Measurements Of Foot Research Articles

Anthropometric Measurements of Foot in Undergraduate Medical Students of a Medical College: A Descriptive Cross-sectional Study.

Anthropometry is one of the important parameters for differentiation of sex which varies significantly based on hereditary, geographical, racial, sexual, and other factors. This study was done to provide baseline foot anthropometric data for Nepali medical students to improve the accuracy of stature estimations and enhance forensic and clinical applications. The aim of the study was to calculate anthropometric measurements of foot in undergraduate medical students of a medical college. A descriptive cross-sectional study was conducted on medical students studying at a tertiary care hospital during the period of November 6, 2022 to February 28, 2023 after obtaining ethical clearance from the Institutional Review Committee (Reference number: 06/2022). A total population sampling method was used. The present study was conducted to determine the mean foot index from the right and left foot, mean measurements of the left and right foot, and sex-related dimensions of the foot in Nepalese medical students. Data were collected and analyzed using SPSS. Out of 115 participants, the mean foot index for male and female were 38.34±2.13 and 39.33±2.22 respectively. The mean length of the right foot for males and females were 24.12±0.98 cm and 22.10±1.25 cm respectively. The mean length of the left foot for males and females was 24.20±1.06 cm and 22.07±1.24 cm respectively. This study provides mean values of different measurements of the right and left foot of both sexes of the age group of 18-24 years in the students of a medical college.

Foot complaints pre-operative to primary total hip or knee arthroplasty

Purpose of the Study: Aim of the study was to determine the prevalence of foot and ankle complaints and radiographic abnormalities, and their association in patients planned for total joint surgery. Methods: A cross-sectional cohort study of 183 patients, planned for total hip or knee arthroplasty (THA, TKA). Assessments included recording of polyneuropathy, previous trauma, foot deformities, and ankle range of motion (ROM); self-reported foot and ankle complaints; and radiographic severity of the foot and ankle joints OA. Results: In patients planned for THA and TKA, the proportions of patients with risk factors or using bespoke footwear ranged from 21-41%, whereas the proportions with clavus, hammertoes, and/or hallux valgus or rigidus varied between 1-17%. Although the mean foot function scores were good (median FAOS >93 and FFI-5pt 0), up to 24% of patients had a low score on one or more of the subscale scores. Prevalence of patients with signs of radiographic OA in foot and ankle were lower in THA than TKA patients, respectively. For the TKA group, we found an association between radiological scores and both self-reported measures of foot and ankle complaints. Conclusion: About a quarter of patients undergoing THA and TKA report some foot complaints, whereas 32-45% have signs of radiographic OA of foot and/or ankle. Since foot and ankle complaints have shown to have a negative effect on outcome of THA and TKA surgery, pre-operative optimisation concerning the foot complaints should be considered to support a more favourable outcome.

Sex and stature estimation from anthropometric measurements of the foot: linear analyses and neural network approach on a Turkish sample

BackgroundFor over a century, anthropometric techniques, widely used by anthropologists and adopted by medical scientists, have been utilized for predicting stature and sex. This study, conducted on a Eastern Turkish sample, aims to predict sex and stature using foot measurements through linear methods and Artificial Neural Networks. Our research was conducted on 134 medical students, comprising 69 males and 65 females. Stature and weight were measured in a standard anatomical position in the Frankfurt Horizontal Plane with a stadiometer of 0.1 cm precision. Measurements of both feet's height, length, and breadth were taken using a Vernier caliper, osteometric board, and height scale. The data were analyzed using SPSS 26.00.ResultsIt was observed that all foot dimensions in males were significantly larger than in females. Sex prediction using linear methods yielded an accuracy of 94.8%, with a stature estimation error of 4.15 cm. When employing Artificial Neural Networks, sex prediction accuracy increased to 97.8%, and the error in stature estimation was reduced to 4.07 cm.ConclusionsOur findings indicate that Artificial Neural Networks can work more effectively with such data. Using Artificial Neural Networks, the accuracy of sex prediction for both feet exceeded 95%. Additionally, the error in stature estimation was reduced compared to the formulas obtained through linear methods.

