Longitudinal Plantar Arch Research Articles

Use of postural insoles to correct dynamic knee valgus in youth soccer players: a randomized, controlled, double-blind clinical trial

Introduction: Altered alignment of the lower limb promotes dynamic knee valgus (DKV), the foot pronacion is among the injuries associated with DKV and is less studied, as well as their treatment through postural insoles which generate elevation of the medial longitudinal plantar arch of the foot. Objective: To analyze the effect of using a postural insole in correcting DKV in young soccer players. Materials and Method: The following parameters were analyzed: the frontal plane projection angle (FPPA) of the knee by video capture during the lateral step down and the center of pressure excursion index (CPEI) by Computerized Baropodometric Analysis. The sample was randomly divided into 2 groups: Corrective Postural Insole Group (CPIg) and Placebo Postural Insole Group (PPIg). Results: The repeated measures Anova showed significant differences with an increase between the means obtained in the FPPA (P=0.002) and CPEI (P=0.034) assessments of the PPIg group. The means of the evaluations in the CPIg were significant, with an increase for the FPPA (P=0.003), and not significant for the CPEI (P=0.793), but the Bonferroni adjustment showed a significant increase in the means of the FPPA between Ev1 x Ev3 (difference: 6.22º; P=0.001) in PPIg; and between Ev1 x Ev3 (difference: 6.86º; P=0.016) and Ev2 x Ev3 (difference: 4.14º; P=0.015) in the CPIg. Conclusion: The findings allow us to conclude that the use of postural insoles with 5º corrective shims was not effective in reducing DKV, since the PPIg (which did not use corrective shims) also showed the same increase in FPPA.

Coxa pedis: can calcaneal pronation angle be considered a predictive sign of medial plantar arch overload?

PurposeTo assess whether a correlation between the calcaneal pronation angle and the presence of internal plantar arch overload signs (such as upper-medial spring ligament lesion, posterior tibial tendon tenosynovitis, etc.) could lead to a better understanding of coxa pedis pathology.Material and methodsOne hundred ankle MRIs of consecutive patients were retrospectively reviewed measuring the calcaneal pronation angle and either the presence or absence of internal plantar arch overload signs. Next, the association of overload signs with increasing pronation angle was evaluated to establish a cut-off point beyond which coxa pedis pathology could be defined.ResultsThe tibial-calcaneal angle values in patients with and without effusion proved to be significantly different (p < 0.0001). The tibial-calcaneal angle values in patients with and without oedema also demonstrated a significant difference (p < 0.0056). Regarding posterior tibial tendon, a significant difference was found between the two groups (p < 0.0001). For plantar fascia enthesopathy, the result was borderline significant (p < 0.054). A linear correlation was found between the value of pronation angle and the extent of spring ligament injury (p < 0.0001). In contrast, no correlation with age was found.ConclusionIn conclusion, the literature associates medial longitudinal plantar arch overload with posterior tibial tendinopathy and spring ligament complex injuries. Our data show that both injuries are highly correlated with increased calcaneal pronation angle, which could be considered a predictive sign of internal plantar arch overload, prior to the development of the associated signs.

A novel physiotherapeutic approach for the treatment of Os Naviculare: A case study.

Background: Os naviculare in general alters the functional and anatomical balances of the longitudinal plantar arch. A substantial number of the posterior tibialis tendon fibers insert on the accessory ossicle instead of its insertion on tarsal and metatarsal bones resulting in unbalanced stress forces on the tendon. The presence of an accessory navicular type II or type III is a risk factor for PTT tendinopathy and possible PTT tear. Methodology: In this single subject case study, the participant reported with the pre-diagnosed Os naviculare. On examination at initial presentation, the navicular tuberosity of the affected foot was prominent as compared to the contralateral limb. The site was tender on palpation. Ankle range of motion was within normal ranges except ankle dorsiflexion was slightly compromised. Mild pain on active and resisted was noted. Functional tests like star excursion balance test, single leg standing could not be performed due to pain. Pre and post protocol assessment was graded and measured on Cumberland ankle instability tool. The tenderness was recorded using numeric pain rating scale. Star excursion balance test was performed one on 8th day and post protocol. MWM was performed at distal tibiofibular joint on 6 days every week for 3 weeks alongside the conventional regime exercises and ultrasound was applied post treatment session. Result: Result of this study suggested that addition of MWM of distal tibiofibular joint in the conservative exercise protocol was effective in the reduction of pain, dysfunction and improved dynamic control. Conclusion: The results of this study suggests that the addition of MWM of distal tibiofibular joint alongside conservative management shows appreciable effect in improving dysfunction, dynamic stability and reducing pain in individual with congenital Os naviculare.

