Footprint Angle Research Articles

Sexual dimorphism and determination using foot outlines, foot print angles, and foot indices.

Sex determination is one of the fundamental procedures in the forensic investigation during personal identification. Foot dimensions, prints, indices, and angles are assessment tools used by podiatrists and forensic anthropologists. The arch index remains a tool for clinical evaluation of the incidence of pes planus by clinicians. This cross-sectional study was performed to investigate sexual dimorphism and discriminate sex using foot and footprint dimensions, foot angles, and foot indices among the Ebira ethnic group of Nigeria. Bilateral foot outlines and prints were obtained from 317 females and 283 males using a digital Vernier caliper, improvised footpad, and A4 paper. The results revealed that in the right foot and print, the males' bare right foot length (BRFL), bare right foot breadth (BRFB), right arch index (RAI), right Chippaux-Smirak index (RCSI), right footprint angle (RFPA), right ball angle (RBA), and all the measurements of the corresponding toes in the prints are significantly greater (p < 0.05) than the females. The same trend was also observed in the left footprint except for the left ball angle (LBA). The stepwise, binary logistics regression model for sex determination showed that bare left foot breadth (BLFB) and bare right foot length (BRFL) were the single best predictors of sex with an accuracy of 72.5% and 71.7% accuracy. Other foot variables marginally increased the percentage accuracy at each step. The receiver operating characteristic (ROC) curve analysis confirmed the sexing potential of the bare left foot breadth and bare right foot length to be 79%. Sexual dimorphism exists in all the foot dimensions, arch indices, Chippaux-Smirak indices, footprint angles, and ball angles, except the left ball angle. The sexual dimorphism in the foot variables forms the basis of sex determination, with left foot breadth and right foot length as the best sex predictors. Therefore, 25cm can be regarded as the cut-off point for foot length and 9cm as the cut-off point for foot breadth among this tribe.

Classification of foot type from podography: correlation of results between six quantitative assessment methods

Objective: Apply the different methods available in the literature to classify a sample of podography and evaluate the level of agreement between the results. Methods: Six quantitative and one qualitative method to classify foot type from podography were recorded on 30 feet. The podography indexes were calculated, and the level of agreement between methods was explored. Results: Correlation values were above r = 0.84 except for the test arch footprint angle. The highest correlation values were found between the truncated arch index and footprint index (0.99), arch index and footprint index (-0.94), and arch index and truncated arch index (-0.94), and the lowest was the arch footprint angle with the other parameters. However, there was a difference in the classification between the foot types, indicating a lack of agreement of thresholds between foot types. Qualitative visual inspection was the faster method to classify foot type.Conclusion: The visual inspection was the fastest test to apply, followed by the quantitative arch footprint angle test. High correlation values were found between tests, especially the arch index and the footprint index, arch-length index, truncated arch index, and Chippaux-Smirak index tests. Level of Evidence IV; Therapeutic Studies; Case Series.

Anatomy of the distal biceps tendon: an invivo 3-T magnetic resonance imaging study.

On the basis of the current literature, the optimal surgical technique for distal biceps tendon tears remains controversial. Cadaveric studies have investigated distal biceps anatomy but are limited by cohort size and tissue factors. We sought to investigate distal biceps anatomy invivo by retrospectively reviewing magnetic resonance imaging (MRI) scans. An improved understanding of the anatomy of the distal biceps tendon will lead to better definition of the optimal anatomic surgical repair. Two independent observers retrospectively reviewed 3-T MRI scans of elbows. Basic demographic data were collected, and measurements of tendon length, footprint width, footprint length, and footprint angle were taken using simultaneous tracker lines and a standardized technique. From the biceps muscle belly distally, the presence of a single tendon or double tendons was recorded and the tendon interdigitation point was measured if relevant. A total of 106 3-T MRI scans of 106 elbows of 103 patients were included. There were 71 male and 32 female patients, and the mean age was 44.7 years. Most distal biceps tendons exited the biceps muscle belly as separate entities (91%, 96 of 106 elbows) and then coalesced prior to insertion on the radial tuberosity (91%, 87 of 96 elbows). There was a positive correlation between tendon length and footprint length (P<.05), as well as between tendon length and footprint width (P<.05). The mean tendon length was 65.2 mm (95% confidence interval [CI], 63.3-66.8 mm; range, 44.3-86.8 mm), the mean distance from the musculotendinous junction to the interdigitation point was 38.3 mm (95% CI, 35.8-40.9 mm; range, 8.9-64.8 mm), the mean footprint width was 10.3 mm (95% CI, 9.9-10.7 mm; range, 5.9-16.3 mm), the mean footprint length was 16.2 mm (95% CI, 15.6-16.9; range, 7.3-25.4 mm), and the mean footprint angle was 32.1° (95% CI, 29.5°-34.6°; range, 8.5°-84.3°). An invivo, high-resolution study of the anatomy of the distal biceps tendon improves our understanding of its complex morphology and hence our ability to perform an anatomic "footprint repair."

