Research Papers

Medial Longitudinal Arch Angle Presents Significant Differences Between Foot Types: A Biplane Fluoroscopy Study

[+] Author and Article Information
Megan E. R. Balsdon

Wolf Orthopaedic Biomechanics Lab,
Fowler Kennedy Sport Medicine Clinic,
Western University,
London, ON N6A 3K7, Canada;
Department of Mechanical
and Materials Engineering,
Faculty of Engineering,
Western University,
London, ON N6A 5B9, Canada
e-mail: mbalsdon@uwo.ca

Kristen M. Bushey

Wolf Orthopaedic Biomechanics Lab,
Fowler Kennedy Sport Medicine Clinic,
Western University,
London, ON N6A 3K7, Canada;
Department of Mechanical
and Materials Engineering,
Faculty of Engineering,
Western University,
London, ON N6A 5B9, Canada
e-mail: kristen.bushey@gmail.com

Colin E. Dombroski

SoleScience Inc.,
Fowler Kennedy Sport Medicine Clinic,
Western University,
London, ON N6A 3K7, Canada;
Department of Physical Therapy,
Faculty of Health Science,
Western University,
London, ON N6A 5B9, Canada
e-mail: colin@solescience.ca

Marie-Eve LeBel

Roth-McFarlane Hand and Upper Limb Centre,
St. Joseph's Hospital,
268 Grosvenor St.,
London, ON N6A 4V2, Canada
e-mail: mlebel4@uwo.ca

Thomas R. Jenkyn

Wolf Orthopaedic Biomechanics Lab,
Fowler Kennedy Sport Medicine Clinic,
Western University,
London, ON N6A 3K7, Canada;
Department of Mechanical
and Materials Engineering,
Faculty of Engineering,
Western University,
London, ON N6A 5B9, Canada;
School of Kinesiology,
Faculty of Health Sciences,
Western University,
London, ON N6A 3K7, Canada
e-mail: tjenkyn@uwo.ca

1Corresponding author.

Manuscript received December 23, 2015; final manuscript received August 4, 2016; published online September 1, 2016. Assoc. Editor: Kenneth Fischer.

J Biomech Eng 138(10), 101007 (Sep 01, 2016) (6 pages) Paper No: BIO-15-1663; doi: 10.1115/1.4034463 History: Received December 23, 2015; Revised August 04, 2016

The structure of the medial longitudinal arch (MLA) affects the foot's overall function and its ability to dissipate plantar pressure forces. Previous research on the MLA includes measuring the calcaneal–first metatarsal angle using a static sagittal plane radiograph, a dynamic height-to-length ratio using marker clusters with a multisegment foot model, and a contained angle using single point markers with a multisegment foot model. The objective of this study was to use biplane fluoroscopy to measure a contained MLA angle between foot types: pes planus (low arch), pes cavus (high arch), and normal arch. Fifteen participants completed the study, five from each foot type. Markerless fluoroscopic radiostereometric analysis (fRSA) was used with a three-dimensional model of the foot bones and manually matching those bones to a pair of two-dimensional radiographic images during midstance of gait. Statistically significant differences were found between barefoot arch angles of the normal and pes cavus foot types (p = 0.036), as well as between the pes cavus and pes planus foot types (p = 0.004). Dynamic walking also resulted in a statistically significant finding compared to the static standing trials (p = 0.014). These results support the classification of individuals following a physical assessment by a foot specialist for those with pes cavus and planus foot types. The differences between static and dynamic kinematic measurements were also supported using this novel method.

Copyright © 2016 by ASME
Topics: Arches , Bone
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Grahic Jump Location
Fig. 4

Pes cavus participant static barefoot image from the (a) lateral view (fluoroscope A) and (b) anterior–posterior oblique view (fluoroscope B)

Grahic Jump Location
Fig. 3

(a) Solid Works drawing of fluoroscope configuration and proposed platform design and (b) photograph of erected plywood platform designed for biplanar fluoroscopy of the foot with participant performing dynamic trial

Grahic Jump Location
Fig. 2

(a) Example of a pes cavus foot type from the study population and (b) example of a pes planus foot type from the study population

Grahic Jump Location
Fig. 1

(a) Height to length ratio of the MLA, the length represented by the distance from the first metatarsal head to the medial posterior tuberosity of the calcaneus, and the height perpendicular to this line to the navicular tuberosity and medial longitudinal arch angle represented by theta (θ), (b) calcaneus inclination angle and calcaneal–first metatarsal angle, and (c) talonavicular coverage angle and talus–second metatarsal angle

Grahic Jump Location
Fig. 5

The bony landmarks, MP, NT, and MH, were used to calculate the angle of the medial longitudinal arch (MLA) shown in: (a) A perspective view in rhinoceros of bone models and (b) a diagram showing a two-dimensional medial view of the bones and landmarks defining the MLA angle calculated with three-dimensional coordinates

Grahic Jump Location
Fig. 6

Matching bone models to the two fluoroscopic images for one frame of a static barefoot trial with a pes cavus participant. Bone models are exported from osirix into rhinoceros and matched to the pair of fluoroscopic images (labeled fluoroscope A and fluoroscope B) to determine their three-dimensional positions and orientations.

Grahic Jump Location
Fig. 7

Box and whisker plots comparing (a) barefoot trials for three foot types during static and dynamic gait and (b) barefoot trials for all participants during static and dynamic gait. The lower section of each block, the second quartile (Q2), refers to of participants who lie between 25% of the mean and the median, and the upper portion or the third quartile (Q3) refers to the population of people who lay between the median and 75% of the mean. Therefore, the line that separates Q2 and Q3 is the median. The first and fourth quartiles, Q1 and Q4, are represented by the lower and upper whiskers, respectively.




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