Search Results (63)

Background: Plantar pressure distribution is a valuable tool for studying how the ground reaction forces are transmitted from the feet to the body and for detecting abnormalities in foot biomechanics. Objectives: The objective of this study was to determine the effect of the foot type (normal foot, flatfoot, and cavus foot) on plantar pressure distribution in healthy Mexican men and women aged from 3 to 74 years. Methods: A database of the plantar pressure distribution under dynamic and static conditions for both feet was studied using descriptive statistics, regression analysis, and statistical factorial design. The database contained images of the soles of the feet and pressure distribution of 996 persons between 3 and 74 years old (53.9% females and 46.1% males). Two different conditions were evaluated; the first was in a static condition, and the second was during walking. The Chippaux–Smirak Index (CSI) was used to classify the type of feet. Results: In the left foot, a linear regression analysis of the soles of the feet shows that the prevalence of flatfoot (p-value = 3.45 × E⁻⁵) decreased with age, while the normal foot (p-value = 7.39 × E⁻⁵) increased. When people are standing (static), the hindfoot (55.64 ± 18.80%) presents more pressure than the forefoot (45.18 ± 19.50%), while in dynamic, the forefoot (55.95 ± 13.36%) supports more pressure than the hindfoot (44.05 ± 13.36%). Similar behavior occurs in the right foot. A statistical factorial design ANOVA shows that the plantar pressure in the forefoot and hindfoot regions is significantly different (p < 0.05). Conclusions: The prevalence of flatfoot decreased with age, while the proportion of normal foot type increased. Under static conditions, the hindfoot bore more load than the forefoot, whereas under dynamic conditions, the forefoot bore more load than the hindfoot. This research contributes to generating a comprehensive database of reference values of the plantar pressure of different foot types in a Mexican population; this will be useful to podiatrists, clinicians, and physiotherapists for the analysis or treatment of abnormal foot postures. Full article

Background/Objectives: Despite a substantial duration of recovery following the modified Broström procedure (MBP), many individuals do not entirely recover their preinjury sports performance. Return to sports (RTS) can be affected by multiple elements apart from a patient’s motivation. This study aimed to investigate the factors influencing RTS after anatomical ligament repair for chronic ankle instability. Methods: Sixty-two patients aged under 35 who underwent the MBP were regularly monitored for up to 3 years. Of these, 51 patients (82.3%) returned to their preinjury level of sports activity (return group), while 11 patients (17.7%) complained of partial or significant limitations (non-return group). Clinical outcomes were measured by the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). Mechanical stability was examined through physical examination and stress radiography. Peroneal strength was evaluated with an isokinetic dynamometer. Static and dynamic postural control abilities were tested using Biodex posturography. Results: Significant group differences were found in FAOS pain (94.7 points in the return group vs. 85.1 points in the non-return group; p = 0.004) and sports (91.2 vs. 78.8 points; p < 0.001) subscales. In the FAAM, the sports activity subscale also showed significant disparities (90.5 vs. 77.4 points, p < 0.001). Mechanical instability recurred in 2 patients (3.9%) in the return group and 4 patients (36.4%) in the non-return group, indicating a significant difference (p < 0.001). No notable differences were identified in stress radiography values or peroneal strength measurements. Posturographic evaluation showed that static postural control ability (overall stability index) did not differ significantly between the groups (1.22 in the return group vs. 1.43 in the non-return group); however, dynamic postural control ability differed substantially (1.41 vs. 2.33, p = 0.002). Conclusions: Residual pain, recurrence of mechanical instability, and insufficient recovery of dynamic postural control ability were associated with the return to preinjury level of sports activity after the MBP. Comprehensive rehabilitation protocols should address these factors to facilitate optimal postoperative sports participation. Full article

