Calcaneal Eversion Research Articles

Static foot pronation as a risk factor for lower limb overuse injury: A systematic review and meta-analysis

Background: Static foot pronation has long been considered as a risk factor for lower limb overuse injuries, such as Medial Tibial Stress Syndrome, Patellofemoral Pain and Stress Fractures. However, no single source available has systematically appraised and summarised the literature to evaluate this proposed relationship. The aim of this systematic review was to investigate static foot pronation as a risk for lower limb overuse injury. Methods: A systematic search was performed across multiple electronicdatabases (Medline, CINAHL, EmbaseandSportDiscus) to identify prospective studies that investigated static foot pronation (measured quantitatively) as a risk factor for lower limb overuse injury. Studies were assigned into one or both of two groups based on the method of assessing foot posture: (i) static foot pronation assessment or (ii) dynamic foot function assessment. This review presents the results of the studies from (i) static foot pronation assessment. Two reviewers appraised the included studies using an adapted version of the Epidemiological Appraisal Instrument (EAI).Wherepossible, effectswere expressed as standardisedmean differences (SMD) or risk ratios (RR), with 95% confidence intervals, for continuous and nominal scaled data, respectively. Results: Twenty-one studies were included and the appraisal assessment indicated that most studies were of moderate quality. Static foot pronation was a small but significant risk factor for the development of both Medial Tibial Stress Syndrome and Patellofemoral Pain. Static foot pronation variables associatedwith development of lower limb overuse injuries included Navicular Drop, the Foot Posture Index and Calcaneal Eversion Angle. Significant effects ranged from SMDs of 0.28–0.62 for continuous scaled measures and from RRs of 0.97–1.25 for nominal scaled measures. Several non-significant findings were also reported for a pooled group of Unspecified Lower Extremity Injury, Foot and Ankle Injury and Stress Fractures. Discussion: Findings were limited and in some cases inconsistent, however, differences inmeasures of static foot pronationwere identified to increase the riskof lower limboveruse injury, although the significance is small in effect. It is unclear at this stage whether these risk factors can bemeasured reliably in clinic orwhether they will be predictive of dynamic function. As a result, they should be considered as part of a multifactorial injury risk assessment and not used as stand alone measures.

Running retraining in the management of lower limb injury: Combining current evidence with international expert opinion

Background: Static foot pronation has long been considered as a risk factor for lower limb overuse injuries, such as Medial Tibial Stress Syndrome, Patellofemoral Pain and Stress Fractures. However, no single source available has systematically appraised and summarised the literature to evaluate this proposed relationship. The aim of this systematic review was to investigate static foot pronation as a risk for lower limb overuse injury. Methods: A systematic search was performed across multiple electronicdatabases (Medline, CINAHL, EmbaseandSportDiscus) to identify prospective studies that investigated static foot pronation (measured quantitatively) as a risk factor for lower limb overuse injury. Studies were assigned into one or both of two groups based on the method of assessing foot posture: (i) static foot pronation assessment or (ii) dynamic foot function assessment. This review presents the results of the studies from (i) static foot pronation assessment. Two reviewers appraised the included studies using an adapted version of the Epidemiological Appraisal Instrument (EAI).Wherepossible, effectswere expressed as standardisedmean differences (SMD) or risk ratios (RR), with 95% confidence intervals, for continuous and nominal scaled data, respectively. Results: Twenty-one studies were included and the appraisal assessment indicated that most studies were of moderate quality. Static foot pronation was a small but significant risk factor for the development of both Medial Tibial Stress Syndrome and Patellofemoral Pain. Static foot pronation variables associatedwith development of lower limb overuse injuries included Navicular Drop, the Foot Posture Index and Calcaneal Eversion Angle. Significant effects ranged from SMDs of 0.28–0.62 for continuous scaled measures and from RRs of 0.97–1.25 for nominal scaled measures. Several non-significant findings were also reported for a pooled group of Unspecified Lower Extremity Injury, Foot and Ankle Injury and Stress Fractures. Discussion: Findings were limited and in some cases inconsistent, however, differences inmeasures of static foot pronationwere identified to increase the riskof lower limboveruse injury, although the significance is small in effect. It is unclear at this stage whether these risk factors can bemeasured reliably in clinic orwhether they will be predictive of dynamic function. As a result, they should be considered as part of a multifactorial injury risk assessment and not used as stand alone measures.

