Search Results (146)

Flatfeet involve a collapse of the medial longitudinal arch, hindfoot valgus, and forefoot abduction. Flexible flatfoot is the most common type and can often be corrected with physiotherapy or orthotics. While some individuals remain asymptomatic, others develop symptoms for reasons that are not fully understood. This cross-sectional study compared plantar pressure distributions in 16 adults with asymptomatic and 16 with symptomatic flexible flatfeet (FPI-6 > 6; navicular drop > 5 mm), using a resistive-sensor-equipped pressure plate during walking and heel-strike running. During walking, symptomatic participants showed significantly higher total and peak forces at metatarsal 5 (p ≤ 0.003), and the midfoot (p ≤ 0.02146). The medial heel had significantly lower peak force (p = 0.00147), and metatarsal 4 showed higher peak force (p = 0.02539). Force ratios indicated a more lateralized pressure distribution in the symptomatic group. During heel-strike running, the symptomatic group exhibited higher total and peak forces at the fifth metatarsal, the midfoot, and the first metatarsal, with shorter time to peak force in the midfoot and the medial part of the heel. No significant ratio differences were found during running. Symptomatic individuals adopted a lateralized pressure distribution pattern, contrasting the traditional expectation of medial overload in flatfoot conditions. Full article

Background: Intrinsic foot muscle strengthening and orthotic devices such as toe spacers are commonly used to improve foot alignment and function. However, evidence regarding the combined effects of strengthening exercises and interdigital spacers remains limited. Objective: To examine whether adding a silicone toe spacer to a foot strengthening exercise program provides additional benefits compared with exercise alone. Design: Randomized controlled trial. Setting: University biomechanics laboratory. Participants: Twenty-five healthy adults (mean age 23.8 ± 1.3 years) without lower limb injury or neurological disorders were randomly allocated to one of two intervention groups. Interventions: Participants performed a six-week foot strengthening program (22 sessions). One group performed exercises alone, while the second group performed the same exercises while wearing a silicone interdigital toe spacer. Main outcome measures: The primary outcome was hallux valgus angle. Secondary outcomes included active and passive hallux range of motion (ROM), ankle dorsiflexion ROM (weight-bearing lunge test), navicular drop, and postural stability during single-leg stance assessed using center-of-pressure (CoP) measures. Results: Both groups demonstrated improvements over time in hallux valgus angle (p = 0.001, η² = 0.361), active hallux range of motion (p < 0.001, η² = 0.545), and ankle dorsiflexion (p < 0.001). However, no significant between-group differences were observed for the primary outcome or most secondary outcomes. A significant time × group interaction was observed only for passive hallux range of motion (p = 0.040, η² = 0.170), indicating greater improvement in the exercise-only group. Navicular drop and postural stability variables did not change significantly. Conclusions: A six-week foot strengthening program improved hallux alignment, hallux mobility, and ankle dorsiflexion in healthy adults. The addition of a silicone toe spacer did not provide additional short-term benefits compared with exercise alone. Full article

Background/Objectives: Foot impairments are common in older adults, but the independent associations of specific foot indices with locomotive syndrome (LS) severity remain unclear. We examined hallux valgus angle (HV), navicular height (NH), and passive ankle dorsiflexion (ADF). Methods: This cross-sectional study included 119 community-dwelling older adults classified into LS stages 0–3. Bilateral measures were summarized as maximum HV and minimum NH/ADF, reflecting the worst-affected side. Proportional-odds ordinal logistic regression modeled LS stage (0–3) with foot indices and covariates (age, sex, body mass index [BMI]). Extended models additionally adjusted for Timed Up and Go (TUG), gait speed, or single-leg stance (SLS). Sensitivity analysis used binary logistic regression (LS ≥ 2 vs. <2). Results: Greater ADF was independently associated with lower LS severity (OR per 1°, 0.91; 95% CI, 0.85–0.98; p < 0.01), whereas higher BMI was associated with greater LS severity (OR per 1 kg/m², 1.15; 95% CI, 1.01–1.30; p < 0.05). HV and NH were not significant. After adjustment for TUG, gait speed, or SLS, ADF remained inversely associated with LS severity (ORs, 0.92–0.93; p < 0.05), while the BMI association was attenuated. In binary logistic regression, greater ADF was associated with lower odds of LS ≥ 2 (OR per 1°, 0.85; 95% CI, 0.76–0.94; p < 0.005). Conclusions: Reduced passive ankle dorsiflexion is independently associated with greater LS severity, robust after accounting for key mobility and balance measures. Interventions targeting ankle mobility may represent a potentially modifiable factor and warrants confirmation in longitudinal and interventional studies. Full article