Using worn out insole to express human foot

The human foot is unique, which is evident in its print. The purpose of this work was to determine the foot's work volume given a footprint. Five volunteers participated in the study who supplied their used shoes. The insole images were processed to find the effective regions. The correct spots were identified and were marked. The drawn footprints looked similar geometrically; however, each footprint had a different node positions profile. The aspect ratio of the foot length, width, and height congregated to 3:1:1, and the footprint angle was 30 degrees. The actual plots revealed that the ranges of the foot length ratio and the footprint angle were 2.20 to 3.00, and 30 degrees to 45 degrees, respectively. Therefore, the human foot identity may be expressed by simple measurements of the foot height, the foot width, the foot height following the standardised node locations.

Using worn out insole to express human foot

The human foot is unique, which is evident in its print. The purpose of this work was to determine the foot's work volume given a footprint. Five volunteers participated in the study who supplied their used shoes. The insole images were processed to find the effective regions. The correct spots were identified and were marked. The drawn footprints looked similar geometrically; however, each footprint had a different node positions profile. The aspect ratio of the foot length, width, and height congregated to 3:1:1, and the footprint angle was 30 degrees. The actual plots revealed that the ranges of the foot length ratio and the footprint angle were 2.20 to 3.00, and 30 degrees to 45 degrees, respectively. Therefore, the human foot identity may be expressed by simple measurements of the foot height, the foot width, the foot height following the standardised node locations.

The identification and reliability of static and dynamic barefoot impression measurements: A systematic review

ObjectiveBarefoot impressions collected from crime scenes can be used in forensic analysis. The reliability of the measurement method employed during comparison of these foot impressions is paramount to prevent incorrect conclusions being made. A number of methods of obtaining measurements from barefoot impressions have been described in the research literature; however there has been no comprehensive review of their reliability. Therefore, the aim of this systematic review was to determine the reliability of measurements used to describe footprint morphology obtained from static and dynamic barefoot impressions. MethodsFour electronic databases were searched from inception to 23 November 2017. Eligible studies were required to report either the test–retest, intra or inter-rater reliability of measurements taken from barefoot impressions for the purposes of identification or classification of foot morphology. Methodological quality was assessed using the COSMIN checklist. ResultsEleven studies were identified that reported the reliability of 10 measurements (Reel method, arch index, Chippaux-Smirak index, footprint angle, Staheli index, contact area, Martirosov’s K index, toe score and metatarsal ridge-to-toe measurement). High intra-rater reliability has been established for the Reel method (ICC=0.98–0.99), arch index (ICC=0.96–0.99), Chippaux-Smirak index (ICC=0.98–0.99), footprint angle (ICC=0.97–0.98), Staheli index (ICC=0.98–0.99) and footprint index (ICC=0.96–0.97). High inter-rater reliability has been established for the Reel method (ICC=0.99) and footprint angle (ICC=0.99). Overall methodological quality was rated as ‘Poor’ to ‘Fair’. ConclusionThe measurement developed by Reel et al. has both its intra- and inter-rater reliability established to be high. However, the findings of this review were unable to inform a recommendation of one specific technique based on reliability data due to a small body of research at this time. Furthermore, there is a lack of data on the reliability of footprint measurement and comparison techniques in real-world scenarios. Overall, the findings regarding reliability of the techniques covered in this systematic review are to be interpreted with caution due to the methodological quality of reliability testing conducted within the included studies.

