An Investigation of Structure, Flexibility, and Function Variables that Discriminate Asymptomatic Foot Types

in Journal of Applied Biomechanics
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It has been suggested that foot type considers not only foot structure (high, normal, low arch), but also function (overpronation, normal, oversupination) and flexibility (reduced, normal, excessive). Therefore, this study used canonical regression analyses to assess which variables of foot structure, function, and flexibility can accurately discriminate between clinical foot type classifications. The feet of 61 asymptomatic, healthy adults (18–77 years) were classified as cavus (N = 24), rectus (N = 54), or planus (N = 44) using standard clinical measures. Custom jigs assessed foot structure and flexibility. Foot function was assessed using an emed-x plantar pressure measuring device. Canonical regression analyses were applied separately to extract essential structure, flexibility, and function variables. A third canonical regression analysis was performed on the extracted variables to identify a combined model. The initial combined model included 30 extracted variables; however 5 terminal variables (malleolar valgus index, arch height index while sitting, first metatarsophalangeal joint laxity while standing, pressure-time integral and maximum contact area of medial arch) were able to correctly predict 80.7% of foot types. These remaining variables focused on specific foot characteristics (hindfoot alignment, arch height, midfoot mechanics, Windlass mechanism) that could be essential to discriminating foot type.

Shultz is with the School of Sport and Exercise, Massey University, Wellington, New Zealand. Song is with Gait Study Center, Temple University School of Podiatric Medicine, Philadelphia, PA, USA. Kraszewski, Backus, and H.J. Hillstrom are with Leon Root M.D. Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA. Hafer is with Leon Root M.D. Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA; and the Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA. Rao is with Leon Root M.D. Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA; and the Department of Physical Therapy, New York University, New York, NY, USA. R.M. Hillstrom is with Leon Root M.D. Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA; and Medical Engineering Research Group, Faculty of Science and Technology, Anglia Ruskin University, Chelmsford, Essex, UK.

Address author correspondence to Sarah Shultz at s.p.shultz@massey.ac.nz.
  • 1.

    Michelson JD, Durant DM, McFarland E. The injury risk associated with pes planus in athletes. Foot Ankle Int. 2002;23(7):629–633. PubMed doi:

  • 2.

    Nakhaee Z, Rahimi A, Abaee M, Rezasoltani A, Kalantari KK. The relationship between the height of the medial longitudinal arch (MLA) and the ankle and knee injuries in professional runners. Foot. 2008;18(2):84–90. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Esterman A, Pilotto L. Foot shape and its effect on functioning in Royal Australian Air Force recruits. Part 1: prospective cohort study. Mil Med. 2005;170(7):623–628. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Carvalho ACA, Hespanhol LC, Costa LOP, Lopes AD. The association between runners’ lower limb alignment with running-related injuries: a systematic review. Br J Sports Med. 2011;45:339. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Tong JW, Kong PW. Association between foot type and lower extremity injuries: systematic literature review with meta-analysis. J Orthop Sports Phys Ther. 2013;43(10):700–714. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Kaufman KR, Brodine SK, Shaffer RA, Johnson CW, Cullison TR. The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med. 1999;27(5):585–593. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Hillstrom HJ, Song J, Kraszewski AP, et al. Foot type biomechanics part 1: structure and function of the asymptomatic foot. Gait Posture. 2013;37(3):445–451. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Queen RM, Mall NA, Nunley JA, Chuckpaiwong B. Differences in plantar loading between flat and normal feet during different athletic tasks. Gait Posture. 2009;29(4):582–586. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Jonely H, Brismee JM, Sizer PS, Jr, James CR Relationships between clinical measures of static foot posture and plantar pressure during static standing and walking. Clin Biomech (Bristol, Avon). 2011;26(8):873–879. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Teyhen DS, Stoltenberg BE, Collinsworth KM, et al. Dynamic plantar pressure parameters associated with static arch height index during gait. Clin Biomech (Bristol, Avon). 2009;24(4):391–396. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Burns J, Crosbie J, Hunt A, Ouvrier R. The effect of pes cavus on foot pain and plantar pressure. Clin Biomech (Bristol, Avon). 2005;20(9):877–882. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Mootanah R, Song J, Lenhoff MW, et al. Foot type biomechanics part 2: Are structure and anthropometrics related to function? Gait Posture. 2013;37(3):452–456. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Morag E, Cavanagh PR. Structural and functional predictors of regional peak pressures under the foot during walking. J Biomech. 1999;32(4):359–370. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Cavanagh PR, Morag E, Boulton AJ, Young MJ, Deffner KT, Pammer SE. The relationship of static foot structure to dynamic foot function. J Biomech. 1997;30(3):243–250. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Joshi R, Song J, Mootanah R, Rao S, Backus SI, Hillstrom HJ. Structure and function of the foot. In: Altchek DW, DiGiovanni CW, Dines JS, Positano RG, eds. Foot and Ankle Sports Medicine. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:11–29.

