Search Results (130)

Background/Objectives: While restricted dorsiflexion range of motion (DF-ROM) is linked to deleterious sagittal and frontal plane knee and hip kinematics during landing, the literature is conflicted as to whether excessive foot pronation is linked to knee injury. The purpose of this study was to examine the relationship between static foot posture, DF-ROM, and lower extremity biomechanics during a drop-landing task. Methods: Fifteen physically active adults (age: 22.6 ± 2.4 years, height: 1.69 ± 0.08 m, mass: 66.40 ± 9.95 kg) volunteered to participate in this study. Static foot posture was measured by the six criteria of the Foot Posture Index (FPI-6) and DF-ROM was measured using the weight-bearing lunge test (WB-LT). Sagittal and frontal plane kinematics and kinetics of the hip, knee, and ankle were captured using a 3D motion capture system and force plate during a drop-landing task. Results: FPI-6 scores (4.67 ± 2.94) correlated with knee abduction angle at initial contact (1.08 ± 3.30°, r = −0.59, p = 0.02), ankle sagittal plane excursion (39.11 ± 7.67°, r = −0.63, p = 0.01) and knee adduction moment (0.58 ± 0.51 N/kg, r = 0.60, p = 0.017). DF-ROM correlated with knee adduction moment (r = −0.59, p = 0.02). The combination of FPI-6 and DF-ROM accounted for 56% of the variance in knee adduction moment (r = 0.746, p = 0.008). No significant relationships were identified for hip variables (p > 0.05). Conclusions: Participants with a more pronated static foot posture displayed less knee adduction angle at initial contact and decreased ankle sagittal plane excursion. Those with less DF-ROM and a pronated static foot posture exhibited increased maximum knee adduction moment. Foot and ankle structure influence lower extremity biomechanics. Full article

Introduction: Although gait alterations associated with excess body weight have been widely studied, most available evidence comes from laboratory-based analyses, which limit ecological validity and the translation of findings into clinical practice. This study addresses this gap by examining gait biomechanics across BMI categories using portable sensor-based insoles that allow gait assessment in real-world conditions. Methods: A cross-sectional study including 96 adults categorized as normal weight (NW), overweight (OW), or obese (OB) was conducted. Gait biomechanics were recorded using PODOSmart^® intelligent insoles, which capture spatiotemporal and angular parameters during natural walking. Foot health, quality of life and comorbildities were evaluated throught valeted questionnarires. Differences between groups were analyzed using ANOVA and chi-square tests. Age and sex, known to influence gait, were comparable across BMI groups and were considered in the interpretation of the results. Results: Overall, the participants in the OB group exhibited reduced stride length, gait speed, and swing time, increased double-support time, and greater pronation–supination and progression angles than OW and NW participants. Partial eta-squared values (η²p) were predominantly medium to large, reinforcing the robustness of these between-group differences (e.g., double-support time, p > 0.001; η²p = 0.19). Individuals with obesity reported poorer general and foot health and more difficulty finding suitable footwear. BMI was also significantly associated with hypertension, dyslipidemia, arthritis, and depression (all p <0.05), whereas diabetes, cardiopathies, knee pain, and fatigue andwalking or social activity limitations showed no significant differences. Conclusions: By using portable gait analysis technology in ecological conditions, this study provides novel evidence of clinically meaningful gait impairments across BMI groups. Higher BMI is associated with clinically relevant gait impairments, poorer perceptions of foot and general health, and a higher prevalence of several comorbidities. Full article

