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Jiao X, Hu T, Li Y, Wang B, Acquah MEE, Wang Z, Chen Q, Gan Y, Gu D. Association between Elastic Modulus of Foot Soft Tissues and Gait Characteristics in Young Individuals with Flatfoot. Bioengineering (Basel) 2024; 11:728. [PMID: 39061810 PMCID: PMC11273929 DOI: 10.3390/bioengineering11070728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Flatfoot is a common foot deformity, causing foot pain, osteoarthritis of the midfoot, and even knee and hip dysfunction. The elastic modulus of foot soft tissues and its association with gait biomechanics still remain unclear. For this study, we recruited 20 young individuals with flatfoot and 22 age-matched individuals with normal foot arches. The elastic modulus of foot soft tissues (posterior tibial tendon, flexor digitorum brevis, plantar fascia, heel fat pad) was obtained via ultrasound elastography. Gait data were acquired using an optical motion capture system. The association between elastic modulus and gait data was analyzed via correlation analysis. The elastic modulus of the plantar fascia (PF) in individuals with flatfoot was higher than that in individuals with normal foot arches. There was no significant difference in the elastic modulus of the posterior tibial tendon (PTT), the flexor digitorum brevis (FDB), or the heel fat pad (HFD), or the thickness of the PF, PTT, FDB, and HFD. Individuals with flatfoot showed greater motion of the hip and pelvis in the coronal plane, longer double-support phase time, and greater maximum hip adduction moment during walking. The elastic modulus of the PF in individuals with flatfoot was positively correlated with the maximum hip extension angle (r = 0.352, p = 0.033) and the maximum hip adduction moment (r = 0.429, p = 0.039). The plantar fascia is an important plantar structure in flatfoot. The alteration of the plantar fascia's elastic modulus is likely a significant contributing factor to gait abnormalities in people with flatfoot. More attention should be given to the plantar fascia in the young population with flatfoot.
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Affiliation(s)
- Xin Jiao
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (X.J.); (Z.W.); (Y.G.)
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; (T.H.); (Y.L.); (B.W.); (M.E.E.A.)
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Tianyi Hu
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; (T.H.); (Y.L.); (B.W.); (M.E.E.A.)
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Yongjin Li
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; (T.H.); (Y.L.); (B.W.); (M.E.E.A.)
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Binbin Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; (T.H.); (Y.L.); (B.W.); (M.E.E.A.)
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Mirabel Ewura Esi Acquah
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; (T.H.); (Y.L.); (B.W.); (M.E.E.A.)
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Zengguang Wang
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (X.J.); (Z.W.); (Y.G.)
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; (T.H.); (Y.L.); (B.W.); (M.E.E.A.)
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Qianqian Chen
- Department of Ultrasound, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yaokai Gan
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (X.J.); (Z.W.); (Y.G.)
| | - Dongyun Gu
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (X.J.); (Z.W.); (Y.G.)
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; (T.H.); (Y.L.); (B.W.); (M.E.E.A.)
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
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The diagnosis and management of common childhood orthopedic disorders: An update. Curr Probl Pediatr Adolesc Health Care 2020; 50:100884. [PMID: 33069588 DOI: 10.1016/j.cppeds.2020.100884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Musculoskeletal illness represents a significant portion of office visits to primary and urgent care clinicians. Despite this, little emphasis is placed on learning pediatric orthopaedics during medical school or residency. The focus of this paper is to provide a systematic approach to this general musculoskeletal physical exam and to assist in the recognition of what conditions are normal development and what conditions require observation, workup and referral to an experienced pediatric orthopaedist.
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Posa G, Betak O, Nagy E. Balance in focus: a simple observational scale to monitor the effect of exercises on static balance in case of childhood flexible flat foot. J Phys Ther Sci 2020; 32:735-741. [PMID: 33281289 PMCID: PMC7708003 DOI: 10.1589/jpts.32.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/22/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Childhood flexible flat foot is the most common lower limb deformity.
Observational evaluation of the underlying elements of reactive balance during static
positions is an accepted tool besides the timed measures. We aim to assess the effects of
combined balance training on the foot function and to test the usefulness of our
observational static balance score. [Participants and Methods] A total of 19 healthy
primary school students with flexible flat foot deformity volunteered for the study. We
evaluated the foot’s dynamic properties and static postural stability before and after a
20-week combined balance training. On the basis of the observational findings, the time
vs. quality observational static balance score was developed. All data were subjected to
Wilcoxon’s test and Friedman’s ANOVA to compare the effects of the training on foot
trajectory and observational static balance score. [Results] Better strength and endurance
in the foot extensors and improved foot function were noted after the training. Using our
observational static balance score, the quality of the balance performance remarkably
changed. [Conclusion] The quality domain of our new scale seems to be a useful tool in
daily clinical practice and a more sensitive measure in eyes-closed situations.