The Relation Between Clinical Measurements of Plantar Characteristics and Static and Dynamic Balance Indices

Background: None of plantar arch characteristics such as arch height, heel varus and arch flexibility can affect balance indices in different manners. Objectives: The current study aimed to evaluate the relation between these structural characteristics and balance indices. Patients and Methods: The study population was 100 male and female students from Semnan University of Medical Sciences, Semnan, Iran. To evaluate plantar arch, indices such as heel height, arch angle index, rear angle, navicular drop, longitudinal arch angle and footprint angle were recorded and Staheli and Denis methods were used. Static and dynamic data were recorded using the Biodex Balance System. Results: There was a significant correlation between arch height, and static and dynamic balance indices (maximum correlation coefficient = 0.46, moderate correlation coefficient); also, there was a direct significant correlation between rear and footprint angles and some other balance indices (correlation coefficient = 0.2, weak correlation). There was a significant inverse association between navicular drop and balance indices (maximum correlation coefficient = 0.3, moderate correlation coefficient). Evaluating arch and longitudinal arch angle indices by the Staheli and Denis correlation methods showed insignificant association between these variables and balance indices (P > 0.05). Conclusions: It seems that plantar changes have insignificant effect on static and dynamic indices evaluated by the Biodex Balance System.

Paper 208: The Use of 3-D CT Scan to Validate the Position of the Femoral Tunnels in Anatomic Double-bundle ACL Reconstruction

The success of anatomic double-bundle ACL reconstruction is strongly related to tunnel positioning. Quantification and validation of tunnel location is still subject to debate. We performed a clinical study for evaluating the positioning of femoral anteromedial (AM) and posterolateral (PL) tunnels following anatomic double-bundle ACL reconstruction using high-speed 3-D computed tomography (3-D CT). We hypothesize that the position of the tunnels drilled with a specifically designed aimer will be located within the native ACL femoral footprint limits. case controlled series anatomic double-bundle ACL reconstruction with hamstrings tendons was performed with the Anatomic Director instruments set. During surgery the centre of each bundle was marked with a thermal probe. After drilling the AM tunnel through the AM portal, the PL tunnel was drilled with a specific PL aimer inserted through a far medial portal in the previously drilled AM tunnel. Thirty five continuous patients were enrolled in the study and prospectively evaluated with high speed 3-D CT scan performed within 1–3 days following surgery. Three-D reconstructions of both intact and involved knees were performed using the volume rendering technique, with the contralateral knee as control. In the control group, we measured the angle formed between the resident's ridge -which is parallel to the longitudinal axis of the ACL footprint- and the axis of the femoral diaphysis, named the “footprint angle” (FA) and the angle formed between the ridge and the Blumensaat's line (FB). On the involved side, using the axis passing through the centres of both tunnels as a reference line, FA and FB angles were also measured. The AP- and proximo-distal diameters of the ACL attachment area were measured. Also, in the involved side, the distances of ACL from the anterior, posterior and distal cartilage borders were measured and compared with the results of anatomical studies available in the literature. Finally, the distance from the centres and the bone bridge between the tunnels were also measured. the morphometric data for the involved group were the following: FA 31.4° ± 15.2°, FB 67.0° ± 16.9°, AP footprint diameter (mm) 17.2 ± 2.1, proximo distal diameter 8.1 ± 0.9, distances to cartilage (mm), posterior 2.2 ± 1.6, anterior 1.1 ± 0.7, distal 2.7 ± 1.2, distance between AM and PL bundle centres (mm) 9.4 ± 1.2. For the control group, FA 26.5° ± 4.7°, FB 61.6° ± 6.8°, AP footprint diameter (mm) 17.3 ± 1.7, proximo distal diameter 8.8 ± 1, distances to cartilage (mm), posterior 2.5 ± 1.1, anterior 1.8 ± 1.3, distal 2.8 ± 1.5, distance between AM and PL bundle centres (mm) 8.2 ± 1.2. There was no significant difference between the different values of the two groups. The native and reconstructed footprints were always entirely located distal to the resident's ridge. A highly significant correlation was found between FA and FB in both control (r = 0.71) and involved (r = 0.9) groups. The bone bridge thickness between the tunnels was 2.9mm ± 1.1mm. the morphometry of the femoral footprint of the ACL can be quantified using both its orientation and distances with regard to the local anatomical bony ridges, and cartilage borders landmarks. Locating the tunnels within the ACL footprint limits with appropriate restoration of the angle between the long axis of the femur and the long axis of the ACL femoral footprint are appropriate criteria to validate the proper positioning of the femoral tunnels when an anatomic double-bundle ACL reconstruction is performed. The use of a specifically-designed posterolateral femoral aimer allows duplicating the true morphometry of the native ACL footprint. Finally, as FA and FB are highly correlated, it is possible to use FB only to validate the footprint orientation on regular X-ray lateral view.