Do athletes know the morphology of their longitudinal plantar arch?

The foot corresponds to the body segment that allows the exchange of forces between the support surface and the athlete's body; itsmorphology and function influence the quality of movement and body alignment. Moreover, the foot morphology can be modified according to the different adaptations that different sports cause, such as running, sport combat and team sports. This work aimed to define the knowledge that a sample of athletes has about their Medial Longitudinal Foot Arch (MLA). A sample of 119 athletes, separated into three groups (runners, combat athletes, and team players), were given a self-perception questionnaire of their MLA. Their responses were contrasted with the Arch Index (AI), which is a reliable objective measurement of the MLA.Just 18.5% of thesample were able to identify their MLA, as 67.2% stated they did not know, and 14.3% erred in their self-diagnosis. Combat athletes had the highest percentage who correctly identified their MLA(25%). Association was found between the knowledge demonstrated by athletes and the sport they practiced (X2= 9.926, df = 4, p = 0.04). The ignorance about MLAby the athletes studied is presented as a problem of which consequences are unknown; this opens future research focused on the study of injuries caused by misalignment of the foot and the need to prescribe sports shoes as orthoses.

Intra- and inter-rater reliability in the assessment and classification of the longitudinal plantar arch of children 6 to 10 years of age

Aims: This study aimed to analyze the intra- and inter-rater reliability in the assessment and classification of the longitudinal plantar arch of children from 6 to 10 years old in the eyes-open (EO) testing condition. Methods: A total of two-hundred and seventy-eight Brazilian children (556 feet), boys and girls, from 6 to 10 years of age participated in the study. The children’s feet were examined on a baropodometric platform, and the Staheli index was used for calculating the plantar arch index. Footprint analyses were performed at two different times, with an interval of 7 to 10 days, by three physical therapists in a single testing condition, resulting in 3,336 footprints. To determine the reliability of the continuous measurements, the Intraclass Correlation Coefficients (ICC) with 95% confidence intervals (CIs), Standard error of the mean (SEM), absolute value and percentage, and the Minimum Detectable Change (MDC) were calculated. To determine the reliability of the longitudinal arch classification, inter-rater reliability was evaluated by Weighted Fleiss Kappa Coefficient and the test-retest reliability was estimated by Weighted Cohen Kappa Coefficient. Results: Regarding inter-rater reliability, we observed values of ICC ranging from 0.79 to 0.96; thus, the results were classified as substantial to excellent reliability), being the lowest ICC values occur for line B, mainly in the first assessments. SEM ranges from 0.08 to 0.21 (percentage: 3.74 to 28.7), being the best, the lowest SEM values occur for Plantar Arch Index assessments and the MDC varies between 0.22 and 0.59. Regarding intra-rater reliability, the results indicated excellent reliability: values of ICC range from 0.92 to 0.99, being the lowest ICC values also occurs for line B analysis. SEM ranges from 0.03 to 0.20 (percentage: 2.32 to 26.6), being the lowest SEM values occur for Plantar Arch Index assessments and MDC varies between 0.09 and 0.54. Analyzing the inter-rater reliability for the longitudinal arch classifications, we observed values of Weighted Fleiss Kappa Coefficient ranging from 0.83 to 0.87, expressing almost perfect agreement among the raters before and after evaluations. The test-retest reliability of the longitudinal arch classification resulted in values of Weighted Cohen Kappa Coefficient ranging from 0.80 to 0.996, expressing substantial to almost perfect agreement intra-rater. Conclusion: The study showed high reliability in the clinical assessment of the longitudinal plantar arch index of children from 6 to 10 years of age indicating that the Staheli method is applicable to pressure platform assessments with intra- and inter-rate reliability.