Background/Objectives: The anatomical variability of the human foot represents a subject of substantial interest, offering valuable insights in anthropological research as well as in clinical practice. The aim of this study is to document anatomical variants of the tarsal bones in a CISC//XXI skeletal sample (21st Century Identified Skeletal Collection), with a particular focus on the prevalence of accessory ossicles. Methods: The studied sample consisted of 163 individuals (83 females and 80 males). The prevalence of six accessory tarsal bones was recorded (os trigonum, calcaneum secundarium, the accessory navicular bone, os sustentaculum, os vesalianum and os intermetatarseum). Results: A total of 35 individuals (21.4%; 35/163) exhibited at least one accessory ossicle, with 13 females (15.7%; 13/83) and 22 males (27.5%; 22/80). The os trigonum and calcaneum secundarium were the most frequently observed accessory bones, respectively, in 9.3% (15/162) and 6.9% (11/159) of the individuals. No sex differences were observed. All accessory bones occurred more frequently unilaterally, and no co-occurrences of accessory bones were observed. Conclusions: These findings are crucial in both the biomedical and anthropological fields, where a detailed knowledge of foot anatomy and its variations is relevant. Full article

Objectives: To investigate the association between calcaneal bump height and hindfoot radiographic parameters on weight-bearing lateral radiographs in adult males with Progressive Collapsing Foot Deformity (PCFD), and to determine whether posterior calcaneal morphology differs between feet with and without PCFD-related flatfoot alignment. Materials: We retrospectively reviewed 583 men (1166 feet), aged 17–46 years, who underwent standing weight-bearing lateral foot radiographs between 1 January 2024 and 31 August 2025. Radiographic measurements included calcaneal pitch, Meary’s angle, navicular height, tibiocalcaneal angle, Böhler’s angle, Fowler–Philip angle, calcaneal bump height, and additional calcaneal morphological indices. A flatfoot alignment consistent with PCFD was defined as a calcaneal pitch < 18°. Receiver operating characteristic (ROC) analysis and multivariable logistic regression were performed to assess diagnostic performance and identify parameters independently associated with flatfoot alignment. Results: Flatfoot alignment was identified in 232 feet (19.9%) from 153 patients (26.2%). Compared with normally aligned feet, the flatfoot group demonstrated significantly lower navicular height, calcaneal bump height, and Böhler’s angle, along with higher tibiocalcaneal and Meary’s angles (all p < 0.001). ROC analysis showed navicular height to be the most accurate diagnostic parameter (AUC = 0.75), followed by the tibiocalcaneal angle (AUC = 0.69). Multivariable logistic regression revealed that navicular height ≤ 52.7 mm, tibiocalcaneal angle > 64.6°, Böhler’s angle ≤ 32.9°, Meary’s angle > 4.9°, calcaneal bump height ≤ 3.9 mm, and Fowler–Philip angle > 61.1° were independently associated with flatfoot alignment (Nagelkerke R² = 0.293, p < 0.001). Conclusions: Calcaneal bump height is reduced in PCFD and reflects posterior calcaneal remodelling associated with hindfoot malalignment and medial arch collapse. Although not a primary diagnostic parameter, calcaneal bump height provides complementary morphological information that may inform surgical planning and osteotomy strategy aimed at restoring physiologic hindfoot biomechanics and Achilles tendon loading in patients with PCFD. Full article