Features of anthropometric indicators of the feet of adolescents of Zhambyl region

The comfort of shoes is one of the main indicators of the quality of shoes, which ensures the normal functioning and development of the foot in the process of growth and in general. In turn, the normal functioning and development of the foot determines the normal state of the whole organism, since the appearance of deviations in the foot leads to disturbances throughout the body. In the work, measurements of the feet of young men of the Zhambyl region were carried out in order to develop a size range of shoes, design shoe lasts and shoes with rational dimensional indicators. The measurements of the young men's feet were carried out using both standard and modern 3D scanning methods. The measurements were carried out among schoolchildren and students of higher educational institutions aged 15 to 18 years. As a result of measurements of young men's feet, variational series of dimensional characteristics, statistical data, and correlation-regression equations were calculated. The analysis of the obtained data was calculated using the methods of mathematical statistics and programming. The results of the study of the size of the feet will improve the socio-economic situation, which is expressed in providing the population of Kazakhstan with comfortable shoes that would take into account the anatomical, physiological and psychological characteristics of young men in Kazakhstan. The given data on the size of the feet of young men can be used in shoe factories, organizations for the tailoring of orthopedic and special shoes.

Automatic estimation of hallux valgus angle using deep neural network with axis-based annotation

ObjectivesWe developed the deep neural network (DNN) model to automatically measure hallux valgus angle (HVA) and intermetatarsal angle (IMA) on foot radiographs. The objective is to assess the accuracy of the model by comparing to the manual measurement of foot and ankle surgeons.Materials and methodsA DNN was developed to predict the bone axes of the first proximal phalanx and all metatarsals from the first to the fifth in foot radiographs. The dataset used for model development consisted of 1798 radiographs collected from a population-based cohort and patients at our foot and ankle clinic. The retrospective validation cohort comprised of 92 radiographs obtained from 92 consecutive patients visiting our foot and ankle clinic. The mean absolute error (MAE) between automatic measurements by the model and the median of manual measurements by three foot and ankle surgeons was compared to 3° using one-tailed t-test and was also compared to the inter-rater difference in manual measurements among the three surgeons using two-tailed paired t-test.ResultsThe MAE for HVA was 1.3° (upper limit of 95% CI 1.6°), and this was significantly smaller than the inter-rater difference of 2.0 ± 0.2° among the surgeons, demonstrating the superior accuracy of the model. In contrast, the MAE for IMA was 0.8° (upper limit of 95% CI 1.0°) that showed no significant difference from the inter-rater difference of 1.0 ± 0.1° among the surgeons.ConclusionOur model demonstrated the ability to measure the HVA and IMA with an accuracy comparable to that of specialists.

Evaluation of professional footwear and its relationships with the foot structure among clinical nurses.

Purpose: This study aimed to evaluate professional footwear comfort, functionality and style as well as their relationships with the foot structure among nurses. Methods: We examined 120 clinical nurses aged 40-50 years, occupationally active, wearing specific type of foot-wear at work for a minimum of 7 h a day, for 5 days prior to the research. The study relied on the CQ-ST podoscope for measurements of foot. Perception of footwear comfort, functionality and style scales were also used in the research. The results were analysed with the use of Mann-Whitney U-test and Spearman's rank correlation. Results: Statistically significant negative associations were found between right and left foot length and overall comfort of footwear ( p = 0.045, p = 0.045) as well as between right and left foot width and arch height ( p = 0.015, p = 0.028). Heel angle positively correlated with safety ( p = 0.008, p = 0.050), ease of donning and doffing ( p = 0.001, p = 0.004), as well as shoe style ratings ( p = 0.047). Variables determining shoe comfort were positively correlated with most shoe functionality characteristics as well as with shoe style (p < 0.05). Conclusions: Tested medical footwear meets the requirements of nurses in terms of comfort, functionality and aesthetics, and the studied features of footwear can be a useful guideline for the selection of shoes for representatives of this professional group. These footwear can be an element of workwear, and even, in the case of women with transverse flat feet - an alternative to ordinary utility shoes. There is a need to consider different widths for the same length size in medical footwear designs.

