Assessment Of Foot Research Articles

Assessment of foot and ankle muscle strength using hand held dynamometry in patients with established rheumatoid arthritis

BackgroundThe foot and ankle are frequently affected in patients with rheumatoid arthritis (RA). One of the negative consequences of RA on the physical function of patients is a decrease in muscle strength. However, little is known about foot and muscle strength in this population. The aim of the study was to evaluate significant differences in foot and ankle muscle strength between patients with established RA against age and sex-matched controls using hand-held dynamometry.MethodsThe maximal muscle strength of ankle plantarflexion, dorsiflexion, eversion and inversion was assessed in 14 patients with RA, mean (SD) disease duration of 22 (14.1) years, and 20 age and sex-matched control participants using hand-held dynamometry.ResultsSignificant differences were observed in muscle strength between the two groups in plantarflexion (p = 0.00), eversion (p = 0.04) and inversion (p = 0.01). No significant difference was found in dorsiflexion (p > 0.05). The patients with RA displayed a significantly lower plantarflexion-dorsiflexion ratio than the control participants (p = 0.03).ConclusionsThe results from this study showed that the RA patients displayed a significant decrease in ankle dorsiflexion, eversion and inversion when compared to the non-RA control group suggesting that foot and ankle muscle strength may be affected by the pathological processes in RA. This study is a preliminary step for the measurement of muscle impairments within the RA population.

Assessment of foot and ankle muscle strength using hand held dynamometry in patients with established rheumatoid arthritis

Assessment of foot and ankle muscle strength using hand held dynamometry in patients with established rheumatoid arthritis

Musculoskeletal conditions of the foot and ankle: Assessments and treatment options

Musculoskeletal conditions of the foot and ankle are an important public health challenge due to their increasing incidence combined with their substantial negative impact on patients' quality of life. Non-pharmacological treatments serve as the first line of treatment and are frequently used for patients with musculoskeletal conditions of the foot and ankle. This review provides a summary of the assessments and non-invasive treatment options based upon available evidence. Recent studies show that individuals with foot and ankle pain have multiple co-existing impairments in alignment, motion, load distribution and muscle performance that may be evident in static and/or dynamic tasks. In addition, both clinical and epidemiological studies support the inter-dependence between the foot and proximal joints. For instance, aberrant foot structure has been linked to foot osteoarthritis (OA), as well as OA and pain at the knee and hip. Most recently, advances in motion capture technology and plantar load distribution measurement offer opportunities for precise dynamic assessments of the foot and ankle. In individuals with musculoskeletal conditions of the foot and ankle, the chief objectives of treatment are to afford pain relief, restore mechanics (alignment, motion and/or load distribution) and return the patient to their desired level of activity participation. Given that most patients present with multiple impairments, combinational therapies that target foot-specific as well as global impairments have shown promising results. In particular, in individuals with rheumatoid arthritis and other rheumatic diseases, comprehensive rehabilitation strategies including early detection, foot-based interventions (such as orthoses) and wellness-based approaches for physical activity and self-management have been successful. While significant improvements have been made in the last decade to the assessment and treatment of foot and ankle conditions, few randomised clinical trials specifically have investigated patients with foot or ankle conditions to provide global insights into this area. Consequently, current recommendations vary based upon the scope of studies presented in this review as well as the strength of studies. This review indicates a need for more in-depth investigations into the components of assessment and treatment options for foot and ankle musculoskeletal conditions.

