Assessment of foot posture and mobility development of a physical therapy model
This presentation is the property of its rightful owner.
Sponsored Links
1 / 46

Assessment of FOOT Posture and Mobility: Development of a “Physical Therapy” Model PowerPoint PPT Presentation


  • 203 Views
  • Uploaded on
  • Presentation posted in: General

Assessment of FOOT Posture and Mobility: Development of a “Physical Therapy” Model. Thomas McPoil, PT, PhD, ATC, FAPTA School of Physical Therapy. Recognize and Thank. Professor Mark Cornwall Northern Arizona University The DPT Graduate Students who have assisted me in my research efforts.

Download Presentation

Assessment of FOOT Posture and Mobility: Development of a “Physical Therapy” Model

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Assessment of foot posture and mobility development of a physical therapy model

Assessment of FOOTPosture and Mobility:Development of a “Physical Therapy” Model

Thomas McPoil, PT, PhD, ATC, FAPTA

School of Physical Therapy


Assessment of foot posture and mobility development of a physical therapy model

Recognize and Thank

  • Professor Mark Cornwall

    • Northern Arizona University

  • The DPT Graduate Students who have assisted me in my research efforts


Overview of presentation

Overview of Presentation

  • Why are PT’s interested in foot posture & mobility?

  • Major requirements for clinical measurements

  • Current measurement methods

    • Foot Posture

    • Foot Mobility

  • Foot Image Platform (FIPs)

  • Foot Assessment Platform (FAPs)


Why are pt s interested in foot posture mobility

Why are PT’s interested in FOOT Posture & Mobility

  • The basic premise underlying the understanding of foot mechanics - given structural foot type will display certain functional characteristics

  • These characteristics are often associated with pathological dysfunction of the LE

  • Clinical measurement of FOOT posture & mobility are inherent components of foot type classification


Major requirements for clinical measurements

Major Requirements for Clinical Measurements

  • Must have an operational definition to guide process

    • Identifies a specific observable event & tells clinician how to measure the event

  • The measurement must be reproducible

    • Must demonstrate inter- & intra-rater reliability

      • Intraclass Correlation Coefficients (ICCs)

      • Standard Error of the Measurement (SEMs)

  • Measurements must be valid

    • They must yield “true” measurements of the event being measured


Current objective measurement methods

Current “Objective” Measurement Methods

  • Foot Posture

    • Boney Arch Index

    • Valgus Index

    • Longitudinal Arch Angle

    • Arch Height Ratio

  • Foot Mobility

    • Navicular Drop

    • NavicularDrift

  • Podiatric Model

    • Attempted to use static foot posture to predict dynamic foot movement


Current measurement methods

Current Measurement Methods

  • Foot Posture

    • Longitudinal Arch Angle

      • McPoil & Cornwall, JAPMA 2005 - walking

      • McPoil & Cornwall, JAPMA 2007 - running


Laa is

> 150o

< 130o

RSP vs. MS (r = .971; r2 = .943)

Supinated Foot Posture

Pronated Foot Posture

LAA is

  • Can be used to statically classify foot structure

  • HIGHLY predictive of dynamic foot posture during walking


Current measurement methods1

Arch Height

Ball Length

Arch Height

Ball Length

AHR=

50% of

Foot Length

Current Measurement Methods

  • Foot Posture

    • Arch Height Ratio (AHR)

      • Williams & McClay, Phys Ther, 2000

      • McPoil et al, FOOT, 2008


Arch height ratio

Arch Height

Ball Length

50% of

Foot Length

Arch Height Ratio

  • McPoil et al, FOOT, 2008

    • Norm values (n = 850)

      • Total Foot Length

        • Rt = 0.253 + 0.02

        • Lt = 0.249 + 0.02

      • Truncated Length

        • Rt = 0.345 + 0.03

        • Lt = 0.341 + 0.03


Arch height ratio1

Arch Height Ratio

  • Static AHR appears to be predictive of midstance during walking

    • Franettovich et al, JAMPA 97:115, 2007

      • Reported that the AHR obtained in static standing correlated to AHR at midstance in walking

      • r = 0.85; r2 = 0.72


Current measurement methods2

Current Measurement Methods

  • Foot Posture

    • Boney Arch Index

    • Valgus Index

    • Longitudinal Arch Angle

    • Arch Height Ratio

Major limitation with Foot

Posture categorizations is

do not account

for

Foot Mobility


Current measurement methods3

Current Measurement Methods

  • Foot Posture

    • Boney Arch Index

    • Valgus Index

    • Longitudinal Arch Angle

    • Arch Height Ratio

  • Foot Mobility

    • Navicular Drop

    • Navicular Drift


Current measurement methods4

Current Measurement Methods

  • Navicular Drop test

    • Change in naviculartuberosity height b/w resting posture & subtalarjt neutral position

      • First described Brody in 1982

      • Stated that normal was a 10 mm change; abnormal > 15 mm

      • NO data to substantiate!

