Type of Feet in a Mexican Population: Analysis of the Footprint Morphology and Literature Review / Tipos de pies en una Población Mexicana: Análisis de la Morfología de la Huella Plantar y Revisión de la Literatura

ABSTRACT There is no specific age when the vault of the feet is completely formed. The objective of this study was to analyze the footprint morphology and obtain the Chippaux-Smirak Index in a Mexican population to identify the type of feet and its prevalence. A database of images of the soles of both feet was analyzed. The database contained images of 1,014 persons between 2 and 73 years old from Guanajuato state, Mexico. Moreover, a literature review was performed to identify the type of feet in the Mexican population. It was observed that less than 17 % of the population have cavus foot (p= 0.018). Furthermore, less than 25 % of the population between 17 and 73 years have flatfoot 3 (p= 0.0079) in the left foot. Also, only nine articles related to the type of foot in the Mexican population were found, but most of them were performed on young population. The formation of the medial arc could be beyond the first decade of life and the relatively high prevalence of flatfoot in adult life should be studied. Finally, the results found can be useful for orthopedists, physiotherapists, clinicians, and parents who are concerned about the foot health of their children.

RESUMEN No hay una edad específica en la que la bóveda de los pies esté completamente formada. El objetivo de este estudio fue analizar la morfología de la huella de los pies y obtener el Índice de Chippaux-Smirak en una población mexicana para identificar el tipo de pie y su prevalencia. Se analizó una base de datos de imágenes de las plantas de ambos pies. La base de datos contenía imágenes de 1,014 personas de entre 2 y 73 años del estado de Guanajuato, México. Además, se realizó una revisión bibliográfica para identificar el tipo de pie en la población mexicana. Se observó que menos del 17 % de la población tiene pie cavo (p= 0,018). Además, menos del 25 % de la población entre 17 y 73 años tiene pie plano 3 (p= 0,0079) en el pie izquierdo. Además, se encontraron 9 artículos relacionados con el tipo de pie en población mexicana, pero la mayoría de ellos fueron desarrollados en población joven. La formación del arco medial podría estar más allá de la primera década de vida. Se encontró una prevalencia relativamente alta de pie plano en la vida adulta que debe ser estudiada. Finalmente, los resultados encontrados pueden ser útiles para ortopedistas, fisioterapeutas, médicos y padres preocupados por la salud de los pies de sus hijos.

Pediatric Charcot-Marie-Tooth disease: A case report and diagnostic challenges

Charcot-Marie-Tooth (CMT) disease is a hereditary motor sensory neuropathy affecting about one in 2500 individuals that is characterized by progressive weakness and loss of touch sensation affecting different parts of the body. Despite its significant genetic heterogeneity, CMT is rarely reported in the Indian literature. We report a 10-year-old boy with CMT presented with severe calf pain, bilateral pes cavus deformity, and areflexia. His mother also had similar symptoms, and the diagnosis was confirmed by neuroimaging and nerve conduction studies. This highlights the importance of considering CMT disease in patients with progressive muscle weakness and deformities, especially with a family history of similar symptoms.

Influencia del pie como receptor en la postura corporal, la simetría facial y cráneo-mandibular / The influence of foot as a receptor on body posture and on facial, mandibular and cranial symmetries

Introducción: Un apoyo plantar incorrecto puede considerarse un factor etiológico de asimetrías faciales y cráneo-mandibulares pues modifica, de forma instantánea, la relación entre el maxilar y la mandíbula. Por tanto, resulta vital identificar la etiología de estas asimetrías para establecer diagnósticos y tratamientos certeros. Objetivo: Determinar la influencia del apoyo plantar en la postura corporal, la simetría facial y cráneo-mandibular en adolescentes. Métodos: Se realizó un estudio descriptivo y transversal de enero a septiembre de 2019 con 180 adolescentes que asistieron al servicio de Ortodoncia de la Clínica Docente de Especialidades «Victoria de Santa Clara», los cuales cumplían con criterios de selección de la investigación. Se analizaron variables faciales, posturales y cefalométricas. Se determinó: la simetría facial mediante el análisis de líneas faciales, el apoyo plantar al calcular el índice cavitario, la postura corporal, según la prueba de Di Rocca, y la simetría mandibular con el método modificado de Kurt y Uysal. Se siguieron las normas éticas y fueron aplicadas la prueba de Fisher, la de McNemar, y la técnica de conglomerado. Resultados: Predominaron los adolescentes con apoyo plantar asimétrico y los pies varo. Del total de casos con asimetría facial, 72,53 % presentó apoyo plantar asimétrico, y 39,44 % planos biilíaco y biclavicular desequilibrados y divergentes. La asimetría mandibular se observó en el 56,11%, la mayoría con apoyo plantar asimétrico. Conclusiones: Se pudo constatar la influencia del apoyo plantar en la postura corporal, la simetría facial y cráneo-mandibular, pues se observó un alto grado de relación entre las variables estudiadas.