The footprint of femoral insertion of anterior cruciate ligament three-dimensionally reconstructed by dual-source CT

Objective To measure the double-bundle footprints of the anterior cruciate ligament (ACL) three-dimensionally reconstructed by dual-source three-dimensional computed tomography (DSCT) so as to provide parameters for anatomic double-bundle ACL reconstruction in clinic.Methods This study enrolled 55 healthy volunteers,32 men and 23 women,20 to 50 years of age (average,28 years).One hundred and ten knees were scanned and processed with 64-slice spiral CT workstation (GE,Volume Share2-AW 4.4 version).The lateral wall of the intercondylar notch and the ACL femoral footprint were reconstructed three-dimensionally.The angle,length and width of the footprint,the distance between the double-bundle centers (DDBC) (anteromedial bundle and posterolateral bundle),and the distance from the footprint edge to the margin of the articular cartilage were measured.Results In this serial,the footprint angle averaged 6.8° ± 4.6°,the long footprint axis 16.8 ± 1.7 mm,the short footprint axis 7.5 ± 1.4 mm,DPCM 1.9 ± 1.0 mm,DDCM 1.5 ± 1.3 mm,and DDBC 8.0 ± 1.0 mm.There were no significant differences concerning footprint angle,long footprint axis,short footprint axis,DPCM,DDCM and DDBC between the left and the right knees in men and in women ( P ＞ 0.05) except concerning DPCM between the left and the right knees in women ( P ＜ 0.05).There were no significant differences concerning footprint angle and short footprint axis between men and women (P＞ 0.05),but there were significant differences concerning long footprint axis,DPCM,DDCM and DDBC between men and women ( P ＜ 0.05).Conclusions Measurements of femoral ACL footprints by DSCT reconstruction in normal population are reliable and representative.The footprint angle,DDBC and the distance from the footprint edge to the margin of the articular cartilage vary from individual to individual. Key words: Anterior cruciate ligament; Femur; Tomography; spiral computed

Three-dimensional reconstruction of the femoral footprint of anterior cruciate ligment by dual-source CT