Background: Pes planus is a condition where the arch of the foot collapses, resulting in the entire sole contacting the ground. The biomechanical implications of pes planus on gait have been widely studied; however, research specific to Black African populations, particularly recreational runners, is scarce. Aim: This study aimed to describe the forefoot centre of pressure (CoP) trajectory during the barefoot gait cycle among Black African recreational runners with pes planus. Methods: A prospective explorative and quantitative study design was employed. Participants included Black African male recreational runners aged 18 to 45 years diagnosed with pes planus. A Freemed™ 6050 force plate was used to collect gait data. Statistical analysis included cross-tabulations to identify patterns. Results: This study included 104 male participants across seven weight categories, with the majority in the 70-to-79 kg range (34.6%, n = 36). Most participants with pes planus showed a neutral foot posture (74.0%, n = 77) on the foot posture index 6 (FPI-6) scale. Flexible pes planus (94.2%, n = 98) was much more common than rigid pes planus (5.8%, n = 6). Lateral displacement of the CoP was observed in the right forefoot (90.4%, n = 94) and left forefoot (57.7%, n = 60). Load distribution patterns differed between feet, with the right foot favouring the medial heel, arch, and metatarsal heads, while the left foot favoured the lateral heel, medial heel, and lateral arch. No statistical significance was found in the cross-tabulations, but notable lateral CoP displacement in the forefoot was observed. Conclusions: The findings challenge the traditional view of pes planus causing overpronation and highlight the need for clinicians to reconsider standard diagnostic and management approaches. Further research is needed to explore the implications of these findings for injury prevention and management in this population. Full article

The first ray plays a fundamental role in foot biomechanics, particularly in stabilizing the medial longitudinal arch and enabling efficient weight transfer during the mid-stance and propulsion phases of gait. When dorsiflexed—a condition known as metatarsus primus elevatus—especially in its flexible form, this structure disrupts load distribution, impairs propulsion, and contributes to various clinical symptoms. Despite its clinical importance, the biomechanical impact of orthotic elements placed beneath the first ray remains underexplored. This study aimed to quantify the variations in medio-lateral (Fx), antero-posterior (Fy), and vertical (Fz) force vectors generated during gait in response to different orthotic elements positioned under the first ray. A quasi-experimental, post-test design was conducted involving 22 participants (10 men and 12 women) diagnosed with flexible metatarsus primus elevatus. Each participant was evaluated using custom-made insoles incorporating various orthotic elements, while gait data were collected using a dynamometric platform during the mid-stance and propulsion phases. Significant gait-phase-dependent force alterations were observed. A cut-out (E) reduced medio-lateral forces during propulsion (p < 0.05), while a kinetic wedge (F) was correlated with late-stance stability (r = −0.526). The foot posture index (FPI)/body mass index (BMI) mediated the vertical forces. The effect sizes reached 0.45–0.42 for antero-posterior force modulation. Phase-targeted orthoses (a cut-out for propulsion, a kinetic wedge for late stance) and patient factors (FPI/BMI) appear to promote biomechanical efficacy in metatarsus primus elevatus, enabling personalized therapeutic strategies. Full article

Background: Iliotibial band syndrome (ITBS) through the tensor fascia latae (TFL) is a well-known pathology among runners whose etiology is not completely clear, nor is the effectiveness of plantar insoles for different types of feet known well enough for them to be considered a possible approach for this issue. Objective: to understand how foot type and foot orthotics may influence the electromyographic (EMG) activity of the TFL. Methods: A total of 41 healthy recreational runners (mean age 32.66 ± 3.51) were recruited for the present cross-sectional study, categorizing them as neutral (NEUg = 15), supinators (SUPg = 15), and pronators (PROg = 11) according to the foot postural index, over a period of 11 months. The EMG of the TFL was measured using a surface electromyograph device while they ran on a treadmill at a constant speed of 9 km/h for 3 min, randomly using supinating (SUP), pronating (PRO), or heel lift (TAL) insoles of 5 mm each one, compared to the baseline condition (SIN). The intraclass correlation coefficient (ICC) was performed to check the reproducibility of the tests, pairwise comparisons with Bonferroni adjustment were made, and to test the differences between measurements, the Friedman test was performed. Results: The Shapiro–Wilk test indicated a normal distribution of the sample (p > 0.05). Almost all obtained results showed a “perfect reproducibility” close to one; a significant statistical increase was observed in the mean EMG values from NEUg (87.58 ± 4.81 mV) to SUPg (97.17 ± 4.3 mV) (p < 0.05) during SIN+ basal condition. Additionally, there was a statistical reduction from SIN (87.58 ± 4.81 mV) vs. PRO (74.69 ± 3.77 mV) (p < 0.001) in NEUg and from SIN (97.17 ± 4.3 mV) vs. PRO (90.96 ± 4 mV) (p < 0.001) in SUPg. Conclusions: The SUPg exhibited increased activation of TFL fibers compared to the NEUg, likely due to the biomechanical demands associated with a supinated foot type. In contrast, the use of PRO appeared to promote relaxation of the TFL fibers by inducing internal rotation of the lower limb. Based on these preliminary results from a cross-sectional study in a healthy population, it is recommended to assess foot type when addressing ITBS and to consider the use of PRO as a complementary therapeutic strategy alongside conventional treatments. Full article

