Size of the abductor hallucis muscle in older women with hallux valgus

Abstract of paper that was presented at the 4th Congress of the International Foot and Ankle Biomechanics (i-FAB) Community Busan, Korea, 8-11 April 2014

International Foot and Ankle Biomechanics Community (i-FAB): past, present and beyond

The International Foot and Ankle Biomechanics Community (i-FAB) is an international collaborative activity which will have an important impact on the foot and ankle biomechanics community. It was launched on July 2nd 2007 at the foot and ankle session of the International Society of Biomechanics (ISB) meeting in Taipei, Taiwan. i-FAB is driven by the desire to improve our understanding of foot and ankle biomechanics as it applies to health, disease, and the design,development and evaluation of foot and ankle surgery, and interventions such as footwear, insoles and surfaces

Systematic review of the psychometric properties of patient-reported outcome measures for foot and ankle in rheumatoid arthritis

Background Foot problems and pain are common in patients with rheumatoid arthritis. Patient-reported outcome measures provide a standardized method of capturing patients’ perspectives of their functional status and wellbeing. There are many instruments specific to people with feet affected by rheumatoid arthritis but knowledge of their psychometric validation or methodological quality is lacking Objectives To identify patient-reported outcome measures specific to the foot and ankle and rheumatoid arthritis and investigate their methodological quality and psychometric properties Design Systematic review. Data source : A search was conducted for psychometric or validation studies on patient-reported outcomes in Rheumatoid Arthritis published in different languages, by examining the Pubmed; Scopus, CINAHL; PEDro and Google Scholar databases. Review methods . The systematic review performed was based on the following inclusion criteria: psychometric or clinimetric validation studies on patient-reported outcomes specific to the foot and ankle that included patients with Rheumatoid arthritis. Two authors independently assessed the quality of the studies and extracted datas Results Of the initial 431 studies, fourteen instruments met the inclusion criteria. Significant methodological flaws were detected in most with only SEFAS met the COSMIN quality criteria. Conclusion SEFAS had the best quality and was ranked most appropriate for use with patients living with Rheumatoid Arthriti

Size of the abductor hallucis muscle in older women with hallux valgus

Toe deformities are highly prevalent in older people with up to 74% of older men and women having some degree of hallux valgus [1]. Despite the well documented hypotheses that atrophied, or weak toe flexor muscles are associated with the formation of toe deformities [2], there has been little evidence to support this theory. Only one study has directly compared the toe flexor strength of individuals with toe deformities to those without, revealing that older people with hallux valgus have reduced hallux strength compared to those without the deformity [3]. Therefore, to further investigate the pathomechanics of hallux valgus, this study aimed to determine whether the size of the abductor hallucis muscle differed in older women with and without hallux valgus deformity

Reliability of ultrasound to measure morphology of the toe flexor muscles

Measuring the strength of individual foot muscles is very challenging; however, measuring muscle morphology has been shown to be associated with strength [1]. A reliable method of assessing foot muscle atrophy and hypertrophy would therefore be beneficial to researchers and clinicians. Real-time ultrasound (US) is a non-invasive, objective and inexpensive method of assessing muscle morphology and has been employed widely to quantify cross-sectional area (CSA) and linear dimensions of larger muscles (e.g. quadriceps, triceps surae). Few studies, however, have determined its ability to measure the small muscles of the foot and ankle. This study aimed to determine whether US is a reliable tool to measure the morphology of the toe flexor muscles

The effect of stroke on foot kinematics and the functional consequences

Background Although approximately one-third of stroke survivors suffer abnormal foot posture and this can influence mobility, there is very little objective information regarding the foot and ankle after stroke. Objective As part of a programme of research examining foot and ankle biomechanics after stroke, we investigated multi-planar kinematics and the relationship with function. Methods In a single assessment session, static foot posture (Foot Posture Index); mobility limitations (Walking Handicap Scale) and multi-segment foot and ankle kinematics during stance phase of walking were measured in 20 mobile chronic stroke survivors and 15 sex and age-matched healthy volunteers. Results Compared to the healthy volunteers, the stroke survivors demonstrated consistently reduced range of motion across most segments and planes, increased pronation and reduced supination, disruption of the rocker and the timing of joint motion. Changes in pronation/supination were associated with limited walking ability. Conclusions This study provides evidence of structural and movement deficiencies in the intrinsic foot segments affected by stroke. These would not have been detectable using a single segment foot model. Data do not support common clinical practices that focus on correction of sagittal ankle deformity and assumed excessive foot supination. Some of these abnormalities were associated with limitation in functional ability. Biomechanical abnormalities of foot and ankle are modifiable and there is potential for clinical studies and future developments of interventions to help prevent or treat these abnormalities which may improve functional ability post stroke

Is retail footwear fit for purpose for the feet of adults who are obese?