Demographic, Physical, and Radiographic Factors Associated with Functional Flatfoot Deformity

In 1 of our previous studies, the occurrence of self-reported flatfoot was associated with self-reported increased age, male gender, Asian and African American races, veteran status, poor health, increased body mass index, callus, bunion, hammertoe, and arthritis. However, we had to rely on survey data to identify these risk factors, and the accuracy of the survey results was unknown. Therefore, we decided to identify the risk factors associated with flatfeet using objectively and more accurately measured data. A total of 94 patients were enrolled in the present study. The demographic data and physical and radiographic examination results were recorded by the investigators in the clinic. The data were then analyzed to identify the factors unique to flatfoot, measured and defined using a plantar pressure measurement system during natural gait. We learned that a painful tibialis posterior tendon was associated with flatfoot. The calcaneal inclination angle was also decreased in the flatfoot group. The talar declination, intermetatarsal, hallux abductus, and calcaneal cuboid angles, and static calcaneal stance eversion were elevated in the flatfoot group compared with the non-flatfoot group. Systematic evaluation of these associated factors will help in the understanding of the functional status of the flatfoot deformity.

Biomechanical variation of joint angles in overweight females

Background: An increase in body weight is considered to cause overload of the foot, which represents the interface between the body and ground. This can induce various stress and strain during walking that can predispose to overuse injuries of the lower limb. The purpose of the present study is to determine biomechanical variation of the joint angles of the lower limb such as calcaneal eversion (CE), gastrocnemius extensibility (GE), angle of toe-out (ATO), and Q-angle in overweight females. Methodology: The total of 25 overweight female subjects (body mass index [BMI] =25-29.9) were assigned as test group to determine biomechanical variation CE, GE, ATO and Q-angle. While 25 healthy female subjects (BMI = 18.5-24.9), were selected as a control group. CE and GE were measured in the prone position. While, Q-angle was measured in weight bearing and ATO was measured in walking position. Result: Independent Student's t-test was performed for comparing age, BMI, various angles among both normal and overweight female subjects. Significant increase in CE and ATO were found among overweight females as compared to normal females. While GE was significantly decreased among overweight female. Conclusion: Within limits of the present study, significant variation was found in CE, ATO (increase) and GE (decrease) in overweight females.

A Comparative Study to Find out the Calcaneal Eversion in Overweight and Normal Individuals

Background: Obesity is a major health problem worldwide. An increase in body weight is considered to cause overload of the foot, which represents the interface between the body and ground. This can induce various stress and strains during walking that can predispose to overuse injuries of the lower limb.

Posterior tibial tendon dysfunction and flatfoot: Analysis with simulated walking

Many biomechanical studies investigated pathology of flatfoot and effects of operations on flatfoot. The majority of cadaveric studies are limited to the quasistatic response to static joint loads. This study examined the unconstrained joint motion of the foot and ankle during stance phase utilizing a dynamic foot–ankle simulator in simulated stage 2 posterior tibial tendon dysfunction (PTTD). Muscle forces were applied on the extrinsic tendons of the foot using six servo-pneumatic cylinders to simulate their action. Vertical and fore-aft shear forces were applied and tibial advancement was performed with the servomotors. Three-dimensional movements of multiple bones of the foot were monitored with a magnetic tracking system. Twenty-two fresh-frozen lower extremities were studied in the intact condition, then following sectioning peritalar constraints to create a flatfoot and unloading the posterior tibial muscle force. Kinematics in the intact condition were consistent with gait analysis data for normals. There were altered kinematics in the flatfoot condition, particularly in coronal and transverse planes. Calcaneal eversion relative to the tibia averaged 11.1±2.8° compared to 5.8±2.3° in the normal condition. Calcaneal-tibial external rotation was significantly increased in flatfeet from mean of 2.3±1.7° to 8.1±4.0°. There were also significant changes in metatarsal-tibial eversion and external rotation in the flatfoot condition. The simulated PTTD with flatfoot was consistent with previous data obtained in patients with PTTD. The use of a flatfoot model will enable more detailed study on the flatfoot condition and/or effect of surgical treatment.