Background and Objectives: Gait and posture alterations are reported in patients with diabetic foot. We evaluated whether gait and postural parameters are associated with a well-known parameter, e.g., glycated hemoglobin levels in blood, and the salivary markers 1,5-anhydro-D-glucitol (1,5-AG) and Advanced Glycation End-Products (AGEs) measured in saliva samples. Materials and Methods: Gait and postural impairment was assessed using a wearable inertial sensor, and the evaluation of balance/gait and risk of fall was determined by the Tinetti Scale and Downton Index, respectively. Glycemic control was measured by glycated hemoglobin concentration and fasting glycemia. The salivary concentration of 1,5-AG and AGEs was measured using an enzyme-linked immunosorbent assay. Results: Eighty-five patients were evaluated, revealing significant associations (p < 0.05) between salivary 1,5-AG and sway path displacement along the medio-lateral axis (rho = 0.365, p = 0.017) and sway area (rho = 0.334, p = 0.031) during tandem position tests with eyes closed. Salivary AGEs were significantly associated with sway path displacement along the anterior–posterior axis (rho = 0.419, p = 0.004) and medio-lateral axis (rho = 0.436, p = 0.002) in the tests performed with eyes closed, feet close together, and foam pads, as well as with sway area (rho = 0.387, p = 0.007). The concentration of HbA1c was significantly correlated with sway path displacement along the anterior–posterior axis in the tests performed with eyes closed, feet close together, and foam pads (rho = 0.236, p = 0.043), as well as with sway area (rho = −0.236, p = 0.043). A significant difference was observed in the salivary AGE concentration between patients with previous ulcers versus those without (p = 0.035). By applying Bonferroni correction for multiple comparisons, the associations remained significant (p < 0.05) for AGE concentration in saliva and postural instability parameters. Conclusions: The results suggest a link between salivary glycemic control biomarkers, in particular AGEs and postural changes in patients with diabetic foot, indicating a new interesting filed for further studies on fall risk. Full article

Background/Objectives: The foot posture index (FPI-6) is a practical clinical tool for evaluating standing foot posture using six specific criteria. Although widely used, its reliability and correlation with radiographic parameters remain uncertain. This study aimed to assess the inter-rater reliability of the FPI-6, in both asymptomatic individuals and patients with foot and ankle symptoms, and to examine its correlation with radiographic measurements. Methods: We included 40 asymptomatic male volunteers (group A) and 60 symptomatic patients (group B). Four raters independently assessed the FPI-6 scores, and inter-rater reliability was evaluated using the intraclass correlation coefficient. Radiographic parameters included the talocalcaneal angle (TCA) on anteroposterior (AP) and lateral views, talonavicular coverage angle (TNCA), AP talo-first metatarsal angle (TMA), hindfoot alignment angle (HAA), calcaneal pitch angle (CPA), and Meary’s angle (MA). Correlations between the FPI-6 and radiographic measurements were analyzed using Pearson’s correlation (r). Results: The FPI-6 showed good to excellent inter-rater reliability in both groups, with higher consistency in group B and among experienced raters. The total FPI-6 score significantly correlated with TNCA (r = 0.665), AP TMA (r = 0.453), lateral TCA (r = 0.369), MA (r = 0.570), and HAA (r = −0.773) (all p < 0.001). Group B demonstrated overall stronger correlations between the FPI-6 and radiographic measurements compared to group A (TNCA: 0.664 vs. 0.258; AP TMA: 0.542 vs. 0.139; lateral TCA: 0.492 vs. −0.101; MA: 0.544 vs. 0.172; and HAA: −0.712 vs. −0.374). Conclusions: With careful application, the FPI-6 is a reliable and valid tool for clinical assessment of foot posture, especially in settings without immediate access to radiographs. Full article

