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AIMS: To investigate the contribution of foot type to plantar pressures in a community-dwelling adult population with type 2 diabetes. METHODS: Foot Posture Index-6 (FPI-6) as a measure of foot type, barefoot plantar pressure (peak pressures and pressure-time integrals), presence of forefoot deformities, peripheral neuropathy, ankle and first metatarsophalangeal joint (MTPJ) dorsiflexion range of motion (ROM), and demographic variables were measured. Standard multiple regression models were used to investigate the independent contribution of FPI-6 on plantar pressure variables at the hallux, forefoot, and rearfoot. RESULTS: 122 adults (mean age 70.9 ± 9.3, n = 58 female) with type 2 diabetes were recruited. A lower (more supinated) FPI-6 significantly contributed to an increased forefoot pressure-time integral (ß = -0.285, p = 0.04). FPI-6 was not a statistically significant independent predictor of peak pressure at the hallux, forefoot or rearfoot. CONCLUSIONS: When screening for at-risk sites of elevated plantar pressure in adults with type 2 diabetes, clinicians should consider performing the FPI-6 along with other clinical measures that have been shown to be associated with increased plantar pressures including first MTPJ dorsiflexion ROM, and presence of digital deformities. Evidence-based treatments to offload these areas should then be considered.

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BACKGROUND: Clinicians employ foot morphology assessment to evaluate the functionality of the method and anticipate possible injuries. This study aims to correlate static foot posture and the dynamic barefoot evaluation in a sample of healthy adult participants. METHODS: The foot posture was evaluated using the Foot Posture Index-6 (FPI-6) and the dynamics were evaluated through baropodometric examination. Two operators independently assessed the participants' foot posture through FPI-6, and then a dynamic evaluation was performed by asking them to walk 8 times across a platform. One hundred participants (mean age: 32.15 ± 7.49) were enrolled. RESULTS: The inter-rater agreement between the two assessors was found to be excellent. The majority of the feet belonged to the 0 < FPI < 4 class (32%), followed by the 4 < FPI < 8 (31%) and the FPI > 8 ranges (19.5%). Our "area of contact" analysis showed a significant poor correlation between FPI and total foot, midfoot, and the second metatarsophalangeal joint (MTPJ) (-0.3 < r < 0). Regarding "force" parameters, the analysis showed a poor correlation between the midfoot, hallux, and the second toe (-0.2 < r < 2); finally the "pressure" analysis showed a poor correlation between FPI, the fourth MTPJ, and the second toe (-0.2 < rs < 0.3) and a moderate correlation between the hallux (r = 0.374) and the fifth MTPJ (r = 0.427). CONCLUSIONS: This study emphasizes the constrained correlation between static foot posture observation and dynamic barefoot examination.

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BACKGROUND:Kinesio taping is often used for the treatment of various sports injuries.The methods of foot and ankle sports taping are complex and diverse.Among them,Fascia taping is applicable to a wider range of people and can be used for different foot posture types,but it still lacks of practical verification,and its specific biomechanical role is not clear. OBJECTIVE:To observe the changes in plantar pressure characteristics of subjects with different foot positions during walking and jogging after Fascia taping. METHODS:Thirty-seven young healthy subjects were recruited from the Yantai campus of Binzhou Medical University to conduct the test.They were scored according to the foot posture index-six items version,and were divided into the supination foot group,the neutral foot group,and the pronation foot group.The static foot morphological indexes(including navicular drop,arch height index,arch height flexibility-longitudinal arch,and arch height flexibility-transverse arch)and the pressure-time integral of each foot zone during walking and jogging were collected and calculated respectively before and after Kinesio taping.The specific biomechanical mechanism of Fascia taping was analyzed. RESULTS AND CONCLUSION:(1)General data:There was no statistical difference among the three groups of subjects in general data,such as gender,height,and body mass index(P>0.05).Before taping,there was a significant difference in the foot morphological indexes and the areas of the outer front foot,midfoot,and hindfoot between different foot posture groups(P<0.01).(2)Static foot morphological indexes:After taping,there was no statistically significant difference between the groups in navicular drop,arch height flexibility-longitudinal arch,and arch height flexibility-transverse arch(P>0.05),while there was still a significant difference between the groups in the arch height index(P<0.05).In the supination foot group,the arch height index increased slightly,but there was no significant difference before and after taping(P>0.05).In the pronation foot group,the navicular drop and arch height flexibility-longitudinal arch was significantly reduced,and the arch height index was increased.There was a significant difference before and after taping(P<0.05).(3)The index of plantar pressure during walking:After taping,there was no significant difference between the three groups in the area of lateral forefoot and medial midfoot(P>0.05).In the pronation foot group,the lateral load of the forefoot increased after taping(P<0.05).In the supination position group,the load of the lateral forefoot and midfoot regions increased significantly(P<0.05),while the difference in the rear foot region was not significant(P>0.05).(4)The index of plantar pressure during jogging:After taping,there was no statistically significant difference between groups in the lateral forefoot(P>0.05).In the pronation foot group,the load of the medial forefoot increased significantly(P<0.05).In the supination position group,the load of the lateral forefoot,the middle foot and the rear foot region increased significantly(P<0.05).(5)The results showed that the Fascia taping was suitable for different foot postures.It could not only correct the static foot structure of subjects with different foot postures,but also regulate the abnormal plantar pressure distribution during the dynamic activities of walking and jogging,and the load of the midfoot,forefoot,and hindfoot in the supination and pronation posture tended to normal foot posture load level.