Clinical Assessment of the Medial Longitudinal Arch in Children: Rater Agreement and Relationship to Objective Foot Arch Measurements

The purpose of this study was to (1) investigate the agreement among clinical experts regarding the classification of the medial longitudinal arch in children and to (2) examine the relationship between the expert ratings and the static and dynamic foot arch measurements. Eleven foot experts were asked to identify foot arches of seventy-four children (mean ± SD age of 9.0 ± 1.81 years) using three categories (low, normal, and high arch). Additionally, dynamic footprint data of all children were captured with a pedobarographic platform. For static arch measurements, a specially constructed caliper was used to assess heel-to-toe length and dorsum height. Agreement among raters was determined using the kappa statistic. For comparisons between clinical rating and diagnostic systems, receiver operating characteristic (ROC) curves and ordinal logistic regression were calculated. The combined kappa score for all three arch types (0.422, 32.8%) shows borderline moderate agreement between raters. Area under the curves (AUC) values of the ROC curves ranging from 0.48 to 0.68 show poor relationship between quantitative and qualitative arch height measurements. The highest agreement was found for the dynamic arch index and foot experts’ ratings for low arched vs non-low arched feet (AUC = 0.68) and normal vs low arched feet (AUC = 0.67). The results of this study showed borderline moderate agreement among clinical experts in the clinical assessment of the medial longitudinal plantar arch in children. Also, only a poor relationship between the clinical foot arch assessments and the static and dynamic foot measurements was revealed. Further research is necessary to establish an accurate and consistent diagnostic system for the measurement of the medial longitudinal arch in children.

Immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation in adults with cavus foot: A randomized controlled trial.

Background:Cavus foot is a deformity represented by an increased and rigid medial longitudinal arch, and it is often associated with persistent pain and gait disturbances. None of the conservative conventional treatments for cavus foot have shown conclusive evidence of effectiveness, and so further is research needed to understand how to manage this condition better. This study aimed to assess the immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation of the plantar fascia in adults with idiopathic cavus foot.Methods:A randomized, single-blinded clinical trial was conducted. Sixty-eight participants with idiopathic cavus foot, as determined by an internal Moreau–Costa–Bertani angle (MCBA) less than 125° in a lateral weight-bearing foot radiograph, were equally distributed into a neuromuscular stretching group (NSG) or a control group (no intervention). The NSG underwent a single session, combining transcutaneous electrical nerve stimulation with static stretching of the plantar fascia. Primary measurements of 3 angles were taken using a lateral weight-bearing foot radiograph: the internal MCBA; the calcaneal pitch angle (CPA); and the first metatarsal declination angle (FMDA). Outcomes were collected at baseline, immediately postintervention, and 1 week after intervention.Results:Analysis of variance revealed a significant group effect for all angles (all, P < .05). NSG participants showed a significant increase in the internal MCBA (P = .03), and a significant decrease in the CPA (P = .01) and FMDA (P = .04) from baseline to immediately postintervention. These changes remained statistically significant 1 week after the intervention (all, P < .05).Conclusion:The combination of static stretching and transcutaneous electrical stimulation of the plantar fascia, compared with no treatment, achieved immediate and short-term changes in the internal MCBA, the CPA, and the FMDA, which resulted in flattening the medial longitudinal plantar arch in adults with idiopathic cavus foot.

The efficacy of a diabetic educational program and predictors of compliance of diabetes mellitus patient’s

Category: Diabetes Introduction/Purpose: Diabetes mellitus has become a global public health problem. Not only has its incidence remained high in developed countries such as Japan and the United States, but, also, the number of cases has been growing alarmingly in developing countries such as Brazil. The concept of detection and management of diabetes mellitus in primary care centers is widely practiced in Brazil by the general physician. The purpose of this study was to evaluate the efficacy of our educational diabetics program for patients with diabetes mellitus and to determine the predictors of compliance. Since our patient orientation protocols and the insensitive footwear we provide reduce our hospital admission costs. Methods: A prospective study (2005-2017) was performed in a quaternary hospital where patients with diabetes were referred to the outpatient clinic of the diabetic foot group. The epidemiological profile of these patients under treatment in a specialized multidisciplinary outpatient unit was evaluated. A specific protocol included notes on the age, body mass index, length of disease, use of insulin, degree of sensation as evaluated by the Semmes-Weinstein monofilament test, deformity in feet, palpation of peripheral pulses, cigarette smoking, and previous operative procedure in foot an ankle.The same specialist orthopedic doctors in foot and ankle completed the protocol and performed the specific physical examination (reports were made on deformities regarded as risky for the incursion of ulcers such as plantar callosities, alterations of the hallux and lesser toes, loss of the longitudinal plantar arch, and all those related to Charcot arthropathy) and performed the same a guidelines for foot care. Results: Out of the 578 diabetic patients, the mean age of was 67 years, 69% being of the female gender. There was 53% made use of insulin, the time of disease was 14 years, and 85% patients were obese. Evaluation of protective sensibility showed that 68% were significantly decreased (from the 4.0 g monofilament). The ulcers was found in 64 patients, 57% had degree 1 in the Wagner classification, and 63% was affected in the forefoot. Charcot neuroarthropathy was diagnosed in 54 patients, 52% had the phase 3 in the Eichenholz classification, and 61% was affected in the midfoot. Fifty-three patients had amputations at the time of their first appointment, 66% on toes. 127 patients required surgery resulted from clinical complications: ulcers, osteomyelitis, and Charcot arthropathy. Conclusion: The costs related to the disease increase greatly with the appearance of the complications, especially if there is need of hospitalization and surgical treatment. The prevention of injuries, with adequate glycemic control and supply of protective shoes is essential.

