The accuracy of marker placement on palpable surface anatomical landmarks is an important consideration in\ud biomechanics. Although marker placement reliability has been studied in some depth, it remains unclear whether\ud or not the markers are accurately positioned over the intended landmark in order to define the static position and\ud orientation of the segment. A novel method using commonly available X-ray imaging was developed to identify\ud the accuracy of markers placed on the shoe surface by palpating landmarks through the shoe.\ud An anterior–posterior and lateral–medial X-ray was taken on 24 participants with a newly developed marker\ud set applied to both the skin and shoe. The vector magnitude of both skin- and shoe-mounted markers from the\ud anatomical landmark was calculated, as well as the mean marker offset between skin- and shoe-mounted\ud markers. The accuracy of placing markers on the shoe relative to the skin-mounted markers, accounting for shoe\ud thickness, was less than 5mm for all markers studied. Further, when using the developed guidelines provided in\ud this study, the method was deemed reliable (Intra-rater ICCs¼0.50–0.92). In conclusion, the method proposed\ud here can reliably assess marker placement accuracy on the shoe surface relative to chosen anatomical landmarks\ud beneath the skin
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