Reliability and correlation of weight-bearing cone beam CT and Foot Posture Index (FPI) for measurements of foot posture: a test-retest study

ObjectiveTo assess test-retest reliability and correlation of weight-bearing (WB) and non-weight-bearing (NWB) cone beam CT (CBCT) foot measurements and Foot Posture Index (FPI)Materials and methodsTwenty healthy participants (age 43.11±11.36, 15 males, 5 females) were CBCT-scanned in February 2019 on two separate days on one foot in both WB and NWB positions. Three radiology observers measured the navicular bone position. Plantar (ΔNAVplantar) and medial navicular displacements (ΔNAVmedial) were calculated as a measure of foot posture changes under loading. FPI was assessed by two rheumatologists on the same two days. FPI is a clinical measurement of foot posture with 3 rearfoot and 3 midfoot/forefoot scores. Test-retest reproducibility was determined for all measurements. CBCT was correlated to FPI total and subscores.ResultsIntra- and interobserver reliabilities for navicular position and FPI were excellent (intraclass correlation coefficient (ICC) .875–.997). In particular, intraobserver (ICC .0.967–1.000) and interobserver reliabilities (ICC .946–.997) were found for CBCT navicular height and medial position.Interobserver reliability of ΔNAVplantar was excellent (ICC .926 (.812; .971); MDC 2.22), whereas the ΔNAVmedial was fair-good (ICC .452 (.385; .783); MDC 2.42 mm). Using all observers’ measurements, we could calculate mean ΔNAVplantar (4.25±2.08 mm) and ΔNAVmedial (1.55±0.83 mm). We demonstrated a small day-day difference in ΔNAVplantar (0.64 ±1.13mm; p<.05), but not for ΔNAVmedial (0.04 ±1.13mm; p=n.s.).Correlation of WBCT (WB navicular height - ΔNAVmedial) with total clinical FPI scores and FPI subscores, respectively, showed high correlation (ρ: −.706; ρ: −.721).ConclusionCBCT and FPI are reliable measurements of foot posture, with a high correlation between the two measurements.

Alterations in electrochemical skin conductance as a marker of autonomic dysfunction in multiple system atrophy

BackgroundMultiple System Atrophy (MSA) is a rare neurodegenerative disease with pronounced autonomic failure (AF). Severe cardiovascular AF is associated with poor prognosis. Since sweating dysfunction is less well known, we investigated the interest of a quick and non-invasive assessment of sweating using electrochemical skin conductance (ESC) as a marker for AF in MSA. Methods138 MSA patients of the French Reference center for MSA with an annual follow-up including the Unified MSA Rating Scale (UMSARS), COMPASS (autonomic symptoms) and measurements of foot and hand ESC (Sudoscan®) participated to this study (age 65 ± 8 years, 66% probable MSA, 72% AMS-P). Statistical analysis included: (i) correlations between ESC and MSA type, age, disease duration, severity, blood pressure (BP), COMPASS, (ii) comparisons between groups with normal or abnormal ESC, and (iii) multivariate analysis by logistic regression. Relationships between severity progression during follow-up with ESC and other variables were modeled by Generalized Estimating Equation. ResultsHands and feet ESCs were abnormal in 81/138 (59%) and 93/138 (67%) cases, respectively. Abnormal ESCs were significantly correlated to disease severity and several features of AF. ESCs worsening over time was more pronounced than other autonomic features such as orthostatic hypotension. Abnormal ESCs at baseline were significantly associated with a higher progression of UMSARS's score during follow-up. ConclusionSweating dysfunction assessed by ESC is frequent in MSA and is significantly related to disease severity and AF. The gradual decrease in ESC with disease duration could be useful as a quantitative marker of autonomic dysfunction.

The relationship between foot and ankle joint flexibility measures and barefoot plantar pressures in healthy older adults: a cross-sectional study