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PURPOSE: The 6-item Foot Posture Index (FPI-6) is a reliable tool for the evaluation of foot deformities. Our aim was to translate and cross-culturally validate the FPI-6 for use in French-speaking countries and to determine the intra-rater and inter-rater reliability of the French version. METHODS: Cross-cultural adaptation was performed according to guidelines. Two clinicians assessed the FPI-6 in 52 asymptomatic individuals. We evaluated intra- and inter-rater reliability with the intraclass correlation coefficients (ICC), correlations (p-value < 0.05) and Bland-Altman plots. Standard error of measurement (SEM) and minimum detectable change (MDC95) were determined. RESULTS: For the cross-cultural adaptation, we modified several items of the FPI-6 user guide and added footnotes to ensure correct interpretation. ICC of the total FPI-6 scores were 0.94 to 0.96 for the intra- and inter-rater reliability for dominant and non-dominant lower limb. Correlations were significant (p < 0.001); r 0.88 to 0.92. Total score SEM was 0.68 to 0.78 and MDC95 was 1.58 to 1.82. CONCLUSIONS: Intra- and inter-rater reliability of this French version of the FPI-6 was excellent for the total score and good to excellent for each item. The French FPI-6 can be used in French-speaking countries. The identification of SEM and MDC scores is useful for clinical interpretation.

The French version of the 6-item Foot Posture Index (FPI-6) can be used in clinical practice in French-speaking countriesIntra- and inter-rater reliability of total FPI score are excellentWe provide minimal detectable change value for clinical interpretation (1.58 to 1.82).

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The objective of this study was to establish the accuracy of the resting calcaneal stance position (RCSP) for the assessment of flat foot (FF) in children, aligned to the validity of the foot posture index (FPI). The RCSP cut-off point was explored, in context of both FF prevalence and the relationship between FF and body weight. A total of 205 healthy children, aged 5 to 10 years, participated in a cross-sectional study. Correlation was performed between RCSP and FPI. ROC curve technique was calculated to assess differentiation between groups. A score equal to or greater than 7 on the FPI was used as the 'gold standard' for analysis. The correlation between FPI and RCSP was significant (r = 0.63; p < 0.01). The discrimination score on the ROC curve (6 points/degrees) shows that the model can be used to identify FF through RCSP, with a sensitivity of 67% and specificity of 85% returned.  Conclusion: The results of this study indicate the role of RCSP for simple, accessible and quick screening of paediatric FF. This is especially pertinent for non-podiatric healthcare professional without specialised paediatric foot knowledge. What is Known: • Most children develop a normal arch quickly, and flat feet usually resolve on their own between 2 and 6 years of age. • The measurement used to diagnose flat foot in children must be accurate, consistent, and valid to characterize the standard foot position. The Resting Calcaneal Stance Position (RCSP) is another widely used measure to evaluate the position of the flat foot in children. What is New: • The RCSP cut-off point 6 shows a sensitivity of 67% and a specificity of 85% thanks to the FPI as the Gold standard. • The RCSP is useful for health professionals who are not specialised in pediatric foot health. The RCSP is useful to detect flat foot in children.