Change in the Height of the Medial Longitudinal Plantar Arch according to the Distance between the Knees While Performing Squats

Background The squat is not only used for training purposes in many sports, but also for rehabilitation after knee surgery, such as cruciate ligament repair surgery. However, when the squatting posture becomes unstable during the exercise or the body alignment changes, it can cause injury to the back or knees. Purpose This study examined the change in height of the medial longitudinal plantar arch according to the distance between the knees while performing squats. Study design Pre/post–test design. Methods The subject maintained a squat against a wall, with the hips and knees at 90 degrees. The distance between the knees was the independent variable: two-, three, and four-thirds of the pelvic width. We measured the navicular drop in the three squatting stances. Results The navicular drop differed significantly among the three conditions. Conclusions Changing the distance between the knees while squatting affects the medial longitudinal plantar arch. Clinicians should educate their patients on the correct squat position.

Flatfoot in school-age children: prevalence and associated factors.

Flatfoot has been shown to cause abnormal stresses on the foot and lower extremity. The altered mechanical stresses on these structures can aggravate the foot deformity. Screening of the flatfoot and its associated factors helps detect underlying risks influencing the stresses on the foot. The purpose of this study was to analyze the structure of the medial foot arch and investigate its associated factors in students, aged 7 to 14 years. Multistage cluster sampling was used and each cluster included 2 other random sampling levels. A total of 667 Iranian school children were recruited and their feet were bilaterally evaluated using a static footprint while standing in a fully weightbearing position. The footprint, an observational measurement, and a questionnaire were used for the foot assessment. The prevalence of flatfoot was 17.1% in the population studied. There was no gender difference but the prevalence of flatfoot did decrease with age. The significant differences were observed in the prevalence of flatfoot between normal-weight, overweight, and obese groups (P < .01); more overweight participants had flatter feet. This study demonstrated that development of the longitudinal plantar arch in school-age children is influenced by age and weight. Age and weight were the primary predictive factors of flatfoot. Prognostic, Level IV: Case series.

Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis

OBJECTIVE:To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF).INTRODUCTION:PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries.METHODS:Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries) and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images.RESULTS:There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners.CONCLUSIONS:Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms.

Locomotor anatomy and biomechanics of the Dmanisi hominins

The Dmanisi hominins inhabited a northern temperate habitat in the southern Caucasus, approximately 1.8 million years ago. This is the oldest population of hominins known outside of Africa. Understanding the set of anatomical and behavioral traits that equipped this population to exploit their seasonal habitat successfully may shed light on the selection pressures shaping early members of the genus Homo and the ecological strategies that permitted the expansion of their range outside of the African subtropics. The abundant stone tools at the site, as well as taphonomic evidence for butchery, suggest that the Dmanisi hominins were active hunters or scavengers. In this study, we examine the locomotor mechanics of the Dmanisi hind limb to test the hypothesis that the inclusion of meat in the diet is associated with an increase in walking and running economy and endurance. Using comparative data from modern humans, chimpanzees, and gorillas, as well as other fossil hominins, we show that the Dmanisi hind limb was functionally similar to modern humans, with a longitudinal plantar arch, increased limb length, and human-like ankle morphology. Other aspects of the foot, specifically metatarsal morphology and tibial torsion, are less derived and similar to earlier hominins. These results are consistent with hypotheses linking hunting and scavenging to improved walking and running performance in early Homo. Primitive retentions in the Dmanisi foot suggest that locomotor evolution continued through the early Pleistocene.