Introduction: an incorrect plantar support can be considered an etiological factor of facial, mandibular and cranial asymmetries since it instantly modifies the relationship between the maxilla and mandible. Therefore, it is vital to identify the etiology of these asymmetries to establish accurate diagnoses and treatments. Objective: to determine the influence of plantar support on body posture and on facial, mandibular and cranial symmetries in adolescents. Methods: a descriptive and cross-sectional study was carried out from January to September 2019 with 180 adolescents who were seen in the Orthodontics service at "Victoria de Santa Clara" Specialty Teaching Dental Clinic, who met the research selection criteria. Facial, postural and cephalometric variables were analyzed. Facial symmetry was determined through the analysis of facial lines, plantar support by means of cavity index, body posture according to the Di Rocca test, and mandibular symmetry with the modified method of Kurt and Uysal. Ethical standards were followed and Fisher's and McNemar's tests as well as clustering technique were applied. Results: adolescents with asymmetric plantar support and varus feet predominated. The 72.53% had asymmetric plantar support from the total cases with facial asymmetry, and 39.44% had unbalanced and divergent biiliac and biclavicular planes. Mandibular asymmetry was observed in 56.11%, mostly with asymmetric plantar support. Conclusions: the influence of plantar support on body posture and on facial, mandibular and cranial symmetries was posible to verify since a high degree of relationship was observed among the variables studied.

Correlation between cyphose and lordose with the foot support of adolescents with idiopathic scoliosis / Correlação entre cifose e lordose com o apoio dos pés de adolescentes com escoliose idiopática / Correlación entre cifosis y lordosis con el soporte de los pies de adolescentes con escoliosis idiopática

ABSTRACT: Objective: To verify the correlation between the thoracic and lumbar Cobb angle and the type of foot, and the parameters of plantar support during gait in adolescents with idiopathic scoliosis. Material and Methods: Sixty adolescents with idiopathic scoliosis (AIS) were divided into three groups: normal foot (n=20), cavus foot (n=20), and flat foot (n=20). The Cobb angles of thoracic kyphosis and lumbar lordosis were evaluated by radiographic examination. The plantar arch was recorded the podoscope and calculated by the ratio between the midfoot and the total foot area. The adolescents performed the march on a 20-meter track, with their feet resting on the pressure platform, totaling an average of 12 steps of the foot (right and left). The variables evaluated were: contact area, peak pressure, and maximum force on the four regions of the feet: hindfoot (medial and lateral), midfoot, and forefoot. Results: There was a positive correlation between the Cobb angle of lumbar lordosis and the arch plantar cavus (r=0.40; p=0.048) and flat (0.25; p=0.004), with no significant correlations for the Cobb angle thoracic (p>0.005). The pressure peak strongly correlated with the cavus plantar arch (r=0.92, p=0.001) in the lateral hindfoot and forefoot region, while the flat foot with the midfoot region. Conclusion: The Cobb lumbar lordosis angle positively correlates with the plantar arch height and the plantar support pattern during gait in adolescents with idiopathic scoliosis. Level of Evidence II; Observational and Cross-Sectional Study.

RESUMO: Objetivos: Verificar a correlação entre o ângulo de Cobb torácico e lombar e o tipo de pé e os parâmetros do apoio plantar durante a marcha de adolescentes com escoliose idiopática. Material e Métodos: Foram avaliados 60 adolescentes com escoliose idiopática (EIA), divididos em três grupos: pé normal (n= 20), pé cavo (n=20) e pé plano (n=20). Os ângulos de Cobb da cifose torácica e da lordose lombar foram avaliadas pelo exame radiográfico. O arco plantar foi registrado pelo podoscópio e calculado pela razão entre a área do mediopé e a área total do pé. Os adolescentes realizavam a marcha sobre uma pista de 20 metros, com o registo do apoio dos pés sobre a plataforma de pressão, totalizando em média 12 passos (direito e esquerdo). Foram avaliados: área de contato, pico de pressão e força máxima sobre 4 regiões dos pés: retropé (medial e lateral), mediopé e antepé. Resultados: Houve uma correlação positiva entre o ângulo de Cobb da lordose lombar e o arco plantar cavo (r=0,40; p=0,048) e plano (0,25; p=0,004), sem correlações significantes para o ângulo de Cobb torácico (p>0,005). O pico de pressão obteve uma correlação forte com o arco plantar cavo (r=0,92, p=0,001) em região de retropé lateral e antepé, enquanto que o pé plano com a região do mediopé. Conclusão: O ângulo de Cobb da lordose lombar tem correlação positiva com a altura do arco plantar e o padrão de apoio plantar durante a marcha de adolescentes com escoliose idiopática. Nível de Evidência II; Estudo Observacional e Transversal.

RESUMEN: Objetivos: Verificar la correlación entre el ángulo de Cobb torácico y lumbar y el tipo de pie y los parámetros de soporte plantar durante la marcha en adolescentes con escoliosis idiopática. Material y Métodos: Sesenta adolescentes con escoliosis idiopática (EIA) fueron divididos en tres grupos: pie normal (n=20), pie cavo (n=20) y pie plano (n=20). Los ángulos de Cobb de la cifosis torácica y la lordosis lumbar se evaluaron mediante examen radiográfico. El arco plantar fue registrado por el podoscopio y calculado por la relación entre el área del mediopié y el área total del pie. Los adolescentes realizaron la marcha sobre una pista de 20 metros, con los pies apoyados en la plataforma, totalizando un promedio de 12 pasos (derecho e izquierdo). Fueron evaluados área de contacto, pico de presión y fuerza máxima en las 4 regiones de los pies: retropié (medial y lateral), mediopié y antepié. Resultados: Hubo correlación positiva entre el ángulo de Cobb de la lordosis lumbar y el arco cavo plantar (r=0,40; p=0,048) y plano (0,25; p=0,004), no existiendo correlaciones significativas para el ángulo de Cobb torácico (p> 0,005). El pico de presión obtuvo una fuerte correlación con el arco plantar cavo (r=0,92, p=0,001) en la región lateral del retropié y antepié, mientras que el pie plano con la región del mediopié. Conclusión: El ángulo de Cobb de la lordosis lumbar tiene una correlación positiva con la altura del arco plantar y el patrón de apoyo plantar durante la marcha en adolescentes con escoliosis idiopática. Nivel de Evidencia II; Estudio Observacional y Transversal.