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Running is a highly physical activity, and it is related to injuries when there is an excessive pronation of the foot. This study evaluates, from a sample group of healthy recreational runners, if the foot tends to pronate after a period of running activity and when, with respect to a period of running compared to walking, evaluated during several phases: after 30, 45, and 60 min. This quasi-experimental study has been carried out on a total of 36 healthy recreational subjects. The subjects were evaluated during two different activities: running activity for a period of an hour with respect to normal walking activity. The main outcome measures were the foot posture index (FPI) and the navicular drop test (NDT), which were evaluated at p1 (the screening day), after 30 min of activity (p2), after 45 min of activity (p3), and finally after 60 min (p4) during running or walking activity. The analysis showed significant differences for the FPI and NDT variables in both groups and on both feet, comparing p1 and p4. These changes showed a significant relationship comparing p1 and p3 for the FPI variable, and for the NDT variable (p < 0.001) of the left foot and, with respect to the right foot, significance was shown to the FPI comparing the p1 and p2. A significant difference was found in the tendency to pronate the foot after a period of running compared to the same period of walking after 60 min of activity. Running produced an excessive pronation of the foot after 45 min of activity, evaluated with the FPI for both feet.

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Background  The hamstring muscle is related to the lumbar spine, pelvic, and lower limb movement dysfunction, as well as low back pain and abnormal gait. The kinematic chain's distal elements dysfunctions may affect the body's proximal segments. There is a biomechanical connection between the foot and proximal segments of the body and its effect on the body's functional status, but there is a lack of research that focuses on the correlation between foot posture and hamstring muscle tightness. The study aimed to find the correlation between hamstring muscle tightness and foot posture using the foot posture index (FPI). Methods After obtaining ethical committee approval, necessary authorization was obtained from relevant authorities to proceed with participant screening. Informed consent was obtained from every participant, accompanied by a comprehensive explanation of the study. Screening of participants was conducted based on specific inclusion and exclusion criteria. These criteria were crucial for selecting a homogeneous sample and ensuring the study's objectives were met. The assessment of foot posture was carried out using FPI, and hamstring tightness was examined using an active knee extension test. Result and discussion In our study, which included 188 participants aged between 18 and 25 (mean age: 21.91±1.97), we examined the correlation between FPI and active knee extension (AKE) test results. Using Pearson's correlation coefficient, we found a statistically significant correlation between the FPI and AKE test results. For the right side, the r-value was 0.678 (p-value = 0.0001); for the left side, the r-value was 0.653 (p-value = 0.0001); and for the total, the r-value was 0.663 (p-value = 0.0001). These findings indicate a significant relationship between the FPI and AKE test results. Conclusion The findings of our study revealed a significant relationship between hamstring tightness and pronation of the foot, as measured by the FPI. Understanding this relationship is crucial as it sheds light on the potential impact of hamstring tightness on foot biomechanics. By establishing this link, our study contributes to the body of knowledge surrounding the prevention of alterations in foot biomechanics. It highlights the importance of addressing hamstring tightness to mitigate potential foot pronation issues. Moreover, the study serves as a stepping stone for future research endeavors. It lays the groundwork for further large-scale investigations that encompass a broader range of age groups.

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The potential effects of asymptomatic flexible flatfoot (FF) on children's health-related quality of life (QoL) and objective clinical foot characteristics have been poorly investigated in the literature. Therefore, this study aimed to analyse these indicators, comparing the children with asymptomatic FF and a control group. METHODS: In total, 351 children were enrolled in this cross-sectional study-160 children with asymptomatic FF and 191 controls (children with normal feet). The children and their parents completed the Paediatric Quality of Life Inventory (PedsQLTM 4.0). The objective foot characteristics included clinical foot posture measures, footprints, general hyperlaxity, and X-ray measurements. RESULTS: Children with asymptomatic FF had a significantly lower QoL (overall and all four dimensions). The parents' assessment of the QoL of their children with asymptomatic FF in most cases was lower compared to their children's self-reported QoL. Moreover, almost all clinical foot measures also had significantly worse profiles among asymptomatic FF cases compared to the controls. This was observed with the Foot Posture Index-6 (FPI-6), the navicular drop (ND) test, the Chippaux-Smirak Index (CSI), Staheli's Index (SI), the Beighton scale, and radiological angles (except the talo-first metatarsal angle). CONCLUSION: The findings suggest that asymptomatic FF not always reflects a normal foot development. This condition is related to decreased health-related quality of life, so the 5-10-year-old children's and their parents' complaints should be considered more closely in identification, treatment, and monitoring plans.