A new protocol for 3D assessment of foot during gait: Application on patients with equinovarus foot

Background The aim of this study is to assess the clinical value of a recently introduced original protocol for full three dimensional analysis of ankle rotations in patients with equinovarus foot. Methods A preliminary study merging the Total3Dgait protocol and the conventional Vicon® Plug-in-Gait marker-sets on five patients with foot deformity was performed to compare the output exactly over the same gait cycles. In the second study, 15 patients with equinus varus foot were assessed retrospectively by means of the Total3Dgait protocol before and after surgery. Data on ankle kinematics were compared to those of a control group. The Functional Ambulation Categories scale and other goals such as orthosis/aids removal, decrease in foot pain, healing of calluses and sores were considered as measures of clinical outcome. Findings The Total3Dgait protocol provides additional joint motion, in the coronal and transverse planes. Kinematics in the three anatomical planes improved significantly although no changes in time-distance parameters were evident. Improvement in clinical outcome measures was also achieved. Interpretation The new protocol provides valuable additional data in measuring full three dimensional kinematics of the foot during gait. Whereas the speed of walking was unchanged after surgery for most of patients, the kinematic changes in the three anatomical planes, as measured by the new protocol, were the only measures able to demonstrate motion changes induced by surgery at the foot and to explain subject-specific gains as improvement in stability during walking, relief of pain, calluses and sores, and removal or modification of foot orthosis and aids.

Magnetic Resonance Imaging of the Rheumatic Foot According to the RAMRIS System Is Reliable

In rheumatology, magnetic resonance imaging (MRI) is predominantly applied in the assessment and outcome measurement of rheumatoid arthritis (RA) in hands and wrists, leading to the development of the RAMRIS (RA-MRI-Scoring) system. It was initiated by the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT). The RAMRIS system has not been applied widely in the measurement of feet. We investigated the interreader and intrareader agreement of the RAMRIS scoring system in the assessment of feet in RA. Twenty-nine patients with RA who had radiological damage and/or arthritis underwent MRI. Two experienced readers independently read both complete sets. One reader read 6 random sets after the initial session, in order to assess the intrareader agreement. For evaluation of the intrareader and interreader reliability, quadratic-weighted κ scores were calculated per joint and lesion. For the forefeet, interreader scores were excellent, ranging from 0.77 (bone edema) to 0.95 (bone erosion). Hindfoot interreader agreement scores were highest for erosion (0.90) and synovitis global score (0.88), but edema and synovial thickness agreement were also acceptable (0.83 and 0.86). Intrareader scores were on the whole slightly lower, but excellent. Reliability (interreader and intrareader agreement) in the assessment of the rheumatoid foot according to the RAMRIS method is excellent.

Greater peak rearfoot eversion predicts foot orthoses efficacy in individuals with patellofemoral pain syndrome

ObjectiveThere is growing evidence for the provision of foot orthoses when treating individuals with patellofemoral pain syndrome (PFPS), and prescription is frequently based on the assessment of foot posture/function. However,...

Understanding Inconsistent Step-Length Asymmetries Across Hemiplegic Stroke Patients

Background. In hemiplegic gait, step length typically differs in magnitude between paretic and nonparetic sides. However, the direction of step-length asymmetry varies across stroke patients. Objective. The study sought to understand directional variations in step-length asymmetry in terms of asymmetries in forward foot placement relative to the trunk and trunk progression. Methods. A total of 10 hemiplegic stroke patients and 9 healthy elderly controls walked at a self-selected comfortable speed while pelvic and heel marker positions were recorded. Step length, forward foot placement relative to the trunk, and trunk progression of paretic and nonparetic steps were quantified, as well as the asymmetries therein. Results. The 3 asymmetry indices in question varied within individual patients and occasionally fell within control reference ranges, whereas directional variations across stroke patients were observed for asymmetries in step length and forward foot placement only. Despite heterogeneity in asymmetry across patients, step-length asymmetry was determined by the sum of asymmetries in forward foot placement and trunk progression. Asymmetries in trunk progression and forward foot placement were negatively correlated. No significant association was observed between step-length asymmetry and any other asymmetry index. Conclusions. Step-length asymmetry was accounted for by asymmetries in forward foot placement and trunk progression, whereas their relative contribution accounted for directional variations in step-length asymmetry. Partitioning of step-length asymmetry further helped to identify individual impairments and compensatory gait strategies. An encompassing hemiplegic gait evaluation should therefore include an assessment of foot positioning relative to the trunk.