Exercises and neuromuscular electric stimulation for medial longitudinal arch: clinical trial / Exercícios e estimulação elétrica neuromuscular para arco longitudinal medial: ensaio clínico

ABSTRACT Objective The extrinsic muscles, such as the posterior tibialis and long flexor of the hallux and the intrinsic of the foot, are part of the active subsystem of the central system of the foot and play an essential role in the control of the medial longitudinal arch resulting from difficulty in contracting the muscle, neuromuscular electrostimulation (NMES) becomes a resource combined with strengthening and recommended for rehabilitation. T this work aims to evaluate the effectiveness of NMES associated with exercise in deforming the medial longitudinal arch. Methods This is a randomized blind clinical trial. 60 asymptomatic participants were divided into three groups: NMES, exercise and control. The NMES and exercise group performed seven exercises for the intrinsic and extrinsic muscles twice a week for 6 weeks, and the NMES group used an NMES associated with five exercises. Navicular height and medial longitudinal arch angle were taken before and after the intervention period. Results No statistically significant differences existed between groups for navicular height and medial longitudinal arch angle. Conclusion NMES associated with exercise does not change the characteristics of the medial longitudinal arch in association with asymptomatic. Level of Evidence I; Randomized clinical trial.

RESUMO Objetivo Os músculos extrínsecos, como o tibial posterior e flexor longo do hálux e os intrínsecos do pé fazem parte do subsistema ativo do foot core system e exercem papel essencial no controle do arco longitudinal medial. Devido à dificuldade na contração desses músculos, a eletroestimulação neuromuscular (EENM) torna-se um recurso aliado ao fortalecimento e é recomendada para reabilitação. O objetivo desse trabalho é avaliar a eficácia da EENM associada ao exercício na deformação do arco longitudinal medial. Métodos Este é um ensaio clínico randomizado cego. 60 participantes assintomáticos foram divididos em três grupos: EENM, exercício e controle. O grupo EENM e exercício realizaram sete exercícios para os músculos intrínsecos e extrínsecos duas vezes por semana por seis semanas, sendo o grupo EENM utilizou a EENM associada a cinco exercícios. A altura do navicular e o ângulo do arco longitudinal medial foram medidos antes e após o período de intervenção. Resultados Não houve diferenças estatisticamente significativas entre os grupos para a altura do navicular e ângulo do arco longitudinal medial. Conclusão A EENM associada ao exercício não altera as características do arco longitudinal medial em indivíduos assintomáticos. Nível de Evidência I; Estudo Clínico Randomizado.

Factores de riesgo asociados a patologías musculoesqueléticas en deportistas con pie cavo anterior a través de estudios de baropodometría / Risk factors associated to musculoskeletal pathologies in athletes with cavus foot through baropodometric studies

Resumen: Introducción: El pie cavo es una patología musculoesquelética con un aumento del arco medial del pie. La etiología del pie cavo aún es incomprensible, está relacionada con afecciones neurológicas, enfermedad de Charcot-Marie-Tooth, ataxia de Friedreich y parálisis cerebral. El objetivo de esta investigación fue analizar la distribución de la presión plantar en atletas jóvenes con pie cavo. Material y métodos: Se reclutaron 83 atletas jóvenes de entre nueve y 20 años de edad, que presentaban patología de pie cavo. La masa y el promedio de altura fueron 56.9 ± 12.36 kg y 1.61 ± 0.10 m, respectivamente. La distribución de la presión plantar de los pies se registró durante condiciones estáticas. Se compararon las presiones del antepié y el retropié. Resultados: La distribución de la presión plantar se categorizó en tres grupos. En el primer grupo los participantes presentaron mayor presión en la parte anterior del pie; en el segundo grupo los atletas mostraron una presión similar en la región posterior y anterior de los pies y en el último los sujetos revelaron una mayor presión en el retropié. Para ser considerado en uno de los tres grupos, la diferencia de presión entre la parte posterior y anterior del pie se estableció en 16%. Conclusión: Muchos trastornos musculoesqueléticos en el cuerpo humano son de origen biomecánico y están relacionados con la anatomía del pie. El pie cavo es una patología con alta prevalencia en atletas y está relacionada con las fuerzas mecánicas sobre los pies en condiciones dinámicas.