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

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BACKGROUND: Pronated foot is a deformity with various degrees of physical impact. Patients with a pronated foot experience issues such as foot pain, ankle pain, heel pain, shin splints, impaired balance, plantar fasciitis, etc. Objective: The study intended to compare the effectiveness of IASTM (instrument-assisted soft tissue mobilization) and static stretching on ankle flexibility, foot posture, foot function, and balance in patients with a flexible pronated foot. METHODS: Seventy-two participants between the ages of 18-25 years with a flexible pronated foot were included and allocated into three groups: Control, stretching, and IASTM group using single-blinded randomization. Range of motion (ROM) measuring ankle flexibility, foot posture index (FPI), foot function index (FFI), and dynamic balance was measured at baseline and after 4 weeks of intervention. Soft tissue mobilization was applied on to the IASTM group, while the stretching group was directed in static stretching of the gastrocnemius-soleus complex, tibialis anterior, and Achilles tendon in addition to the foot exercises. The control group received only foot exercises for 4 weeks. RESULTS: The result shows the significant improvement of the right dominant foot in ROM plantar flexion, (F = 3.94, p = 0.03), dorsiflexion (F = 3.15, p = 0.05), inversion (F = 8.54, p = 0.001) and eversion (F = 5.93, p = 0.005), FFI (control vs. IASTM, mean difference (MD) = 5.9, p < 0.001), FPI (right foot, control vs. IASTM MD = 0.88, p = 0.004), and in dynamic balance of the right-leg stance (anterior, pre vs. post = 88.55 ± 2.28 vs. 94.65 ± 2.28; anteromedial, pre vs. post = 80.65 ± 2.3 vs. 85.55 ± 2.93; posterior, pre vs. post = 83 ± 3.52 vs. 87 ± 2.99 and lateral, pre vs. post = 73.2 ± 5.02 vs. 78.05 ± 4.29) in the IASTM group. The FFI was increased remarkably in the stretching group as compared to the control group. CONCLUSIONS: Myofascial release technique, i.e., IASTM with foot exercises, significantly improves flexibility, foot posture, foot function, and dynamic balance as compared to stretching, making it a choice of treatment for patients with a flexible pronated foot.

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BACKGROUND: Although foot diseases are common, only a few studies have detailed the biomechanical and anatomical components of each disorder. The most reliable diagnostic tool for flatfoot is X-ray radiography. Achieving a similar accurate and objective diagnosis using another assessment tool, such as plantar pressure measurements, can be more convenient in clinical practice. RESEARCH QUESTION: To identify foot plantar pressure characteristics that primarily detect flatfoot based on X-ray, which addresses the use of such assessments for flatfoot diagnosis. In addition, to compare between the normal foot, flatfoot with positive Foot Posture Index-6 (FPI), and flatfoot with positive FPI and radiographic measures. METHODS: Sixty-two feet were examined from healthy female subjects aged 20.38 ± 1.10 years. According to the results of FPI and X-ray, each sample was assigned to one of the three groups (normal: negative FPI; FPI+: FPI ≥ +6; X-ray and FPI+: Arch Angle ≥ 165°, CP ≤ 12.3° and FPI ≥ +6) and compared using plantar pressure variables. RESULTS: As per normal group compared to X-ray and FPI+ group, there was a significant difference in the surface area (P-value: 0.01, 95 % CI: -26.58 to -3.62), force (P-value: 0.04, 95 % CI: -10.37 to -0.09), and pressure (P-value: 0.01, 95 % CI: -56.78 to -6.35) in the medial foot. Similarly, the arch index among the normal group and the X-ray and FPI+ group showed significant differences (Static AI; P-value: 0.003, 95 % CI: -0.21 to -0.04). CONCLUSION: There was a significant difference in plantar pressure between the normal feet and flatfeet with positive FPI and X-ray in the medial foot area. SIGNIFICANCE: To attain a consensus among diagnostic approaches to identify flatfoot, the combined comparison of observational, foot pressure, and radiographic methods that have shown considerable reliability can be useful for clinical practice.