Influence of calcaneus angle and muscle forces on strain distribution in the human Achilles tendon

BackgroundHeterogeneous distribution of tendon strain is considered to contribute to the development of the Achilles tendon overuse injuries. Force distribution between the three portions of the triceps surae muscle and position of the calcaneus might affect the extent of strain differences within the Achilles tendon. Purpose of this study was to determine the effect of changes in force distribution within the triceps muscle and changes in calcaneus position on intratendinous strain distribution of the Achilles tendon. MethodsFive cadaveric Achilles tendons including complete triceps surae and calcaneus were dissected. Specimens were mounted in a loading simulator allowing independent force application for the three parts of triceps muscle and changes calcaneus eversion and inversion position. Strain was determined in different aspects of the Achilles tendon. FindingsChanges of calcaneus position resulted in intratendinous strain differences up to 15%, changes in force distribution within the triceps muscle resulted in strain differences up to 2.5%. Calcaneal eversion was connected to a higher degree of strain in medial tendon portions, while inversion increased strain in lateral tendon portions. InterpretationMedio-lateral, proximo-distal and dorsal–ventral distribution of tendon strain is rather influenced by kinematics of the subtalar joint than by muscular imbalances within the triceps muscle. Clinical movement analyses should focus on motion pattern combining rearfoot eversion with high Achilles tendon load. The results indicate that twist of the Achilles tendon fascicles seems of paramount importance in balancing tendon strain. To get more insight into the Achilles tendon injuries pathogenesis future research should focus on methods monitoring heterogeneous distribution of strain in vivo.

Effects of Medially Wedged Foot Orthoses on Knee and Hip Joint Running Mechanics in Females With and Without Patellofemoral Pain Syndrome

We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.

What to Measure When Determining Orthotic Needs in Children With Down Syndrome

To compare the effects of off-the-shelf foot orthoses and supramalleolar orthoses on the gait of children with Down syndrome (DS), and establish criteria for determining orthoses prescription for a child with DS. We assessed the gait of 6 children (aged 4-7 years) with DS using the GAITRite system, and obtained height, weight, leg length, hypermobility, calcaneal eversion, navicular drop, and tibial torsion measurements. Supramalleolar orthoses lead to a longer cycle time than foot orthoses (P = .05) and barefoot walking (P = .03) and a lower cadence than barefoot walking (P = .04). Significant strong correlations with gait parameters were obtained for height, leg length, and hypermobility. Biomechanical measurements showed no significant correlations with gait parameters. The role of physical examination data, including anthropometric and biomechanical measurements in the prescription of orthoses requires further investigation.

Effects of calcaneal eversion on three-dimensional kinematics of the hip, pelvis and thorax in unilateral weight bearing

Understanding the kinematic chain from foot to thorax will provide a better basis for assessment of malalignment of the body. The purpose of this study was to investigate the effects of induced calcaneal eversion on the kinematics of the hip, pelvis and thorax in three dimensions under unilateral weight-bearing. Twenty-eight healthy males were requested to stand on one leg under three conditions: normal (standing directly on the floor), and on wedges producing 5° and 10° calcaneal eversion. Recorded kinematic parameters included the angles of the hip joint, pelvis, and thorax in three dimensions. Eversion induced by wedges produced significant increases in hip flexion, hip medial rotation, pelvic anterior tilt, and thoracic lateral tilt and axial rotation to the standing side. In the frontal plane, pelvic lateral tilt to the standing side was decreased in 5° eversion condition compared with normal condition; conversely, it was increased in 10° eversion condition compared with 5° eversion condition. Arch height was negatively correlated with change in thoracic axial rotation to standing side from the normal to 10° eversion ( r = −.528, p < .01). We concluded that induced calcaneal eversion affects the three-dimensional kinematics of the thorax through the hip joint and the pelvis.

Effect of Impeded Medial Longitudinal Arch Drop on Vertical Ground Reaction Force and Center of Pressure During Static Loading