Foot and Ankle Strength Assessment Using Hand-Held Dynamometry: Reliability and Age-Related Differences

Background: Age-related reduction in lower limb muscle strength has been shown to be related to disability, falls and loss of independence. While there have been a number of studies on age-related changes in muscle strength, they have concentrated on more proximal muscle groups with little research into how ageing affects the muscles of the foot and ankle. Objective: To evaluate the intra- and interrater reliability of hand-held dynamometry for the assessment of foot and ankle strength, and to compare the values obtained between young and older people. Methods:The muscle groups which perform ankle dorsiflexion, plantar flexion, inversion, eversion and plantar flexion of the hallux and lesser digits were recorded for 36 young participants (17 males, 19 females, mean age 23.2 ± 4.3 years) and 36 older people (17 males, 19 females, mean age 77.1 ± 5.7 years) using a Citec hand-held dynamometer. Differences in muscle strength between the groups as well as intrarater and interrater reliability of two assessors were determined. Results: The reliability of the hand-held dynamometry procedure was excellent for both intrarater (ICC_3,1 = 0.78–0.94) and interrater (ICC_3,1 = 0.77–0.88) comparisons. There were significant differences between the muscle strength of the young and older participants for all muscle groups tested (p < 0.001) with older participants being weaker than the young participants by a magnitude of between 24 and 37%. Conclusions:Hand-held dynamometry is a reliable instrument to measure the foot and ankle strength of young and older adults. Ageing is associated with a reduction in strength of between 24 and 37% for the muscles responsible for movement of the foot and ankle.

Analysis and assessment of foot posture in children with flat feet

AbstractThe paper presents the methods for foot assessment such as: X‐ray, graphic contour testing, ground reaction force, and pressure distribution. Some of this methods can be used just in static. The platforms with sensors are very good tools in assessment foot posture during human walking. The evaluation was carried on 20 typical subjects and 60 children with foot deformities. GRF parameters, compared to clinical radiographic measurement demonstrated generally a good correlation. The analysis of fround reaction force and pressure distribution represent a strong tool to validate clinical tests and can be used for screening, diagnosis and treatment choice in clinical practice. (© 2009 Wiley‐VCH Verlag GmbH &amp; Co. KGaA, Weinheim)

Physical examination of the foot and ankle by orthopaedic and accident and emergency clinicians

Our aim was to test the knowledge of clinicians in the Orthopaedic clinic and in the Emergency department of the surface anatomical landmarks that should be examined routinely in the assessment of foot and ankle injuries. A survey of 109 clinicians was conducted. Each participant was asked to palpate six important surface landmarks. Two participants failed to identify even a single landmark. Of 109 assessed only 27% correctly identified all six landmarks. The mean number of landmarks correctly identified by each clinician was 4.1 with a standard deviation of 1.5 and range of 0–6. The knowledge of surface anatomy overall by junior Orthopaedic and Emergency clinicians was found to be very poor. Clinicians are becoming more reliant on potentially unnecessary and expensive imaging investigations. They have neglected the basic art of physical examination based on a sound knowledge of human anatomy. At present, the authors believe that the anatomical teaching that should begin in undergraduate medicine is inadequate.

Inter‐rater reliability of the Foot Posture Index (FPI‐6) in the assessment of the paediatric foot

BackgroundReliability is an integral component of clinical assessment and necessary for establishing baseline data, monitoring treatment outcomes and providing robust research findings. In the podiatric literature traditional measures of foot assessment have been shown to be largely unreliable. The Foot Posture Index (FPI-6) is a clinical tool used in the assessment of foot and to date, there is limited research published which evaluates the reliability of this tool in children and adolescents.MethodThirty participants aged 5 - 16 years were recruited for the research. Two raters independently recorded the FPI-6 score for each participant.ResultsAlmost perfect agreement between the two raters was identified following weighted kappa analysis (Kw = 0.86).ConclusionThe FPI-6 is a quick, simple and reliable clinical tool which has demonstrated excellent inter-rater reliability when used in the assessment of the paediatric foot.