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The aims of this study were as follows: (1) to assess how foot posture and morphology assessments change according to body mass index (BMI) status; (2) to determine which body composition parameter (BMI or waist circumference) correlates better with the foot posture index (FPI), arch height index (AHI), and midfoot width (MFW) in children. Foot morphometry (FPI, AHI, and MFW) and body composition (BMI and waist circumference (WC)) were assessed in a cross-sectional study of 575 children (mean age = 7.42 ± 1.67 years; 53.27% female). When comparing BMI groups, an increase of 8.3% in AHI and 13.6% in MFW (both p < 0.0001) was seen. In linear regression analyses, BMI and WC were positively associated with MFW explaining together 64.8% of its variance. Noteworthy, MFW is the most related to body composition parameters. CONCLUSION: Foot morphology assessed by FPI, AHI, and MFW differs among BMI categories in children. Noteworthy, WC correlates better with foot measures than does the more commonly used BMI, and more importantly the MFW is the foot measure best explained by children's body weight. Since foot morphometry is different among different BMI groups, children would benefit from shoes with different patterns (thinner and wider), as well as a good system to adjust midfoot height. WHAT IS KNOWN: • Children who are overweight and obese have flatter feet, when assessed using footprints. • Up to 72% of people have incorrectly fitted shoes. WHAT IS NEW: • Children with underweight have thinner and flatter feet than children with normal weight, while children with overweight and obesity have wider and higher arched feet. • Body weight is related to foot shape, which has relevance for footwear manufacturers.

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BACKGROUND: Various clinical measures of static foot posture have been developed and used. However, consensus among clinical measures to classify foot posture remains to be established. Therefore, this study aimed to determine the level of agreement as a reliability component between two common clinical methods in asymptomatic adults: the normalised navicular height truncated (NNHt) and the Foot Posture Index-6 (FPI-6). METHODS: The NNHt and FPI-6 were conducted on 102 asymptomatic adults. The measurement sequence was randomly arranged for each participant. Weighted Kappa (Kw) was used to determine the agreement between the methods. RESULTS: Both the NNHt and FPI-6 achieved similar foot posture distributions: approximately 40-50% of the participants had a normal foot, approximately 40% had a pronated foot and approximately 10-20% had a supinated foot. The agreement between the methods to classify foot posture was excellent (Kw = 0.84). CONCLUSIONS: The present study found excellent agreement between two commonly used clinical measures. This finding highlights the NNHt and FPI-6 consensus for foot posture classification in asymptomatic adults.

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This study aimed to conduct a meta-analysis of randomized controlled trials to examine the effects of the short-foot exercise (SFE) compared to foot orthosis or other types of interventions. Eligibility criteria involved participants with flatfoot engaging in the SFE compared to other forms of intervention or control groups without specific intervention. Relevant studies published before the end of June 2022 were identified from databases. A meta-analysis was performed by calculating the mean differences (MD) and standard MD (SMD) using the random effects model. Six trials with 201 patients (out of 609 records) that met selection criteria were reviewed. Five of the six trials implemented distinct interventions in the control group such as shoe insoles and muscle strengthening exercises, while in the remaining trial, controls received no intervention. The SFE group significantly reduced the navicular drop test (NDT) values (MD: -0.23; 95% confidence interval: -0.45 to -0.02; p = 0.04) and the foot posture index (FPI-6) score (MD: -0.67; 95% confidence interval: -0.98 to -0.36; p < 0.0001) when compared to the control group. The muscle hypertrophy did not differ significantly between the groups. The SFE may contribute more benefits than other intervention as it affects flatfoot individuals' foot alignment. Hence, the SFE is recommended as a beneficial dynamic support when facing flatfoot problems.