Arch supports commonly used to alleviate foot pain can impede the normal drop of medial longitudinal arch (MLA) thereby altering its function. The purpose of the study was to examine the effect of using arch supports on vertical ground reaction force (GRF) and center of pressure (COP) during simulated midstance while the foot was statically loaded. Ten healthy young subjects were recruited. Two dimensional (2D) analysis of the MLA was captured for both barefoot (BF) and arch support conditions before and after loading via a custom made weight loading apparatus. The foot was loaded and positioned to simulate the midstance phase of walking. Two-dimensional reflective markers demarcated the MLA and captured with the loaded foot on a force platform. The impeded MLA drop was compared between the unloaded BF, loaded BF and loaded arch support conditions. The vertical GRF, the anterior-posterior and the medial-lateral COP displacements were also measured in response to the impeded MLA by the arch supports. The arch supports impeded the MLA drop (p<0.05) and shifted the COP toward the medial side (p<0.05), specifically for the rearfoot (calcaneal segment region), but no changes were determined for the vertical GRF (p>0.05). The impedance of MLA drop by the arch support altered the pattern of the ML COP shift in the rearfoot region. The use of arch supports may not relieve painful foot conditions that are associated with excessive calcaneal eversion indicated by altering COP shifts in localized foot regions.

Initial Neuromotor and Postural Effects After Continual Use of Augmented Low-Dye Taping

Augmented low-dye (ALD) tape increases medial longitudinal arch height, reduces calcaneal eversion and tibial internal rotation, alters plantar pressure distribution, and reduces leg muscle activity. This study evaluated continual wear of ALD tape and its initial effect on foot posture and mobility, three-dimensional motion, and muscle recruitment patterns of the lower limb in 28 individuals. Participants were then randomly allocated for an intervention period to either a group that was exposed to ALD tape continually or a group that was not exposed. Following the intervention period, all participants attended a second test session, which reevaluated the initial physiological effects of tape. Analysis of differences in exposure status revealed minimal changes in the initial physiological effects of ALD tape, and those differences were likely due to natural variation. The initial physiological effects of ALD tape appear to be consistent, even after continual use over approximately 11 days.

The mechanical relationship between the rearfoot, pelvis and low-back

The purpose of this study was first to investigate whether foot pronation (measured as calcaneal eversion) induced an anterior tilt of the pelvis and increased the degree of lumbar lordosis. Second the study investigated whether foot supination (measured as calcaneal inversion) induced a posterior pelvic tilt and a decreased lumbar lordosis. Participants placed their feet in 18 different foot positions while standing on a rigid platform. Seven of these positions ranged from 15 degrees of foot eversion to 15 degrees of foot inversion and 11 positions ranged from 40 degrees of external foot rotation to 40 degrees of internal foot rotation. Pelvic tilt and lumbar lordosis were estimated using a 3D motion analysis system. Foot pronation and supination did not have a significant relationship with pelvic tilt ( r = 0.3) and lumbar lordosis ( r = 0.05). Internally rotating the legs caused the pelvis to tilt anteriorly and externally rotating the legs caused the pelvis to tilt posteriorly ( r = 0.58). There was no relationship between leg rotation and lumbar lordosis ( r = 0.24). Since the effects of pelvic tilt on the lumbar spine were only noticeable when pelvic tilt was exaggerated beyond values seen this study it seems unlikely that there is a link between induced foot pronation and an increase in lumbar lordosis.

Orthoses Alter In Vivo Segmental Foot Kinematics During Walking in Patients With Midfoot Arthritis

Rao S, Baumhauer JF, Tome J, Nawoczenski DA. Orthoses alter in vivo segmental foot kinematics during walking in patients with midfoot arthritis. Objective To assess the effect of a 4-week intervention with a full-length carbon graphite (FL) orthosis on pain and function in patients with midfoot arthritis, and to identify alterations in in vivo foot kinematics accompanying FL use in patients with midfoot arthritis. These results have immediate application for enhancing patient care through effective orthotic recommendations. Design Experimental laboratory study supplemented by a case series. Setting University based clinical research laboratory. Participants Patients (n=30) with midfoot arthritis and age-, sex-, and body mass index–matched control subjects (n=20). Intervention Four-week intervention with FL orthoses. Main Outcome Measures Pain and function were assessed using the Foot Function Index–Revised (FFI-R). In vivo foot kinematics were quantified as peak and total range of calcaneal eversion, forefoot abduction, first metatarsal plantarflexion, and first metatarsophalangeal joint dorsiflexion during walking in 2 conditions: with FL orthoses and with shoes only. A paired t test and repeated-measures analysis of variance were used to assess statistical significance (α=.05) of change in FFI-R score and in vivo foot kinematics, respectively. Results Significant improvements in pain and function, discerned as lower FFI-R scores ( P<.001), were noted after the 4-week intervention with FL orthoses. During walking, FL orthosis use resulted in decreased first metatarsophalangeal joint dorsiflexion ( P=.024) and first metatarsal plantarflexion range of motion ( P=.038), compared with the shoe-only condition. Conclusions Orthotic intervention emphasizing a “stiffening” strategy of the first metatarsal and first metatarsophalangeal joint may be valuable in patients with midfoot arthritis and early degenerative changes.