BackgroundRestriction in foot and ankle joint range of motion, such as an ankle equinus, has been associated with increased plantar pressure and its complications. However, previous research is limited by its scope of measures and study populations. The aim of this study was to investigate the relationship between foot and ankle joint range of motion on barefoot plantar pressures during walking in healthy older adults.MethodsThis cross-sectional study recruited 49 older adults. Participants underwent measures of foot (first metatarsophalangeal dorsiflexion range of motion, and navicular drop and drift) and ankle joint range of motion, foot posture, body mass index, and plantar pressure during barefoot walking. Spearman Rank Order Correlations were used to explore the relationship between foot and ankle measures, body mass index, and plantar pressure, with significant correlations explored in a hierarchical regression analysis. A Mann-Whitney U test was performed to compare plantar pressure values between those with and without ankle equinus per region of the foot.ResultsMean (SD) age and BMI were 72.4 years (5.2) and 29.8 kg/m2 (5.9) respectively. A total of 32 of the 49 participants (65%) identified as female sex. Mean (SD) ankle joint range of motion was 32.7 (6.4) degrees with 17/49 (34.7%) participants classified as having an ankle equinus (defined as < 30 degrees of ankle joint dorsiflexion range of motion). We found that an ankle equinus predicted a statistically significant amount of peak forefoot plantar pressure (p = 0.03). Participants with an ankle equinus displayed significantly higher forefoot peak pressure 677.8 kPa (589.9 to 810.4) compared to those with no equinus 565.58 kPa (447.3 to 651.2), p = 0.02. A statistically significant correlation was found between body mass index and midfoot peak pressure (p < 0.01) and pressure-time integral (p < 0.01). No other significant correlations were found.ConclusionClinicians should consider screening for an ankle equinus and body mass index as a simple way to identify which healthy older adults may be at risk of pressure-related complications in the mid- and forefoot.

Experimental Analysis of Commercial Optical Methods for Foot Measurement.

Due to the increasing trend of online shopping, shoes are more and more often bought without being tried on. This leads to a strong increase in returns, which results in a high financial as well as ecological burden. To prevent this, feet can be measured either in the store or at home by various systems to determine the exact dimensions of the foot and derive an optimal shoe size. In this paper, we want to present an overview of the methods currently available on the market for the measurement of feet. The most important commercial systems are classified according to the underlying basic technology. Subsequently, the most promising methods were implemented and tested. The results of the different methods were finally compared to find out the strengths and weaknesses of each technology. After determining the measurement accuracy of the length and width for each measurement method and also comparing the general shape of the 3D reconstruction with the GT, it can be said that the measurement using a ToF sensor is currently the most robust, the easiest and, among other methods, the most accurate method.

Estimation of Gestational Age From Fetal Foot Length Measurement

The estimation of G. age is vital part of obstetrical ultrasound examination for managing the pregnancy as well as monitoring the growth of the fetus. FFL measurement is a precise method for the calculation of the G.age of the fetus when other methods do not give accurate measurement. Objectives: The main objective of our review is to assess the role of ultrasonographic measurement of foot of the fetus in the calculation of G. age and secondary objective is to measure the FL to FFL ratio in the normal fetuses. Methods: We conducted the systemic review with the help of following search engines and websites: Google scholar, NCBI, Medline and Medscape databases, Research gate, Science direct, PubMed, Global Health Library, Web of Science, Cochrane, from 1987-2019. Only those studies were included in this review that reported on the determination of the G. age from the FFL measurements on antenatal ultrasonography and on at least one statistic assessing the accuracy of gestational age estimation. The duplicate, non-English and incomplete studies were excluded. After initial screening of 120 studies only 20 studies were eligible for inclusion. All data extracted from them was analyzed using SPSS version 24. Results: After fulfilling eligibility criteria, we were left with 20 studies between years 1987 to 2019. Majority of the studies were conducted in Asia (60%) with study population greater than 50 participants (95%).All of our studies measured FFL for estimation of GA in singleton (80%) and normal (90%) pregnancies. Studies varied in their use of GA reference method, (5%) studies used LMP alone, (10%) studies relied on EDS, (10%) studies used either EDS or LMP as a comparison method, (45%) studies used both EDS and LMP and (30%) studies did not report their reference method. Ten studies reported R with mean value of 0.90002 and SD of 0.073997, 13 studies reported R2 with mean value of 0.85192 and SD of 0.156988. Six studies (38%) measured FL to FFL ratio with mean value of 0.96.Fifteen studies reported regression coefficient with mean value of 1.39057 and SD of 1.15890. Conclusions: After reviewing literature of 20 studies it was concluded that FFL is a precise method for the calculation of GA of the fetus. FFL is equally reliable when used with other ultrasonographic parameters as well as when used alone. FFL is also reliable for predicting the estimated FW in the last trimester of pregnancy. FL/FFL is useful in the detection of fetal skeletal dysplasia.