Background: The origin of hallux abducto valgus (HAV) is considered to be multifactorial; however, evidence regarding the factors involved in its development is scattered and often contradictory. Understanding the factors that contribute to the onset of HAV is crucial for informing both prevention and clinical management strategies. This review aims to explore the etiological factors associated with the development of HAV. Methods: A literature search was conducted in PubMed, Embase, Web of Science and Scopus. The search included observational studies that investigated etiological or risk factors related to the development of HAV. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklists, and the level of evidence was classified according to the Oxford Centre for Evidence-Based Medicine (OCEBM). Results: A total of 36 observational studies (20 cross-sectional and 16 case–control) were included, involving 14,500 participants, predominantly females. Genetic evidence indicated strong familial aggregation and variants in collagen- and extracellular matrix-related genes as potential hereditary determinants. The most consistent biomechanical factors were first-ray hypermobility, abnormal foot pronation and reduced activity of the abductor hallucis muscle. Additionally, female sex, older age and prolonged use of narrow or inadequate footwear were identified as recurring predictive variables. Overall, the findings support a complex etiological model based on the interaction of intrinsic and extrinsic factors. Conclusions: The development of HAV appears to be determined by the interaction of genetic, structural and biomechanical factors that alter first-ray stability and forefoot function. Current evidence supports a multifactorial etiological model with a strong hereditary component and higher susceptibility in women. Longitudinal studies employing standardized methods are needed to establish causal relationships and quantify the relative contribution of each factor. Full article

Background: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal disorder that involves various biomechanical factors, including the altered positioning of the patella, weakness of the lower extremity muscles, delayed activation of the vastus medialis muscle, and excessive pronation of the foot. Although the short- and long-term effects of external support among the recommended conservative treatment methods for PFPS have been examined, there remains a lack of consensus regarding their impacts. This study was conducted to investigate the immediate effects of braces and rigid taping applied to control pain on proprioception, functional status, and balance in patients with PFPS, and to compare these outcomes with normative values obtained from healthy individuals. Methods: The study included 18 patients with PFPS and 18 healthy individuals who met the inclusion criteria. Through randomization of the intervention sequence, patients were evaluated under conditions of rigid taping, support, or without any support. Their pain levels before and after the application were assessed using the Visual Analog Scale; their functional status was evaluated with the Kujala Patellofemoral Scoring, the 10-Step Up Test, and the Squat; their balance performance was measured using the Y-Balance Test and the Single Leg Stance Test; and their proprioception was assessed with the Joint Position Sense Test. Results: It has been determined that rigid taping and bracing have similar effects in the immediate management of pain, proprioception, functional status, and balance issues in patients with PFPS. The interventions were observed to bring patients’ static balance and proprioception parameters closer to the values seen in healthy individuals. Conclusions: Rigid taping and bracing are both effective interventions in the management of PFPS, offering benefits such as pain relief, prevention of proprioceptive deficits, mitigation of balance impairments, and enhancement of functional outcomes. The selection of the most appropriate modality should be based on the individual patient’s characteristics and tolerance levels. Full article

Background: Flatfoot is an alteration of the normal structure of the foot, characterized by a partial or total reduction of the medial longitudinal plantar arch, valgus deformity of the heel, and abduction of the forefoot. While treatments often include strengthening of the intrinsic foot muscles, evidence of its efficacy in adults with flatfoot remains limited. Objectives: The main objective of this review was to evaluate the effects of strengthening the plantar intrinsic muscles in adults with flatfoot. Methods: Searches were conducted in PubMed, Embase, Cochrane, PEDro, and Web of Science databases up to October 2023. The review protocol was developed and followed according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies included were those published on intrinsic muscle strengthening in adult populations. A qualitative synthesis of all included articles was performed, along with a quantitative sub-analysis of randomized controlled trials and a critical methodological assessment. Results: Eleven studies involving a total of 374 participants were selected. Most studies identified the “short foot exercise” as the optimal exercise for isolating and training the plantar intrinsic foot muscles. The most commonly analyzed variables were the Foot Posture Index and the Navicular Drop Test. Conclusions: Strengthening the plantar intrinsic muscles enhances the height of the medial longitudinal arch, improves hindfoot posture and balance, and increases hallux abductor muscle activity. This strengthening, whether achieved through short foot exercises alone or in combination with other techniques, is effective in treating adult flatfoot. Current literature suggests that a duration of 4–6 weeks may be sufficient to achieve beneficial outcomes. Full article

