Variable Lower Limb Alignment of Clinical Measures With Digital Photographs and the Footscan Pressure System

in Journal of Sport Rehabilitation
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Objective: This study examines the effect of the lower limb misalignment and its possible compensatory effect on plantar pressure in a normal population. The aim of this paper is to present a structured method for the analysis of posture and its changes using a standardized digital photography technique and plantar pressure measuring device. Design: Cohort. Setting: Laboratory. Participants: A total of 200 adult volunteers between 18 and 22 years of age who had no current symptoms of pain and foot or ankle pathology participated in the study. Main Outcome Measures: The gold standard measure of lower limb alignment with weight-bearing status is the mechanical axis and their angles using Image J software. Structural and functional measurements of the same foot were taken using a plantar pressure measuring device. In this study, 5 alignment (thigh, knee, leg, ankle, and foot) characteristics were measured on the lower limb using the 2 techniques, and, additionally, the foot contact area, peak pressure, foot axis, rearfoot angle, and subtalar joint flexibility score were analyzed in 10 different regions of the foot. Results: This study has shown a reasonable correlation between digitalized measurements and plantar pressures values. Quadriceps angle affected midfoot impulse, foot axis angle, subtalar joint minimum angle, and rearfoot angle positively. Subtalar joint flexibility scores were analyzed in 10 different regions of the foot. There was a positive correlation between rearfoot angle and quadriceps angle (P = .009, r = .261). Results of both methods show that they endorse each other. Conclusions: The posture of the standing feet may have influence on lower limb alignment. Currently, there are no studies carried out by using digital photogrammetry and foot scan. The authors claim that patient-friendly digital photogrammetry would have a positive contribution to the monitoring of patients, even including new ones in the treatment programs, reducing any possible loss in the personal and national economy.

Govsa, Nteli Chatzioglou, Pinar, and Bedre are with the Digital Imaging and Modelling Laboratory, Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey. Hepguler is with the Department of Physical Therapy, Faculty of Medicine, Ege University, Izmir, Turkey.

Govsa (figen.govsa@ege.edu.tr) is corresponding author.
  • 1.

    Buldt AK, Levinger P, Murley GS, Menz HB, Nester CJ, Landorf KB. Foot posture is associated with kinematics of the foot during gait: a comparison of normal, planus and cavus feet. Gait Posture. 2015;42(1):4248. PubMed ID: 25819716 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Jonely H, Brismée JM, Sizer PS Jr, James CR. Relationships between clinical measures of static foot posture and plantar pressure during static standing and walking. Clin Biomech. 2011;26(8):873879. PubMed ID: 21632159 doi:

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

    Jafarnezhadgero AA, Majlesi M, Etemadi H, Robertson DGE. Rehabilitation improves walking kinematics in children with a knee varus: randomized controlled trial. Ann Phys Rehabil Med. 2018;61(3):125134. PubMed ID: 29476933 doi:

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

    Walsh P, Pinkney L, Samim M. Abnormal alignment of the left lower extremity and irregular gait. Skeletal Radiol. 2018;47(7):10391040. doi:

  • 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):700714. PubMed ID: 23756327 doi:

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

    Laumets R, Viigipuu K, Mooses K, et al. Lower leg length is associated with running economy in high level caucasian distance runners. J Hum Kinet. 2017;56(1):229239. PubMed ID: 28469761 doi:

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

    Khamis S, Dar G, Peretz C, Yizhar Z. The relationship between foot and pelvic alignment while standing. J Hum Kinet. 2015;46(1):8597. PubMed ID: 26240652 doi:

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

    Ferreira EA, Duarte M, Maldonado EP, Bersanetti AA, Marques AP. Quantitative assessment of postural alignment in young adults based on photographs of anterior, posterior, and lateral views. J Manipulative Physiol Ther. 2011;34(6):371380. PubMed ID: 21807260 doi:

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

    Pinto RZ, Souza TR, Trede RG, Kirkwood RN, Figueiredo EM, Fonseca ST. Bilateral and unilateral increases in calcaneal eversion affect pelvic alignment in standing position. Man Ther. 2008;13(6):513519. PubMed ID: 17910932 doi:

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

    Sheehy L, Cooke TD, McLean L, Culham E. Standardized standing pelvis-to-floor photographs for the assessment of lower-extremity alignment. Osteoarthritis Cartilage. 2015;23(3):379382. PubMed ID: 25528105 doi:

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

    Sritharan P, Lin YC, Richardson SE, Crossley KM, Birmingham TB, Pandy MG. Lower-limb muscle function during gait in varus mal-aligned osteoarthritis patients. [published online ahead of print February 23, 2018]. J Orthop Res. PubMed ID: 29473665 doi:

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

    Nguyen AD, Boling MC, Slye CA, Hartley EM, Parisi GL. Various methods for assessing static lower extremity alignment: implications for prospective risk-factor screenings. J Athl Train. 2013;48(2):248257. PubMed ID: 23672390 doi:

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

    Ashnagar Z, Hadian MR, Olyaei G, et al. Reliability of digital photography for assessing lower extremity alignment in individuals with flatfeet and normal feet types. J Bodyw Mov Ther. 2017;21(3):704710. PubMed ID: 28750988 doi:

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

    Akasaka K, Tamura A, Katsuta A, et al. Does trampoline or hard surface jumping influence lower extremity alignment? J Phys Ther Sci. 2017;29(12):21472150. PubMed ID: 29643592 doi:

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

    do Rosário JL. Photographic analysis of human posture: a literature review. J Bodyw Mov Ther. 2014;18(1):5661. PubMed ID: 24411150 doi:

  • 16.