Foot and ankle ability measure: validación de la versión española de 29 ítems en el área de rehabilitación

ObjectiveThe Foot and Ankle Ability Measure (FAAM) is an internationally widely used outcome measure of foot and ankle disorders available in several languages. The purpose of this study was to develop and validate a FAAM Spanish-version with 29 items of Activities of Daily Living (ADL) and SPORT subscales in rehabilitation setting. Materials and methodsA two-stage observational study was conducted. The FAAM was cross-culturally adapted to Spanish through a double-forward translation and a double-backward translation; the psychometric properties were then validated. The participants (n = 147), with various chronic foot and ankle disorders, completed the Spanish version of the Foot and Ankle Ability Measure ADL and SPORT, SF-36, and a pain intensity visual analogue scale (Pain VAS). The full sample was used to determine the factor structure, the internal consistency, and the convergent criterion validity, and a subgroup (n = 46) was used to determine the reliability at 48–72 h. ResultsThe factor structure of Spanish version of FAAM ADL and SPORT subscales were both one-dimensional, demonstrating high internal consistency (α = 0.97 and α = 0.93, respectively). The reliability values were ICC = 0.90 and ICC = 0.76, respectively. The convergent validity criterion of Spanish version of FAAM with the Pain VAS (r = 0.50) and Physical Function of SF-36 (r = 0.64) were moderately correlated. ConclusionsThe Spanish version of FAAM with 29 items are a valid foot and ankle disorder outcome measure with similar psychometric properties to the original version and versions in other languages.

Comparison of Gender Prediction Accuracy between Regression Models Derived from Hand, Foot Measurements and Long Bone Measurements in a Sample of Kolhapur Population

Introduction: Here, we aim to compare the accuracy of the regression formula derived to predict genderusing data on measurements of foot and hand with the formula derived to predict gender using the lengthmeasurements data of the long bones (tibia and ulna).Methods: Patients attending the outpatient services at the Orthopedic Department, and between the agerange 18 to 50 years were recruited (n=1000; 500 males and 500 females). Subjects suffering from any kindof bone deformity were excluded. Vallois method was used to estimate the measurements of hand, foot,tibia, and ulna. Regression formulas were obtained from the hand, foot-long bones measurements; to predictgender, using multiple logistic regression.Results: Differences between male’s and female’s measurements of hand (P&lt;0.001), long bones (P&lt;0.001),and foot (P&lt;0.001) were significant. The accuracy of the model used to predict gender, which was calculatedfrom the dimensions of hand and foot was 81.5%. The accuracy of the model used to predict gender calculatedfrom the long bone measurement was 78.3%.Conclusions: Dimensions of hand and foot are a better predictor (81.5%) of gender vs the length of longbones (tibia and ulna) (78.3%) in the Kolhapur population.

Chronic Plantar Heel Pain Is Principally Associated With Waist Girth (Systemic) and Pain (Central) Factors, Not Foot Factors: A Case-Control Study.

To determine the independent associations of potential clinical, symptom, physical activity, and psychological factors with chronic plantar heel pain. Case-control. We investigated associations by comparing 220 participants with chronic (more than 3 months in duration) plantar heel pain to 100 age- and sex-matched controls, who were recruited randomly from the electoral roll. Exposures measured were waist girth, body mass index, body composition, clinical measures of foot and leg function, physical activity via accelerometry, depression and pain catastrophizing, symptoms of prolonged morning stiffness anywhere in the body, and multisite pain. Data were analyzed using multivariable conditional logistic regression. Waist girth (centimeters) (odds ratio [OR] = 1.06; 95% confidence interval [CI]: 1.03, 1.09), ankle plantar flexor strength (kilograms) (OR = 0.98; 95% CI: 0.97, 0.99), pain at multiple sites (pain at 1 other site: OR = 2.76; 95% CI: 1.29, 5.91; pain at 4 or more other sites: OR = 10.45; 95% CI: 3.66, 29.81), and pain catastrophizing status (none, some, or catastrophizer) (some: OR = 2.91; 95% CI: 1.33, 6.37; catastrophizer: OR = 6.79; 95% CI: 1.91, 24.11) were independently associated with chronic plantar heel pain. There were univariable but not independent associations with morning stiffness, first metatarsophalangeal joint extension range of motion, depression, and body mass index. There were no significant associations with physical activity or body composition (bioelectrical impedance analysis). Waist girth, ankle plantar flexor strength, multisite pain, and pain catastrophizing, but not foot-specific factors, were independently associated with chronic plantar heel pain. Of these 4 factors, 3 (waist girth, multisite pain, and pain catastrophizing) were central or systemic associations. J Orthop Sports Phys Ther 2021;51(9):449-458. Epub 7 May 2021. doi:10.2519/jospt.2021.10018.