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Affiliation(s)
- Gabriella Posa
- Juhász Gyula Faculty of Education Institute of Applied Health Sciences and Health Promotion, University of Szeged, Hungary
| | - Orsolya Betak
- Physiotherapy Programme, Faculty of Health and Social Sciences, University of Szeged, Hungary
| | - Edit Nagy
- Department of Physiotherapy, Faculty of Health and Social Sciences, University of Szeged: H-6726 Szeged, Temesvári krt. 31, Hungary
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Blasimann A, Eichelberger P, Lutz N, Radlinger L, Baur H. Intra- and interday reliability of the dynamic navicular rise, a new measure for dynamic foot function: A descriptive, cross-sectional laboratory study. Foot (Edinb) 2018; 37:48-53. [PMID: 30326410 DOI: 10.1016/j.foot.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/02/2018] [Accepted: 08/17/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The lack of reliable parameters to evaluate dynamic foot function, emphasizes the need for a deeper insight in foot biomechanics. The aims were to investigate the reliability of a new parameter (dynamic navicular rise dNR), and its relationship with the dynamic navicular drop (dND). METHODS Twenty healthy participants (mean age 30.2±8.1years) had to walk on even ground and downstairs. Data of ten trials per task on two measurement days were recorded. The dNR was defined as the difference in millimetres (mm) between the minimum navicular height (NH) during stance and the NH at toe off. To test intra- and interday reliability, Intraclass Correlation Coefficients (ICC2.1) and repeatability were calculated. To obtain the absolute repeatability (RP) in mm, the equation RP=1.96×SDdifferences was used. Furthermore, the relationship between the dNR and the dND was examined by calculating Pearson (r) or Spearman (rs) correlation coefficients. RESULTS Included participants showed a mean dNR of (12.2±3.7) mm for level walking and (14.8±3.4) mm for stair descent. The ICC2.1 for the dNR were 0.98 (intraday), 0.91 (interday) for level walking and 0.97 (intraday), 0.94 (interday) for stair descent. The interday repeatability was 3.2mm (level walking), 2.7mm (stair descent) respectively. For level walking, r was 0.31 (p=0.049), and rs=0.88 (p<0.001) for stair descent. CONCLUSIONS The dNR seems to be highly reliable (ICCs), however, repeatability is unacceptable. For level walking, the dNR might be an independent measure, but not for stair climbing.
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Affiliation(s)
- Angela Blasimann
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, CH-3008 Bern, Switzerland.
| | - Patric Eichelberger
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, CH-3008 Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland
| | - Nicole Lutz
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, CH-3008 Bern, Switzerland
| | - Lorenz Radlinger
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, CH-3008 Bern, Switzerland
| | - Heiner Baur
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, CH-3008 Bern, Switzerland
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Hollander K, de Villiers JE, Sehner S, Wegscheider K, Braumann KM, Venter R, Zech A. Growing-up (habitually) barefoot influences the development of foot and arch morphology in children and adolescents. Sci Rep 2017; 7:8079. [PMID: 28808276 PMCID: PMC5556098 DOI: 10.1038/s41598-017-07868-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/04/2017] [Indexed: 02/06/2023] Open
Abstract
The development of the human foot is crucial for motor learning in children and adolescents as it ensures the basic requirements for bipedal locomotion and stable standing. Although there is an ongoing debate of the advantages and disadvantages of early and permanent footwear use, the influence of regular barefootness on foot characteristics in different stages of child development has not been extensively evaluated. A multicenter epidemiological study was conducted to compare the foot morphology between habitually barefoot children and adolescents (N = 810) to age-, sex- and ethnicity-matched counterparts that are used to wearing shoes. While controlling for confounders, we found that habitual footwear use has significant effects on foot-related outcomes in all age groups, such as a reduction in foot arch and hallux angles. The results indicate an impact of habitual footwear use on the development of the feet of children and adolescents. Therefore, growing up barefoot or shod may play an important role for childhood foot development, implying long-term consequences for motor learning and health later in life.