Background/Objectives: Flatfoot is a common pediatric foot deformity characterized by a reduced or absent medial longitudinal arch (MLA). The condition can lead to altered gait, pain, and potential long-term morbidity if untreated. Identifying potential risk factors—such as body mass index (BMI), ligamentous or joint instability, shoe choices, and physical activity—is crucial for prevention and management. The objectives are to systematically review and synthesize current evidence on how flatfoot severity correlates with BMI and other risk factors in children and adolescents, and to highlight methodological considerations essential for future research. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched five electronic databases from inception to February 2024. Flatfoot severity was measured by various clinical or radiographic indices. Two reviewers independently screened and assessed the risk of bias. Results: Thirty-seven studies met the inclusion criteria. Children with high BMI had increased odds of flatfoot (pooled Odds Ratio = 2.3, 95% Confidence Interval: 1.6–3.1), with one outlier reporting an OR of 9.08. Heterogeneity (I² up to 70%) stemmed from varied diagnostic methods. Other factors, including joint instability, shoe choices, and physical activity, showed mixed associations. Conclusions: Elevated BMI strongly correlates with pediatric flatfoot severity, highlighting the importance of proactive weight management and foot assessments. Future standardized, longitudinal studies are needed to clarify causality and refine interventions. Full article

Background: Fibromyalgia (FM) is a chronic disorder causing widespread musculoskeletal pain, often leading to physical deconditioning that affects posture and gait. This study evaluates the effects of a manual therapy protocol targeting dorsal muscles in the lower back on plantar pressure modifications, considering body mass index (BMI) influence. Methods: A single-arm, non-randomized clinical trial included 24 women diagnosed with FM for at least three years. They underwent an eight-session manual therapy protocol over four weeks, applying moderate pressure to dorsal muscles in the lower back. Baropodometric analyses were conducted pre- and post-intervention under dynamic conditions. Statistical analyses used paired t-tests and effect size calculations to assess intervention effects and BMI impact. Results: Significant improvements in plantar pressure distribution were observed in both the left foot (p = 0.01, d = −0.54) and the right foot (p = 0.008, d = −0.59). However, strength and peak pressure metrics showed no significant changes. Patients with normal BMI exhibited greater improvements than those in the overweight category. Conclusions: Preliminary findings suggest that manual therapy positively influenced plantar pressure distribution in FM patients, particularly in those with normal BMI. Further research is needed to explore long-term effects and broader clinical applications. Full article

Background/Objectives: As a representative anatomic ankle ligament repair technique, the Broström procedure continues to be modified to reach better clinical outcomes, superior mechanical stability, early rehabilitation, and minimal risk of recurrent instability. This study aimed to evaluate the intermediate-term clinical outcomes after the modified Broström procedure (MBP) with suture-tape augmentation for chronic lateral ankle instability. Methods: Ninety-four patients with chronic lateral ankle instability were followed for ≥3 years after MBP augmented with suture tape. The patient-reported clinical outcomes were evaluated with the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). The changes in mechanical ankle stability were evaluated with physical examination and periodic stress radiography. The changes in static and dynamic postural control ability were assessed with the single-leg stance test and Biodex posturography. Results: FAOS and FAAM scores significantly improved from preoperative means of 52.6 and 54.2 points to 91.8 and 90.5 points at final follow-up, respectively (p < 0.001). Talar tilt angle and anterior talar translation significantly improved from preoperative means of 15.4° and 14.3 mm to 2.7° and 4.5 mm at final follow-up, respectively (p < 0.001). Two patients (2.1%) complained of a recurrence of mechanical and functional instability. One patient (1.1%) showed non-specific inflammation related to a suture tape. Balance retention time significantly improved from a preoperative mean of 3.7 to 6.4 s at final follow-up (p < 0.001), with a non-significant side-to-side difference. The overall stability index significantly improved from a preoperative mean of 3.7 to 1.9 at final follow-up (p < 0.001), with a significant side-to-side difference. Conclusions: The MBP augmented with suture tape appears to be an effective surgical technique for chronic lateral ankle instability. Through anatomic repair of attenuated ankle ligaments and suture-tape augmentation, this modified procedure can provide reliable stability and minimal risk of recurrent instability. In addition, static and dynamic postural control ability may be improved through continuous proprioceptive-oriented rehabilitation following surgery. Full article

