot orthoses are effective in the management of patellofemoral pain syndrome (PFPS). However, the identification of those most likely to benefit from foot orthoses has not been adequately explored. The aim of this study was to develop a preliminary clinical prediction rule to help identify individuals with PFPS who are most likely to benefit from foot orthoses. A total of 60 individuals with PFPS were issued with noncustomized prefabricated foot orthoses containing built-in arch supports and 4° rear foot varus wedging. Patient-reported level of improvement was documented at 12 wk. Potential baseline predictor variables of interest included patient demographics, pain characteristics, footwear motion control properties, foot and ankle characteristics, and functional performance measures. Fourteen (25%) participants reported marked improvement at 12 wk. The number of participants with marked improvement increased to 78% if three of the following four criteria were met: footwear motion control properties score of <5.0 (indicative of less supportive footwear), usual pain <22.0 mm, ankle dorsiflexion range of motion (knee flexed) <41°, and reduced single-leg squat pain when wearing the orthoses. Individuals with PFPS who wear less supportive footwear, report lower levels of pain, exhibit less ankle dorsiflexion range of motion, and report an immediate reduction in pain with foot orthoses when performing a single-leg squat are more likely to benefit from foot orthoses.

Foot and Ankle Strength, Range of Motion, Posture, and Deformity Are Associated With Balance and Functional Ability in Older Adults

Spink MJ, Fotoohabadi MR, Wee E, Hill KD, Lord SR, Menz HB. Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults. Objective To determine the extent to which measures of foot and ankle strength, range of motion, posture, and deformity are associated with performance in a battery of balance and functional ability tests in older adults. Design Cross-sectional study of people over 65 years. Setting Community. Participants Participants (N=305; age range, 65–93y) recruited for a randomized trial investigating the efficacy of a podiatry intervention to prevent falls. Interventions Not applicable. Main Outcome Measures Clinical measures of foot and ankle strength (using hand-held dynamometry), range of motion, posture, and deformity, and a battery of balance tests (postural sway, maximum balance range, lateral stability, coordinated stability) and functional ability tests (alternate step test, sit-to-stand, timed 6-m walk). Results Most (67/88) of the correlations between the foot and ankle tests and performance on the balance and functional tests were statistically significant. Hierarchic linear regression analysis identified hallux plantar flexion strength and ankle inversion-eversion range of motion to be the most consistent significant and independent predictors of balance and functional test performance, explaining up to 25% of the variance in the test scores. Conclusions Foot and ankle characteristics, particularly plantar flexor strength of the hallux and ankle inversion-eversion range of motion, are important determinants of balance and functional ability in older people. Further research is required to establish whether intervention programs that include strengthening and stretching exercises for the foot and ankle may achieve improvements in balance and functional ability and reduce the risk of falls in older people.

Foot and Ankle Characteristics in Patellofemoral Pain Syndrome: A Case Control and Reliability Study

Case-control and reliability study. To compare foot and ankle characteristics between individuals with and without patellofemoral pain syndrome (PFPS) and to identify reliable weight-bearing foot and ankle measurements for use in future research on PFPS. PFPS is a common presentation to sports medicine and orthopaedic clinics. Characteristics of the foot and ankle are often linked with PFPS development, although evidence to support this link is equivocal and there is a lack of consensus on how best to evaluate these characteristics. A variety of weight-bearing foot and ankle measurements were evaluated by 3 raters of varying experience in 20 individuals with PFPS and 20 controls matched by age, sex, height, and body mass. Between-group comparisons were made for each measurement using data from an experienced podiatrist blinded to group assignment of the participants. Intrarater and interrater reliability was compared between all measurements using the first 15 participants from each group. Between-group comparisons showed that the individuals in the PFPS group had a more pronated foot posture when assessed by the foot posture index and longitudinal arch angle, and for all measurements relative to subtalar joint neutral. Foot posture index, normalized navicular drop, and calcaneal angle relative to subtalar joint neutral measurements also possessed high reliability in both groups when used by experienced raters. Reliability was not influenced by rater experience or the presence of PFPS for relaxed-stance foot posture measurements. Both tester inexperience and the presence of PFPS reduced reliability for all measurements of foot posture relative to subtalar joint neutral and measurement of weight-bearing ankle dorsiflexion. The foot posture index, normalized navicular drop, and calcaneal angle relative to subtalar joint neutral are all reliable and sensitive to group differences when used in a population with PFPS. Individuals with PFPS possess a more pronated foot posture and increased foot mobility compared to controls. Prospective evaluation of these measurements is now required to determine whether they contribute to the development of PFPS. J Orthop Sports Phys Ther 2010;40(5):286-296, Epub 12 April 2010. doi:10.2519/jospt.2010.3227.

Foot and Ankle Risk Factors for Falls in Older People: A Prospective Study

Foot problems are common in older people and are associated with impaired balance and functional ability. Few prospective studies, however, have been undertaken to determine whether foot problems are a risk factor for falls. One hundred seventy-six people (56 men and 120 women, mean age 80.1, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity) and physiological falls risk factors (including vision, sensation, strength, reaction time, and balance) and were followed for 12 months to determine the incidence of falls. Seventy-one participants (41%) reported falling during the follow-up period. Compared to those who did not fall, fallers exhibited decreased ankle flexibility, more severe hallux valgus deformity, decreased plantar tactile sensitivity, and decreased toe plantarflexor strength; they were also more likely to have disabling foot pain. Discriminant function analysis revealed that decreased toe plantarflexor strength and disabling foot pain were significantly and independently associated with falls after accounting for physiological falls risk factors and age. Foot and ankle problems increase the risk of falls in older people. Interventions to address these factors may hold some promise as a falls prevention strategy.

