STUDY DESIGN: Controlled laboratory study. OBJECTIVE: To explore potential associations between foot posture index (FPI-6) composite scores and dynamic plantar pressure measurements, and to describe each of the 6 subscales and the FPI-6 composite scores across our sample. BACKGROUND: The FPI-6 is a static foot posture assessment comprised of 6 observations. Extreme scores have been associated with increased injury risk. However, knowledge describing the relationship between FPI-6 scores and plantar pressure distributions during gait is limited. METHODS: Participants (n = 1000; 566 males, 434 females) were predominantly active adults (mean ± SD age, 30.6 ± 8.0 years; body mass index, 26.2 ± 3.7 kg/m²), who ran 3.1 ± 1.4 d/wk. Static and dynamic foot characteristics were compared using the FPI-6 and a capacitance-based pressure platform. Correlation and hierarchical stepwise regression analyses were performed to determine the most parsimonious set of dynamic pressure data associated with FPI-6 scores. RESULTS: The mean ± SD FPI-6 score was 3.4 ± 2.9 (range, –6.0 to 11.0). Only 31 participants received a score of –2 (supinated foot) on any FPI-6 subscale. Classification of a pronated foot was 2.4 times more likely than a supinated foot. A 5-variable model (R = 0.57, R² = 0.32) was developed to describe the association between dynamic plantar pressures and FPI-6 scores. CONCLUSION: The multivariate model associated with FPI-6 scores comprised clinically plausible variables which inform the association between static and dynamic foot postures. Different cutoff values may be required when using the FPI-6 to screen for individuals with supinated feet, given the limited number of high-arched participants identified by FPI-6 classifications.

J Orthop Sports Phys Ther 2011;41(2):100-107, Epub 22 October 2010. doi:10.2519/jospt.2011.3412

KEY WORDS: anthropometrics, arch height, foot, foot posture index, podography

J Orthop Sports Phys Ther 2009;39(3):188-200, Epub 24 October 2008. doi:10.2519/jospt.2009.2940

This article provides the physical therapist with a practical way to construct a functional orthotic device in the clinic. The procedure explained requires a minimal amount of supplies and can be easily fabricated during the patient's treatment session.

J Orthop Sports Phys Ther 1983;5(1):30-32.

J Orthop Sports Phys Ther 1985;7(2):69-72.

J Orthop Sports Phys Ther 1986;8(3):123-127.

The purpose of this study was to determine the incidence of forefoot varus, forefoot valgus, subtalar varus, subtalar valgus, and tibiofibular varum in healthy females between the ages of 18 and 30 years. Fifty-eight females had both lower extremities evaluated to determine their foot type. Chi-square testing was used to determine significance between extremities for both the forefoot and rearfoot deformity groups. The relationship between left or right extremities for forefoot or rearfoot deformities was not significant. The forefoot valgus deformity was the most common forefoot imbalance in this sample. Rearfoot varus was present in 97 (83.6%) of the feet surveyed. Eighteen (31%) of the subjects had a different forefoot or rearfoot foot type bilaterally.

J Orthop Sports Phys Ther 1988;9(12):406-109.

J Orthop Sports Phys Ther 1991;14(1):18-23.

Key Words: Ankle orthotics, Taping, Ankle exercise devices

The Heel Pain-Plantar Fasciitis Guidelines link the International Classification of Functioning, Disability, and Health (ICF) body structures (Ligaments and fascia of ankle and foot, and Neural structures of lower leg) and the ICF body functions (Pain in lower limb, and Radiating pain in a segment or region) with the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD) health condition (Plantar fascia fibromatosis/Plantar fasciitis). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) prognosis, (3) interventions provided by physical therapists, and (4) assessment of outcome for common musculoskeletal disorders.

J Orthop Sports Phys Ther. 2008;38(4):A1-A18. doi:10.2519/jospt.2008.0302

The original article was corrected in October 2008, and the amended article PDF is provided here. Please see: October 2008 Errata

KEY WORDS: APTA, clinical practice guidelines, ICD, ICF, Orthopaedic Section

Plantar fasciitis is a common pathological condition of the foot and can often be a challenge for clinicians to treat successfully. The purpose of this article is to present and discuss selected literature on the etiology and clinical outcome of treating plantar fasciitis. Surgical and nonsurgical techniques have been used in the treatment of plantar fasciitis. Nonsurgical management for the treatment of the symptoms and discomfort associated with plantar fasciitis can be classified into 3 broad categories: reducing pain and inflammation, reducing tissue stress to a tolerable level, and restoring muscle strength and flexibility of involved tissues. Each of these treatments has demonstrated some level of effectiveness in alleviating the symptoms of plantar fasciitis. Previous studies have grouped all forms of nonsurgical therapy together. It is, therefore, difficult to determine if one type of treatment is more effective compared with another. Until such research is available, the clinician would be wise to include treatments from all 3 categories.