Background: The use of foot orthoses to treat different pathologies in pronated feet in adults is widespread among podiatric professionals, although it has not been conclusively demonstrated to modify foot posture in the short or medium term. Objective: The aim of this study was to evaluate whether prefabricated foot supports reduce pronated foot posture in adults, as measured by the foot posture index (FPI). Methods: A randomised controlled clinical trial was conducted in 109 subjects with pronated feet. The participants were randomly placed into a control group that did not receive any intervention and an experimental group that used prefabricated orthoses for 6 months. The changes in the FPI were evaluated in both groups at 6 months. Results: Over the six-month follow-up period, the delta FPI variable was changed by −1.1 ± 2.2 points in the experimental group, whereas the same variable was reduced by 1.2 ± 2.1 points in the control group (p = 0.001). The participants in the experimental group neutralised their FPIs significantly more than those in the control group did (39.3% vs. 8.5%; p = 0.041). Moreover, individuals in the experimental group were more likely to migrate from highly pronated feet to pronated feet than those in the control group were (45.8% vs. 20%; p < 0.001). Finally, multivariate analysis indicated that prefabricated foot orthoses were associated with an improved FPI (OR: 6.23, CI%95: 2.72–17.09; p < 0.001). However, the corrective effect provided by the prefabricated foot orthoses, which neutralised the pronated posture, was nullified by the presence of index minus metatarsal formula. Conclusions: The use of prefabricated orthoses resulted in a decreased FPI in adults, especially in those with highly pronated feet. However, the index minus presence nullified the effect of prefabricated orthoses on foot posture neutralisation. Full article

Objective: To evaluate the morphofunctional alterations in the foot and their association with functionality, considering aspects such as disability, pain, and limitations in daily activities in patients with fibromyalgia syndrome (FMS). Methods: A case–control study was conducted in patients with FMS (case group) and without FMS (control group), matched by age and sex. Foot posture was assessed using the foot posture index (FPI), along with the presence of hallux valgus (HV), trigger points, hyperkeratosis, and dorsiflexion of the first metatarsophalangeal joint and ankle. Foot functionality was evaluated using the foot function index (FFI) questionnaire. Results: A total of 100 women with FMS and 100 women without FMS, with a mean age of 61.97 ± 9.26 years, were recruited. HV (p < 0.001), hyperkeratosis (p < 0.001), pronated and supinated foot (p < 0.001), as well as limitations in dorsiflexion of the first metatarsophalangeal joint (p < 0.001) and the ankle with the knee flexed (p < 0.001) and extended (p < 0.001), along with the activity of the flexor hallucis brevis (p = 0.006), adductor hallucis (p = 0.006), and dorsal interosseous (p = 0.002) muscles, were significantly associated with the FFI, being higher in individuals with FMS, indicating greater impairment of foot functionality in these patients. Multivariate analysis revealed a statistical association between FMS and low educational level (OR = 2.57, 95% CI 1.05–5.72), the presence of another rheumatic disease (OR = 5.07, 95% CI 2.34–11), and the presence of any active trigger point (OR = 11.15, 95% CI 3.97–31.31). Conclusions: The study highlights the relationship between morphofunctional foot alterations, specifically the presence of active myofascial trigger points, and functionality in patients with FMS. Full article