Abstract: Introduction: The cavus foot is a musculoskeletal pathology with an increase of the medial arch of the concavity of the foot. The etiology of the cavus foot is still enigmatic, it is related with neurologic conditions, Charcot-Marie-Tooth disease, Friedreich's ataxia, and cerebral palsy. The aim of this research was to analyze the plantar pressure distribution of the feet on young athletes with cavus foot. Material and methods: Eighty-three young athletes between nine and 20 years old, that presented cavus feet pathology were recruited. The mass and height average were 56.9 ± 12.36 kg and 1.61 ± 0.10 m respectively. Plantar pressure distribution of the feet was recorded during static conditions. The hindfoot and forefoot pressure were compared in each foot. Results: The plantar pressure distribution were categorized in three groups. In the first group the participants presented higher pressure in the hindfoot than forefoot, in the second group, the athletes showed similar pressure in the posterior and anterior region of the feet and in the last one, the subjects revealed higher pressure in the forefoot. To be considered in one of the three groups, the difference of pressure between the posterior and anterior part of the foot was established at 16%. Conclusion: Many musculoskeletal disorders in the human body are biomechanical in origin and related with foot anatomy. The cavus foot is a pathology with high prevalence in athletes and it is related with the mechanical forces over the feet during dynamic conditions.

Subtalar joint in neutral and relaxed positions for evaluation of medial longitudinal arch / Articulação subtalar em posições neutra e relaxada para avaliação do arco longitudinal medial

ABSTRACT Objective: The medial longitudinal arch is the main structure of load bearing and shock absorption of the foot. The evaluation of medial longitudinal arch, such as the navicular height, the medial longitudinal arch angle and the Feiss line should be performed with the subtalar joint in the neutral and relaxed position. Our study analyzed the correlation between the measurements of the subtalar joint in neutral and relaxed positions during the evaluation tests of the medial longitudinal arch. Methods: This is a cross-sectional study, in which 51 healthy volunteers (102 feet; 36 women; 28 ± 5 years, 1.66 ± 0.10 m; 24.5 ± 4.5 kg/m2) had their navicular height, medial longitudinal arch angle and Feiss line measured in the neutral and relaxed positions. The correlation between the measures was evaluated using Pearson's test. Results: A strong correlation of the 102 feet Feiss line measurements between neutral and relaxed positions (r = 0.81) was observed, and a moderate correlation between the medial longitudinal arch angle (r = 0.78) and between navicular height in neutral and relaxed positions (r = 0.76). Conclusion: The measurements of the longitudinal medial arch between the neutral and relaxed positions are strongly correlated. Therefore, it is not necessary to measure the medial longitudinal arch in both neutral and relaxed positions. Level of Evidence II, Diagnostic Studies - Investigating a diagnostic test.

RESUMO Objetivo: O arco longitudinal medial é a estrutura principal para suporte de carga e absorção de impacto no pé. Medidas para avaliação do arco longitudinal medial, como a altura navicular, o ângulo do arco longitudinal medial e a linha de Feiss devem ser realizadas com a articulação subtalar na posição neutra e relaxada. Este estudo analisou a correlação entre as medidas da articulação subtalar em posições neutra e relaxada durante os testes de avaliação do arco longitudinal medial. Métodos: Neste estudo transversal, 51 voluntários saudáveis (102 pés; 36 mulheres; 28 ± 5 anos, 1,66 ± 0,10 m; 24,5 ± 4,5 kg/m2) tiveram altura navicular, ângulo do arco longitudinal medial e linha de Feiss medida nas posições neutra e relaxada. A correlação entre eles foi avaliada pelo teste de Pearson. Resultados: Houve uma correlação muito forte das medidas de linha de Feiss de 102 pés entre a posição neutra e relaxada (r = 0,81) e uma correlação moderada entre o ângulo do arco longitudinal medial (r = 0,78) e altura navicular nas posições neutra e relaxada (r = 0,76). Conclusão: As medidas do arco medial longitudinal entre as posições neutra e relaxada estão fortemente correlacionadas. Não é necessário, portanto, medir o arco longitudinal medial nas posições neutra e relaxada. Nível de Evidência II, Estudos diagnósticos - Investigação de um exame para diagnóstico.

Deformidades de los pies en niños / Foot deformities in children

Las alteraciones en los pies son una consulta frecuente en ortopedia pediátrica. La gran mayoría corresponde a condiciones que no constituyen patología y habitualmente no necesitan tratamiento, como el pie plano flexible. Por otro lado, existen deformidades patológicas que necesitarán un adecuado estudio y tratamiento. Según su morfología podemos clasificarlas en cavo-varo, plano-valgo y misceláneas. Su origen puede ser congénito o adquirido y de diversas etiologías, destacando el pie bot, metatarso varo, hallux valgus juvenil y aquellas secundarias a enfermedades neuromusculares, entre otras. Conocer la historia natural de cada deformidad nos permite decidir el momento más adecuado para cada tratamiento. Los antecedentes mórbidos y perinatales del paciente son muy importantes, así como el nivel de actividad física y/o deportiva. El examen físico debe incluir observar la marcha, extremidades inferiores, tobillo y pie. En el pie se debe analizar cada segmento por separado (antepié, mediopié y retropié) y las articulaciones respectivas. Es muy importante distinguir entre deformidades rígidas y flexibles. El tratamiento incluye la observación (condiciones benignas y autolimitadas), calzado adecuado, insertos plantares, órtesis, yesos correctores, cirugía de partes blandas y cirugía ósea; todo complementado por un adecuado programa de rehabilitación funcional y deportivo.