Background: Flatfoot is an alteration of the normal structure of the foot, characterized by a partial or total reduction of the medial longitudinal plantar arch, valgus deformity of the heel, and abduction of the forefoot. While treatments often include strengthening of the intrinsic foot muscles, evidence of its efficacy in adults with flatfoot remains limited. Objectives: The main objective of this review was to evaluate the effects of strengthening the plantar intrinsic muscles in adults with flatfoot. Methods: Searches were conducted in PubMed, Embase, Cochrane, PEDro, and Web of Science databases up to October 2023. The review protocol was developed and followed according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies included were those published on intrinsic muscle strengthening in adult populations. A qualitative synthesis of all included articles was performed, along with a quantitative sub-analysis of randomized controlled trials and a critical methodological assessment. Results: Eleven studies involving a total of 374 participants were selected. Most studies identified the “short foot exercise” as the optimal exercise for isolating and training the plantar intrinsic foot muscles. The most commonly analyzed variables were the Foot Posture Index and the Navicular Drop Test. Conclusions: Strengthening the plantar intrinsic muscles enhances the height of the medial longitudinal arch, improves hindfoot posture and balance, and increases hallux abductor muscle activity. This strengthening, whether achieved through short foot exercises alone or in combination with other techniques, is effective in treating adult flatfoot. Current literature suggests that a duration of 4–6 weeks may be sufficient to achieve beneficial outcomes. Full article

Background/Objectives: Foot mobility is considered an intrinsic risk factor for lower-limb injury, yet commonly used pronated/neutral/supinated classifications rely on arbitrary cut-points. This study aimed to develop a data-driven framework for characterizing a continuous SSNDT–injury risk gradient and deriving clinically interpretable relative-risk bands that define practical injury risk zones along the sit-to-stand navicular drop test (SSNDT) continuum. Methods: Data from 137 physically active male students (274 feet) were analyzed. Intra-rater reliability of the sit-to-stand navicular drop test (SSNDT) was assessed using ICC(3,1). A quadratic mixed-effects logistic regression model was used to characterize the SSNDT–injury relationship and derive odds-ratio-based risk bands for interpretive and screening purposes. Results: SSNDT demonstrated good intra-rater reliability (ICC(3,1) = 0.82). Model comparison supported a non-linear, U-shaped association between SSNDT and injury risk, with a minimum risk value at approximately 5.5 mm. Bootstrap analysis supported a smooth continuous risk gradient. Four representative OR levels (1.2, 1.5, 1.8, and 2.0) were selected to define SSNDT-based interpretative risk bands. Injury prevalence showed an overall increasing trend across these zones, ranging from 4.2% in the Safe zone to 52.4% in the Extreme zone. Conclusions: SSNDT provides a robust, data-driven basis for quantifying foot-mobility–related injury risk along a continuous non-linear gradient and for deriving clinically interpretable relative-risk bands grounded in a validated model. The proposed framework avoids arbitrary cut-points and supports individualized risk screening. Full article

Background/Objectives: Mueller–Weiss syndrome (MWS) is a rare condition characterized by spontaneous adult-onset osteonecrosis of the navicular bone. This study aimed to assess the diagnostic value of quantitative and semi-quantitative standardized uptake value (SUV) measurements on Tc-99m MDP SPECT/CT for differentiating MWS from other foot pathologies. Methods: We retrospectively reviewed 21 MWS patients who underwent SPECT/CT and compared them with 10 feet from 5 non-MWS patients as controls. MWS severity was staged using the Maceira classification. Volumes of interest (VOIs) were defined in the lateral navicular and distal tibia. SUV_max values were measured for the navicular bone (N), tibial metaphysis (Tm), and diaphysis (Td). Uptake ratios (N/Tm and N/Td) were calculated for semi-quantitative comparison. Results: MWS patients showed significantly higher SUV_max in the navicular compared with controls (9.2 vs. 1.5, p < 0.001). Both N/Tm and N/Td ratios were also significantly elevated (p < 0.001). SUV_max and uptake ratios positively correlated with Maceira stage and visual navicular uptake intensity. Diagnostic thresholds of N SUV_max > 3.77 (AUC = 0.93), N/Tm > 1.139 (AUC = 0.95), and N/Td > 0.93 (AUC = 0.93) effectively distinguished MWS from non-MWS cases. Conclusions: Quantitative and semi-quantitative SUV analysis on SPECT/CT offers a reliable tool for diagnosing MWS and evaluating disease severity. Semi-quantitative ratios, by normalizing metabolic variability, provide a practical and reproducible alternative to absolute SUV measurements for early detection and treatment planning in MWS. Full article

