Reading material on improving movement analysis and therapy

In the analysis, evaluation and programming of the rehabilitation process, it is important to keep in mind the physiological changes associated with the change in appearance, alignment of the lower extremities (more news in the e-manual). 
In adults, abnormalities and complaints of pain in the feet are a common problem. Foot pain complaints, depending on the literature, are observed in 13%-36% of subjects. They are more often observed in women, in obese individuals (BMI > 30.0 kg/m²). These complaints tend to increase with age. In two large cohort studies conducted on Caucasian individuals, pain complaints occurred from 13% (Chingford 1000 Women Study)-36% (Johnston County Osteoarthritis Project). The latter studies compared the frequency of pain complaints occurring in Caucasian individuals compared to African-Americans. The prevalence in these groups was comparable (35% to 36%, respectively). The least frequent complaints of pain were noted in Asians. 

The most common forefoot abnormalities include hallux valgus, stiff toe, hammer toe, and calluses. Their incidence, according to the literature, is sequentially: 23% (and increases with age – after 65 years of age 35.7%), hammer toe 8.9%, rigid toe painful (believed to affect 1% of people over 30). Studies indicate that the presence of these abnormalities can affect: quality of life, can be associated with pain, reduced quality of function, and can create difficulties in selecting comfortable footwear. Another equally common dysfunction in the foot is flat feet. Salinas-Torres, V. M. et al. (2023) conducted a systematic review of the literature on the incidence of flat feet. They analysed 12 publications including 2509 cases of flat feet in their evaluation. The results of their study indicate that flatfoot is more common among male individuals, at younger ages (3-5 years, 11-17 years), of Asian race and obese. Female gender and white race are less associated with flat feet. The literature indicates that one of the most common ankle injuries is inversion torsion injury of the ankle joint. It is estimated that one out of every 1,000 people suffers an ankle sprain or dislocation injury per day, and about 6% of young athlete representatives. 

In clinical practice, the gold standard for diagnosing dysfunctions in the foot and lower extremities is an X-ray. In physiotherapy practice, podoscopes can be used to assess the shape of the sole evaluation of the foot. After the examination, information is obtained on: the length and width of the foot, the quality of the longitudinal and transverse arches, the alignment of the toe and the fifth toe. To supplement the study of foot alignment, it is worth using the widely used and highly reliable Foot Posture Index (FPI) Test. This test is a simple and quick to perform test that does not require any additional equipment. This test evaluates the alignment of six elements (palpation of the head of the ankle bone, curves below and above the lateral ankle, alignment of the heel bone convexity of the ankle-ankle joint area, medial longitudinal arches of the foot, adduction/adduction of the forefoot relative to the rear foot). For each element, the examinee receives a certain number of points and the sum of the obtained points allows to classify the foot into one of the categories. (A detailed description of the test is included in the e-manual). 

In the available literature, there are reports indicating links between disorders of foot structure or function and the potential impact on higher segments. However, there is no consensus among researchers and the potential impact should be considered individually. Researchers indicate that the presence of a hallux valgus toe may often be associated with: earlier degenerative changes in the knee joint, patellofemoral pain, greater internal rotation at the hip joint, higher Q-angle values, greater valgus valgus at the rearfoot, decreased flexibility of the patellofemoral band, higher anterior-posterior body swings and an increased risk of degenerative changes in the spine compared to a control group. Another abnormality in the foot that may result in a potential impact on the higher segments is the presence of a limitus toe. Its presence results in reduced internal rotation at the hip joint, a different range of motion at the ankle and pelvis during gait compared to the control group. On the other hand, ankle sprain injuries can result in problems related to spine and knee pain, and the presence of flat feet can often be associated with: knee pain, lumbar spine pain and a higher incidence of degenerative changes in the hip joints. Hence, it seems that covering the patient extensively with a holistic assessment is crucial. (Extension of this information in table form included in the e-manual). When assessing the alignment of the lower extremities, it is worth remembering that the way of standing and walking can be conditioned not only by dysfunctions localized in the foot, but also by the specific anatomical structure of the lower extremities above the ankle joints. An example is femoral anteversion, the size of which changes with growth and reaches a physiological value of 10°-15° around age 12. In the case of excessive femoral anteversion, both the patella and the foot will point inward during walking. As the literature indicates, the presence of excessive femoral anteversion is associated with an increased risk of non-contact ACL injury. In the opposite situation, that is, femoral retroversion, patients will be characterized by the opposite pattern.  
With this news in mind, try to look at foot alignment in a slightly broader way considering the positioning and influence of one element on another.