scholarly journals Evaluation of the inter and intraobserver reproducibility of the GRASP method: a goniometric method to measure the isolated glenohumeral range of motion in the shoulder joint

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Miguel Angel Ruiz Ibán ◽  
Susana Alonso Güemes ◽  
Raquel Ruiz Díaz ◽  
Cristina Victoria Asenjo Gismero ◽  
Alejandro Lorente Gomez ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Outpatient Setting ◽  
Interobserver Reproducibility ◽  
Level Of Evidence ◽  
Intraclass Correlation Coefficients

Abstract Purpose To evaluate the intra and interobserver reproducibility of a new goniometric method for evaluating the isolated passive range of motion of the glenohumeral joint in an outpatient setting. Methods This is a prospective observational study on healthy subjects. The Glenohumeral ROM Assessment with Scapular Pinch (GRASP) method is a new method for assessing the isolated range of motion (ROM) of the glenohumeral joint (GH) by a single examiner with a clinical goniometer. It measures the isolated glenohumeral passive abduction (GH-AB), passive external rotation (GH-ER) and internal rotation (GH-IR) with the arm at 45º of abduction. These three GH ROM parameters were measured in both shoulders of 30 healthy volunteers (15 males/15 females, mean age:41.6[SD = 10.3] years). The full shoulder passive abduction, passive external rotation and internal rotation 45º of abduction were measured by the same examiners with a goniometer for comparison. One examiner made two evaluations and a second examiner made a third one. The primary outcome was the intra- and interobserver reproducibility of the measurements assessed with intraclass correlation coefficients (ICC) and the Bland–Altman plot. Results The intra-observer ICC for isolated glenohumeral ROM were: 0.84 ± 0.07 for GH-ABD, 0.63 ± 0.09 for GH-ER, and 0.61 ± 0.14 for GH-IR. The inter-observer ICC for isolated glenohumeral ROM were: 0.86 ± 0.06 for GH-ABD, 0.68 ± 0.12 for GH-ER, and 0.62 ± 0.14 for GH-IR. These results were similar to those obtained for full shoulder ROM assessment with a goniometer. Conclusion The GRASP method is reproducible for quick assessment of isolated glenohumeral ROM. Level of evidence III

scholarly journals Reliability of a standing isokinetic shoulder rotators strength test using a functional electromechanical dynamometer: effects of velocity

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9951
Author(s):  
Dario Martinez-Garcia ◽  
Angela Rodriguez-Perea ◽  
Paola Barboza ◽  
David Ulloa-Díaz ◽  
Daniel Jerez-Mayorga ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
New Technology ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Relative Reliability ◽  
Intraclass Correlation Coefficients ◽  
Repeated Measures Analysis ◽  
Male Patients

Background The evaluation of the force in internal rotation (IR) and external rotation (ER) of the shoulder is commonly used to diagnose possible pathologies or disorders in the glenohumeral joint and to assess patient’s status and progression over time. Currently, there is new technology of multiple joint isokinetic dynamometry that allows to evaluate the strength in the human being. The main purpose of this study was to determine the absolute and relative reliability of concentric and eccentric internal and external shoulder rotators with a functional electromechanical dynamometer (FEMD). Methods Thirty-two male individuals (21.46 ±  2.1 years) were examined of concentric and eccentric strength of shoulder internal and external rotation with a FEMD at velocities of 0.3 m s−1 and 0.6 m s−1. Relative reliability was determined by intraclass correlation coefficients (ICC). Absolute reliability was quantified by standard error of measurement (SEM) and coefficient of variation (CV). Systematic differences across velocities testing circumstances, were analyzed with dependent t tests or repeated-measures analysis of variance in case of 2 or more than 2 conditions, respectively. Results Reliability was high to excellent for IR and ER on concentric and eccentric strength measurements, regardless of velocity used (ICC: 0.81–0.98, CV: 5.12–8.27% SEM: 4.06–15.04N). Concentric outcomes were more reliable than eccentric due to the possible familiarization of the population with the different stimuli. Conclusion All procedures examined showed high to excellent reliability for clinical use. However, a velocity of 0.60 m s−1 should be recommended for asymptomatic male patients because it demands less time for evaluation and patients find it more comfortable.