Pitching requires effective transfer of ground reaction force (GRF), and structural breakdown of the medial longitudinal arch (MLA) may influence glenohumeral internal rotation (IR) deficits. This study investigated whether changes in foot morphology of the stride leg and soft tissue characteristics are associated with loss of IR during repeated pitching. Fifteen male college pitchers completed 60 pitches in a simulated game. IR range of motion (IRROM) was assessed before and after pitching. The navicular height, mechanical properties of the abductor hallucis (AbH) and plantar fascia, and GRF were measured at multiple time points. Correlation analysis and a linear mixed model were used to identify predictors of IRROM change. The mean change in shoulder IRROM during pitching was −21.9° ± 8.4°. IRROM and navicular height decreased significantly over time. The AbH elasticity increased throughout the pitching sequence. Greater reductions in IRROM appeared related to a higher vertical GRF (p = 0.021) and increased AbH elasticity (p = 0.046). Vertical GRF was unrelated to fastball velocity (p = 0.260), whereas anteroposterior GRF correlated with fastball velocity (p = 0.038). Morphological and mechanical changes in the stride leg, particularly within the support of the MLA, can influence IRROM. Reducing vertical GRF and stress on the AbH may help preserve the IRROM without compromising performance. Full article

Background/Objectives: Flexible symptomatic flat foot in children can be surgically treated with calcaneus stop screws. This raises the question of whether pre- and postoperative radiographs (X-ray) can be analyzed in two planes using AI. Methods: In this monocentric retrospective study, angle measurements generated by Bone Metrics AI (Gleamer) were compared with manual measurements using Centricity™ (GE Healthcare). A total of 659 X-rays from 124 operated feet (2014–2024) were available, of which 422 were analyzable by AI and 299 met defined quality criteria. Bland–Altman plots were used to assess agreement. Linear and logistic regression analysis examined the influence of age, gender, accessory navicular bone, additional foot pathologies, and flat foot severity on comparability of the measurement methods and measurability by the AI. Finally, radiographs meeting and missing quality criteria were compared. Results: AI measurements were comparable to manual measurements for calcaneus inclination, hallux valgus, 1st–2nd and 1st–5th metatarsal angle both pre- and post-operatively. For the talus-1st metatarsal and medial arch angles, AI results differed significantly (p < 0.001 and p ≤ 0.013) from manual measurement. AI generated talus-1st metatarsal angle was measured larger by 6.14°, 95% [−7.14; −5.14] pre-operatively and 2.80°, 95% [−3.79; −1.81] post-operatively. Medial arch angle was smaller by 1.63° pre-operatively, 95% [1.03; 2.23] and 0.52° post-operatively, 95% CI [0.11; 0.93] with AI. Post-operative measurability was not significantly lower than pre-operative. AI measured angles on incorrectly taken radiographs as often or more often than on correctly taken ones. Discussion: Screw implantation did not negatively impair measurability or AI accuracy. However, age, gender, and flat foot severity influenced AI performance. Bad radiograph quality did not affect AI measurability negatively, indicating that AI cannot yet distinguish between X-rays suitable and unsuitable for angle measurements. Conclusions: Manual measurements are still indispensable in the diagnosis of children’s flat feet. In the future, continuous training of the AI is expected to bring it into line with manually measured radiological values. Full article

