Validity of clinical methods in the detection of leg-length discrepancies.

INTRODUCTION: Lower limb-length discrepancy is highly prevalent in the general population. Numerous methods and measurement instruments for its diagnosis appear in the literature, but there has not been an agreement about their validity. The aim of this work is to determine the validity of the Weber-Barstow manoeuvre (WB) of the pelvic measuring device (PMD) and the block method (BM), in comparison with standing anteroposterior telemetry of the lower limbs in subjects with leg-length discrepancy (LLD). METHODS: 71 subjects took part in the study. First, the WB was carried out in the supine position. the LLD was then quantified standing with the PMD and with the BM. Lastly, standing anteroposterior telemetry of the lower limbs was obtained. This was measured with Autocad 2013, using the highest part of the head of the femur and the most distal edge of the bisection of the femur as points of reference. RESULTS: The Kappa index was calculated to check the agreement between the WB manoeuvre and the telemetry. This was 0.52. The relation of the PMD, BM and telemetry difference variables was calculated. A direct relation between the BM and telemetry was shown, with p > 0.05 (0.48 cm and 0.51 cm, respectively). CONCLUSIONS: The WB manoeuvre got acceptable validity results. The PMD was not valid according to the results obtained in this work. The BM achieved a good validity result for the diagnosis of LLD.

The Validity and Reliability of a New Simple Instrument for the Measurement of First Ray Mobility.

Several methods have been described to quantify the first ray mobility. They all have certain disadvantages (great size, sophistication, or lack of validation). The objective of this work was to study the validity and reliability of a new instrument for the measurement of first ray mobility. Anterior-posterior radiographs were obtained from 25 normal feet and 24 hallux valgus feet, with the first ray in a neutral position, maximally dorsiflexed and maximally plantarflexed. The first ray mobility was radiographicaly measured in both groups, and was also manually examined with the new device. A cluster analysis determined whether normal and hallux valgus feet were correctly classified, and a graphic analysis of Bland-Altman was performed to compare the radiographic and manual measurement techniques. Based on the radiographs, the first ray mobility only showed significant differences in dorsiflexion between both groups (P = 0.015). First ray dorsiflexion, plantarflexion and total range of motion measured with the new device were different between both groups (P = 0.040, P = 0.011 and P = 0.006, respectively). The silhouette measure of the cohesion and separation coefficients from the cluster analysis was greater than 0.50 for the dorsiflexion, plantarflexion and total range of motion obtained from the radiographs and from the new device. The Bland-Altman graph suggested that 96% of the data presented agreement between both measurement methods. These results suggested that the new instrument was valid and reliable.

Static Range of Motion of the First Metatarsal in the Sagittal and Frontal Planes.

The first metatarsal and medial cuneiform form an important functional unit in the foot, called "first ray". The first ray normal range of motion (ROM) is difficult to quantify due to the number of joints that are involved. Several methods have previously been proposed. Controversy exists related to normal movement of the first ray frontal plane accompanying that in the sagittal plane. The objective of this study was to investigate the ROM of the first ray in the sagittal and frontal planes in normal feet. Anterior-posterior radiographs were done of the feet of 40 healthy participants with the first ray in a neutral position, maximally dorsiflexed and maximally plantarflexed. They were digitalized and the distance between the tibial malleolus and the intersesamoid crest in the three positions mentioned was measured. The rotation of the first ray in these three positions was measured. A polynomic function that fits a curve describing the movement observed in the first ray was obtained using the least squares method. ROM of the first ray in the sagittal plane was 6.47 (SD 2.59) mm of dorsiflexion and 6.12 (SD 2.55) mm of plantarflexion. ROM in the frontal plane was 2.69 (SD 4.03) degrees of inversion during the dorsiflexion and 2.97 (SD 2.72) degrees during the plantarflexion. A second-degree equation was obtained, which represents the movement of the first ray. Passive dorsiflexion and plantarflexion of the first ray were accompanied by movements in the frontal plane: 0.45 degrees of movement were produced in the frontal plane for each millimeter of displacement in the sagittal plane. These findings might be useful for the future design of instruments for clinically quantifying first ray mobility.

Ankle sprain as a work-related accident: status of proprioception after 2 weeks.

PURPOSE: This study aims at verifying whether proprioception is abnormal or not, two weeks after a grade 1 and 2 ankle sprain in the scope of work-related accident. METHODS: A descriptive, observation and transversal study was designed to compare speed, movement and oscilation of centre of pressure in employees of companies signed up to a mutual company. Participants' healthy feet comprised the control group, and feet that had undergone an ankle sprain due to a work-related accident comprised the cases group. The following stability tests were undertaken to both the healthy and injuried feet using a force plate: Monopodal Romberg test with eyes open, Monopodal Romberg test with eyes open on a 30 mm thick foam rubber, Monopodal Romberg test with eyes closed, and Romberg test as monopodal support with eyes closed on a 30 mm thick foam rubber. A multiple logistic regression analysis was performed. From the results of this regression model the COR curve test was performed. RESULTS: 71.7% accuracy in the predictions was attained. The equation was as follows: Condition (injured or healthy) = 0.052⋅% RGC AP Movement - 0.81⋅MREO AP Movement. The variable MREO antero-posterior movement was used in the COR curve methodology. The area under the curve was greater than 0.65 and at a 95% confidence interval the 0.75 value was included, which in our case was the injured subject condition. Values for sensitivity, specificity, positive predictive value and negative predictive value were 0.667, 0.633, 64.5%, and 65.5%, respectively. CONCLUSION: The participants in this study showed a diminished capacity for postural control in an ankle two weeks after an ankle sprain.