Diabetic neuropathy, foot ulceration, peripheral vascular disease and potential risk factors among patients with diabetes in Bahrain: a nationwide primary care diabetes clinic-based study.

BACKGROUNDAlthough epidemiological studies have persistently shown a high prevalence of diabetes in Arabs, the control of diabetes is still poor and complications of diabetes are common. We examined the prevalence of diabetic peripheral neuropathy (DN), neuropathic foot ulceration (FU) and peripheral vascular disease (PVD), and potential risk factors for these complications among patients attending primary care diabetes clinics in Bahrain.PATIENTS AND METHODSWe studied 1477 diabetic patients (Type 2 diabetes 93%); to, including 635 men and 842 women, with ages ranging from 18–75 years in a cross-sectional study. The main predictor variables were demographic and clinical data, including assessment of foot and blood parameters.RESULTSMean age of the patients and duration of diabetes were 57.3±6.32 and 9.5±8.4 years, respectively. DN was present in 36.6% of the population, FU in 5.9%, and PVD in 11.8%. Diabetic patients with neuropathy were older than patients without neuropathy (P=0.001) and had had diabetes longer (P=0.002). Diabetic patients with foot ulcers had more severe neuropathy and higher vibration perception thresholds values than patients without foot ulcers (P<0.05). Older age, poor glycemic control, longer duration of diabetes, elevated cholesterol levels, current smoking, obesity defined by body mass index, large waist circumference, elevated triglycerides levels and hypertension but not gender, were significant risk factors for DN in both the univariate and the multivariate analyses (P< 0.05). DN and PVD also remained significant risk factors for foot ulceration in the multiple logistic regression analysis.CONCLUSIONRates of DN and PVD are high among diabetic patients in Bahrain. Implementation of strategies for prevention, early detection, and appropriate treatment at the primary health care level are urgently needed.

Foot and Ankle Kinematics and Ground Reaction Forces During Ambulation

Assessing patients with foot and ankle disorders by observation of gait is dependent on the examiner's experience and cannot provide information about three-dimensional movement, forces, or motion of segments of the foot. Gait analysis models usually consider the foot as a rigid body and study the foot and ankle as a unit. These models are adequate to describe ankle sagittal plane mechanics but are limited in their ability to provide accurate analysis in the other planes or of segments of the foot. They are, therefore, less effective for objective assessment of foot and ankle disorders than multisegment foot models. We performed gait analysis using foot-specific analysis methods and evaluated kinematics, ground reaction forces, temporal force factors, and time-related gait factors in 20 normal subjects during level walking. Eleven reflective markers were applied to the foot and leg, and ten cameras and force plates were used. Subjects were tested in athletic shoes. A three-segment model was constructed to determine three-dimensional motion in the sagittal, coronal, and transverse planes. This model enabled the determination of calcaneal-tibial (ankle-hindfoot complex) and metatarsal-calcaneal (midfoot) movement in three planes. Ground reaction forces, temporal force factors, cadence, stance time, swing time, and percentage of stance time were determined. These data provide baseline information for assessment of patients with disorders of the ankle and foot.