Objective To reconstruct three-dimensional femoral footprint of the anterior cruciate ligament (ACL) by dual-source CT (DSCT),which can provide a novel positioning system particularly applicable in the anatomic ACL reconstruction under arthroscopy. Methods DSCT scanning was performed for the bilateral knees of 30 healthy volunteers.Three-dimensional reconstruction of the lateral wall of the intercondylar notch was done with 64-slice spiral CT workstation (GE,Volume Share2-AW 4.4 version).Double-bundle footprints of the ACL femoral insertions were identified, outlined and marked on the three-dimensional models.The over-the-top junction of the distal femur and the trochlea of femoral lateral condyle was dotted as a reference point O.The femoral footprint long and short axes,the footprint angle between the line passing through 2 centers of anteromedial and posterolateral bundles and the femoral shaft,the distance between 2 bundle centers,the shortest distance from the footprint edge to the distal femoral cartilage,and the shortest distance from the footprint edge to the posterior margin of the femoral cartilage were measured on the models with a standardized scale. Results All the ACL femoral footprints were successfully reconstructed by DSCT in the 60 knee joints.They were relatively protruding,plain,irregular in shape but identical in grey scale,distinct areas on the image. On the three-dimensional models of femoral lateral condyle,a 3-point-2-angle positioning system applicable in arthroscopic anatomic ACL reconstruction was successfully established and used to define and describe the double-bundle insertions of ACL.The mean long and short axes of ACL femoral footprint were respectively 16.5 ± 1.8 mm and 8.0 ± 1.3 mm; the mean ACL footprint angle was 8.3° ±4.9°; the mean distance between 2 bundle centers was 7.8 ± 1.0 mm; the mean shortest distance from the footprint edge to the distal femoral cartilage was 1.6 ± 1.5 mm; the mean shortest distance from the footprint edge to the posterior margin of the femoral cartilage was 1.7 ± 0.9 mm. Conclusions Three-dimensional ACL femoral footprints can be clearly reconstructed with DSCT.Natural ACL femoral footprints vary from person to person,which indicates a need of individualized reconstruction in order to restore the anatomy in maximum.The 3-point-2-angle positioning system we have developed is just suitable for arthroscopic ACL reconstruction. Key words: Anterior cruciate ligament; Femur; Tomography, spiral computed

Validation of the position of the femoral tunnels in anatomic double-bundle ACL reconstruction with 3-D CT scan

This study compares the positioning of femoral AM and PL tunnels obtained with specific ancillary instruments during anatomic double-bundle ACL reconstruction with the native ACL footprint using three-dimensional computed tomography (3-D CT). In 35 consecutive patients, anatomic double-bundle ACL reconstruction was performed with specific ancillary instruments. Three-dimensional CT reconstruction of both knees was performed using the volume rendering technique. In the controls (contralateral knee, with intact ACL), the angle between the longitudinal axis of the footprint and the axis of the femur, the "footprint angle" (FA) was measured. On the involved side, using the axis passing through the tunnel centers, FA was also measured. In both the groups, footprint's length and width, and distances to cartilage margins were measured. FA was 28.1 degrees +/- 5.0 degrees in the controls and 32.9 degrees +/- 15.8 degrees on the involved side (n.s.). There was no statistical difference between the two groups for the other morphometric parameters: footprint's length and width, and distances to cartilage margins. Using specific ancillary instruments the morphometric parameters of the reconstructed femoral ACL footprint were similar to the native ACL.

Management of Congenital Talipes Equinovarus by Ponseti Technique: A Clinical Study

The purpose of this study was to evaluate the early results of treatment of idiopathic congenital talipes equinovarus (CTEV) by the Ponseti method and compare the results with those of other manipulation techniques and surgical treatment reported in the literature. A total of 100 patients with 156 clubfeet (80 males, 20 females), were treated for idiopathic CTEV by the Ponseti method. The average age at presentation was 4.5 months. Scoring of each foot was done according to the Pirani score. Photographs showing the deformity and podograms were taken to have an objective record against which the results were compared. The mean total Pirani score at the start of treatment was 4.26 and mean foot print angle (FPA) was 14.2 degrees. Post correction, there was a significant difference (P < .001, z = 18.638) in the mean FPA. There was also a statistically significant difference between the pre- and postcorrection Pirani scores (P < .001, z = 55.427). In 95% of the patients correction of the deformity was achieved. The Ponseti technique is based on sound understanding of the pathoanatomy of clubfoot. The good results obtained by the Ponseti technique show that posteromedial soft tissue release may no longer be required for most cases of idiopathic CTEV.