3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

2019 ◽  
Vol 40 (6) ◽  
pp. 720-726 ◽  
Author(s):  
Jian Zhong Zhang ◽  
François Lintz ◽  
Alessio Bernasconi ◽  
Shu Zhang ◽  
Keyword(s):  
Computed Tomography ◽  
Comparative Study ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Mean Values ◽  
Intraclass Correlation Coefficients ◽  
Prospective Comparative Study

Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

scholarly journals Reliability of the ForceFrame With and Without a Fixed Upper-Limb Mold in Shoulder Rotation Strength Assessments Compared With Traditional Hand-Held Dynamometry

2021 ◽  
pp. 1-4
Author(s):  
Jamon Couch ◽  
Marc Sayers ◽  
Tania Pizzari
Keyword(s):  
Upper Limb ◽  
External Rotation ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Shoulder Abduction ◽  
Minimal Detectable Change ◽  
Retest Reliability ◽  
Intraclass Correlation Coefficients ◽  
Shoulder Strength ◽  
Test Retest Reliability

Context: An imbalance between shoulder internal rotation (IR) and external rotation (ER) strength in athletes is proposed to increase the risk of sustaining a shoulder injury. Hand-held (HHD) and externally fixed dynamometry are reliable forms of assessing shoulder IR and ER strength. A new externally fixed device with an attachable fixed upper-limb mold (The ForceFrame) exists; however, its reliability in measuring shoulder strength is yet to be investigated. Objective: To determine the test–retest reliability of the ForceFrame, with and without the fixed upper-limb mold, in the assessment of shoulder IR and ER strength, as compared with HHD. Design: Test–retest reliability study. Setting: Laboratory, clinical. Participants: Twenty-two healthy and active individuals were recruited from the university community and a private physiotherapy practice. Main Outcome Measures: Maximal isometric shoulder IR and ER strength was measured using the ForceFrame and traditional HHD in neutral and at 90° shoulder abduction. Mean (SD) strength measures were calculated. Test–retest reliability was analyzed using intraclass correlation coefficients (3, 1). The SEM and minimal detectable change were calculated. Results: Good to excellent test–retest reliability was found for all shoulder strength tests across Hand-held dynamometry (HHD) and externally fixed dynamometry (EFD) are reliable forms (intraclass correlation coefficients [3, 1] = .854–.916). The minimal detectable changes ranged between 25.61 and 41.84 N across tests. Test–retest reliability was not affected by the dynamometer or testing position. Conclusions: The results from this study indicate that both the ForceFrame and HHD are suitable for measuring shoulder strength in clinical practice. The use of the fixed upper-limb mold with the ForceFrame does not improve reliability.

scholarly journals Factors Affecting the Outcomes of Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986762 ◽  
Author(s):  
Syed M. Rizvi ◽  
Ahmed J. Harisha ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Linear Regression Analysis ◽  
Frozen Shoulder ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Capsular Release ◽  
Arthroscopic Capsular Release

Background: Arthroscopic capsular release has been shown to provide excellent short- and long-term outcomes in patients with idiopathic frozen shoulder. Some surgeons delay surgery in the belief that operating in the early stages of adhesive capsulitis results in a poorer prognosis. However, it is unclear which factors, particularly the stage of the disorder, affect the surgical outcome of this procedure. Hypothesis: Patients who undergo capsular release during the early symptomatic stage of idiopathic adhesive capsulitis would have less improvement in range of motion compared with those who undergo surgery at a later stage. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 189 shoulders with idiopathic adhesive capsulitis that underwent arthroscopic capsular release were evaluated. All patients completed a L’Insalata questionnaire and had their range of motion and strength tested prior to surgery and at 1, 6, and 12 weeks and 6 months post–capsular release. Post hoc, patients were grouped by whether they had symptoms lasting <10 months (shorter symptoms group; n = 131) or ≥10 months (longer symptoms group; n = 38). Multiple linear regression analysis was performed to determine which preoperative factors were independently associated with a favorable outcome. Results: Patients in the shorter symptoms group were more restricted prior to surgery than were those in the longer symptoms group (mean ± SEM: external rotation, 17° ± 2° vs 27° ± 4° [ P = .04]; abduction, 78° ± 3° vs 92° ± 6° [ P = .04]; internal rotation, S3 ± 1 vs S1 ± 1 [ P = .03]). The shorter symptoms group had greater postoperative improvement in internal rotation (from S3 ± 1 preoperatively to T12 ± 1 vertebral levels) compared with the longer symptoms cohort (from S1 ± 1 to L2 ± 1) ( P = .02). Conclusion: Patients with a frozen shoulder and a duration of symptoms <10 months made greater improvements in internal rotation and had similar final results for flexion, abduction, and external rotation following arthroscopic capsular release when compared with patients who had a longer duration of symptoms, so there is no reason to delay surgery.