Foot disorders are a frequent cause of consultation in pediatric orthopaedics. The vast majority correspond to conditions that don't constitute pathology and usually don ́t need treatment, such as flexible flat foot. On the other hand, there are pathological deformities that will require a proper study and treatment. According to their morphology we can classify them in cavo-varus, plano-valgus and miscellaneous. Its origin can be congenital or acquired and due to various etiologies, highlighting clubfoot, metatarsus adductus, juvenile hallux valgus and those secondary to neuromuscular diseases, among others. Knowing the natural history of each deformity allows us to decide the most appropriate time for each treatment. Patient's morbility and perinatal history is very important, as well as their level of physical and/or sports activity. Physical exam should include gait obsevation, lower limbs, ankles and feet. In the foot, each segment should be analyzed separately (forefoot, midfoot and hindfoot) and their joints. It ́s very important to distinguish between rigid and flexible deformities. Treatments include observation (benign and self-limited conditions), adequate footwear, insoles, orthosis, corrective casting, soft tissue surgery and bone surgery; all complemented by an adequate functional and sports rehabilitation programs

Longitudinal Evaluation of Calf MRI in a Patient with Charcot-Marie-Tooth Disease 2E：A Case Study / The Japanese Journal of Rehabilitation Medicine

We present a case report that a longitudinal calf MR evaluation was performed for a patient with Charcot-Marie-Tooth disease who underwent bilateral reconstructive foot surgeries. A 39 years-old female was referred to our department because of severe bilateral cavus foot deformities and difficulty to walk. On radiological findings, severe bilateral cavus foot deformities were confirmed. On MR findings, fatty infiltrations were detected in the wide range of bilateral lower leg compartments. Difficulty to walk aggravated despite of the conservative treatment, so bilateral reconstructive foot surgeries were performed. She acquired plantigrade and better walking function postoperatively. Two years after surgery, no recurrence of cavus foot deformity was observed, but claw toe deformities and fatty infiltrations were mildly progressing. Since CMT is slowly progressive, we need to conduct a careful follow-up.

Longitudinal Evaluation of Calf MRI in a Patient with Charcot-Marie-Tooth Disease 2E：A Case Study / The Japanese Journal of Rehabilitation Medicine

We present a case report that a longitudinal calf MR evaluation was performed for a patient with Charcot-Marie-Tooth disease who underwent bilateral reconstructive foot surgeries. A 39 years-old female was referred to our department because of severe bilateral cavus foot deformities and difficulty to walk. On radiological findings, severe bilateral cavus foot deformities were confirmed. On MR findings, fatty infiltrations were detected in the wide range of bilateral lower leg compartments. Difficulty to walk aggravated despite of the conservative treatment, so bilateral reconstructive foot surgeries were performed. She acquired plantigrade and better walking function postoperatively. Two years after surgery, no recurrence of cavus foot deformity was observed, but claw toe deformities and fatty infiltrations were mildly progressing. Since CMT is slowly progressive, we need to conduct a careful follow-up.

Frecuencia de alteraciones de la huella plantar en escolares de una comunidad mexicana / Frequency of footprints alterations in school children from a Mexican community

Resumen: Introducción: Las alteraciones de la huella plantar en el niño es causa de preocupación en los padres de familia. Objetivo: Determinar la frecuencia de alteraciones de la huella plantar en escolares. Determinar si existe relación entre el sobrepeso y la obesidad con la presencia de alteraciones de la huella plantar. Material y métodos: Estudio observacional, transversal y prospectivo. Se evaluaron 959 escolares de seis a 13 años de edad. Se registró peso, talla, índice de masa corporal para la edad. La huella plantar se catalogó en pie plano y pie cavo utilizando el índice del arco. Para el análisis y comparación estadística se utilizó el programa SPSS versión 24 con las pruebas χ2 y ANOVA. Resultados: Se revisaron 530 niños (55.3%) y 429 niñas (44.7%). La media de edad fue de 8.97 años. Se observaron 182 niños (19%) con alteración de la huella plantar, 42.3% con pie plano y 57.7% con pie cavo. Ninguno mostró sintomatología del pie. Ciento treinta y un niños tenían sobrepeso y 52 obesidad, sin influir en la presencia de alguna alteración de la huella plantar (p = 0.20). La relación de pie plano fue mayor en los hombres (2.5:1) y de pie cavo fue mayor en las mujeres (1.3:1). Conclusiones: En nuestro grupo de estudio se encontró mayor prevalencia del pie cavo en comparación con el pie plano. El peso corporal no influyó en las alteraciones de la huella plantar.

Abstract: Introduction: Alterations in the plantar footprint in the child are a cause for concern in parents. Objective: Determine the frequency of plantar footprint alterations in school children. Determine if there is a relationship between overweight and obesity with the presence of alterations of the plantar footprint. Material and methods: Observational, transversal and prospective study. 959 schoolchildren aged six to 13 were evaluated. Weight, size, body mass index for age were recorded. The plantar footprint was cataloged on flat foot and cavus foot using the arch index. For statistical analysis and comparison, the SPSS version 24 program was used with the χ2 and ANOVA tests. Results: 530 children (55.3%) and 429 girls (44.7%). The median age was 8.97 years. 182 children were found (19%) with alteration of the plantar footprint, 42.3% with flat foot and 57.7% with cavus foot. None of them had foot symptoms. 131 children were overweight and 52 obese, without influencing the presence of any alteration of the plantar footprint (p = 0.20). The flat-foot ratio was higher in men (2.5:1) and standing cavus major in women (1.3:1). Conclusions: In our study group we find a higher prevalence of the cavus foot compared to the flat foot. Body weight did not influence plantar footprint alterations.