Lower longitudinal plantar arch in diabetic neuropathy: Effects in plantar pressure during gait

Diabetic neuropathy may promote higher peak pressures during gait probably due to bone prominences, joint deformities and alterations in the architecture of the longitudinal plantar arch. The arch index (Cavanagh and Rodgers, 1987) is a potential predictor of plantar peak pressure in midfoot (Morag et al., 1999; Menz et al., 2005). Therefore, we aimed at investigating if flat feet in neuropathic diabetic subjects influences plantar pressure distribution.

What is the best method for child longitudinal plantar arch assessment and when does arch maturation occur?

Background The medial longitudinal arch modifies significantly during growth. Nevertheless, authors differ on the age at which the foot acquires the adult-like shape. The best method to assess this arch in children is also controversial. Objectives Characterize the longitudinal arch of children between 3 and 10 years and compare the applicability of five evaluation methods. Methods Plantar prints were acquired from 391 healthy preschools children from the University of Sao Paulo, Brazil. We calculated the arch indexes of: Cavanagh and Rodgers, Chipaux-Smirak, Staheli and the Alfa Angle, and compared them with the feet posture assessment. Non-parametric tests were used to compare among methods and ages. Spearman correlation was used to establish relationships among indexes. Results 3 and 4 years old showed a high prevalence of low arches (36–86%). Between 4 and 5 years old, significant difference was observed for all indexes. The indexes presented good correlation among them, although the proportions of the different arch types were different for each age group ( p < 0.001). Conclusions The longitudinal arch acquires an adult-like shape progressively, being statistically notorious the moment of medial longitudinal arch's formation between 4 and 5 years old. The Chipaux-Smirak Index is the best index to assess children's feet; it provides a better classification for lower arches and is easily calculated.

The Os Navicular of Humans, Great Apes, OH 8, Hadar, and Oreopithecus: Function, Phylogeny, and Multivariate Analyses

Abstract To clarify fossil hominid behavior and phylogeny, and to test the accuracy of basing these studies on single bones, navicular measurements of Olduvai and Hadar hominids, Oreopithecus, and a representative sample of humans and great apes were compared. The measurements chosen for comparison quantify the relative orientation, articular area, and curvature of the navicular facets. The measurements demonstrate that the OH 8 navicular belongs to a rigid foot with an adducted hallux and a strong commitment to terrestriality. The Hadar naviculars belong to a foot which lacked a fixed longitudinal plantar arch and had at least a degree of hallucal opposability comparable to that of mountain gorillas. The Oreopithecus navicular belongs to a mobile foot with a widely divergent hallux committed to arboreal behaviors. Multiple discriminant and canonical variate analyses of navicular measurements emphasize the uniqueness of Oreopithecus and the similarities between OH 8 and humans, and between Hadar and Afric...

The settlement of the longitudinal plantar arch of some African Plio-Pleistocene hominids: a morphological study

An anatomical study of the talo-navicular area of some Pleio-Pleistocene African hominids has been undertaken and compared with observations on human and pongid dissections. The results of this work confirm the formal existence in fossil hominids of a longitudinal plantar arch (L.P.A.). This arch is, from a well known notion, an attribute of hominids and is not shared by pongids. It is possible to summarize a number of morphological traits which are typical of modern humans and are either different from or more marked than pongid traits: The morphogenetical evolution of talar angles. The progressive rising of sustentaculum tali (S.T.) The obvious presence of the ligamentar portion of the calcaneo-navicular plantar ligament (C.N.P.L.) whose sliding print can be observed on the talar head and which represents one of the main tensor ligaments of the medial longitudinal plantar arch. These different observations allow for the differentiation of these individuals from non-hominid primates, totally independent of permanent bipedal status.

Tarsal bone disintegration in leprosy

Tarsal bone disintegration is characterised by fragmentation and progressive collapse of one or more tarsal bones. It occurs in 10% of leprosy patients, and is responsible for many severe foot deformities associated with this disease. The main cause is micro-traumata, but sensory impairment, sepsis and osteoporosis are predisposing factors. In this series of 400 consecutive patients the talus and navicular were involved most frequently (2% of 119 tarsal lesions). Treatment, including prolonged immobilisation of the foot, results in dense sclerosis of the affected bone, and leaves a functional limb. Initial radiological features include: (i) Bone fragmentation. (ii) Calcified fragments in adjacent soft tissues. (iii) Linear fractures. (iv) Progressive compression and deformity of the affected bone. (v) Loss of density of the affected bone. (vi) Flattening of the longitudinal plantar arch. Illustrative case histories are presented, and the differential diagnosis discussed.