scholarly journals The Effect of Straight-Line Long-Toss Versus Ultra-Long-Toss Throwing on Passive Glenohumeral Range of Motion Recovery After Pitching

2021 ◽  
pp. 194173812098001
Author(s):  
T. David Luo ◽  
Aaron D. Sciascia ◽  
Austin V. Stone ◽  
Chukwuweike U. Gwam ◽  
Christopher A. Grimes ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
National Collegiate Athletic Association ◽  
External Rotation ◽  
Level Of Evidence ◽  
Left Hand ◽  
Right Hand ◽  
Straight Line ◽  
Significant Difference ◽  
Baseball Pitchers

Background: Repetitive throwing in baseball pitchers can lead to pathologic changes in shoulder anatomy, range of motion (notably glenohumeral internal rotation deficit), and subsequent injury; however, the ideal strengthening, recovery, and maintenance protocol of the throwing shoulder in baseball remains unclear. Two strategies for throwing shoulder recovery from pitching are straight-line long-toss (SLT) throwing and ultra-long-toss (ULT) throwing, although neither is preferentially supported by empirical data. Hypothesis: ULT will be more effective in returning baseline internal rotation as compared with SLT in collegiate pitchers after a pitching session. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 24 National Collegiate Athletic Association Division I baseball pitchers with mean age 20.0 ± 1.1 years were randomized to either the ULT group (n = 13; 9 right-hand dominant, 4 left-hand dominant) or SLT group (n = 11; 10 right-hand dominant, 1 left-hand dominant). Measurements (dominant and nondominant, 90° abducted external rotation [ER], internal rotation [IR], and total range of motion [TROM]) were taken at 5 time points across 3 days: before and immediately after a standardized bullpen session on day 1; before and immediately after a randomized standardized ULT or SLT session on day 2; and before practice on Day 3. Results: ULT demonstrated significantly greater final ER compared with baseline (+10°; P = 0.05), but did not demonstrate significant IR changes. Similarly, SLT demonstrated significantly greater post-SLT ER (+12°; P = 0.02) and TROM (+12°; P = 0.01) compared with baseline, but no significant IR changes. Final ER measurements were similar between ULT (135° ± 14°) and SLT (138° ± 10°) ( P = 0.59). There was also no statistically significant difference in final IR between ULT (51° ± 14°) and SLT (56° ± 8°) ( P = 0.27). Conclusion: The routine use of postperformance, ULT throwing to recover from range of motion alterations, specifically IR loss, after a pitching session is not superior to standard, SLT throwing. Based on these findings, the choice of postpitching recovery throwing could be player specific based on experience and comfort. Clinical Relevance: The most effective throwing regimens for enhancing performance and reducing residual impairment are unclear, and ideal recovery and maintenance protocols are frequently debated with little supporting data. Two strategies for throwing shoulder recovery from pitching are SLT and ULT throwing. These are employed to help maintain range of motion and limit IR loss in pitchers. The routine use of ULT throwing for recovery and to limit range of motion alterations after a pitching session is not superior to SLT throwing.

scholarly journals Analysis of interobserver reproducibility in grading histological patterns of dysplastic nevi*

2013 ◽  
Vol 88 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Aretha Brito Nobre ◽  
Juan Piñeiro-Maceira ◽  
Ronir Raggio Luiz
Keyword(s):  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Weighted Kappa ◽  
Risk Markers ◽  
Diagnostic Agreement ◽  
Interobserver Reproducibility ◽  
Intraclass Correlation Coefficients ◽  
Dysplastic Nevi ◽  
Different Levels ◽  
Histopathological Parameter

BACKGROUND: Dysplastic nevi are among the most important cutaneous melanoma simulators. They are important risk markers for this neoplasia and can be its potential precursors. Some authors found a statistically significant relationship between the degree of dysplasia and the risk for developing melanoma. However, reproducibility of grading criteria ranged from poor to fair in the researched articles. OBJECTIVE: To test the reproducibility of the grading criteria proposed by Sagebiel et al. regarding dysplastic nevi. METHODS: Histological specimens of 75 dysplastic nevi were graded, independently and in a blinded fashion, according to preestablished criteria, by a panel of 10 pathologists with different levels of experience. Diagnostic agreement was calculated using weighted kappa and intraclass correlation coefficients. RESULTS: The average of weighted kappa values was 0.13 for all observers, 0.12 for dermatopathologists, 0.18 for general pathologists and 0.05 for residents. Intraclass correlation coefficient values were 0.2 for all observers, 0.18 for dermatopathologists, 0.33 for general pathologists and 0.15 for residents. CONCLUSIONS: Histopathological grading for dysplastic nevi was not reproducible in this Brazilian series, so the criteria used are not a helpful histopathological parameter for clinicopathological correlation.