    Naraghi R, Bremner A, Slack-Smith L, Bryant A. The relationship between foot posture index, ankle equinus, body mass index and intermetatarsal neuroma. J Foot Ankle Res. 2016;9:46. PubMed ID: 27980684 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Kanchan T, Krishan K, Shyam Sundar S, Aparna KR, Jaiswal S. Analysis of footprint and its parts for stature estimation in Indian population. Foot. 2012;22(3):175180. PubMed ID: 22456109 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Khamis S, Yizhar Z. Effect of feet hyperpronation on pelvic alignment in a standing position. Gait Posture. 2007;25(1):127134. PubMed ID: 16621569 doi:

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

    Ribeiro AP, Trombini-Souza F, Tessutti V, Rodrigues Lima F, Sacco Ide C, João SM. Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis. Clinics. 2011;66(6):10271033. PubMed ID: 21808870 doi:

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

    Kernozek TW, Ricard MD. Foot placement angle and arch type: effect on rearfoot motion. Arch Phys Med Rehabil. 1990;71(12):988991. PubMed ID: 2241547

  • 21.

    Mou P, Zeng Y, Yang J, Zhong H, Yin SJ, Li RB. The effectiveness of medial femoral epicondyle up-sliding osteotomy to correct severe valgus deformity in primary total knee arthroplasty. J Arthroplasty. 2018;33(9):28682874. PubMed ID: 29805102 doi:

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

    Nguyen AD, Shultz SJ. Identifying relationships among lower extremity alignment characteristics. J Athl Train. 2009;44(5):511518. PubMed ID: 19771290 doi:

  • 23.

    Rhee SJ, Cho JY, Jeung SH, Poon KB, Choi YY, Suh JT. Combined rotational alignment change after total knee arthroplasty in different tibial component designs: implications for optimal tibial component rotational alignment. Knee Surg Relat Res. 2018;30(1):7483. PubMed ID: 29482307 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Krawczky B, Pacheco AG, Mainenti MR. A systematic review of the angular values obtained by computerized photogrammetry in sagittal plane: a proposal for reference values. J Manipulative Physiol Ther. 2014;37(4):269275. PubMed ID: 24793372 doi:

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

    Moncrieff MJ, Livingston LA. Reliability of a digital-photographic-goniometric method for coronal-plane lower limb measurements. J Sport Rehabil. 2009;18(2):296315. PubMed ID: 19561371 doi:

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

    Tasci Bozbas G, Gurer G. Does the lower extremity alignment affect the risk of falling? Turk J Phys Med Rehabil. 2017;64(2):140147. PubMed ID: 31453504 doi:

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

    Abu Bakar SN, Aspalilah A, AbdelNasser I, et al. Stature estimation from lower limb anthropometry using linear regression analysis: a study on the Malaysian population. Clin Ter. 2017;168(2):e84e87. PubMed ID: 28383619 doi:

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

    Caia J, Weiss LW, Chiu LZ, Schilling BK, Paquette MR, Relyea GE. Do lower-body dimensions and body composition explain vertical jump ability? J Strength Cond Res. 2016;30(11):30733083. PubMed ID: 26950351 doi:

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

    Cornwall MW, McPoil TG. Relationship between static foot posture and foot mobility. J Foot Ankle Res. 2011;4:4. PubMed ID: 21244705 doi:

  • 30.

    Scattone Silva R, Veronese LM, Granado Ferreira AL, Serrão FV. The influence of forefoot varus on eccentric hip torque in adolescents. Man Ther. 2013;18(6):487491. PubMed ID: 23756032 doi:

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

    Cobb SC, James CR, Hjertstedt M, Kruk J. A digital photographic measurement method for quantifying foot posture: validity, reliability, and descriptive data. J Athl Train. 2011;46(1):2030. PubMed ID: 21214347 doi:

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

    Park J, Lee SG, Bae J, Lee JC. The correlation between calcaneal valgus angle and asymmetrical thoracic-lumbar rotation angles in patients with adolescent scoliosis. J Phys Ther Sci. 2015;27(12):38953899. PubMed ID: 26834376 doi:

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

    Park YB, Ha CW, Kim HJ, Park YG. Preoperative prediction of anterior cruciate ligament tibial footprint size by anthropometric variables. Knee Surg Sports Traumatol Arthrosc. 2017;25(5):16381645. PubMed ID: 27193008 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Nor FM, Abdullah N, Mustapa AM, Qi Wen L, Faisal NA, Ahmad Nazari DA. Estimation of stature by using lower limb dimensions in the Malaysian population. J Forensic Leg Med. 2013;20(8):947952. PubMed ID: 24237796 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Schmitt H, Kappel H, Moser MT, et al. Determining knee joint alignment using digital photographs. Knee Surg Sports Traumatol Arthrosc. 2008;16(8):776780. PubMed ID: 18551275 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Cornwall MW, McPoil TG, Lebec M, Vicenzino B, Wilson J. Reliability of the modified Foot Posture Index. J Am Podiatr Med Assoc. 2008;98(1):713. PubMed ID: 18202328 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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