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Affiliation(s)
- Karsten Hollander
- Department of Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, Hamburg, Germany.
| | - Johanna Elsabe de Villiers
- Department of Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, Hamburg, Germany.,Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus-Michael Braumann
- Department of Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Ranel Venter
- Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa
| | - Astrid Zech
- Department of Sport Science, Friedrich Schiller University Jena, Jena, Germany
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Aenumulapalli A, Kulkarni MM, Gandotra AR. Prevalence of Flexible Flat Foot in Adults: A Cross-sectional Study. J Clin Diagn Res 2017; 11:AC17-AC20. [PMID: 28764143 DOI: 10.7860/jcdr/2017/26566.10059] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/06/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Flat foot (pes planus) is a commonly observed disorder in clinical practice. The height of Medial Longitudinal Arch (MLA) determines the degree of pes planus. Majority of the previous studies on prevalence of flexible flat foot were done among children. AIM The present study was undertaken to determine the prevalence of flexible flat foot among 18-21-year-old Indian adults using Navicular Drop Test (NDT) which is regarded as reliable and valid method to characterise MLA. MATERIALS AND METHODS The present study was a cross-sectional study in which Brody's Navicular Drop Test was performed in five hundred healthy subjects (250 males and 250 females) aged 18-21-year-old. Navicular Drop (ND) of ≥ 10 mm was regarded as flexible flat foot. Statistical analysis was done using SPSS version 23.0. RESULTS The prevalence of flexible flat foot was 13.6% (for males-12.8%; for females-14.4%). The median with Inter Quartile Range (IQR) for ND among males was 6 mm (4-8) and 6 mm (4-9) for right and left foot respectively. The median with IQR for ND among females was 6mm (4-10) and 7mm (3-8) for right & left respectively. The correlation of Right Side Navicular Drop (RND) with height and weight was significant, but insignificant correlation was found between RND and BMI. The correlation of Left Side Navicular Drop (LND) with height, weight and BMI of individuals was statistically not significant. The difference between the ND of males and female group was statistically not significant. CONCLUSION The present study quantified the prevalence of flexible flat foot and gender wise normative values of ND among 18-21-year-old Indian adults. The information obtained by this study will be useful in the field of orthopaedics.
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Affiliation(s)
- Ashok Aenumulapalli
- Assistant Professor, Department of Anatomy, SBKS Medical Institute and Research Centre, Vadodara, Gujarat, India
| | - Manoj Mohan Kulkarni
- Associate Professor, Department of Anatomy, SBKS Medical Institute and Research Centre, Vadodara, Gujarat, India
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Um GM, Wang JS, Park SE. An analysis on muscle tone of lower limb muscles on flexible flat foot. J Phys Ther Sci 2015; 27:3089-92. [PMID: 26644650 PMCID: PMC4668141 DOI: 10.1589/jpts.27.3089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/06/2015] [Indexed: 12/04/2022] Open
Abstract
[Purpose] The aim of this study was to examine differences in the muscle tone and
stiffness of leg muscles according to types of flexible flat foot. [Subjects and Methods]
For 30 subjects 10 in a normal foot group (NFG), 10 in group with both flexible flat feet
(BFFG), and 10 in a group with flexible flat feet on one side (OFFG), myotonometry was
used to measure the muscle tone and stiffness of the tibialis anterior muscle (TA), the
rectus femoris muscle (RF), the medial gastrocnemius (MG), and the long head of the biceps
femoris muscle (BF) of both lower extremities. [Results] In the measurement results, only
the stiffness of TA and MG of the NFG and the BFFG showed significant differences. The
muscle tone and stiffness were highest in the BFFG, followed by the OFFG and NFG, although
the difference was insignificant. In the case of the OFFG, there was no significant
difference in muscle tone and stiffness compared to that in the NGF and the BFFG.
Furthermore, in the NFG, the non-dominant leg showed greater muscle tone and stiffness
than the dominant leg, although the difference was insignificant. [Conclusion] During the
relax condition, the flexible flat foot generally showed a greater muscle tone and
stiffness of both lower extremities compared to the normal foot. The stiffness was
particularly higher in the TA and MG muscles. Therefore, the muscle tone and stiffness of
the lower extremity muscles must be considered in the treatment of flat foot.