Assessment of the medial longitudinal arch in children and adolescents with obesity: footprints and radiographic study

The purpose of this study was to evaluate foot arch types of obese children and adolescents aged 9-16.5 years using both indirect and direct measures. Fifty-eight obese children/adolescents attending the paediatric endocrinology unit of the University Hospital "Lozano Blesa" in Zaragoza were selected as experimental subjects. Fifty-eight gender and age matched, normal-weight children/adolescents were selected as control subjects. To assess the medial longitudinal arch (MLA) height, which is used as a main reference for the diagnosis of flatfoot, footprints from both feet were collected (in both groups) and lateral weight-bearing radiographs of both feet were taken (of 49 of the 58 obese children). Footprint angle (FA) and the Chippaux-Smirak index (CSI) were calculated from the footprints. Talus-first metatarsal (TFMA) and calcaneal inclination angles (CIA) were obtained from lateral feet radiographs. In the normal-weight group, mean values of FA and CSI indicated a normal MLA. In the obese group, morphological flatfoot was identified. Comparison between both groups, by side and gender, showed a decrease of FA (p<0.001) and an increase of CSI (p<0.001) in obese subjects. Mean values of TFMA and CIA in the obese group indicated a lowering of the MLA. Obese children/adolescents between 9 and 16.5 years of age had significantly lower values of FA and higher CSI, related to a lower MLA. Radiographic parameters supported these findings and mean values were associated with a fall of this arch.

The Use of Volume Rendering Technique to Validate the Position of the Femoral Tunnels in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction (SS-51)

The Use of Volume Rendering Technique to Validate the Position of the Femoral Tunnels in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction (SS-51)

A footprint-based approach for the rational classification of foot types in young schoolchildren

Background Discrepancy in the classification criteria among footprint parameters complicates attempts for rational classification of feet. Objective To develop a footprint-based classification technique for the rational classification of foot types by allowing simultaneous use of several parameters (co-classification). Method Static standing footprints were recorded from 132 schoolchildren. The Arch Index (AI), Martirosov's K Index (KI), Footprint Angle (FPA) and Chippaux-Smirak Index (CSI) were determined. k-means cluster analysis was applied to obtain individual classifications and co-classifications. Results Identification across classified foot types coincided with all parameters for 0.8–3.5% of the sample. Values ranged from 2.3 to 10.6% when classification coincided with three out of four parameters. The inconsistency between every initial individual classification and co-classifications corresponded to 15.2% for AI, 49.2% for KI, 41.7% for FPA and 48.5% for CSI. Conclusions The co-classification process indicated low percentages of correctly identified foot types from all parameters that suggest the dependence of the classification on the parameter of choice used to assess arch configuration. The AI gave the lowest percentages of misclassified cases during the co-classification process. The co-classification model with the 4-cluster solution is proposed and confidence limits are reported for a rational classification of feet in young schoolchildren.

Development of a quantitative assessment system for correlation analysis of footprint parameters to postural control in children

It is known that neurological impairments impact postural stability, but few studies have observed the biomechanical influence of foot structure on balance. The aim of this study was to develop an integrated device for investigating the relationship between static balance and the foot structure, derived from a footprint image, under clinical tests of sensory interactions. Quantitative analysis of the footprint image acquired during balanced standing was developed as an indirect measure of the longitudinal arch, an important structural component of the foot. A data pool was collected from 64 children, 32 children from each of two age groups (4–5 years old versus 8–10 years old). Six common footprint parameters derived from the footprint angle or contact area were used to investigate the relationship between footprint parameters and postural stability. Postural balance ability was evaluated by analyzing sway area in posturography under visual or somatosensory confliction conditions. The footprint parameters, derived from the footprint image, inter-correlated well with each other (p < 0.01). The relationships between footprint parameters and sway area were correlated only for younger children under visually deprived (eye close) and cutaneous unreliable (standing on compliant foam) conditions. This implies that the correlations between footprint parameters and sway area are very subtle which can only be observed in unreliable visual and somatosensory conditions of younger children. In addition, younger children with a lower arch height would have a smaller sway area and better posture control which might result from more cutaneous somatosensation or a flexible biomechanical structure in low arch feet during conditioned static standing.

Can static plantar pressures of prepubertal children be predicted by inked footprints?