Foot pain in community-dwelling older people: an evaluation of the Manchester Foot Pain and Disability Index

The objectives of this study were (i) to examine the psychometric properties of the Manchester Foot Pain and Disability Index (MFPDI) in community-dwelling older people, and (ii) to determine the correlates of disabling foot pain in this age-group. A questionnaire consisting of medical history, the MFPDI, the Goldberg Anxiety and Depression Scale (GADS) and the Medical Outcomes Study Short Form 36 (SF-36) was administered to a sample of 301 community-dwelling people (117 men, 184 women) aged between 70 and 95 yr (mean 77.2, s.d. 4.9), who also underwent a clinical assessment of foot problems. Using the MFPDI case definition, 108 people (36%) were found to have disabling foot pain. Within this subgroup, the MFPDI had high internal consistency (Cronbach's alpha=0.89). Principal components analysis revealed a four-factor structure representing the constructs of functional limitation, pain intensity, concern about appearance, and activity restriction, which explained 62% of the variance in the original items. Participants with disabling foot pain were more likely to report pain in the back, hips, knees and hands or wrists, and exhibited flatter feet and less range of motion in the ankle joint. The MFPDI and its subscales were significantly associated with scores on the GADS depression subscale and the general health and mental health components of the SF-36. These findings confirm the high prevalence of disabling foot pain in older people, and suggest that the MFPDI is a suitable tool for assessing foot pain in this population.

Use of a Torque-Range-of-Motion Device for Objective Differentiation of Diabetic from Normal Feet in Adults

The ability of the foot and ankle complex to act as an energy absorber is reflected in its viscoelastic properties. The Torque-Range-of-Motion (TROM) device was designed to provide an effective objective assessment of foot and ankle passive mechanical function. The hypothesis of this study was that mechanical parameters derived from passive TROM curves of otherwise normal feet of adults with diabetes would be significantly different from those of adults without diabetes. The TROM device is a single-degree-of-freedom hinge transducer system that is manually rotated through plantarflexion and dorsiflexion. The device was rotated manually with the muscles relaxed during a 50-second data acquisition period. A strain gauge provided the torque signal and a precision single-turn potentiometer provided plantarflexion-dorsiflexion angle to a two-channel portable data acquisition system. With the TROM device connected to a computer, input for instantaneous torque and range of motion was acquired and displayed as angle (degrees) versus torque (Newton-meters) on an output screen. The period provided sufficient data to average 16 to 20 cycles of motion. The study included 41 feet in adults without diabetes and 42 age-matched feet in adults with diabetes but no known foot problems. For a probability level of.0001 there were significant differences in hysteresis area (normal: 91.1 +/- 46.9 Nm-deg and diabetic: 161.7 +/- 65.7 Nm-deg) and both dorsiflexion (normal: 0.4 +/- 0.1 Nm/deg and diabetic: 0.9 +/- 0.3 Nm/deg) and plantarflexion stiffness (normal: 0.3 +/- 0.1 Nm/deg and diabetic: 0.7 +/- 0.3 Nm/deg). The feet of adults with diabetes absorb more energy during cyclic motion (thus must dissipate more energy per cycle) and are stiffer in the terminal regions (where muscle-tendon-ligament properties prevail) than are the feet of adults without diabetes. These results suggest that this passive TROM method may be a sensitive, objective measurement of the viscoelastic properties of the foot and ankle, which may be an early indicator of diabetic patients who are at risk for the development of foot problems.

Physical assessment of the diabetic foot.

To provide physicians and nurses with an overview of diabetic foot assessment. This continuing-education activity is intended for physicians and nurses with an interest in learning about proper diabetic foot assessment. After reading the article and taking the test, the participant will be able to: 1. Review the epidemiology of diabetes, diabetic foot ulcers, and lower-extremity amputation related to diabetes. 2. Identify risk factors for foot ulceration in patients with diabetes. 3. Identify normal and abnormal findings in the dermatologic, vascular, neurologic, and musculoskeletal assessment of the foot in patients with diabetes.