Effect of Posterior Capsule Tightness and Humeral Retroversion on 5 Glenohumeral Joint Range of Motion Measurements: A Cadaveric Study

2019 ◽  
Vol 47 (6) ◽  
pp. 1434-1440 ◽  
Author(s):  
Dayana P. Rosa ◽  
Paula R. Camargo ◽  
John D. Borstad
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Posterior Capsule ◽  
Joint Range Of Motion ◽  
Motion Measurements ◽  
Humeral Retroversion ◽  
Clinical Measurements ◽  
Joint Range

Background: Altered glenohumeral joint range of motion can be caused by increased humeral retroversion (HR) and/or posterior capsule tightness (PCT). To make informed clinical decisions, it is vital to understand how HR and PCT alterations, individually and in combination, affect joint range of motion measurements. Purpose: To evaluate the effect of experimental tissue alterations on clinical range of motion measures. Study Design: Controlled laboratory study. Methods: Five clinical measurements were quantified in 8 fresh-frozen cadavers under 4 experimentally created conditions: baseline (no alterations), HR condition (20° increase in HR by transecting the bone), PCT condition (20% decrease in length via thermal energy), and PCT + HR combined. Clinical measurements included bicipital forearm angle, low flexion, glenohumeral internal and external rotation, and horizontal adduction. All measurements were taken by the same blinded tester. Separate 1-factor repeated measures analyses of variance were used to evaluate the effect of the alterations on each clinical measurement. Results: There was a significant main effect of condition for bicipital forearm angle ( P = .02, F = 4.03), low flexion ( P = .02, F = 3.86), internal rotation ( P = .03, F = 3.65), and external rotation ( P < .001, F = 15.15) but not for horizontal adduction ( P = .29, F = 1.33). The HR condition resulted in a decreased bicipital forearm angle of 16.1° and 15.8° as compared with the PCT and PCT + HR conditions, respectively. When compared with baseline, the PCT + HR condition decreased the low flexion test by 13.5°, and the HR condition decreased internal rotation range of motion by 14.2°. All conditions increased external rotation when compared with baseline. Conclusion: Greater measurement changes were noted in both HR conditions, suggesting that bony alterations influence motion to a greater extent than posterior capsule alterations. Clinical Relevance: Clinicians should be aware that humeral retroversion will influence the measurement of posterior shoulder tightness.

scholarly journals Validity and Reliability of a New Inertial Device for Monitoring Range of Motion at the Pelvis during Sexual Intercourse

2020 ◽  
Vol 17 (8) ◽  
pp. 2884 ◽  
Author(s):  
José M. Oliva-Lozano ◽  
Isabel Martín-Fuentes ◽  
José M. Muyor
Keyword(s):  
Range Of Motion ◽  
Sexual Intercourse ◽  
Gold Standard ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Validity And Reliability ◽  
Intraclass Correlation Coefficients ◽  
Non Invasive ◽  
Fast Pace ◽  
Test Retest Reliability

To understand the physical demands of sexual intercourse, it is necessary to monitor the kinematic parameters of this activity using relatively non-invasive technology. The aims of this study are to analyze the validity and reliability of an inertial device for monitoring the range of motion at the pelvis during simulated intercourse and compare the range of motion (ROM). Twenty-six adults were monitored during intercourse using an inertial device (WIMU) and a motion capture system (gold standard) in a test that consisted of 4 sets of 20 simulated in–out cycles (IOC) in missionary and cowgirl positions. Men and women were tested separately in a laboratory setting for simulated intercourse aims. There were no differences between the WIMU and the gold standard system at fast pace (p > 0.05), whereas there were differences at slow pace (~2.04°; p ≤ 0.05; d = 0.17). Intraclass correlation coefficients (ICCs) for the relationship between systems was very close to 1 at both paces (slow: 0.981; fast: 0.998). The test–retest reliability analysis did not show any difference between sets of measurements. In conclusion, WIMU could be considered as a valid and reliable device for IOC range of motion monitoring during sexual intercourse in missionary and cowgirl positions.