Background: The internal morphology and dimensions of shoes are determined by lasts on which they are manufactured, defined by foot shape, aesthetics and manufacturing requirements. Obese adults have larger foot dimensions with flatter morphology and report ill-fitting, uncomfortable footwear. Therefore, it is likely that lasts are not fit for purpose for this subset of around 30% of adults. This research quantified the relationship between the healthy weight foot and retail shoe and compared this with the foot of obese adults and wide-fit shoes targeted at those who are obese. Methods: A 3D foot scanner determined the morphology and dimensions of standard and wide-fit retail lasts and the feet of healthy weight and obese adults. Standard anatomical measurements and differences between multiple cross-sections of foot and lasts were compared with ANOVA. The relationship between a standard retail last and the foot of a healthy weight adult defined a level of acceptable difference in foot/last morphology/dimension, and was thus a benchmark to compare the difference between the obese foot and wide-fit last. Results: The comparison of standard measures demonstrated less spacious dimensions in the wide-fit shoes, specifically heel circumference and ball height. The cross-sectional analysis identified the wide-fit footwear has less spacious width in the rearfoot. In the midfoot and forefoot one of the wide-fit shoes exceeded the benchmark and provided significantly more space than the standard retail shoe. Conclusion: The results alluded to wide-fit footwear not currently being fit for purpose for obese adults; notably the footwear should be wider in the rearfoot. Meeting the footwear needs of the obese wearer may improve foot health and satisfaction, with potential benefits of increasing activity, consequently improving overall health

Effects of age on strength and morphology of toe flexor muscles

Study Design: Cross-sectional. 27 Objective: To compare the strength and size of the toe flexor muscles of older adults relative 28 to their younger counterparts. 29 Background: Age related muscle atrophy is common in lower limb muscles and we therefore 30 speculated that foot muscles also diminish with age. However, there is a paucity of literature 31 characterizing foot muscle strength and morphology, and any relationship between these two, 32 in older people. 33 Methods: Seventeen young adults with a normal foot type were matched by gender and BMI 34 to 17 older adults with a normal foot type, from an available sample of 41 young (18-50 35 years) and 44 older (60+ years) adults. Among the matched groups (n=34), muscle thickness 36 and cross-sectional area (CSA) for five intrinsic and two extrinsic toe flexor muscles were 37 obtained using ultrasound. Toe strength was assessed using a pressure platform. Differences 38 in toe flexor strength and muscle size between the young and older matched groups were 39 determined using ANCOVA (controlling for height). Correlations between strength and size 40 of the toe flexor muscles of the pooled group (n=34) were also calculated. 41 Results: Toe strength and the thickness and CSA of most foot muscles and were significantly 42 reduced in the older adults (P<0.05). Hallux and toe flexor strength were strongly correlated 43 with the size of the intrinsic muscles toe flexor muscles. 44 Conclusion: The smaller foot muscles appear to be affected by sarcopenia in older adults. 45 This could contribute to reduced toe flexion force production and affect the ability of older 46 people to walk safely. Interventions aimed at reversing foot muscle atrophy in older people 47 require further investigation

Lessons from dynamic cadaver and invasive bone pin studies: do we know how the foot really moves during gait?

Background: This paper provides a summary of a Keynote lecture delivered at the 2009 Australasian Podiatry Conference. The aim of the paper is to review recent research that has adopted dynamic cadaver and invasive kinematics research approaches to better understand foot and ankle kinematics during gait. It is not intended to systematically cover all literature related to foot and ankle kinematics (such as research using surface mounted markers). Since the paper is based on a keynote presentation its focuses on the authors own experiences and work in the main, drawing on the work of others where appropriate Methods: Two approaches to the problem of accessing and measuring the kinematics of individual anatomical structures in the foot have been taken, (i) static and dynamic cadaver models, and (ii) invasive in-vivo research. Cadaver models offer the advantage that there is complete access to all the tissues of the foot, but the cadaver must be manipulated and loaded in a manner which replicates how the foot would have performed when in-vivo. The key value of invasive in-vivo foot kinematics research is the validity of the description of foot kinematics, but the key difficulty is how generalisable this data is to the wider population. Results: Through these techniques a great deal has been learnt. We better understand the valuable contribution mid and forefoot joints make to foot biomechanics, and how the ankle and subtalar joints can have almost comparable roles. Variation between people in foot kinematics is high and normal. This includes variation in how specific joints move and how combinations of joints move. The foot continues to demonstrate its flexibility in enabling us to get from A to B via a large number of different kinematic solutions. Conclusion: Rather than continue to apply a poorly founded model of foot type whose basis is to make all feet meet criteria for the mechanical 'ideal' or 'normal' foot, we should embrace variation between feet and identify it as an opportunity to develop patient-specific clinical models of foot function