Optical Pedobarography for Assessing Neuropathic Feet in Diabetic Patients—A Review

The use of optical pedobarography is presented in this article. The limitations of the analytical methods using peak pressures as a parameter for assessment of foot at risk of plantar ulcers are indicated. A new method, which takes into consideration the actual plantar pressure distribution using the power ratio PR (the ratio of high-frequency power to the total power in the walking foot pressure image distribution)and relates it to 3 levels of sensation loss is described. PR is able to detect early loss of foot sensation characterized by a loss of sensation level of 4.5 gm. The methods available in the literature for management of foot ulcers by proper footwear design, and their limitations, are discussed. A new method of individualized footwear based on matching the softness of the footwear insole with the softness of normal foot sole soft tissue (having durometer reading of 20 degrees Shore) and optimum insole thickness (12 mm) is helpful in the prevention of plantar ulcers.

Lower Extremity Preference During Gross and Fine Motor Skills Performed in Sitting and Standing Postures

The evaluation of lower limb preference in physical therapy practice is critical in order for the clinician to assist patients with functional retraining tasks. No studies in the physical therapy literature present a systematic approach to determine the criteria needed to identify the preferred limb. This research was designed to present a series of tests for effectiveness in determining limb preference. The purpose of this study was to determine whether lower limb preference existed in a group of recreationally athletic women when performing either stability or dynamic skills with the lower extremities while sitting or standing. The relationship of such a preference to handedness was also determined. Forty female recreational athletes, 20 right-handed subjects and 20 left-handed subjects, who ranged in age from 21 to 35 years, participated in this study. Subjects performed three repetitions of the following tests in both sitting and standing: kick a ball, swing a leg over a box, pick up a marble with the toes, and trace a triangle with the toes. The subjects were also asked to stand on one leg. The order of performing the tests was randomized. The results indicated that right-handed subjects performed activities more consistently with one lower extremity when compared with left-handed subjects, regardless of posture (sitting or standing). The difference in limb choice between right- and left-handed subjects was significant for all activities (p < .05). The considerable sensitivity of foot and leg performance following neurological insult renders the assessment of foot and leg preference very important for purposes of clinical rehabilitation.

Objective assessment of foot strike in Parkinson's disease*

We assessed the nature of foot strike and the potential effect of acute levodopa dosing in Parkinsonian patients with mild to severe fluctuations of motor performances in comparison with healthy volunteers. Forty-eight patients were enrolled in the study and compared with 33 age and gender matched controls. Each patient was assessed by a computerized electropodographic system before levodopa dosing and 1 and 2-h after intake of a standard fasting morning dose of levodopa plus benserazide. Twelve foot strikes (six right, six left) were analysed per patient. The controls underwent three repeated examinations at 1-h intervals. Patients' motor response to acute levodopa dosing was evaluated at fixed times by a battery of motor tests. Foot strike dynamics differed between patients and controls: in particular, first ground contact of the foot was significantly shifted from heel to forefoot in patients compared to controls. The forward shift in footprint during walking was more marked on the more affected body side but was unrelated to the severity and duration of Parkinsonism and unresponsive to levodopa dosing. Tapping and walking tests were overall responsive to acute levodopa intake. The system seemed suitable to detect irregular patterns of foot strike even at the early stages of Parkinsonism, when lower limb disorder was not clinically overt, and might be useful in the search for clinical markers of Parkinsonian gait.

Kinematics of the Normal Arch of the Foot and Ankle Under Physiologic Loading

We studied 15 cadaver feet to determine three-dimensional motion of selected tarsal bones under axial loading at three different loading levels. We determined the motion of individual joints and also the rotation of the tarsal bones in relation to the tibia. Joint rotations increased consistently with higher loads. The naviculartalar joint had the greatest total screw axis rotation, which averaged 9.4 degrees +/- 2.2 degrees at 667 N of load, followed by the first metatarsal-navicular (mean, 7.2 degrees +/- 1.5 degrees), talartibial (mean, 5.2 degrees +/- 1.6 degrees), and calcaneal-talar (mean, 4.4 degrees +/- 1.7 degrees) joints. The observed changes indicate the need for assessment of foot and ankle alignment clinically and radiologically while the patient is weightbearing.