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PURPOSE: This initiative aimed to assess adherence to Scottish Rite for Children's serial casting protocol for children with idiopathic toe walking (ITW), factors related to adherence, and outcomes after education regarding the protocol. METHODS: 60 patients aged 7.1±2.7 years who completed serial casting were examined at baseline phase (n = 30) and post-education phase (n = 30). Protocols include weekly serial casting for 4 to 6 weeks to achieve 10° of ankle dorsiflexion (ADF) passive range of motion (PROM) with knees extended (KE), assessing the foot posture index (FPI-6) and single leg stance (SLS). Baseline phase evaluated adherence to protocols. Education phase evaluated factors related to adherence and education regarding serial casting findings. Post-education phase evaluated the impact of the education phase. RESULTS: Serial casting averaged 4.8±1.5 weeks (n = 60). ADF PROM was measured with 100% adherence. ADF PROM KE averaged -10.7° pre-cast and significantly improved to +6.5° post-cast (n = 60), and it significantly improved post-cast post-education (p = 0.04). FPI-6 and SLS adherence significantly improved post-cast post-education. FPI-6 total score averaged +5.3 at baseline and +5.8 post-cast (n = 35). CONCLUSION: Education of staff in serial casting protocols improved adherence and patient outcomes. Patients with ITW and ADF PROM KE -10° benefit from serial casting to improve PROM and to allow for orthotic use post-casting.

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Objectives: This study aims to compare ankle force, mobility, flexibility, and plantar pressure distribution of athletes according to foot posture index (FPI). Patients and methods: Between September 2016 and May 2018, a total of 70 volunteer male athletes (mean age: 21.1±2.3 years; range, 18 to 25 years) were included. The athletes were divided into three groups according to their FPI as follows: having supinated feet (Group 1, n=16), neutral/normal feet (Group 2, n=36), or pronated feet (Group 3, n=18). Ankle range of motion (ROM), muscle flexibility, ankle joint strength, and plantar pressure distribution were measured. Results: There were significant differences among the three groups in both right and left ankle dorsiflexion ROM (p=0.009 and p=0.003, respectively). Group 1 had significantly smaller dorsiflexion ROM than the other groups. Group 1 also showed significantly less flexibility in the gastrocnemius and soleus muscles than the other foot posture groups. Groups 2 and 3 exhibited significant differences in the maximum torque (p=0.018), maximum work (p=0.008), and total work (p=0.008) of the right plantar flexor muscles at 60°/sec angular velocity. Peak pressure measurements of the right foot were higher in Group 1, compared to Groups 2 and 3 (p<0.001). Conclusion: The results of this study may help to enhance athletic performance by providing a guide for designing training programs appropriate for athletes with different foot types to address their specific muscle flexibility and strength deficiencies.

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Introduction: Charcot-Marie-Tooth disease (CMT) is a slow and progressive peripheral motor sensory neuropathy frequently associated with the cavo-varus foot deformity. We conducted a scoping review on the clinical scales used to assess foot deviations in CMT patients and analyzed their metric properties. Evidence Acquisition: A first search was conducted to retrieve all scales used to assess foot characteristics in CMT patients from the Medline, Web of Science, Google Scholar, Cochrane, and PEDro databases. A second search was conducted to include all studies that evaluated the metric properties of such identified scales from the same databases. We followed the methodologic guidelines specific for scoping reviews and used the PICO framework to set the eligibility criteria. Two independent investigators screened all papers. Evidence Synthesis: The first search found 724 papers. Of these, 41 were included, using six different scales: "Foot Posture Index" (FPI), "Foot Function Index", "Maryland Foot Score", "American Orthopedic Foot & Ankle Society's Hindfoot Evaluation Scale", "Foot Health Status Questionnaire", Wicart-Seringe grade. The second search produced 259 papers. Of these, 49 regarding the metric properties of these scales were included. We presented and analyzed the properties of all identified scales in terms of developmental history, clinical characteristics (domains, items, scores), metric characteristics (uni-dimensionality, inter- and intra-rater reliability, concurrent validity, responsiveness), and operational characteristics (normative values, manual availability, learning time and assessors' characteristics). Conclusions: Our results suggested the adoption of the six-item version of the FPI scale (FPI-6) for foot assessment in the CMT population, with scoring provided by Rasch Analysis. This scale has demonstrated high applicability in different cohorts after a short training period for clinicians, along with good psychometric properties. FPI-6 can help health professionals to assess foot deformity in CMT patients over the years.