An Assessment of Strapping Techniques Commonly Used for Pronated Foot Deformities

This study investigated the effects of two low-Dye and two high-Dye strapping techniques that are commonly used to treat pronatory sequelae. Plantar pressure distribution in normal adults with a pronated foot type was assessed with a commercially available pressure platform system. Twenty study participants first walked across the platform barefoot and then with each of the four strapping conditions applied. The footprints were averaged and divided into seven areas for analysis. Paired t tests found significant differences between the barefoot and strapping conditions. Overall, there was a general lateralization of pressures indicating an antipronation effect from all strapping conditions. Low-Dye strap 2, used to limit the degree of calcaneal eversion, produced the most significant changes at the foot pressure areas analyzed. The data reported in this study suggest that the four strapping techniques offer different levels of control, and this should be considered during the decision-making process and clinical management of pronatory conditions. It was the contention of this study that low-Dye strap 2 was the most effective strapping technique to control foot mechanics associated with a pronated foot type.

Comparison of Calcaneal Eversion, Gastrocnemius Extensibility and Angle of Toe-Out between Normal and Overweight Females

Comparison of Calcaneal Eversion, Gastrocnemius Extensibility and Angle of Toe-Out between Normal and Overweight Females

Comparison of in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and matched asymptomatic control subjects

The purpose of this study was to compare in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and asymptomatic control subjects. Segmental foot motion during walking and step descent was assessed using a multi-segment foot model in 30 patients with midfoot arthritis and 20 age, gender and BMI matched controls. Peak and total range of motion (ROM), referenced to subtalar neutral, were examined for each of the following dependent variables: 1st metatarso-phalangeal (MTP1) dorsiflexion, 1st metatarsal (MT1) plantarflexion, ankle dorsiflexion, calcaneal eversion and forefoot abduction. The results showed that, compared to level walking, step descent required greater MTP1 dorsiflexion ( p<0.01), MPT1 plantarflexion ( p<0.01), ankle dorsiflexion ( p<0.01), calcaneus eversion ( p=0.03) and forefoot abduction ( p=0.01), in all subjects. In addition, step descent also necessitated greater MTP1 dorsiflexion ( p<0.01), ankle dorsiflexion ( p<0.01) and forefoot abduction ( p=0.02) excursion compared to walking. Patients with midfoot arthritis responded differently to the step task compared to control subjects in terms of MT1 and calcaneus eversion excursion. During walking, patients with midfoot arthritis showed significantly less MT1 plantarflexion excursion compared to control subjects ( p=0.03). However, during step descent, both groups showed similar MT1 plantarflexion excursion. During walking, patients with midfoot arthritis showed similar calcaneus eversion excursion compared to control subjects. However, during step descent, patients with midfoot arthritis showed significantly greater calcaneus eversion excursion compared to control subjects ( p=0.03). Independently or in combination, these motions may contribute to articular stress and consequently to symptoms in patients with midfoot arthritis.

Bilateral Measurement of Resting Calcaneal Stance Position and Tibial Varum Using Digital Photography and Standardized Positioning Protocols

Excessive calcaneal eversion and tibial varum are thought to predispose individuals to overuse injuries such as patellofemoral pain, yet investigations of this relationship have yielded equivocal results. Differences in the methods used, including stance position, may contribute to the observed differences. Forty-six young adults (29 asymptomatic control patients and 17 patients with patellofemoral pain syndrome) participated. Resting calcaneal stance position and tibial varum were measured using a digital photographic-goniometric method while participants adopted three upright, weightbearing stance positions (self-selected, Romberg, and single-limb right or left). Data were collapsed and analyzed by group (asymptomatic, symptomatic) or limb status (uninjured, injured), stance, and limb (right, left). Mean resting calcaneal stance position and tibial varum values differed significantly among the three stance conditions, whereas differences between groups, limb status, and limb were not observed. Pearson product moment correlations revealed no relationship between measures derived under the differing stance conditions (r = -0.08 to -0.37, P > .05) and only weak to moderate relationships in resting calcaneal stance position and tibial varum measures between the right and left limbs (r = 0.37 to 0.71, P < .01). If differences in reported values for resting calcaneal stance position and tibial varum in an individual, between groups, or from study to study are to be interpreted as true differences or as products of the measurement method used, a standardized measurement method must be established and methods must be accurately reported.