A study was conducted to determine whether a pedograph could be used as a field-based screening tool to predict pressures generated on the plantar surfaces of the feet of prepubertal children during single-limb weightbearing stance. Plantar pressures were collected in 51 primary school-aged children using a pressure distribution measurement system. Statistically significant negative correlations were found between footprint angle and both peak force (r = -0.453) and peak area (r = -0.539), and statistically significant positive correlations were found between the Chippaux-Smirak Index and both peak force (rho= 0.285) and peak area (rho = 0.559). Although statistically significant, the weak relationships precluded foot structure variables from being used to predict the plantar pressures of children during static weightbearing. It is therefore recommended that an alternative field-based tool that directly measures plantar pressures be used to screen children in the public school system to identify those at risk of excessive plantar pressures.

Does obesity influence foot structure in prepubescent children?

This study examines the relationship between obesity and foot structure in prepubescent children. Field-based, experimental data on BMI (body mass index) and foot structure were collected for 431 consenting children from 18 randomly selected primary schools. Of the 431 participants, 62 obese (BMI>95th percentile) and 62 non-obese (10th percentile<BMI>90th percentile) children (age = 8.5+/-0.5 y) were selected. Height and weight were measured to calculate BMI. Static weight-bearing footprints for the right and left foot of each subject were then taken using a pedograph to calculate the Footprint Angle and the Chippaux-Smirak Index as representative measures of the surface area of the foot in contact with the ground. A significant difference was found between the Footprint Angle of the obese and non-obese subjects for both the left (t = 3.663; P<0.001) and right (t = 3.742; P<0.001) feet whereby obese subjects displayed a reduced angle. Chippaux-Smirak Index scores were also significantly different for both the left (t = -6.362; P<0.001) and right (t=-5.675; P<0.001) feet between the two subject groups where a greater score for the obese subjects was evident. A decreased footprint angle and an increased Chippaux-Smirak Index are characteristic of structural foot changes that have been associated with compromised foot function. Excess body mass appears to have a significant effect on the foot structure of prepubescent children whereby young obese children display structural foot characteristics which may develop into problematic symptoms if excessive weight gain continues. Further investigation into possible consequences, particularly any effects on foot function, is warranted.

Comparison of footprint parameters calculated from static and dynamic footprints

In attempting to establish relationships between ‘foot-type’ and pathology, many researchers have chosen to use parameters calculated from static footprints to define study groups. In this study the ability of such static information to reflect the dynamic foot was investigated by comparing values for three parameters (Stahelis Arch Index, Chippaux-Smirak Index, Footprint Angle) calculated from static and dynamic prints. Three static and three dynamic footprints were obtained for 20 subjects. Reliability of the electronic data collection technique ( P<0.001) was good for all three parameters, while linear parameters displayed greater between-print reliability ( P<0.001) than the angular. Parameters calculated from dynamic prints were found to differ significantly ( P<0.05) from those calculated from static prints, although good correlation’s between the two states ( P<0.001) indicate a general dynamic increase of 28%. Further, the Stahelis arch and Chippaux-Smirak indices, both claiming to measure the same condition, correlated very well with each other ( P<0.001). Continued investigation of footprint parameters appears warranted.

Single event, multilevel surgery in cerebral palsy: A clinical framework

The purpose of this study was to evaluate the early results of treatment of idiopathic congenital talipes equinovarus (CTEV) by the Ponseti method and compare the results with those of other manipulation techniques and surgical treatment reported in the literature. A total of 100 patients with 156 clubfeet (80 males, 20 females), were treated for idiopathic CTEV by the Ponseti method. The average age at presentation was 4.5 months. Scoring of each foot was done according to the Pirani score. Photographs showing the deformity and podograms were taken to have an objective record against which the results were compared. The mean total Pirani score at the start of treatment was 4.26 and mean foot print angle (FPA) was 14.2°. Post correction, there was a significant difference (P < .001, z = 18.638) in the mean FPA. There was also a statistically significant difference between the pre- and postcorrection Pirani scores (P < .001, z = 55.427). In 95% of the patients correction of the deformity was achieved. The Ponseti technique is based on sound understanding of the pathoanatomy of clubfoot. The good results obtained by the Ponseti technique show that posteromedial soft tissue release may no longer be required for most cases of idiopathic CTEV. Level of Clinical Evidence: 2