Predictors of Improvement After Fasciotomy for Treatment of Chronic Exertional Compartment Syndrome of the Lower Extremity.

Previous studies have demonstrated the effectiveness of lower extremity fasciotomies in treating chronic exertional compartment syndrome (CECS). However, not all patients have demonstrated the same level of symptom improvement. Specific patient variables will lead to enhanced functional improvement after fasciotomy for CECS of the lower extremity. Case series. Level 4. A review of patients undergoing fasciotomy of the lower extremity for treatment of CECS by a single surgeon from 2009 to 2017 was performed. Pre- and postoperative measures of Foot and Ankle Ability Measure-Sports subscale (FAAM-Sports), FAAM-Sports Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain during sporting activities were collected at a minimum of 12 months postoperatively. The primary outcomes of change in FAAM-Sports, FAAM-Sports SANE, and VAS during sporting activities were calculated by taking the difference of post- and preoperative scores. Generalized multiple linear regression analyses was performed to determine independent predictors of functional and pain improvement. A total of 61 patients (58% response rate) who underwent 65 procedures were included in this study, with postoperative outcome measures obtained at mean duration of 57.9 months (range, 12-115 months) after surgery. Patients had a mean ± SD improvement in FAAM-Sports of 40.4 ± 22.3 points (P < 0.001), improvement in FAAM-Sports SANE of 57.3 ± 31.6 points (P < 0.001), and reduction of VAS pain of 56.4 ± 31.8 points (P < 0.001). Multiple linear regression analysis revealed deep posterior compartment involvement, younger age, a history of depression, and male sex to be significant independent predictors of enhanced improvement after fasciotomy. Fasciotomy is an effective treatment of CECS, with our study identifying certain patient variables leading to greater functional improvement. Male patients, younger patients, patients with depression, and patients with deep posterior compartment involvement may serve to benefit more with fasciotomies for treatment of CECS.

Determination gender using foot, footprint, hand and hand print measurements in a Sinhalese population in Sri Lanka using supervised learning techniques

Foot, footprint, hand and handprint measurements are widely used to determine gender in forensic science to criminal justice and resolve body identification difficulties. Besides, gender determination covers some of the prior identification requirements of a victim. This pioneering study aims to identify the applicability of different machine learning techniques to predict gender using the foot, footprint, hand and handprint measurements in a Sinhalese population in Sri Lanka. Some supervised learning techniques, namely, the Classification and Regression Trees (CART), Naïve Bayes Algorithm and Support Vector Machine (SVM) were used to predict gender. The sample consists of a total of 117 young and healthy undergraduate students, 51 males and 66 females in the age range of 20–30 years. The measurements of foot, footprint, hand and hand print of both left and right sides were measured using standard instruments and techniques. Cross-validation has been used to validate the results. The mean comparison test results show that both left and right side measurements of males are more extensive than that of females (p-value < 0.05). Fitted models show that gender can be determined using the CART algorithm with 95.83% accuracy along with foot length and 91.67% of accuracy along with hand length, hand breadth and palm length. Also SVM, Naïve Bayes and CART algorithms obtained from hand print measurements predict gender with 83.33% accuracy. Particularly, the CART algorithm predicts gender using foot, footprint, hand and hand print measurements with higher accuracies compared to other algorithms. The present study demonstrates the usefulness and reliability of using machine learning techniques for gender determination for the first time among the Sri Lankan population. Hence, the results provide the foundation for future detailed studies.

Correlation Between Three-Dimensional Biometric Weightbearing CT Assessment of Hindfoot Alignment and Conventional Measurements of Adult Acquired Flatfoot