    • Search Google Scholar
    • Export Citation
  • 16.

    Bevans JS. Biomechanics and plantar ulcers in diabetes. Foot. 1992;2:166–172. doi:

  • 17.

    Theriot CP, Zifchock RA, Neary M, Hillstrom H, Song J, Brechue W. Arch flexibility: a proposed categorization scheme and the effects of short-term intense military training. Paper presented at: World Congress of Biomechanics; 2014; Boston.

    • Export Citation
  • 18.

    Nilsson MK, Friis R, Michaelsen MS, Jakobsen PA, Nielsen RO. Classification of the height and flexibility of the medial longitudinal arch of the foot. J Foot Ankle Res. 2012;5:3. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Rao S, Song J, Kraszewski A, et al. The effect of foot structure on 1st metatarsophalangeal joint flexibility and hallucal loading. Gait Posture. 2011;34(1):131–137. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Razeghi M, Batt ME. Foot type classification: a critical review of current methods. Gait Posture. 2002;15(3):282–291. PubMed doi:

  • 21.

    Jarvis HL, Nester CJ, Jones RK, Williams A, Bowden PD. Inter-assessor reliability of practice based biomechanical assessment of the foot and ankle. J Foot Ankle Res. 2012;5:14. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Budiman-Mak E, Conrad KJ, Roach KE, et al. Can foot orthoses prevent hallux valgus deformity in rheumatoid arthritis? a randomized clinical trial. J Clin Rheumatol. 1995;1(6):313–322. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Root ML. Normal and Abnormal Function of the Foot. 1st ed. Los Angeles, CA: Clinical Biomechanics Corp.; 1977.

  • 24.

    Song J, Hillstrom HJ, Secord D, Leavitt J. Foot type biomechanics: comparison of planus and rectus foot types. J Am Podiatr Med Assoc. 1996;86:16–23. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Butler RJ, Hillstrom H, Song J, Richards CJ, Davis IS. Arch height index measurement system: establishment of reliability and normative values. J Am Podiatr Med Assoc. 2008;98:102–106. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Shultz SP, Sitler MR, Tierney RT, Hillstrom HJ, Song J. Consequences of pediatric obesity on the foot and ankle complex. J Am Podiatr Med Assoc. 2012;102(1):5–12. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Zifchock RA, Davis I, Hillstrom H, Song J. The effect of gender, age, and lateral dominance on arch height and arch stiffness. Foot Ankle Int. 2006;27(5):367–372. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    McPoil TG, Cornwall MW, Dupuis L, Cornwell M. Variability of plantar pressure data. A comparison of the two-step and midgait methods. J Am Podiatr Med Assoc. 1999;89(10):495–501. PubMed doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Ellis SJ, Stoecklein H, Yu JC, Syrkin G, Hillstrom H, Deland JT. The accuracy of an automasking algorithm in plantar pressure measurements. HSS J. 2011;7(1):57–63. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Glasoe WM, Nuckley DJ, Ludewig PM. Hallux valgus and the first metatarsal arch segment: a theoretical biomechanical perspective. Phys Ther. 2010;90(1):110–120. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Fernandez-Seguin LM, Diaz Mancha JA, Sanchez Rodriguez R, Escamilla Martinez E, Gomez Martin B, Ramos Ortega J. Comparison of plantar pressures and contact area between normal and cavus foot. Gait Posture. 2014;39(2):789–792. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Angin S, Crofts G, Mickle KJ, Nester CJ. Ultrasound evaluation of foot muscles and plantar fascia in pes planus. Gait Posture. 2014;40(1):48–52. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Menz HB, Dufour AB, Riskowski JL, Hillstrom HJ, Hannan MT. Planus foot posture and pronated foot function are associated with foot pain: the Framingham Foot Study. Arthritis Care Res (Hoboken). 2013;65(12):1991–1999. PubMed doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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