Rotational Motion Changes in the Glenohumeral Joint of the Adolescent/Little League Baseball Player

2005 ◽  
Vol 33 (5) ◽  
pp. 693-698 ◽  
Author(s):  
Keith Meister ◽  
Timothy Day ◽  
Marybeth Horodyski ◽  
Thomas W. Kaminski ◽  
Michael P. Wasik ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Rotational Motion ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Age Groups ◽  
Baseball Player ◽  
Cross Sectional ◽  
Little League ◽  
Total Range

Background Differences in range of motion and rotational motion between the dominant and nondominant shoulders in throwing athletes are well documented, although the age at which these changes begin to occur is not known. Hypothesis Changes in glenohumeral rotational motion in the shoulder of the Little League/adolescent baseball player occur during the most formative years of physical development. Study Design Cross-sectional study. Methods Elevation, internal rotation at 90° of abduction, and external rotation at 90° of abduction were measured in the dominant and nondominant shoulders of 294 baseball players, aged 8 to 16 years. Results Analysis of variance revealed 2-way interactions between arm dominance by age for elevation (P =. 005) and internal rotation (P =. 001). Significant differences were noted between dominant and nondominant arms for internal rotation at 90° (P =.001) and external rotation at 90° (P =. 001). Elevation, internal rotation at 90°, external rotation at 90°, and total range of motion varied significantly (P =. 001) among age groups. Elevation in the dominant arms of 16-year-olds was on average 5.3° less than in 8-year-olds (179.6° vs 174.3°). In the nondominant arms, mean elevation for 16-year-olds was 5.6° less than in 8-year-olds (179.7° vs 174.1°). Internal rotation at 90° for the dominant arms averaged 39.0° at age 8 and only 21.3° at age 16. In the non-dominant arms, internal rotation for 8-year-olds averaged 42.2° and only 33.1° for 16-year-olds. Conclusions Elevation and total range of motion decreased as age increased. These changes may be consequences of both bone and soft tissue adaptation. The most dramatic decline in total range of motion was seen between the 13-year-olds and 14-year-olds, in the year before peak incidence of Little Leaguer's shoulder. This decrease in rotational motion may cause increased stress at the physis during throwing.

Effect of the Modified Lapidus Procedure for Hallux Valgus on Foot Width

2019 ◽  
Vol 41 (2) ◽  
pp. 154-159 ◽  
Author(s):  
Matthew S. Conti ◽  
Aoife MacMahon ◽  
Scott J. Ellis ◽  
Elizabeth A. Cody
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Level Of Evidence ◽  
Intermetatarsal Angle ◽  
Intraclass Correlation Coefficients ◽  
Valgus Angle ◽  
Akin Osteotomy

Background: Despite the importance of shoe wear to patients with hallux valgus (HV), few studies have investigated changes in foot width following surgery in this population. The purpose of our study was to determine if the modified Lapidus procedure would effectively decrease foot width in patients with HV. Methods: Thirty-one feet (19 left, 12 right) in 30 patients (29 females, 1 male) who underwent a modified Lapidus procedure in combination with a modified McBride and Akin osteotomy for treatment of HV were included in the study. All patients had preoperative and at least 5-month postoperative imaging, consisting of both weightbearing radiographs and computed tomography (WBCT) scans, which were used to measure bony and soft tissue foot widths pre- and postoperatively by 2 independent observers. Results: Intraclass correlation coefficients (ICCs) demonstrated high interobserver reliability (all ICCs >0.90). Bony foot width decreased significantly, by a mean of 8.9 mm (9.1%) on radiographs and 7.9 mm (8.4%) on WBCT scans ( P < .001). The soft tissue foot width also decreased significantly, by a mean of 6.9 mm (6.3%) on radiographs and 6.7 mm (6.4%) on WBCT scans ( P < .001). Changes in the hallux valgus angle and intermetatarsal angle correlated with changes in bony foot width on WBCTs (both r > 0.4, P < .02). Conclusions: The modified Lapidus procedure in combination with a modified McBride and Akin osteotomy resulted in statistically significant changes in both bony and soft tissue foot width. Patients should be counseled that foot width decreases, on average, by 0.5 to 1 cm. Level of Evidence: Level III, comparative series.

Sign in / Sign up

Export Citation Format

Share Document