The torsional characteristics of human tendons are recognized to have functional and clinical relevance, but are underexplored due to the limited in vivo assessment methods available to measure the dynamic torsion characteristics of a tendon during movement. This study aimed to validate the use of transverse plane ultrasound speckle tracking (ST) for measuring dynamic torsion on silicone phantoms, and to evaluate the capability and reliability of ST in measuring dynamic torsion of the human tibialis posterior tendon (TPT) in vivo. Of the ten silicone phantoms tested in the validation study, ST measurement results strongly correlated with the referencing marker tracking method (R² = 0.81–0.95) and had measurement error similar to or smaller than the hypothesized accuracy of 3° (p > 0.045). Subsequently, when ST was applied to nineteen healthy participants’ TPT in vivo, it was capable of characterizing the dynamic external torsion of the TPT during 0–20° passive foot pronation. Strong correlations were found between the ST-measured angle and the foot pronation angle (R² = 0.98–0.99), and the test–retest reliability was moderate to good (ICC = 0.73–0.87). These findings suggested that ST is a valid and reliable method for measuring dynamic tendon torsion characteristics. Full article

Background/Objectives: Foot mobility is considered an intrinsic risk factor for lower-limb injury, yet commonly used pronated/neutral/supinated classifications rely on arbitrary cut-points. This study aimed to develop a data-driven framework for characterizing a continuous SSNDT–injury risk gradient and deriving clinically interpretable relative-risk bands that define practical injury risk zones along the sit-to-stand navicular drop test (SSNDT) continuum. Methods: Data from 137 physically active male students (274 feet) were analyzed. Intra-rater reliability of the sit-to-stand navicular drop test (SSNDT) was assessed using ICC(3,1). A quadratic mixed-effects logistic regression model was used to characterize the SSNDT–injury relationship and derive odds-ratio-based risk bands for interpretive and screening purposes. Results: SSNDT demonstrated good intra-rater reliability (ICC(3,1) = 0.82). Model comparison supported a non-linear, U-shaped association between SSNDT and injury risk, with a minimum risk value at approximately 5.5 mm. Bootstrap analysis supported a smooth continuous risk gradient. Four representative OR levels (1.2, 1.5, 1.8, and 2.0) were selected to define SSNDT-based interpretative risk bands. Injury prevalence showed an overall increasing trend across these zones, ranging from 4.2% in the Safe zone to 52.4% in the Extreme zone. Conclusions: SSNDT provides a robust, data-driven basis for quantifying foot-mobility–related injury risk along a continuous non-linear gradient and for deriving clinically interpretable relative-risk bands grounded in a validated model. The proposed framework avoids arbitrary cut-points and supports individualized risk screening. Full article

Background: Accurate assessment of pediatric foot biomechanics is challenging due to growth-related variability and limited quantitative tools. The supination and pronation angles of the ankle are critical for understanding lower limb alignment and pathological gait patterns. Objectives: This study introduces a novel digital pedoscopic system designed to enhance the quantitative evaluation of foot alignment and to demonstrate its clinical utility through clustering analysis of pediatric ankle angles. Methods: Thirty-five pediatric patients (mean age = 6.17 ± 4.54 years) with neurological or developmental disorders were evaluated using a semi-automated digital pedoscopic system to obtain quantitative measurements of ankle alignment. Key anatomical landmarks, including the heel, calf, and knee centers, were manually identified from posterior images, and the system automatically calculated ankle pronation and supination angles. K-means clustering analysis was applied to classify participants based on their biomechanical profiles. Results: A total of thirty-five pediatric patients were assessed, and the revised abstract now explicitly reports this sample size to improve clarity. Data-driven k-means clustering of bilateral rearfoot angles identified three clearly defined alignment subgroups—neutral, pronated, and supinated—each exhibiting characteristic distribution patterns and degrees of inter-individual variability. These findings highlight the system’s ability to quantitatively distinguish biomechanical phenotypes within a heterogeneous pediatric population. Visualization through scatter, box, and violin plots demonstrated distinct cluster-specific distributions and inter-individual variability in rearfoot alignment, demonstrating the feasibility of objective biomechanical stratification in pediatric populations. Conclusions: The digital pedoscopic imaging system provides a reliable and reproducible approach for quantitative assessment of foot alignment in children. Clustering analysis enables stratification of biomechanical subtypes, supporting individualized rehabilitation strategies and longitudinal monitoring in pediatric clinical practice. Full article