J Orthop Sports Phys Ther. 1999;29(12):756-760.

Key Words: foot pathology, injury overuse, treatment

Measurement of calcaneal inversion and eversion during walking is limited when subjects wear shoes. The authors of this study propose the use of transverse tibial rotation as a viable alternative measurement when barefoot assessment is not possible. The purpose of this study, therefore, was to: 1) determine the relationship between transverse tibial rotation and rearfoot motion during the stance phase of normal walking and 2) demonstrate the usefulness of measuring transverse tibial rotation when evaluating the effect of footwear and insole foot orthotic devices. Part 1 consisted of 8 volunteers (5 women, 3 men) whose rearfoot and transverse tibial motion was videotaped while they walked along a 12-m walkway. The results of this study showed that although absolute values were not comparable, the 2 motion patterns are related to each other. The correlation between the mean rearfoot and tibial motion patterns of all 16 feet was r = .953. Part 2 investigated the effect of footwear and orthotics on transverse tibial rotation using 2 case presentations. A video camera was positioned in front of each subject as they walked at a self-selected speed under various footwear or orthotic conditions. The results of the case studies revealed that footwear or foot orthotics decrease maximum tibial internal rotation compared with barefoot walking. In addition, internal tibial rotation velocity and acceleration were decreased by the use of shoes, an accommodative orthosis, and an inflatable medial longitudinal arch support. A rigid orthotic produced a slight increase in transverse tibial rotation and a dramatic increase in transverse tibial acceleration. It is felt that measurement of transverse tibial rotation may prove useful in evaluating footwear and orthotic effectiveness.

J Orthop Sports Phys Ther. 1995;21(6):337-344.

Key Words: walking, orthotics, tibial rotation

Recent research has raised serious concerns regarding the reliability and validity of the evaluation and treatment scheme proposed by Root et al. Although the Root et al theory is widely referenced in the physical therapy literature and commonly taught in continuing education courses, current issues of concern include: 1) measurement technique reliability, 2) the criteria proposed for normal foot alignment, and 3) the position of the subtalar joint between midstance and heel-off during walking. The intent of this paper is to review these 3 problem areas which have been identified with the Root et al theory, as well as to propose the use of a "tissue stress model" which the authors have found to be an effective alternative for evaluating and treating foot disorders.

J Orthop Sports Phys Ther. 1995;21(6):381-388.

Key Words: foot, orthopaedics, management

The purpose of this study was to determine the relationship of the static angle of the rearfoot during single leg standing, relaxed standing foot posture, and subtalar joint neutral position with the pattern of rearfoot motion during walking. The authors felt that this study was important to gain a better understanding of the relationship between dynamic rearfoot motion and 3 static rearfoot angles, which are often included in foot examination procedures. The pattern of rearfoot motion was assessed using 2-dimensional video recordings for each lower extremity of 31 healthy young adult subjects with a mean age of 25.2 years. The mean path of rearfoot motion during walking crossed relaxed standing foot posture but did not cross single leg standing or subtalar neutral position. These findings suggest that the mean path of rearfoot motion during the first 60% of the walking cycle occurs between the static angles of relaxed standing foot posture and single leg standing. In addition, the static angle of the rearfoot in single leg standing may serve as a clinical indicator of the degree of maximum rearfoot eversion occurring during the walking cycle.

J Orthop Sports Phys Ther. 1996;23(6):370-375.

Key Words: walking, rearfoot, eversion, subtalar joint

Despite the fact that clinicians regularly perform static lower extremity measurements on their patients, to date, little research has been published supporting their ability to predict dynamic rearfoot motion. The abilities of static measurements to predict dynamic foot motion could have important implications considering the fact that excessive rearfoot motion has been associated with various injuries of the lower extremity. The purpose of this study, therefore, was to determine if static lower extremity measurements could be used to predict the magnitude of rearfoot motion during walking. Rearfoot motion of each lower extremity was measured from videotape of 27 healthy young adult subjects with a mean age of 26.1 years. In addition, 17 static measurements were measured and recorded bilaterally for each subject. The results of a multiple regression analysis indicated that the only variable that was able to predict maximum rearfoot pronation was the "difference in navicular height" (r2 = .17). None of the 17 measurements were found to predict time to maximum pronation. These results indicate that static measurements of the lower extremity and foot are poor predictors of dynamic rearfoot motion as measured by maximum pronation or time to maximum pronation in healthy individuals without severe foot deformities.

J Orthop Sports Phys Ther. 1996;24(5):309-314.

Key Words: lower extremity, physical examination, rearfoot motion, foot