Foot and Ankle Characteristics Associated With Impaired Balance and Functional Ability in Older People

Ageing is associated with changes to the structure and function of the foot and ankle, and there is preliminary evidence that foot problems impair balance and increase the risk of falls. To explore this in more detail, we conducted a study to determine the relative contribution of several foot and ankle characteristics to performance on a range of balance and functional tests. One hundred seventy-six people (56 men and 120 women, mean age 80.1 years, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity), sensorimotor function (including vision, sensation, strength, and reaction time), and balance and functional ability (including tests of standing balance, leaning balance, stepping, sit-to-stand, and walking speed). Many foot and ankle characteristics and sensorimotor measures were associated with performance on the balance and functional tests in univariate analyses. Multiple regression analysis consistently revealed that ankle flexibility, plantar tactile sensitivity, and toe plantarflexor strength were significant and independent predictors of balance and functional test performance, explaining up to 59% of the variance in these test scores. Foot and ankle characteristics, particularly ankle flexibility, plantar tactile sensation, and strength of toe plantarflexor muscles, are significant independent predictors of balance and functional ability in older people. Programs to improve the strength and flexibility of the foot and interventions to augment plantar sensation may be beneficial in improving mobility and reducing the risk of falls.

Clinical determinants of plantar forces and pressures during walking in older people

The aim of this study was to determine the extent to which clinical tests of structural characteristics of the foot and ankle could account for variation in the magnitude of regional forces and pressures under the foot during walking in older people. Plantar forces and pressures were obtained from 172 older people (53 men, 119 women) aged 62-96 years (mean 80.0, S.D. 6.4) using a floor-mounted resistive sensor mat system. Subjects also completed tests of foot posture, range of motion, strength, sensation and toe deformity. Multiple regression analysis was then used to determine which clinical variables were most strongly correlated with plantar forces and pressures. Maximum forces and peak pressures under most regions of the foot were largely explained by differences in bodyweight, with some important exceptions. Loading under the midfoot was associated with the arch index, loading under the first metatarsophalangeal joint (1st MPJ) was associated with 1st MPJ range of motion, and loading under the hallux was associated with hallux plantarflexor strength, 1st MPJ range of motion and the degree of hallux valgus deformity. Clinical measurements accounted for 13-53% of the variance in maximum force and 4-40% of the variance in peak pressures. These findings indicate that structural foot and ankle characteristics identified from clinical measurements can explain some key aspects of plantar loading patterns of the foot. This information provides further insights into the dynamic function of the foot, which might assist in the development of interventions for pressure-related foot complaints in older people.

13.20 Do foot and ankle characteristics predict peak plantar forces and pressures during level walking in older adults?

13.20 Do foot and ankle characteristics predict peak plantar forces and pressures during level walking in older adults?

18.17 Foot and ankle characteristics associated with impairedbalance and functional ability in older people

18.17 Foot and ankle characteristics associated with impairedbalance and functional ability in older people

Reliability of clinical tests of foot and ankle characteristics in older people.

Lower-extremity problems are common in older people; however, the reliability of clinical tools used to assess foot and ankle characteristics has not been rigorously evaluated. This study evaluated the test-retest reliability of a battery of simple clinical tests of foot and ankle characteristics (tactile sensitivity of the first metatarsophalangeal joint, navicular height, foot length and width, hallux valgus severity, an overall foot problem score, ankle flexibility, ankle dorsiflexion strength, and foot pain) in 31 individuals (13 men and 18 women) aged 76 to 87 years recruited from the community. Three examiners performed the tests on two occasions approximately 2 weeks apart. Intraclass correlation coefficients and coefficients of variation were calculated for continuously scored tests, and the kappa statistic (kappa) was used to determine the reliability of hallux valgus severity grading. All of the continuously scored tests had acceptable reliability (intraclass correlation coefficients of 0.64 to 0.98; coefficients of variation of 0.6% to 15.0%), as did hallux valgus severity grading (kappa = 0.77; absolute percentage agreement, 84%). These simple clinical tests can now be used with confidence in clinical and research settings to provide reliable and functionally important information regarding foot and ankle characteristics in older people.

Microcirculation in venous disorders: the role of the white blood cells.

The haemodynamic hallmark of chronic venous disease in the legs is raised ambulatory venous pressure. This is probably the principal cause of both the symptoms of long-standing varicose veins and the trophic changes round the ankle characteristics of chronic venous insufficiency, presumably by an effect on the microcirculation. The microcirculatory consequences of raised venous pressure include morphological changes, as well as functional abnormalities ranging from haemorheological changes, increased capillary permeability and abnormalities of fibrinogen metabolism to trapping of white blood cells in the dependent legs. This last is now known to be accompanied by sequestration of platelets, which is irreversible. It is postulated that leucocyte activation releases cytokines, leucocyte-derived oxygen free radicals, proteolytic enzymes and platelet activating factor. It has been shown that external compression not only relieves stasis but also decreases white cell trapping. A strategy for management of the complications of venous disease should therefore be aimed at treatment of both the macrocirculatory haemodynamic defect and the microcirculatory abnormalities. The latter is an ideal target for systemic pharmacotherapy.