Aims: Structural lower limb-length discrepancies (LLLD) have been classically associated with the etiology of low back pain. However, their biomechanical effects on lower-limb muscle activity during running remain unclear. This pilot crossover study aimed to evaluate the influence of orthotic interventions—designed to compensate for LLLD and modify foot biomechanics—on the electromyographic (EMG) activity of the contralateral tensor fasciae latae (TFL) in healthy runners. Methods: A total of 41 recreational male and female runners (mean age 32.27 ± 6.09) with structural LLLD were recruited and classified as neutral (Ng), supinated (SPg), or pronated (PRg) based on their foot posture. Surface EMG activity of the TFL in the longer leg was recorded with specific surface electrodes while participants ran on a treadmill at a constant speed of 9 km/h for 3 min. Each subject randomly wore standard orthoses with 5 mm pronating (PRO), supinating (SUP) wedges or orthoses with a heel lift (TAL) to compensate for the shorter leg, alongside the baseline condition (SIN). Results: Perfect reliability (close to 1) was obtained for all measurements. A statistically significant reduction in TFL EMG activity was recorded in the Ng group: SIN 105.64 ± 50.6%MVC vs. PRO 100.16 ± 48.61%MVC (p < 0.05), and SIN vs. TAL 93.49 ± 15.88%MVC (p < 0.001). A significant reduction was also observed in the PRg group: SIN 91.82 ± 40.75%MVC vs. TAL 80.08 ± 31.75%MVC (p < 0.05). Conclusion: Orthotic compensation for LLLD and foot pronation modifications produced measurable changes in TFL EMG activity during running. These findings provide mechanistic insight into the interaction between limb-length asymmetry, foot biomechanics, and proximal muscle activation in runners, and may inform future studies on overuse injuries such as iliotibial band syndrome. Full article

Background: Childhood obesity is a growing global concern associated with early-onset orthopedic complications that may persist into adulthood. Among the anthropometric indicators, abdominal adiposity plays a key role in assessing health risks during pediatric evaluations. However, the relationship between abdominal fat distribution and biomechanical alterations, such as changes in posture and foot support, remains poorly understood. Ultrasonography (US) is a validated, noninvasive imaging method capable of distinguishing preperitoneal and intraperitoneal fat in children. Despite its diagnostic advantages, no study to date has directly examined ultrasound-measured abdominal adiposity-predicted pronated foot posture in children. Objective: We aimed to verify the impact of abdominal adiposity on foot support and its association with obese, overweight, and eutrophic schoolchildren. Methods: This is a cross-sectional study. Sixty-five pupils (aged 6–9 years) from a public school in São Paulo, Brazil, were divided into three groups according to nutritional status: obese (n = 25), overweight (n = 20), and eutrophic (n = 20). Anthropometric measurements and foot posture, assessed using the Foot Posture Index (FPI), were collected during the initial evaluation. Abdominal adiposity was determined by ultrasonography, measuring subcutaneous, preperitoneal, and intraperitoneal fat thickness. Statistical Analysis: Analyses compared group differences and relations between abdominal fat and foot posture, with significance set at p < 0.05. Results: Obese and overweight schoolchildren showed pronated foot posture when compared to eutrophic children, on both sides of the feet. Abdominal adiposity was a good predictor of a more pronated footrest for the right and left feet, showing a high-to-moderate association. Conclusions: Ultrasound-measured abdominal adiposity was identified as a significant predictor of pronated foot posture in schoolchildren. These findings highlight the importance of monitoring abdominal fat accumulation during pediatric evaluations, as excessive adiposity may increase the risk of musculoskeletal dysfunctions and pain in the lower limbs. Early detection of these alterations may help prevent postural and musculoskeletal disorders in overweight and obese children. Full article