A Physiological and Psychological Basis for Anti-Pronation Taping from a Critical Review of the Literature

Anti-pronation taping is a treatment technique commonly used by clinicians in the management of lower extremity musculoskeletal pain and injury. The clinical efficacy of anti-pronation tape is described anecdotally and has some support through clinical trials for some foot conditions. However, the mechanism(s) underlying its clinical efficacy is unknown, but are broadly categorized under mechanical, neurophysiological and psychological hypotheses. This article explores these hypotheses and contributes to the understanding of the technique.A computer database search was conducted to identify relevant experimental studies using an a priori defined search strategy. Data were extracted from reviewed articles and wherever possible mean differences between baseline and taped condition and the 95% confidence interval, as well as percentage change scores and effect size statistics were calculated. Articles were organized pertaining to the hypothetical mechanism investigated and presented accordingly into biomechanical, neurophysiological or psychological paradigms.Overall, the research to date has focused predominantly on the mechanical paradigm with far fewer papers being found for the neurophysiological and psychological paradigms. The literature provides evidence that anti-pronation tape has a biomechanical effect, which has been demonstrated by increases in navicular height and medial longitudinal arch height, reductions in tibial internal rotation and calcaneal eversion and alteration of plantar pressure patterns, under both static (i.e. standing) and dynamic (i.e. walking, jogging, running) conditions. The reduction in pronation was dependent on the surrogate measure of pronation used, but generally ranged from as little as 5% increase in longitudinal arch height during jogging to as much as a 33% change in calcaneal eversion during walking. Preliminary evidence from few studies suggests that anti-pronation tape has a neurophysiological effect as it has been shown to reduce the activity of several muscles of the leg during dynamic tasks such as walking, hopping, cutting, back pedalling and drop jumps. Data were difficult to extract from these papers, but it would appear from a small study that the reduction is in the order of about 45% for tibialis posterior. To date, there has been limited investigation of the psychological effects of anti-pronation tape. A main issue, as with most placebo or sham interventions for physical therapy research, is that of an appropriate comparator in this regard. Consequently, these effects are currently not well understood. This article reports of evidence in support of anti-pronation tape exerting a biomechanical effect. As its name suggests, it does reduce pronation. There is emerging evidence of a neurophysiological effect, which is generally one of reduction in muscle activity, but caution is urged in over-interpreting a few studies on small sample sizes. Further research is required in this paradigm before sports medicine practitioners can utilize these findings in day-to-day clinical practice. Due to insufficient evidence, this article was unable to draw any conclusions as to the psychological effects of the tape, but the article does prompt the need for further exploration into the possible role of placebo in the clinical effects of anti-pronation taping.

Bilateral and unilateral increases in calcaneal eversion affect pelvic alignment in standing position

Excessive foot pronation has been associated with the occurrence of low back pain, possibly for generating changes in the lumbopelvic alignment. However, the influence of foot pronation (measured as calcaneal eversion) on pelvic alignment during standing has not been well established. Fourteen young healthy subjects participated in the study. A Motion Analysis System was used to obtain pelvic positions in sagittal and frontal planes and calcaneal position in the frontal plane. Volunteers were filmed in relaxed standing position during three trials, in three conditions: control; unilateral experimental with increased right calcaneal eversion and bilateral experimental with increased bilateral calcaneal eversion. Increased calcaneal eversion was obtained using wedges tilted 10° medially, unilaterally and bilaterally. Repeated measures ANOVAs with Bonferroni corrections were used for statistical analysis. Unilateral and bilateral use of medially tilted wedges produced a significant increase of calcaneal eversion ( P⩽0.01), on the right and left sides. Bilateral and unilateral increases of the calcaneal eversion caused average pelvic anteversion of 1.57° ( P=0.003) and 1.41° ( P=0.021), respectively. Unilaterally increased everted position generated an average pelvic lateral tilt of 1.46° ( P<0.001). Excessive calcaneal eversion during standing changes pelvic alignment and should be considered, associated with other relevant factors, when assessing pelvic misalignments.