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Affiliation(s)
- Gi-Mai Um
- Department of Physical Therapy, Yeoju Institute of Technology: 338 Sejong-ro, Yeoju-si, Gyeonggi-do, Republic of Korea
| | - Joong-San Wang
- Department of Physical Therapy, Yeoju Institute of Technology: 338 Sejong-ro, Yeoju-si, Gyeonggi-do, Republic of Korea
| | - Si-Eun Park
- Department of Physical Therapy, Yongin University, Republic of Korea
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Blasimann A, Eichelberger P, Brülhart Y, El-Masri I, Flückiger G, Frauchiger L, Huber M, Weber M, Krause FG, Baur H. Non-surgical treatment of pain associated with posterior tibial tendon dysfunction: study protocol for a randomised clinical trial. J Foot Ankle Res 2015; 8:37. [PMID: 26279682 PMCID: PMC4536665 DOI: 10.1186/s13047-015-0095-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 08/04/2015] [Indexed: 12/31/2022] Open
Abstract
Background Symptoms associated with pes planovalgus or flatfeet occur frequently, even though some people with a flatfoot deformity remain asymptomatic. Pes planovalgus is proposed to be associated with foot/ankle pain and poor function. Concurrently, the multifactorial weakness of the tibialis posterior muscle and its tendon can lead to a flattening of the longitudinal arch of the foot. Those affected can experience functional impairment and pain. Less severe cases at an early stage are eligible for non-surgical treatment and foot orthoses are considered to be the first line approach. Furthermore, strengthening of arch and ankle stabilising muscles are thought to contribute to active compensation of the deformity leading to stress relief of soft tissue structures. There is only limited evidence concerning the numerous therapy approaches, and so far, no data are available showing functional benefits that accompany these interventions. Methods After clinical diagnosis and clarification of inclusion criteria (e.g., age 40–70, current complaint of foot and ankle pain more than three months, posterior tibial tendon dysfunction stage I & II, longitudinal arch flattening verified by radiography), sixty participants with posterior tibial tendon dysfunction associated complaints will be included in the study and will be randomly assigned to one of three different intervention groups: (i) foot orthoses only (FOO), (ii) foot orthoses and eccentric exercise (FOE), or (iii) sham foot orthoses only (FOS). Participants in the FOO and FOE groups will be allocated individualised foot orthoses, the latter combined with eccentric exercise for ankle stabilisation and strengthening of the tibialis posterior muscle. Participants in the FOS group will be allocated sham foot orthoses only. During the intervention period of 12 weeks, all participants will be encouraged to follow an educational program for dosed foot load management (e.g., to stop activity if they experience increasing pain). Functional impairment will be evaluated pre- and post-intervention by the Foot Function Index. Further outcome measures include the Pain Disability Index, Visual Analogue Scale for pain, SF-12, kinematic data from 3D-movement analysis and neuromuscular activity during level and downstairs walking. Measuring outcomes pre- and post-intervention will allow the calculation of intervention effects by 3×3 Analysis of Variance (ANOVA) with repeated measures. Discussion The purpose of this randomised trial is to evaluate the therapeutic benefit of three different non-surgical treatment regimens in participants with posterior tibial tendon dysfunction and accompanying pes planovalgus. Furthermore, the analysis of changes in gait mechanics and neuromuscular control will contribute to an enhanced understanding of functional changes and eventually optimise conservative management strategies for these patients. Trial registration ClinicalTrials.gov Protocol Registration System: ClinicalTrials.gov ID NCT01839669
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Affiliation(s)
- Angela Blasimann
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Patric Eichelberger
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Yvonne Brülhart
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Isam El-Masri
- Salem-Spital, Foot Surgery, Schänzlistrasse 39, 3013 Bern, Switzerland
| | - Gerhard Flückiger
- Sonnenhofspital, Foot Surgery, Buchserstrasse 30, 3006 Bern, Switzerland
| | - Lars Frauchiger
- Spital STS AG, Orthopaedics & Traumatology, Krankenhausstrasse 12, 3600 Thun, Switzerland
| | - Martin Huber
- Outpatient Clinic for Foot Surgery Bern, Schänzlistrasse 33, 3013 Bern, Switzerland
| | - Martin Weber
- Siloah, Clinic for Orthopaedics and Traumatology, Worbstrasse 316, 3073 Gümligen bei Bern, Switzerland
| | - Fabian G Krause
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Freiburgstrasse, 3010 Bern, Switzerland
| | - Heiner Baur
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
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Lizis P, Posadzki P, Smith T. Relationship between explosive muscle strength and medial longitudinal arch of the foot. Foot Ankle Int 2010; 31:815-22. [PMID: 20880486 DOI: 10.3113/fai.2010.0815] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There has been a suggested link between muscle strength and arch type of the foot. However, a distinct cause and effect dependence has yet to be established. The purpose of this study was to compare the outcomes from selected explosive strength tests with different arch heights. MATERIAL AND METHODS The medial longitudinal arch (MLA) was measured using a Clarke's angle method. Five hundred seventy-four subjects (n = 574) participated in this study and were divided into three arch height groups and three muscle strength groups, respectively. To evaluate the association between longitudinal arch of the foot with the explosive power of lower limb muscles, Chi-square (χ²) test was used. RESULTS Arch heights were not significantly related to explosive muscle strength. CONCLUSIONS Arch measurement was ineffective in accounting for the observed variability in the explosive strength among young adults. CLINICAL RELEVANCE This data may be useful in evaluating patients with painful flat feet and any strength deficits they may have.
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Affiliation(s)
- Paweł Lizis
- Honorary Research Associate, University of East Anglia, School of Medicine, Health Policy and Practice, Norwich, Norfolk, UK.
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