Plantar fasciitis (PFS) is a leading cause of heel pain, yet its clinical course varies widely. Although plantar fascia thickness (PFT) is often used as a pain marker, its prognostic value remains unclear. Objective: This study investigates whether foot arch morphology underlies distinct biomechanical profiles in PFS patients, potentially explaining the variability in its presentation. Methods: The cross-sectional study included 30 patients with PFS and 10 healthy controls. PFS patients were classified by arch type (pes rectus, pes planus, pes cavus) using the Arch Height Index (AHI). Baseline comparisons between healthy controls and PFS subgroups assessed PFT, Foot Function Index (FFI), joint stiffness ratio, and gait parameters. Results: PFT differed across groups but was not significantly associated with FFI scores (p = 0.233). The pes cavus group exhibited a lower metatarsophalangeal (MTP) stiffness ratio compared with healthy (p < 0.05). Pes planus and pes rectus groups showed excessive pronation, and the pes cavus group showed limited ankle dorsiflexion, indicating distinct gait mechanisms (p < 0.05). Conclusions: Foot arch morphology influences gait biomechanics, stiffness, and PFT in individuals with PFS. Incorporating individual arch types into clinical decision-making may facilitate more personalized interventions and improve treatment outcomes. Full article

Background: Correct use of the feet, step techniques, and positions constitute significant factors in the success of a dancer. Moreover, the type of dance has crucial effects on the posture of the foot and ankle. Therefore, the primary aim of our study was to determine whether there was a relationship between dancesport, dance experience (years), shoe-wearing time (hours), and shoe heel height (centimeters) in dance athletes performing Sportive Latin American Ballroom (SLAB) dance. Second, we aimed to compare the foot posture of SLAB dancers and nondancers with similar demographic characteristics. Methods: Twenty-six professional SLAB dancers and 26 nondancers who had similar demographic characteristics and did not use high-heeled shoes volunteered to take part in this study. Foot posture (using the Foot Posture Index [FPI]), foot pronation (using the navicular drop test [NDT]), tibiocalcaneal angle, hallux valgus angle (HVA) (using a goniometer), and ankle dorsiflexion range of motion (ROM) (using the weightbearing lunge test) were evaluated. Results: There was a positive moderate correlation between FPI score and shoe-wearing time on the dominant (P = .041; r = 0.40) and nondominant (P = .026; r = 0.43) sides. A positive very good correlation was found between shoe heel height and HVA (P < .001; r = 0.75). A negative good correlation was observed between years of dancing and nondominant ankle dorsiflexion ROM (P = .027; r = 20.43). When dancers and nondancers were compared, a statistically significant difference was found between FPI and NDT scores (P < .001). The FPI and NDT scores, tibiocalcaneal angle, HVA, and ankle dorsiflexion ROM were significantly greater in the dancer group compared with the nondancer group (P < .001) in all measurements of the dominant and nondominant sides. Conclusions: Revealing the relationship between dance experience and shoe-wearing time and the difference between the foot posture and deformities of athletes who perform SLAB dance and those of nondancers constitutes a pivotal endeavor that will increase awareness and knowledge among dancers and clinicians. Full article