This study investigated the collapse of the medial longitudinal arch (MLA) as a risk factor for medial tibial stress syndrome (MTSS), hypothesizing that overuse of extrinsic foot muscles to prevent MLA collapse can lead to disability. Twenty healthy adults (age: 20.8 ± 0.8, height: 162.2 ± 10.4, weight: 54.9 ± 9, BMI: 20.8 ± 1.7) (39 feet) with a foot posture index score below 6 and no recent lower extremity orthopedic history participated. Ultrasonography measured foot muscle cross-sectional areas, while three-dimensional motion analysis using VICON assessed foot kinematics during gait, focusing on navicular height at initial contact (ICNH) and dynamic navicular drop (DND) during the stance phase. Hierarchical cluster analysis based on ICNH and DND compared muscle cross-sectional areas between clusters using ANOVA or Kruskal–Wallis test. The analysis indicated that ICNH was lower in clusters 1 and 3 than in cluster 2, and DND was smaller in clusters 1 and 2 than in cluster 3. Although there was no significant difference in muscle cross-sectional area between the clusters, the flexor hallucis longus tended to be thicker in cluster 1 than in cluster 3 (p = 0.051). The findings suggest that flexor digitorum longus may help prevent MLA compression during loading, indicating that overuse of extrinsic foot muscles may contribute to MTSS development. Full article

Background: Foot morphology in children is a crucial factor influencing multiple aspects of their physical development. Between the ages of 5 and 10 years, the critical period of child development is when the movement and stability patterns are consolidated that can affect their long-term physical performance and quality of life. The aim of this study is to analyze how the type of foot influences different physical characteristics, laxity, strength, motor tests, and baropodometric variables in children aged 5 to 10 years. Methods: A cross-sectional study involving 196 children was conducted. Different physical characteristics, laxity, strength, motor tests, and baropodometric variables of the sample were analyzed for age and Foot Posture Index (FPI). Results: Differences in all variables were examined by age and FPI. Statistical analysis showed a moderate to high correlation (r > 0.6, p < 0.01) between FPI and the relaxed calcaneal stance position (RCSP) test. Some significant differences were also found in variables related to foot pronation and supination. These results provide valuable information for understanding differences in motor and functional development during childhood and pre-adolescence. Conclusions: The findings highlight the variability in physical and functional development between age and foot type groups, highlighting the importance of considering these differences in the assessment and management of foot-related conditions and biomechanics in childhood. Foot type significantly influences children’s growth and development. Full article

Severe adult-acquired flatfoot deformity is widely addressed surgically via the Grice–Green subtalar arthrodesis. Standard radiographic measurements have been reported, but these are limited to planar views. These complex deformities and the relevant corrections after surgery should be assessed in weight-bearing using 3D analyses now enabled by modern cone-beam CT scans. The present study is aimed at reporting these 3D radiographical foot bone alignments and the clinical results for this surgery. Ten patients were treated with the Grice–Green procedure. This implies inserting an autologous bone graft from the proximal tibial into the extra-articular sinus-tarsi to perform a subtalar arthrodesis. Before and after surgery, the patients were assessed based on the clinical range-of-motion and Foot-Function and Posture Indexes. Three-dimensional models of the tibia, calcaneus, talus, navicular, and 1st metatarsus were reconstructed from cone-beam CT scans in a single-leg up-right posture. Relevant longitudinal axes were defined to calculate ten spatial angles. Post-operatively, a significant realignment was observed for seven angles, including corrections lift-up of the talus (on average by 15°) and subtalar joint (13° in 3D), as well as the Meary’s angle (21°). Only few correlations were found between traditional clinical and novel 3D radiographical measurements, suggesting the former only limitedly represent the corresponding real skeletal status, and the latter thus offer the physician a more comprehensive evaluation. The present original analysis from modern cone-beam CT scans shows precisely the correction of foot and ankle bone alignments achieved using the Grice–Green surgical procedure, finally in 3D and in weight-bearing. For the first time, traditional clinical and score system evaluations are reported together with bone orientation and joint angles in the three anatomical planes. Full article