Background: Correct use of the feet, step techniques, and positions constitute significant factors in the success of a dancer. Moreover, the type of dance has crucial effects on the posture of the foot and ankle. Therefore, the primary aim of our study was to determine whether there was a relationship between dancesport, dance experience (years), shoe-wearing time (hours), and shoe heel height (centimeters) in dance athletes performing Sportive Latin American Ballroom (SLAB) dance. Second, we aimed to compare the foot posture of SLAB dancers and nondancers with similar demographic characteristics. Methods: Twenty-six professional SLAB dancers and 26 nondancers who had similar demographic characteristics and did not use high-heeled shoes volunteered to take part in this study. Foot posture (using the Foot Posture Index [FPI]), foot pronation (using the navicular drop test [NDT]), tibiocalcaneal angle, hallux valgus angle (HVA) (using a goniometer), and ankle dorsiflexion range of motion (ROM) (using the weightbearing lunge test) were evaluated. Results: There was a positive moderate correlation between FPI score and shoe-wearing time on the dominant (P = .041; r = 0.40) and nondominant (P = .026; r = 0.43) sides. A positive very good correlation was found between shoe heel height and HVA (P < .001; r = 0.75). A negative good correlation was observed between years of dancing and nondominant ankle dorsiflexion ROM (P = .027; r = 20.43). When dancers and nondancers were compared, a statistically significant difference was found between FPI and NDT scores (P < .001). The FPI and NDT scores, tibiocalcaneal angle, HVA, and ankle dorsiflexion ROM were significantly greater in the dancer group compared with the nondancer group (P < .001) in all measurements of the dominant and nondominant sides. Conclusions: Revealing the relationship between dance experience and shoe-wearing time and the difference between the foot posture and deformities of athletes who perform SLAB dance and those of nondancers constitutes a pivotal endeavor that will increase awareness and knowledge among dancers and clinicians. Full article

The astragalus is a key biomechanical link between the autopodium and limb in mammals, modulating stability and mobility during stance. Its morphology provides reliable proxies for inferring posture, body mass, and locomotor behavior in extinct taxa. Mesotheriids (Notoungulata, Mesotheriidae) have traditionally been regarded as fossorial generalists, yet their functional diversity remains poorly tested. The astragali of Caraguatypotherium munozi (Miocene, Chile) and Trachytherus spegazzinianus (early Miocene, Argentina) were analyzed, integrating osteological measurements and functional indices to explore their locomotor ecology. Principal component analyses were performed to compare their morphofunctional spaces with those of 38 extant terrestrial mammals grouped by posture, body mass, top speed, and locomotor habit. Total Angular Excursion (TAE) and Angular Efficiency Index (AEI) were estimated using a comparative dataset of 182 terrestrial mammals spanning 15 taxonomic orders, focused on stance-phase mechanics during comfortable locomotion. C. munozi shows a deeper trochlea and moderately expanded navicular facets, whereas T. spegazzinianus presents a shallower trochlea and narrower articular proportions. Despite these morphological differences, both species share broadly overlapping stance-phase kinematic ranges, reflecting a conserved plantigrade locomotor module optimized for stability and energy-efficient weight support. These findings challenge the view of mesotheriids as functionally uniform and highlight ecological diversification through subtle morphological adjustments within a constrained locomotor framework. Full article