    • ISSUES

      • Fair to Poor levels of inter-rater reliability

        • Result of palpating subtalarjt neutral position

      • ONLY assesses motion in sagittal plane

Subtalar Jt Neutral Position

Resting

Posture


Dynamic movement of navicular bone during walking

Dynamic Movement of Navicular Bone during Walking

  • Cornwall & McPoil, Foot & Ankle Int; 1999

    • Assessed pattern and magnitude of navicular bone movement during walking in 106 subjects

    • Reported both sagittal & medial-lateral movement

Medial-Lateral Movement

Mean = 14.7mm

Sagittal Movement


Current measurement methods5

Current Measurement Methods

Subtalar Jt Neutral Position

  • Navicular Drift

    • Described by Menz, JAPMA, 1998

    • Vinicombe et al, JAPMA, 2001

      • Assessed the reliability of both navicular drop & drift in 20 subjects

        • Inter-rater reliability

          • Navicular Drop ICCs = 0.33 to 0.76; SEMs; + 1.5 to + 3.5 mm

          • Navicular Drift ICCs = 0.31 to 0.62; SEMs; + 3.0 to + 5.0 mm

        • Concluded further research required to improve measurement techniques and reliability

Resting Posture


Current measurement methods6

Current Measurement Methods

Potential But

PROBLEMS

  • Foot Posture

    • Boney Arch Index

    • Valgus Index

    • Longitudinal Arch Angle

    • Arch Height Ratio

  • Foot Mobility

    • Navicular Drop

      • Sagittal Movement

    • Navicular Drift

      • Medial – Lateral Movement


Foot image platform fips

FOOT IMAGE PLATFORM (FIPs)

  • Developed for REEBOK Footwear Company in 2001

    • System for obtaining measurements that was inexpensive, portable, & durable

      • Foot measurements that were reproducible & reliable between multiple raters

      • Require minimal to no skin marking of bony landmarks


Foot image platform

FOOT IMAGE PLATFORM


Foot image platform1

FOOT IMAGE PLATFORM

  • 3 Digital Images Obtained for Each Foot

    • Total time required for image capture - 6 minutes

    • No skin markings required

Bottom View

Back View

WB Arch View


Foot image platform2

FOOT IMAGE PLATFORM

  • FROM THE 3 DIGITAL IMAGES, 15 different measurements were obtained in bilateral standing (50% body weight)

    • Back View – 3 measures

    • WB Arch View – 5 measures

    • Bottom View – 7 measures


Foot image platform3

FOOT IMAGE PLATFORM

  • Positive Points

    • Reliability of the 15 measurements

      • Excellent intra-rater & inter-rater reliability using inexperienced evaluators

    • Reliability of foot placement on the FIP

      • Excellent

  • Negative Points

    • Took approximately 45 to 60 minutes to analyze 8 pictures obtained for each subject

    • NOT feasible for clinical use!


Foot image platform4

FOOT IMAGE PLATFORM

  • Did convince REEBOK to capture WB & NWB medial arch image

WB Arch View

Non-WB Arch View


Sit to stand test

SIT–to–STAND TEST

Sitting

  • Determine amount of rearfoot & midfootmobility

Standing


Arch height change during sit to stand

Arch Height Change duringSit-to-Stand

  • McPoil et al: J Foot Ankle Res, 2008

    • Assessed change in arch height b/w Non-WB and WB in 275 healthy subjects

    • Reported

      • Good to high levels of intra- & inter-rater reliability

      • Validated using x-rays as a criterion measure

      • Mean difference between Non-WB and WB = 1.0 cm

    • Need to make clinically feasible!

    • Account for medial-lateral foot mobility


Foot assessment platform faps

FOOT ASSESSMENT PLATFORM( FAPs )

  • Initially developed in 2004

    • An attempt to create a more clinically applicable device based on the FIPs measurements


Foot assessment platform

FOOT ASSESSMENT PLATFORM

  • Measurements of FootMobility

    • McPoil et al, J Foot Ankle Research 2:6, 2009

  • Difference in arch height at 50% foot length between Non-WB vs WB

  • Difference in midfoot width at 50% foot length between Non-WB vs WB

  • Foot Mobility Magnitude


Foot assessment platform1

FOOT ASSESSMENT PLATFORM

  • Difference in dorsal arch height between NonWB vs WB

    • The WB height of the dorsal aspect of the arch minus the WB dorsal arch height

      • Dorsal height measured at 50% of the length of the foot


Foot assessment platform2

FOOT ASSESSMENT PLATFORM

  • Difference in midfoot width between NonWB vs WB

    • The width of the midfoot is measured at 50% of the length of the foot


Foot assessment platform3

Diff Arch Ht2 + Diff MF Width2

FMM =

FOOT ASSESSMENT PLATFORM

  • Foot Mobility Magnitude (FMM)