Assessment Of Staheli Arch Index In Tribal Children Of Jharkhand State

Pes planus and pes cavus are the two common foot conditions, which fascinate the attention of researchers. Adeviation from normal foot arch structure is associated with unstable gait. This study aims at assessing thestaheli arch index (SAI) of Jharkhand tribal children. This study was carried out on children belonging to varioustribal groups of Ranchi and Angara districts of Jharkhand. Graphical footprints of the study subjects wererecorded and assessed using SPSS-16. The mean right SAI was 0.63 and 0.61 for right and left foot respectively.The mean right SAI was significantly greater than that of left foot. Gender differences in mean SAI was statisticallyinsignificant at p<0.05. The mean SAI of 0.75 and 0.76 at the age of 3:<4 years was reduced to 0.64 and 0.61 by14:<15 years age for right and left foot respectively. There was insignificant correlation of SAI with age and bodymass index (p < 0.05).

Características morfofuncionales del pie de deportistas universitarios chilenos en diez disciplinas deportivas / Morphofunctional foot characteristics of Chilean university athletes in ten sports disciplines

RESUMEN: Se sabe que hay gran variabilidad en la morfología de las zonas del pie entre sujetos. Esto es más evidente en deportistas, ya que la práctica de deportes somete a los pies a presiones y deformaciones anatómicas mayores que las que se ejercen en actividades de la vida diaria. Por lo anterior, se desprende que el conocimiento de la morfología del pie de la población objetivo es de alto interés para la confección de calzado apropiado a su forma y dimensiones. El objetivo de esta investigación es caracterizar variables morfológicas referidas a las dimensiones del pie de deportistas seleccionados universitarios chilenos. La muestra se conformó de 169 sujetos de ambos sexos de una población de deportistas universitarios de 23,27 años, 71 kilogramos, 1,71 metros de estatura e índice de masa corporal de 24,29. En las mediciones se utilizó un antropómetro y la clasificación del Arco Plantar Longitudinal Medial (APLM) se realizó mediante el Arch Index. Se demostró que la longitud del pie en hombres y mujeres se corresponde con el 15 % de la estatura del sujeto. La variable Ancho Antepie Normalizado (AAN) equivale al 39 % de la Longitud del Pie (LP), no registrándose diferencias entre sexos. El Ancho del Retropié por su parte, fue correspondiente con el 25 % de LP. El Ancho de Retropie (AR) equivale al 63 % del Ancho Antepie (AA). En cuanto al APLM, las mujeres presentan valores de normalidad ubicados entre 0,13 y 0,24 para pie izquierdo y 0,17 y 0,24 para pie derecho. Se aprecia que la prevalencia de pies planos fue mayor en hombres (25 % a 28 %) que en mujeres (4 % a 6 %) y la prevalencia de pies cavos fue mayor en mujeres (47 % a 53 %) respecto a hombres (27 % a 31 %).

SUMMARY: It is known that there is great variability in the morphology of feet areas among different subjects. This is more evident in athletes, since the practice of sports subjects their feet to greater pressures and anatomical deformations, other than those exerted during daily life activities. It is clear therefore, that knowledge of the target population foot morphology is of high interest for the production of appropriate footwear to its shapes and dimensions. The objective of this research is to characterize morphological variables related to the feet of selected Chilean university athletes. The sample consisted of 169 subjects of both sexes of university population athletes of an average age of 23.27 years, 71 kilograms, 1.71 meters height and body mass index of 24.29. An anthropometer was used for measurements and the classification of the Medial Longitudinal Plantar Arch (MLPA) was performed by the Arch Index. It was shown that foot length corresponds to 15 % of the subject's height. The Normal Forefoot Width (NFW) variable is equal to 39% of Foot Length (FL), with no differences between sexes. Posterior foot width corresponded to 25 % of LP; posterior foot Width is 63 % of the Forefoot Width (AA). Regarding the APLM, women presented values of normality located between 0.13 and 0.24 for left foot and 0.17 and 0.24 for right foot. The prevalence of flat foot was higher in men (25 % to 28%) than in women (4 % to 6 %) and the prevalence of cavus foot was higher in women (47 % to 53 %) than in men (27 % to 31 %).

Caracterización morfológica del arco plantar longitudinal medial del pie en una población chilena / Morphological characterization of the medial plantar longitudinal arch foot in a Chilean population