Category:Hindfoot; Ankle; OtherIntroduction/Purpose:Semi-automatic three-dimensional (3D) biometric weightbearing CT (WBCT) tools have been shown to accurately demonstrate the relationship between the center of the ankle joint and the tripod of the foot. The measurement of the Foot and Ankle Offset (FAO) represents an optimized biomechanical assessment of foot alignment. The objective of this study was to evaluate the correlation between FAO and traditional adult acquired flatfoot deformity (AAFD) markers, measured in different planes. We hypothesized that the FAO would significantly correlate with other radiographic markers of pronounced AAFD.Methods:In this retrospective comparative study, we included 113 patients with stage II AAFD, 43 men and 70 women, mean age of 53.5 (range, 20 to 86) years. Three-dimensional coordinates (X, Y and Z planes) of the foot tripod (most plantar voxel of the first and fifth metatarsal heads, and calcaneal tuberosity) and the center of the ankle joint (most proximal and central voxel of the talar dome) were harvested by two blinded and independent fellowship-trained orthopedic foot and ankle surgeons. The FAO was automatically calculated using the 3D coordinates by dedicated software. Multiple WBCT parameters related to the severity of the deformity in the coronal, sagittal, and transverse plane were manually measured.Results:We found overall good to excellent intra (range, 0.84-0.99) and interobserver reliability (range, 0.71-0.96) for manual AAFD measurements. FAO semi-automatic measurements demonstrated excellent intra (0.99) and interobserver reliabilities (0.98). Hindfoot moment arm (p<0.00001), subtalar horizontal angle (p<0.00001), talonavicular uncoverage angle (p=0.00004) and forefoot arch angle (p=0.0001) were the only variables found to significantly influence and correlate with FAO measurements, with an R-squared value of 0.79. A value of hindfoot moment arm of 19.8mm was found to be a strong threshold predictor of increased values of FAO, with mean values of FAO of 6.5 when the HMA was lower than 19.8mm and 14.6 when the HMA was equal or higher than 19.8mm.Conclusion:We found that 3D WBCT semi-automatic measurements of Foot and Ankle Offset (FAO) significantly correlated with traditional markers of pronounced AAFD. HMA, subtalar horizontal angle, talonavicular uncoverage angle and forefoot arch angle were found to explain 79% of the variations in FAO measurements. FAO Measurements were also found to be more reliable than the manual measurements. The FAO offers a more complete biomechanical and multiplanar assessment of the AAFD, that that accounts for relative positioning of the foot tripod and the center of the ankle joint, representing in a single measurement the three-dimensional components of the deformity.

Foot Loading Symmetry is Improved after Unicompartmental Knee Arthroplasty

Category:Basic Sciences/Biologics; Midfoot/ForefootIntroduction/Purpose:Unicompartmental Knee Arthroplasty (UKA) is a surgical option for osteoarthritis in a single compartment of the knee. Compared to Total Knee Arthroplasty (TKA), UKA is less expensive, retains the cruciate ligaments and results in lower post-operative morbidity.[1] It has been reported that about 10 percent of UKAs require revision to TKA for multiple reasons. In TKA, ankle alignment has demonstrated a significant effect on outcomes and function. [2] Plantar pressure, a measure of foot and ankle loading, changes after TKAs but has yet to be evaluated in UKAs. The purpose of this study is to evaluate the effects of medial UKA on plantar pressure which may be a variable that contributes to revisions in these patients.Methods:Following IRB approval and informed consent, we evaluated 7 adults (14 Feet) (average age 62; range: 54 to 68 years old; 4F/ 3M). All participants walked at a self-selected speed pre surgery and 7 months post-surgery. The Pedar insole pressure system (Novel), with 99 sensors per insole, was used to collect bilateral plantar pressure during gait at 100 Hz. All participants wore the same type of shoes (Nike Zoom) for the test. The insole was divided into 9 regions for analysis2 (Figure 1). The maximum pressure (MP) within each foot region was calculated for each step and averaged over all steps. Paired and unpaired t- tests were performed to identify differences in the MP from pre to post-op and between operated and contralateral sides, respectively.Results:An average of 24 steps were recorded from each patient pre and post operatively. MP became more symmetrical between feet post-operatively, with significant improvements in bilateral symmetry observed in the medial heel, medial and lateral forefoot regions (all p<0.01). The MP in the lateral midfoot region of the operative side increased during ambulation post- operatively (p<0.05). The MP in the lateral forefoot region of the non-operative side decreased post-operatively (p<0.01).Conclusion:Our results indicate that foot loading, as assessed through plantar pressure, becomes more symmetrical after unilateral UKA and may also affect non-operative foot loading. Although our sample size is small, our data is comparable with a similar study done in TKA patients which reported changes forefoot and lateral midfoot loading.