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The methodological heterogeneity in paediatric foot studies does not entail a stable foundation on which to focus the diagnosis and treatment of the various childhood foot problems. For this reason, the use of highly reliable tests is essential to find relationships and to establish a basis to guide the following studies. The main objective proposed in this cross-sectional observational study protocol is to examine the relationship between hypermobility (Lower Limb Assessment Score and Beighton score) and ankle muscle strength in different types of feet. The second objective is to describe the relationship between physical activity tests in children, and to compare with foot type and ankle muscle strength. The Strengthening Reporting of Observational Studies in Epidemiology (STROBE) criteria will be followed. The hypermobility, posture, strength and physical condition tests will be analyzed through three stations, each one directed by a single specialist in paediatric podiatry. The study has been approved by the Ethics Committee of the Universidad Católica San Antonio de Murcia CE112104. The results will be disseminated regardless of the magnitude or direction of effect. Intra-examiner and inter-examiner reliability will be analyzed.

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Objectives: This study compared the influence of subtalar axis position on foot behavior in a closed kinetic chain in older and younger adults. Methods: The sample included 50 older adults and a control group of 50 younger adults. The variables were initially analyzed for both feet together, and were later analyzed separately, comparing each foot (right and left) between groups. Range of motion was assessed by validated goniometric procedures: the position of subtalar axis was evaluated by the palpation technique, while the Foot Posture Index was used to assess behavior in a closed kinetic chain. Student's t-test / Mann-Whitney test compared the main variables according to sample distribution, while Student's t-test / Wilcoxon test was used for paired samples. A standardized Haberman residuals test was also used to determine the connection between the position of subtalar joint axis and the Foot Posture Index. Results: Data from the right and left feet were similar for all variables. The older group had reduced mobility in the ankle and first metatarsophalangeal joint (5.42º [SD (Standard Deviation), 4.49] and 76.12º [SD, 19.24], respectively) with statistically significant values, (p <0.001), as measured by the Mann-Whitney test for the ankle joint and the t-Sutdent test for the first metatarsophalangeal joint, while the younger group had normal values (11.46º [SD, 6.49] and 97.17º [SD, 13.65], respectively)(p < 0.001). The difference in subtalar axis position was not significant (p = 0.788), with more internal deviations in both groups. There was a significant difference in Foot Posture Index (p = 0.006, by applying the chi-square test), with the normal position more prevalent in the older group and the prone position more prevalent in the younger group. Conclusions: Regarding internal deviations in the subtalar joint axis, the older group had a higher frequency of feet in the normal position, while the younger group had a higher frequency of feet in the prone position which, in this case, agrees with the rotational balance theory. For the normal axis position, a higher frequency of normal position was found in both groups. Regarding external deviations of the subtalar joint axis, neither group followed the pattern expected in rotational balance theory. The most consistent connection in the older group was between external axis position and supine foot position, whereas in the younger group it was between normal axis position and normal foot position.

Objetivos: Este estudo comparou a influência da posição do eixo subtalar no comportamento do pé em cadeia cinética fechada em idosos e adultos jovens. Metodologia: O grupo amostral incluiu 50 idosos e o grupo controle, 50 adultos jovens. As variáveis foram estudadas inicialmente para ambos os pés e comparadas entre os grupos, sendo posteriormente analisadas separadamente, comparando-se cada pé (direito e esquerdo) entre os grupos. A amplitude de movimento articular foi avaliada por procedimentos goniométricos validados; a posição do eixo subtalar foi avaliada pela técnica de palpação; o Foot Posture Index foi utilizado para avaliar o comportamento do pé em uma cadeia cinética fechada. O teste t de Student/teste de Mann-Whitney comparou as principais variáveis de acordo com a distribuição amostral, enquanto o teste t de Student/teste de Wilcoxon foi utilizado para amostras emparelhadas. O teste de resíduais ajustados de Haberman padronizado foi usado para a relação entre a posição do eixo da subtalar e o Foot Posture Index. Resultados: Os dados dos pés direito e esquerdo foram semelhantes para todas as variáveis. O grupo mais velho apresentou mobilidade reduzida no tornozelo e na primeira articulação metatarsofalângica (5,42 [desvio padrão ­ DP, 4,49] e 76,12 [DP, 19,24] graus, respectivamente), enquanto o grupo mais jovem apresentou valores normais (11,46 [DP, 6,49] e 97,17 [DP, 13,65], respetivamente) com valores estatisticamente significativos, (p <0,001), aferidos pelo teste de Mann-Whitney para a articulação do tornozelo e pelo teste t-Sutdent para a primeira articulação metatarsofalângica. A diferença na posição do eixo subtalar não foi significativa (p = 0,788, pela aplicação do teste de Qui-quadrado), com mais desvios internos em ambos os grupos. O Foot Posture Index diferiu significativamente entre os grupos (p = 0,006 pela aplicação do teste de Qui-quadrado), sendo a postura normal mais prevalente no grupo mais velho e a postura pronada mais prevalente no grupo mais jovem. Conclusões: Em relação aos desvios internos do eixo da articulação subtalar, o grupo mais velho apresentou maior frequência de pés na postura normal, enquanto o mais jovem apresentou maior frequência de pés pronados, o que, neste caso, corrobora a teoria do equilíbrio rotacional. Na posição normal do eixo, foi encontrada maior frequência de pés com postura normal em ambos os grupos. Em relação aos desvios externos do eixo da articulação subtalar, nenhum dos grupos seguiu o padrão esperado na teoria do equilíbrio rotacional. A relação mais consistente no grupo mais velho foi entre a posição do eixo externo e a posutra supinada do pé, enquanto no grupo mais jovem se deu entre a posição normal do eixo e a postura normal do pé