El arco plantar longitudinal medial del pie (APLM) es el componente más importante en estática y dinámica de la bóveda plantar. Su altura define pies normales, planos y cavos, estos últimos son factores predisponentes de lesiones. El objetivo de este estudio fue describir y relacionar en una población de estudiantes universitarios chilenos la prevalencia de pies normales, cavos y planos según índice de masa corporal (IMC), sexo y actividad física (AF) semanal y la distribución de asimetrías entre pies. Se estudió a 209 sujetos (128 hombres y 81 mujeres), estudiantes universitarios, cuya edad, estatura, peso e IMC fue de 20,4 años (±3,4); 1,68 m (±0,09); 67,6 Kg (±12,4) y 23,77 (±3,0) respectivamente. Por medio de cuestionario se determinó los hábitos de AF de la muestra. La impresión plantar se obtuvo mediante fotopodoscopía, la cual fue evaluada empleando el Arch Index (AI) de Cavanagh y Rodgers. Los hombres presentan mayor prevalencia de pie plano (31,3 % contra 11,1 %). Hay correlación positiva estadísticamente significativa entre AI e IMC en ambos sexos. Se obtuvo mayor correlación entre AI izquierdo y AF en hombres y mujeres con significancia estadística. El 31,25 % de los hombres y el 37,04 % de las mujeres presentaron asimetrías en APLM. Hombres con IMC normal tienen 64,20 % de pies asimétricos. Las mujeres que practican entre 6 y 10 horas de AF a la semana presentan 50,98 % de pies asimétricos. El IMC se relaciona con una disminución de la altura del APLM, se sugiere el control de esta variable en sujetos con diagnóstico de pie plano flexible y pie plano valgo. La práctica de AF se relaciona con aumento de la altura del APLM en hombres y mujeres y se sabe que también contribuye a disminuir el IMC, actuando en concordancia hacia estas dos variables.

The (MPLA) is the most important component in statics and dynamics of the vault plant. Its height defines normal, flat and cavus feet, which are predisposing factors for injuries. The objective of this research was to describe and relate in a population of Chilean university students the prevalence of normal, cavus and flat feet according to body-mass index (BMI), sex, and weekly physical activity (PA) and the distribution of asymmetries between feet. 209 subject were studied (128 men and 81 women), university students, whose age, height, weight and BMI was of 20.4 years (±3.4); 1,68 m (±0.09); 67.6 kg (±12.4) and 23.77 (±3.0) respectively. The PAs habits of the sample were determined by means of questionnaire. The footprint is obtained by photo-podoscopy, which was evaluated by the Arch Index (AI) of Cavanagh and Rodgers. Men have higher prevalence of flat foot (31.3 % against 11.1 %). There are both statistically significant positive correlations between AI and BMI in both sexes. Greater correlation between left AI and PA in both men and women was obtained with statistical significance. The 31.25 % of men and 37.04 % of women presented asymmetries in MPLA. Men with normal BMI have 64.20 % of asymmetric feet. Women that practice between 6 and 10 hours of PA a week presented 50.98 % of asymmetric feet. The BMI is related to a decrease of the height of MPLA, suggesting the control of this variable in subjects with flexible flat foot and valgus flat foot diagnosis. The practice of PA is related to the height of the MPLA increased in men and women and it is known that it also helps to reduce BMI, acting in accordance to these two variables.

Análise das impressões plantares de bailarinas através de parâmetros plantigráficos / Analysis of plantar prints of ballet dancers through plantigraphy parameters

Introduction: The classical ballet is a dance that most of the times uses extreme positions such as extern rotation of the hips and plantar flexion of ankles and feet. These last ones may suffer morpho structural alterations. Objective: The objective of this study was to analyze the plantar prints of classical dancers through plantigraphy parameters. Methods: It is an observational descriptive study carried out with a sample of 66 classical dancers of Teresina/PI, 17.0 ± 3.1 years old and with at least 2 years of practice. The evaluation instrument used was a PODO tech brand plantigraph and the classification followed Viladot criteria. Data were analyzed using descriptive statistics and the Pearson linear correlation test. Results: We observed the prevalence of cavus deformity (62.1%) followed by normal feet (36.4%) and flatfoot (1.5%). There was no correlation between the type of feet and the period of practice. However, it has been found a weak and moderate correlation between feet type and the points of overpressure and pain, respectively. Conclusion: The practice of classical ballet contributes to the formation of cavus deformity, requiring intervention against possible damage that may be associated to this fact. (AU)

Introdução: O ballet clássico é uma dança que na maioria das vezes utiliza posições extremas como rotação externa dos quadris e flexão plantar de tornozelos e pés. Podendo, estes últimos, sofrerem alterações morfo-estruturais. Objetivo: O objetivo do estudo foi analisar as impressões plantares de bailarinas clássicas através de parâmetros plantigráficos. Material e métodos: Trata-se de um estudo descritivo observacional que foi realizado numa amostra de 66 bailarinas clássicas da cidade de Teresina/PI, com média de idade de 17,0 ± 3,1 anos e no mínimo 2 anos de prática. O instrumento avaliativo utilizado foi um plantígrafo da marca PODO tech e a classificação seguiu os critérios definidos por Viladot. Os dados foram analisados por estatística descritiva e pelo teste de correlação linear de Pearson. Resultados: Verificou-se prevalência de pés cavos (62,1%), seguido por pés normais (36,4%) e pé plano (1,5%). Não houve correlação entre o tipo de pé e o tempo de prática. Contudo, encontrou-se correlação fraca e moderada entre o tipo de pé e os pontos de hiperpressões e as dores, respectivamente. Conclusão: A prática do ballet clássico contribui para a formação de um pé cavo, sendo necessária intervenção frente a possíveis danos que possam estar associados a este fato. (AU)

Relationships Between Self-awareness and Clinical Diagnostic Findings of Abnormal Foot Arch Height in Koreans