Diff in Arch Ht / NonWB - WB

Diff in MF Width / NonWB - WB

FMM


Faps distributions n 690 feet

FAPs DISTRIBUTIONS (n = 690 feet)

Diff Midfoot Width

Foot Mob Mag

Diff in Arch Hgt


Faps data

FAPs Data

  • ICCs

    • Intra-rater = .97 to .99; Inter-rater = .83 to .99

  • SEMs

    • Intra-rater = 0.03 to 0.09 cm; Inter-rater = 0.04 to 0.13 cm


Us army baylor nau

US Army Baylor – NAU

  • Assessed 1,000 individuals using FAPs

    • 566 Males

    • 434 Females

  • Utilized 4 entry-level PT students as raters

  • After 1 hour of training & 1 hour of practice

    • Inter-rater ICCs = .78 to .99

    • SEMs = 0.03 to 0.20 cm


Clinical applications of faps measurements

Clinical Applications of FAPs Measurements

  • 32 yo male with Bilateral Calcaneal Fractures

    • LT was non-displaced

    • RT displaced & required ORIF

Courtesy of Stephanie Albin, PT, TOSH, Salt Lake City, Utah


Clinical applications of faps measurements1

Clinical Applications of FAPs Measurements

  • 32 yo male with Bilateral Calcaneal Fractures

    • LT was non-displaced

    • RT displaced & required ORIF

Courtesy of Stephanie Albin, PT, TOSH, Salt Lake City, Utah


Clinical applications of faps measurements2

Clinical Applications of FAPs Measurements

  • Vicenzino, Collins, Cleland, McPoil: BJSM, 2008

    • Development of clinical prediction rule to identify patients with PFPS who will benefit from foot orthoses

    • One of the four predictor variables

      • Diff Midfoot Width > 11 mm

        • Remaining Predictors

          • Age over 25 years

          • Height less than 165 cm

          • Worst pain less than 53.3 mm on a 100 mm VAS


Clinical applications of faps measurements3

Clinical Applications of FAPs Measurements

  • McPoil, Warren, Vicenzino, Cornwall, JAPMA, in press

    • Assessed 43 individuals with a history of unilateral or bilateral PFPS and 86 controls

      • Nested-case control design

    • PFPS 4 times more likely to have a larger than normal difference between NWB & WB arch height compared with the controls.

    • Mean values for difference in arch height and the foot mobility magnitude were also statistically significant between the patient and control groups.


Future directions

FUTURE DIRECTIONS

  • Have developed a large normative database!

  • Need for clinical trials to determine if measurements can be predictive of LE or Foot pathology

  • Further assessment on usefulness of measurements for determining which patient/client would benefit from foot orthoses


Assessment of foot posture and mobility development of a physical therapy model

Thank You!


The podiatric model

The PODIATRIC Model

  • The most common method used by PT’s for the examination & management of the foot & ankle

    • First described by Podiatrists Merton Root, Bill Orien, & John Weed in the late 60’s

    • Provided a criteria for classifying a “NORMAL” foot posture

    • Defined “ABNORMAL” foot structure

      • Forefoot & Rearfoot deformities

    • Provided method for fabricating foot orthoses


The podiatric model s theorized pattern of rearfoot motion during walking

The Podiatric Model’s Theorized Pattern of Rearfoot Motion During Walking


The podiatric model1

The Podiatric Model

  • Normal & Abnormal Foot Types:

ABNORMAL

NORMAL


The podiatric model2

The Podiatric Model

  • Orthotic Intervention:


The podiatric model3

The Podiatric Model

  • Current evidence to support use

    • Little, if any evidence

      • Legitimacy of using subtalar joint neutral position as the KEY alignment criteria is questionable

        • Wright, et al, JBJS, 1964

        • McPoil & Cornwall; Foot & Ankle, 1994

        • McPoil & Cornwall; JOSPT, 1996

        • Cornwall & McPoil: JAPMA, 2000

    • Unable to predict dynamic foot function based on measurements

      • Hamill, et al, ClinBiomech 1989

      • McPoil & Cornwall, JOSPT 1997

      • Cornwall & McPoil, FOOT, 2004

      • Cornwall, et al, AJPM, 2004

  • Poor inter-rater reliability of the measurements

    • Elveru, et al. Phys Ther 1988

    • Van Gheluwe, et al: JAPMA 2002

  • Thus multiple clinicians cannot compare findings


  • Login