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Background: Asymmetrical foot posture and properties alterations of the gastrocnemius muscle (GM) and Achilles tendon (AT) were observed in knee osteoarthritis (KOA). We aimed to investigate the inter-limbs asymmetries in foot posture and the properties of GM and AT and explore the association between them. Methods: A total of 62 subjects with unilateral or bilateral KOA were included in this study: 30 patients with unilateral pain and 32 patients with bilateral pain were assigned to the bilateral group (BG) and unilateral group (UG), respectively. The relatively serious leg (RSL) and relatively moderate leg (RML) were judged according to the severity of symptoms assessed by using visual analogue scale (VAS) motion. Foot posture and asymmetrical foot posture scores were assessed based on Foot Posture index (FPI-6). Subsequently, all the participants received an assessment for properties of GM and AT, including tone/tension (Hz), stiffness (N/m), and elasticity. We calculated the asymmetry index of AT (Asy -AT) in both legs and the difference of muscle properties between medial and lateral gastrocnemius (D-MLG) in the ipsilateral limb. Results: Asymmetry of foot posture was categorized into three types including normal, asymmetry, and severe asymmetry. The percentage of subjects classified as normal was higher in the BG (62.5%) than in the UG (36.67%), p < 0.05. Tension of AT and tone of lateral gastrocnemius (LG) in RSL were higher than those in RML (15.71 ± 0.91 vs. 15.23 ± 1.01; 25.31 ± 2.09 vs. 23.96 ± 2.08, p < 0.01 and p < 0.01, respectively), and stiffness of AT in the RSL was higher than that in RML (676.58 ± 111.45 vs. 625.66 ± 111.19, p < 0.01). Meanwhile, a positive relationship was found between ipsilateral FPI and tone of MG and LG in the left leg (0.246 per degree, 95% CI: -0.001, 0.129; p = 0.054 and 0.293 per degree, 95% CI: -0.014, 0.157; p = 0.021, respectively) and right leg (0.363 per degree, 95% CI: 0.033, 0.146; p = 0.004 and 0.272 per degree, 95% CI: 0.007, -0.144; p = 0.032, respectively). Moreover, a positive link was observed between asymmetrical FPI scores and K/L grade (0.291 per degree, 95% CI: 0.018, 0.216; p = 0.022). Furthermore, a significantly greater Asy-AT(tension) was detected in the UG than that in the BG (UG vs. UG: 8.20 ± 5.09% vs. 5.11 ± 4.72%, p < 0.01). Additionally, an increased asymmetrical FPI score (i.e., more severe asymmetry) was significantly associated with increases in Asy-AT(tension) and Asy-AT(stiffness) (0.42 per degree, 95% CI: 0.533, 1.881; p = 0.001 and 0.369 per degree, 95% CI: 0.596, 2.82; p = 0.003, respectively). Conclusions: The stiffness and tension of AT and the tone of LG in RSL were higher than those in RML in KOA patients, and inter-limbs foot posture and tension of AT were more asymmetrical in unilateral KOA patients compared to patients with bilateral KOA. Notably, foot posture, as an important biomechanical factor, was significantly associated with properties of GM, AT, and K/L grade in KOA patients.