Predictors of Improvement in Patient Outcomes after Fasciotomy for Chronic Exertional Compartment Syndrome of the Lower Leg

Category:Sports; OtherIntroduction/Purpose:Chronic exertional compartment syndrome (CECS) of the lower leg is the result of increased pressure in intramuscular compartments that occurs during repetitive physical activity. Previous studies have demonstrated the effectiveness of lower extremity fasciotomies in treating CECS. However, not all patients have the same level of symptom improvement or ability to return to sport. The purpose of this study was to determine if any independent patient variables were predictive of outcomes following fasciotomy for CECS of the lower leg.Methods:A retrospective review of patients undergoing fasciotomy of the lower leg for treatment of CECS by a single fellowship-trained orthopaedic surgeon from 2009 to 2017 was performed. All patients had a diagnosis confirmed by pre- and post-exercise compartment pressure testing using the Pedowitz criteria. Patients that underwent a fasciotomy for trauma, infection, or an acute pathologic process or underwent revision fasciotomy were excluded. Preoperative measures of Foot and Ankle Ability Measure-Sport subscale (FAAM-Sport), FAAM-Sport single assessment numeric evaluation (SANE), and visual analog scale (VAS) for pain during sporting activities were collected. Patients with at least 12 months of follow-up were included. The primary outcomes of change (delta, Δ) in FAAM-Sport, FAAM-Sport SANE, and VAS during sporting activities were calculated. To determine significant predictors of outcomes, a generalized multivariate linear regression model developed based on univariate analysis and clinical experience was used. Statistical significance was set at p<0.05.Results:In total, 61 patients underwent 65 procedures, with outcome measures obtained on average 57.9 (range, 12-115) months postoperatively. Median age was 22, median BMI was 24.4, and 59.0% of the cohort was female. Of the 65 fasciotomies, 39 (60.0%) were simultaneous bilateral, 6 procedures (9.2%) performed on 3 patients were staged bilateral, and 18 (27.7%) wereunilateral. There were 16 four-compartment fasciotomies performed (24.6%), while 49 (75.4%) involved 2 compartments. Twenty- two procedures involved deep posterior compartment pressures meeting the Pedowitz criteria. Patients had mean (+- standard deviation) improvement in FAAM-Sport of 40.4 +- 22.3 points (p<0.001), improvement in FAAM-Sport SANE of 57.3 +- 31.6 (p<0.001), and reduction of VAS pain of 56.4 +- 31.8 (p<0.001). Multivariate linear regression results are listed in Table 1.Conclusion::Fasciotomy is an effective treatment of CECS, with our study identifying certain patient variables leading to greater improvement. Independent predictors of improvement of FAAM-Sport SANE following surgery included younger age, history of depression, and male sex. A history of depression was an independent predictor of greater VAS pain reduction following fasciotomy. Patients with deep posterior compartment pressure testing meeting the Pedowitz criteria was an independent predictor of increased improvement in FAAM-Sport. To our knowledge, this is the first study to investigate and identify independent patient variables predictive of greater functional improvement following fasciotomy for CECS.

Portable Gait Lab: Tracking Relative Distances of Feet and CoM Using Three IMUs.

Ambulatory estimation of gait and balance parameters requires knowledge of relative feet and centre of mass (CoM) positions. Inertial measurement units (IMU) placed on each foot, and on the pelvis are useful in tracking these segments over time, but cannot track the relative distances between these segments. Further, drift due to strapdown inertial navigation results in erroneous relative estimates of feet and CoM positions after a few steps. In this study, we track the relative distances using the assumptions of the Centroidal Moment Pivot (CMP) theory. An Extended Kalman filter approach was used to fuse information from different sources: strapdown inertial navigation, commonly used constraints such as zero velocity updates, and relative segment distances from the CMP assumption; to eventually track relative feet and CoM positions. These estimates were expressed in a reference frame defined by the heading of each step. The validity of this approach was tested on variable gait. The step lengths and step widths were estimated with an average absolute error of 4.6±1.5 cm and 3.8±1.5 cm respectively when compared against the reference VICON©. Additionally, we validated the relative distances of the feet and the CoM, and further, show that the approach proves useful in identifying asymmetric gait patterns. We conclude that a three IMU approach is feasible as a portable gait lab for ambulatory measurement of foot and CoM positions in daily life.