Background: In patients with rheumatoid arthritis (RA), the pathologic progression of lowerlimb biomechanics is established. Although specific aspects of RA gait patterns have been studied and described, we are aware of no studies of gait pattern compensations across the entire disease course. This study aimed to describe a model that could predict the evolution of lower-limb pathomechanics in patients with RA. Methods: A literature review was conducted of electronic databases (MEDLINE, PEDro, Trip Database, DOAJ, BioMed Central, PLoS Clinical Trials, ScienceDirect, CRD York University, AHRQ, NICE, and Cochrane Library) to October 3, 2023. Results: A theory was developed that all people with RA induce or augment gait evolution syndromes following the same biomechanical course. Specifically, we postulate rheumatoid equinus syndrome, rheumatoid abnormal pronation syndrome, and rheumatoid shuffle syndrome, which have never been described before. Conclusions: A new model of the evolution of gait compensation in RA is proposed. An important challenge of RA is that it increases the risk of ulcerative lesions, falls, pain, fractures, and health-care costs. The proposed model can be used to reduce morbidity in this patient group by helping explain and reduce the pain, deformity, and ankylosis of foot RA. Full article

Hallux valgus is one of the common causes of forefoot pain in the field of foot and ankle surgery. This condition is characterized by valgus and pronation deformities of the first ray, leading to bunion pain, metatarsalgia, callus formation, and gait disturbances. Conventional open osteotomy of the first metatarsal and proximal phalanx of the first toe has been widely performed. Recently, with increasing reports of favorable radiologic and clinical outcomes of minimally invasive surgery, this technique has been performed by many surgeons. Despite the various surgical methods available, there is still no consensus on the optimal treatment of hallux valgus, and the advantages and disadvantages of open versus minimally invasive techniques remain a topic of debate. This narrative review aims to provide a comprehensive overview of the latest radiographic evaluation and surgical treatment for hallux valgus. Full article

Background: Arthrodesis of the first metatarsophalangeal joint (MTP1) is a common intervention for hallux rigidus (HR). The procedure eliminates MTP1 motion but results in significant pain relief and high satisfaction rates, although MTP1 is eliminated. Less evidence is available regarding the effects on gait and the presence of compensatory mechanisms. The aim of this study is to investigate the effects of MTP1 arthrodesis on gait and patient-reported outcome measures (PROMs) compared with preoperative functioning and healthy individuals. Methods: In this prospective study, 10 patients (10 feet) with HR who underwent MTP1 arthrodesis were evaluated before and after surgery and compared with 15 healthy controls (30 feet). Gait analysis was performed with a motion capturing system using the multi-segment Oxford foot model. Spatiotemporal parameters and kinematics were quantitatively analyzed. PROMs were evaluated using validated questionnaires including the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) scale, the Numeric Pain Rating Scale (NPRS), and the Manchester–Oxford Foot Questionnaire (MOXFQ). Results: MTP1 joint motion was reduced in HR and further reduced after MTP1 arthrodesis compared with healthy controls. Furthermore, intersegmental ROM analysis revealed increased forefoot frontal plane motion (pronation and supination) in HR compared with healthy controls. This was also observed after MTP1 arthrodesis, while additionally increased frontal plane motion in the hindfoot (inversion and eversion) was observed compared with HR and healthy controls. PROM evaluation revealed improved AOFAS-HMI (from 55.7 to 79.1 points, p = 0.002) and NPRS (from 5.7 to 1.5 points, p = 0.004) scores after surgery. Additionally, improvements in the MOXFQ score (from 51.0 to 20.0 points, p = 0.002) were observed. Conclusions: Due to the loss of sagittal hallux motion, foot and ankle kinematics are changed in HR patients and after MTP1 arthrodesis compared with healthy controls. Loss of MTP1 motion results in increased frontal plane motion of the forefoot in HR, and increased frontal plane motion of the fore- and hindfoot after MTP1 arthrodesis. Additionally, substantial improvements in PROMs were recorded after surgery. Full article