Comparing Validity and Diagnostic Accuracy of Clarke’s Angle and Foot Posture Index-6 to Determine Flexible Flatfoot in Adolescents: A Cross-Sectional Investigation

Background: Clinical diagnosis of Paediatric flexible flatfoot is still a challenging issue for the healthcare professionals. Clarke's Angle (CA) is frequently used clinically for assessing foot posture; however there is still a debate about its validity and diagnostic accuracy in evaluation of static foot posture especially in Paediatric population with some previous studies supporting, while the others are refuting its validity. The current study aimed to investigate validity and diagnostic accuracy of CA using radiographic findings as a criterion standard measure to determine flexible flatfoot between ages of 6-18 years. Methods: A cross-sectional study conducted on 612 participants (1224 feet) with flexible flatfoot aged 6-18 years (12.36 {plus minus}3.39) was recruited. The clinical measures results were compared to the criterion standard radiographic measures and displayed on the receiver operating characteristic curve (ROC) and the area under ROC curve (AUC) was computed. Intra-rater reliability, sensitivity, specificity, predictive values, and likelihood ratios were calculated for CA. Fagan nomogram was used to detect the posttest probability. Results: Clarke's angle (CA) demonstrated higher intra-rater reliability (ICC=0.99). CA showed higher sensitivity (98.4%), specificity (98.8), positive predictive value (97.3), negative predictive value (99.3), positive likelihood ratio (84) and negative likelihood ratio (0.02). AUC was 0.98[95%CI= 0095-1.00]. The positive likelihood ratio (LR+) yielded a posttest probability of 97%, while the negative likelihood ratio (LR−) yielded a posttest probability of 0.02. Conclusions: CA is a valid with high diagnostic accuracy in diagnosis of flexible flatfoot between the ages of 6-18 years.

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Evaluation of the paediatric foot using footprints and foot posture index: A cross‐sectional study

Journal of Paediatrics and Child Health ◽

10.1111/jpc.14558 ◽

2019 ◽

Vol 56 (2) ◽

pp. 201-206 ◽

Cited By ~ 1

Author(s):

Gabriel Gijon‐Nogueron ◽

Ana Marchena‐Rodriguez ◽

Jesus Montes‐Alguacil ◽

Angela M Evans

Keyword(s):

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Foot Posture Index ◽

Posture Index ◽

Foot Posture

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Symmetry Criterion for Patients with Rheumatoid Arthritis of the Foot: A Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073619 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3619

Author(s):

Jose Alberto Sanchez-Castillo ◽

Andres Reinoso-Cobo ◽

Gabriel Gijon-Nogueron ◽

Rafael Caliz-Caliz ◽

Manuela Exposito-Ruiz ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cross Sectional Study ◽

Anthropometric Measurements ◽

Wilcoxon Test ◽

Sectional Study ◽

Cross Sectional ◽

Foot Posture Index ◽

Posture Index ◽

Structure And Morphology ◽

Foot Posture

Objective: The aim of the study was to analyze the feet of rheumatoid arthritis (RA) patients, to determine the degree to which both feet were affected, primarily analyzing the severity of RA in both feet looking at structure and morphology, and secondly looking at the symmetry in terms of the anthropometrics and posture. Method: This cross-sectional study was conducted from January to December 2018. The data from 229 patients with RA and with foot pain and no RA recruited (Granada, Spain) were analyzed. Two researchers independently interviewed the patients to obtain the study data. The clinical data were obtained using specific foot health and quality of life questionnaires and a validated platform for foot measurement. Anthropometric measurements were obtained by means of a foot measurement platform and the Foot Posture Index (FPI). The bivariate analysis was performed with the Student’s t test and the non-parametric Wilcoxon test. The level of significance was established at p < 0.05. Results: In the RA group, anthropometric measurements revealed significant differences between the left and right feet in 13 of the 23 parameters considered, as follows: (non-load-bearing) foot length, length of the first metatarsophalangeal joint, maximum height of the internal longitudinal arch, and width of the midfoot (p < 0.001, p = 0.038, p < 0.001, and p = 0.037 respectively); and Foot Posture Index (p = 0.001). Conclusions: In patients with RA, statistically significant differences were found in the Foot Posture Index and in several parameters related to foot structure and morphology. From this, we conclude that from a morphological, structural, and postural standpoint, a pattern of symmetric joint involvement should not be viewed as a specific criterion for RA in the foot.

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Foot morphology and correlation with lower extremity pain in Japanese children: A cross-sectional study of the foot posture Index-6

Journal of Orthopaedic Science ◽

10.1016/j.jos.2021.09.014 ◽

2021 ◽

Author(s):

Manato Horii ◽

Ryuichiro Akagi ◽

Yuya Ogawa ◽

Satoshi Yamaguchi ◽

Seiji Kimura ◽

...

Keyword(s):

Lower Extremity ◽

Cross Sectional Study ◽

Sectional Study ◽

Japanese Children ◽

Cross Sectional ◽

Foot Posture Index ◽

Posture Index ◽

Lower Extremity Pain ◽

Foot Posture ◽

Foot Morphology

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Influence of Age, Sex, and Anthropometric Determinants on the Foot Posture Index in a Pediatric Population

Journal of the American Podiatric Medical Association ◽

10.7547/14-097 ◽

2017 ◽

Vol 107 (2) ◽

pp. 124-129 ◽

Cited By ~ 2

Author(s):

Ana María Jimenez-Cebrian ◽

María Francisca Morente-Bernal ◽

Pedro Daniel Román-Bravo ◽

Juan Francisco Saucedo-Badía ◽

Juan Antonio Alonso-Ríos ◽

...