Radiographic Assessment of Lower-Limb Discrepancy.

BACKGROUND: This study compares different lower-limb length measurements using tests of lower-limb upright full-length radiography and anteroposterior radiography of load-bearing hips. METHODS: Forty-seven consecutive individuals aged 17 to 61 years (mean ± SD, 31.47 ± 11.42 years) voluntarily took part in the study; 23 (48.9%) were women and 24 (51.1%) were men. All individuals presenting a difference of 5 mm or greater between both lower limbs quantified with a tape measure were included. All of the participants signed an informed consent form to take part in the study. Two anteroposterior load-bearing radiographs were taken: one of the hip and an upright full-length radiograph of the lower limbs. Lower-limb-length discrepancy was quantified by taking different reference points. Interobserver and intraobserver reliability was assessed for each radiographic measurement. Any correlation between the different measurements were also verified. RESULTS: Interobserver and intraobserver reliability was high for all of the measurements because the intraclass correlation was greater than 0.75 in all of the cases. There was a strong and positive correlation between the different measurements because when performing bivariate correlations with the Pearson correlation coefficient, positive values close to 1 were found. CONCLUSIONS: In this study, the different reference points reported in the upright full-length radiograph in addition to the hip radiographs are useful for assessing lower-limb-length discrepancy. The results showed that there is a correct correlation between the different measurements.

Metatarsal pain and plantar hyperkeratosis in the forefeet of female professional flamenco dancers.

OBJECTIVES: The objectives of this study were to determine the frequency of metatarsal pain and of hyperkeratosis on the plantar forefoot in female professional flamenco dancers, and to determine whether there is a relationship between the two disorders. METHOD: Forty-four female professional flamenco dancers, with a minimum activity of 25 hrs/wk, participated in this cross-sectional study. The presence or absence of metatarsal pain while dancing was recorded, and plantar pressures were measured on a pressure platform, both barefoot and shod with the usual dance shoe. The heel height of the dance shoe was also measured. RESULTS: Of the dancers, 80.7% experienced metatarsal pain while dancing, and 84.1% presented with plantar hyperkeratosis. Plantar hyperkeratosis coincided with the presence of metatarsal pain in 67.04% of the feet studied. The maximum load point in the feet when the dancers were barefoot was located 59.5% in the rearfoot and 40.5% in the forefoot; when dancers wore their specific flamenco dancing shoes, it was located 52.4% in the rearfoot and 47.6% in the forefoot. CONCLUSIONS: Metatarsal pain and plantar hyperkeratosis in the forefoot are common foot disorders in female flamenco dancing. The incidence of the maximum load point being located in the forefoot, and the difference between the results of the tests while shod or barefoot, are both too low to support the idea that the raised heels of flamenco shoes are a major contributing factor for these injuries. Therefore, these disorders may be caused by chronic repetitive trauma suffered during the practice of footwork dancing.

Morphofunctional study of brachymetatarsia of the fourth metatarsal.

Brachymetatarsia is abnormal anatomical shortness of the metatarsals. We describe a new diagnostic test that enables quantification of the shortening of the fourth metatarsal in brachymetatarsia. The metatarsodigital alterations most frequently related to this deformity are presented.

Rehabilitación y tratamiento ortopodológico en rotura de la fascia plantar. Caso clínico

Presentamos en este trabajo un caso clínico en el que una excesiva terapia con infiltraciones de corticoides y un tratamiento ortopodológico no satisfactorio, unido a práctica deportiva excesiva, provocan que una fascitis plantar recurrente desemboque en la rotura parcial de la misma con la consecuente impotencia funcional. Planteamos así, después de un exhaustivo estudio biomecánico, un tratamiento ortopodológico personalizado junto con electroterapia como elemento coadyuvante, y siempre en coordinación con el trabajo del fisioterapeuta en aquellas alteraciones músculo-tendinosas que sin duda tienden a cronificar la patología. (AU)

Tratamiento físico y ortopodológico en pie plano rígido / Physical and orthopodologic therapy in stiff flat foot

El caso clínico que presentamos a continuación trata de un paciente adolescente al cual diagnosticamos de pie plano rígido en fase de contractura muscular. Planteamos un tratamiento integrado combinando la podología física mediante la realización de movilizaciones articulares, estiramientos musculares y cinesiterapia activa; junto con la ortopodología aplicando un tratamiento evolutivo mediante soportes plantares personalizados (AU)