OBJECTIVE: To see how people think about their own feet, and evaluate whether there are correlations among self-awareness of the participants and clinical examination findings. METHODS: Adult twins and their families who participated in the Healthy Twin study from May 2008 to April 2010 were recruited. Participants were asked whether they thought their feet were normal, flat, or cavus. The lateral talometatarsal angles were measured on foot X-rays to determine the foot arch height. Using the podoscopic footprints taken with the podobaroscope, the Staheli arch index was also measured. Kappa statistics were used to calculate degree of agreement among the three measurement methods. RESULTS: Self-awareness and radiographic findings were significantly different (Pearson chi-square test, p=0.000) and only slightly agreed (kappa measure of agreement=0.136, p=0.000). Self-awareness and podoscopy results revealed a significant difference (Pearson chi-square test, p=0.000), with only slight agreement (kappa measure of agreement=0.072, p=0.000). CONCLUSION: There is significant disagreement between patients' perception of their feet and actual test results. Many people may have an incorrect assumption about their own foot conditions that may be reflected in improper management. Dissemination of accurate information about foot disorders by foot clinicians would be helpful.

Relación entre hiperlaxitud articular, dismetría de miembros inferiores y control postural con los trastornos posturales / Relationship between joint hypermobility, lower limb asymmetry and postural control with postural abnormalities

Objetivos: Determinar si existe relación entre hiperlaxitud articular, dismetría de miembros inferiores y la estabilidad ocontrol postural en bipedestación con los trastornos posturales en adolescentes. Material y métodos: Estudio relacional transversal,realizado en el Instituto Nacional de Rehabilitación “Dra. Adriana Rebaza Flores” Amistad Perú-Japón,Chorrillos-Perú. Participaron todos los estudiantes del 5º año de secundaria de un colegio privado de la ciudad deLima. La hiperlaxitud articular (HA) se evaluó con el score de Beighton; la dismetría de miembros inferiores (DMI),con medición en ortoradiografía; el control postural (CP) con posturografía estática usando una plataforma ISTFOOTWORK; el apoyo plantar (pie plano y pie cavo) con baro-podometría; la escoliosis e hiperlordosis lumbar conmedición radiográfica del ángulo de COBB y de lordosis...

Objectives: To determine an association between joint hypermobility, lower limb asymmetry and postural control withpostural abnormalities in adolescents. Methods: Cross-sectional study conducted at the National Rehabilitation Institute“Dra. Adriana Rebaza Flores” Amistad Perú-Japón, Chorrillos-Perú. All students of the 5th year of a private secondaryschool in Lima participated in the study. Joint hypermobility (JH) was assessed with the Beighton´score; lower limbasymmetry (LLA) was evaluated with X-ray; postural control (PC) was evaluated with static posturography using ISTFOOTWORK platform; plantar surface (flat foot and cavus foot) was evaluated with baro-podometry; scoliosis andlumbar hyperlordosis were measured with X-ray measuring the COBB angle...

Pé cavo: revisão da literatura / Cavus foot: review

OBJETIVO: Realizar uma revisão sobre o pé cavo, sua fisiopatologia, avaliação clínica, diagnósticos diferenciais com ênfase na doença de Charcot-Marie-Tooth e tratamento. MÉTODO: Revisão não sistemática de artigos abordando a fisiopatologia do pé cavo, avaliação clínica, diagnósticos diferenciais e tratamento. RESULTADOS E DISCUSSÃO: Foram utilizados 33 artigos de língua inglesa e 02 artigos em português para a confecção desta revisão. CONCLUSÃO: O pé cavo é geralmente secundário a doenças neurológicas, em especial a doença de Charcot-Marie-Tooth e raramente é originado por doenças não neurológicas. O diagnóstico etiológico do pé cavo permite um melhor tratamento, cirúrgico ou não, com adequada orientação ao paciente quanto ao prognóstico e eficácia da terapia.

OBJECTIVE: We realize a review about cavus foot, discussing pathophysiology, clinical evaluation, differential diagnosis with emphasis on Charcot-Marie-Tooth Disease and treatment. METHOD: We perform a non-systematic review of articles about cavus foot pathophysiology, physical examination, etiology and treatment. RESULTS AND DISCUSSION: We used 33 articles in english and 02 articles in portuguese for this review. CONCLUSION: The cavus foot is mostly a consequence of neurological etiologies, in particular Charcot-Marie-Tooth disease and rarely is caused by non-neurological diseases. The correct diagnosis allows better treatment, conservative or surgical, with appropriate guidance to patients in terms of prognosis and therapy effectiveness.

Diagnosis and Treatment of Cavus Foot / 대한족부족관절학회지

The cavus foot is a deformity characterized by an elevated medial longitudinal arch and a hindfoot varus with plantarflexed 1st ray. The etiology of cavus foot is usually related to neuromuscular disease or idiopathic cause. Thorough clinical and radiographic evaluation is required for differentiating etiology of the cavus. Most cases of cavus foot are stable and slowly progressive deformities which can initially be managed with conservative treatment including orthoses and physical therapies. Determining whether the deformity is flexible or rigid, the apex of the deformity and any muscle imbalances in foot and ankle is important for achievement of an adequately balanced plantigrade foot. Treatment should include systematic preoperative planning for selection of appropriate procedures for maintaining a functional and flexible foot with combinations of soft-tissue release, osteotomy, tendon transfer, and arthrodesis.