Keyword(s):

Pediatric Population ◽

Quantitative Result ◽

Total Sample ◽

Clinical Tool ◽

Foot Posture Index ◽

Posture Index ◽

Asymptomatic Children ◽

Foot Posture ◽

The Mean ◽

Foot Position

Background: The Foot Posture Index (FPI) is a clinical tool for diagnosis that aims to quantify the grade of a foot position as neutral, pronated, or supinated. Its purpose is to develop a simple six-factor method for rating foot posture with an easy and quantitative result. We evaluated possible differences in the FPI by sex and the influences of age, weight, height, foot size, and body mass index (BMI) on foot posture. Methods: In 150 asymptomatic children (79 boys and 71 girls) aged 8 to 13 years, we determined weight, height, BMI, and FPI in the bipedal, static, and relaxed position. The FPI was obtained as the sum of the scores (–2, –1, 0, 1, 2) given to each of the six criteria. Results: The mean ± SD FPI value for the total sample was 5.1 ± 2.1 (boys: 5.1 ± 2.2; girls: 5.2 ± 2.0), so there were no significant differences between the sexes (P = .636). Of the 150 feet examined, none had FPI values of very supinated or highly pronated, two were supinated (1.3%), 76 neutral (50.7%), and 72 pronated (48.0%). Of the total FPI values, 7.7% can be explained by anthropometric variables: height, weight, and foot size (r2 = 0.077; P < .010). Conclusions: The most frequent foot postures in the sample were neutral and pronated. Neither age nor BMI explained variations in the FPI.

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Association between the Foot Posture Index and running related injuries: A case-control study

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2018.12.019 ◽

2019 ◽

Vol 61 ◽

pp. 217-221

Author(s):

Aitor Pérez-Morcillo ◽

Antonio Gómez-Bernal ◽

Vicente F. Gil-Guillen ◽

Javier Alfaro-Santafé ◽

José Víctor Alfaro-Santafé ◽

...

Keyword(s):

Case Control Study ◽

Case Control ◽

Foot Posture Index ◽

Posture Index ◽

Foot Posture ◽

Control Study

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Association between Foot Posture Index and Ankle Sprain in Indoor Football Players

Global Journal of Health Science ◽

10.5539/gjhs.v8n10p160 ◽

2016 ◽

Vol 8 (10) ◽

pp. 160 ◽

Cited By ~ 1

Author(s):

Afsaneh Safar Cherati ◽

Masoud Dousti ◽

Shima Younespour

Keyword(s):

Ankle Sprain ◽

Football Players ◽

Male And Female ◽

Positive History ◽

Foot Posture Index ◽

Posture Index ◽

Foot Posture ◽

History Of ◽

The Relationship

Objective: This study investigated the relationship between foot type and ankle sprain incidence.Method: In a prospective cohort study using the FPI, 68 adult male and female indoor football (Futsal) players were measured and their feet were classified according to foot posture index (FPI) as neutral, supinated and pronated. They were followed over 6 month as a one competition season and at the end, any injuries at the ankle during this period were detected.Result: There was no significant association between FPI score (considering the total FPI score and its six components) and occurrence of ankle sprain. Also, no association was existed between gender, age, height, weight, BMI, duration of professional exercise, dominant foot and occurrence of ankle sprain. In this study, the history of previous ankle sprain was the only significant predictor of the occurrence of ankle sprain in the follow-up period. Participants with the positive history of previous ankle sprain were at higher risk of developing new ankle sprain (OR=6.02, 95% CI: (1.93, 18.84), p=0.002).Conclusion: There was no significant association between FPI score and occurrence of ankle sprain.Limitation: there was scarce of supinated foot in the study so evaluation of relationship between supinated feet and ankle sprain was not applicable.

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Criterion Validation of Four Criteria of the Foot Posture Index

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-94-1-31 ◽

2004 ◽

Vol 94 (1) ◽

pp. 31-38 ◽

Cited By ~ 32

Author(s):

Rolf Scharfbillig ◽

Angela M. Evans ◽

Alexander W. Copper ◽

Marie Williams ◽

Sheila Scutter ◽

...

Keyword(s):

Linear Model ◽

Generalized Linear Model ◽

Initial Study ◽

Radiographic Images ◽

Foot Posture Index ◽

Posture Index ◽

Criterion Validation ◽

Foot Posture ◽

Final Score ◽

Foot Position

The Foot Posture Index is a new multidimensional and multiplanar tool aimed at quantifying the degree of pronation to supination of the foot, comprising eight criteria that sum to produce a final “score” of foot posture. In an initial study involving 31 subjects, angulations measured from dorsoplantar and lateral radiographs were compared with the corresponding Foot Posture Index criteria using Spearman’s rho and the generalized linear model of analysis of variance. Eleven of the participants from Study 1 completed a second study in which wedges were used to alter foot position to determine whether changes to foot position were sensitively reflected in Foot Posture Index criterion scores and associated radiographic images. Study 1 demonstrated a significant correlation for only one criterion (talar head palpation), while Study 2 demonstrated intrasubject sensitivity to overall changes from supinated to pronated and supinated to resting positions but insensitivity to changes from resting to pronated positions. The results suggest that although the Foot Posture Index could be a useful tool to broadly classify foot postures, it is not sensitive to all small movements when assessed by this method. (J Am Podiatr Med Assoc 94(1): 31-38, 2004)

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