Background: This study examined the influence of foot posture and balance function in individuals with knee osteoarthritis (KOA) and nonspecific low-back pain (LBP). Methods: This study included participants aged 40 to 65 years categorized into three groups: nonspecific LBP (n = 44), KOA (n = 43), and healthy controls (n = 45). Demographic data were collected and disability levels were assessed using the Oswestry Disability Index for LBP and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for KOA. Foot posture was evaluated using the Foot Posture Index 6 (FPI- 6) and navicular drop test, whereas balance was quantified using the Y Balance Test. Results: Analysis of the FPI-6 scores on the dominant side revealed significant differences between the LBP and healthy control groups (P = 0.008) and between the LBP and KOA groups (P = 0.005). The Manchester-Oxford Foot Questionnaire (MOXFQ) scores also showed significant differences between the KOA and healthy control groups (P= 0.022) and between the LBP and healthy control groups (P = 0.038). Overall, significant differences were observed among all groups in both FPI-6 (P = 0.006) andMOXFQ(P = 0.033) scores. The results of the multiple linear regression models indicated that MOXFQ scores significantly predicted the Oswestry Disability Index, with an R2 of 0.283 (P = 0.04), whereas WOMAC and FPI-6 scores were significant predictors of theWOMACscore, with an R² of 0.078 (P = 0.04). Conclusions: This study revealed distinct impairments in foot function and posture in KOA and LBP patients. Foot function was compromised in both groups, with more pronounced foot posture changes in the KOA group, whereas balance remained unaffected. Foot function was linked to disability in LBP and foot posture to disability in KOA. These findings highlight the importance of targeted foot assessment in KOA and LBP rehabilitation. Full article

Osteochondroses of the foot represent a unique and less frequently discussed topic. This narrative review aims to provide a comprehensive overview of foot osteochondroses, highlighting their definition, pathophysiology, clinical features, diagnosis, and treatment. Historical sources, including early case reports, were included along with the current literature to picture the current knowledge on the subject. Anatomical mapping of pain locations and associated ossification centers was employed as a framework to present the various forms of foot osteochondroses. Multiple types of foot osteochondrosis were identified. The calcaneus, navicular and lesser metatarsal are among the more common involved bones. Most forms share a multifactorial etiology involving mechanical stress, vascular insufficiency, and delayed ossification. The pain is localized and common to all forms. Diagnosis relies on clinical assessment supported by radiographic and sometimes magnetic resonance imaging findings. During the acute phase, joint rest is essential. Despite the potential for spontaneous resolution, some cases can lead to structural deformities or persistent symptoms. Foot osteochondroses, although rare, require careful clinical evaluation due to their impact on pediatric patients. Increased awareness and standardized treatment approaches may improve early recognition and management, potentially reducing long-term sequelae. Full article

Background/Objectives: The os supranaviculare (OSSN), also known as os talonaviculare dorsale, astragalo-scaphoid ossicle, or Pirie’s bone, is a small extra bone that was first described in 1921 by A.H. Pirie and is located at the top front part of the navicular bone or talonavicular joint. The knowledge regarding the epidemiology of the OSSN is scarcely established, as its prevalence remains unknown and varies significantly among multiple studies. This meta-analysis aims to clarify and systematically summarize all available data on the characteristics and prevalence of the OSSN. Methods: Four major databases (PubMed/Medline, Embase, ScienceDirect, Scopus) were thoroughly searched for studies reporting original data regarding the OSSN up until May 2025. The protocol of this study was pre-registered on PROSPERO (ID: CRD42025638111) and adhered to PRISMA guidelines. To evaluate the between-study heterogeneity, the 95% prediction intervals (95%PI) were calculated; I² statistic and Chi² test were also used. The AQUA-tool was used to assess the quality of included studies. Results: In total, 13 studies (18,745 feet) qualified for inclusion in the quantitative analysis. The pooled prevalence estimate (PPE) of the OSSN in the general population was found to be 0.88% (95%CI: 0.62–1.24%). The PPE of the OSSN was higher in males (0.87%, 95%CI: 0.58–1.32%) than in females (0.48%, 95%CI: 0.14–1.64%). The os supranaviculare was similarly prevalent in both European (1.04%, 95%CI: 0.55–1.96%) and Asian (0.87%, 95%CI: 0.66–1.13%) populations. Conclusions: the os supranaviculare is a very rare anatomical variation that is present in less than one in a hundred feet. Moreover, although usually asymptomatic, it can occasionally be associated with dorsal foot pain or navicular stress fractures. Accurate differentiation from avulsion fractures is essential to avoid unnecessary invasive treatment. Full article