Measurement properties of the Foot Function Index (FFI) questionnaire: A systematic review.

OBJECTIVE: Large numbers of people are subject to alterations and pathologies in the foot. To quantify how these problems of foot function affect the quality of life, clinicians and researchers have developed measures such as the Foot Function Index (FFI). Our aim is to determine the methodological quality of the FFI including adaptations to other languages. DATA SOURCES: The studies considered in this review were extracted from the PubMed, Embase and CINAHL databases. The inclusion criteria were followed: (1) studies of patients with no previous foot or ankle pathology and aged over 18 years; (2) based on English-language patient-reported outcome measures that assess foot function; (3) the patient-reported outcome measures should present measurement properties based on COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria. REVIEW METHODS: The systematic review was conducted following the COSMIN criteria to establish the methodological quality of the original FFI, together with its variants and adaptations. The last search was carried out in May 2024. RESULTS: Of the 1994 studies obtained in the preliminary search, 20 were eligible for inclusion in the final analysis. These results are the validations and cross-cultural adaptations to the following languages: the original FFI has cross-cultural adaptation in 13 languages and the FFI-Revised Short Form has been adapted and validated for use in 2 languages. CONCLUSION: In terms of methodological quality, the FFI-Revised Short Form questionnaire is a valuable instrument for evaluating ankle and foot function and could usefully be expanded to be available in more languages.

Systematic review of the methodological quality of patient-reported outcome measure for patients with chronic ankle instability.

OBJETIVE: Chronic ankle instability is generally associated with ankle sprain. Its consequences can be measured by means of patient-reported outcome measures (PROMs). The aim of this review is to identify the PROMs specifically available for chronic ankle instability and to evaluate their methodological quality and that of the cross-cultural adaptations made. DATA SOURCES: Papers were retrieved from PubMed, Embase, Scopus and Google Scholar databases, with no time limit applied, based on the following inclusion criteria: (1) type of participants: patients with chronic ankle instability, over 18 years of age; (2)type of study: those specifically focused on this pathology, using PROMs specific to chronic ankle instability and published in English; (3) type of outcome: measurement properties based on COSMIN criteria in patient-reported outcomes associated with chronic ankle instability. METHODS: This systematic review, following the COSMIN checklist, was conducted to determine the methodological quality of PROMs specific to foot and ankle pathologies, for patients presenting chronic ankle instability. RESULTS: Of the 576 studies identified in the initial search, 34 were included in the final analysis of measurement properties. Four - the Ankle Instability Instrument, the Chronic Ankle Instability Scale, the Cumberland Ankle Instability Tool and the Identification of Functional Ankle Instability - were original questionnaires, and the remaining 30 were cross-cultural adaptations. CONCLUSION: The Cumberland Ankle Instability Tool and the Identification of Functional Ankle Instability questionnaires can be useful instruments for evaluating chronic ankle instability, both in patients with this condition and also in non-pathological patients.

Transcultural Adaptation and Validation of the Spanish Version of the Visual Analogue Scale for the Foot and Ankle (VASFA).

BACKGROUND: The main aim of this study is to perform a cross-cultural adaptation and validation of the Visual Analogue Scale for the Foot and Ankle (VASFA) questionnaire, creating a Spanish-language version (VASFA-Sp), and to determine the measurement properties of this instrument. METHODS: VASFA was cross-culturally translated into Spanish following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). The study sample was composed of 228 participants who were recruited from February to May 2022. All were at least 18 years old, gave signed informed consent to take part and properly completed the Foot and Ankle Ability Measures-Sp and VASFA-Sp questionnaires. Cronbach's alpha and test/re-test reliability values were calculated. Structural validity was assessed via exploratory factor analysis. RESULTS: The 228 patients included in the final analysis presented the following characteristics: 35.53% were male and 64.47% were female; the mean age was 35.95 (18-81) years; and the mean body mass index was 23.79. Internal consistency was excellent. The Cronbach's alpha for VASFA-Sp was 0.96 and the intraclass correlation coefficient was 0.932 (95% CI; 0.84 to 0.97). Exploratory factor analysis identified one main factor. CONCLUSIONS: VASFA-Sp is a reliable, valid and sensitive questionnaire that is suitable for measuring perceived foot and ankle function impairment in a Spanish-speaking population.

Structural differences in the lower extremities in children aged 7-9 years, caused by playing football: A cross-sectional study.

BACKGROUND: Physical activity during childhood can be beneficial in the long term. However, this practice can influence the child's physiological development. The aim of this study was to determine whether the practice of soccer, in moderation, could be a risk factor for the inadequate development of the lower limb. METHODS: The study group was composed of 115 children, of whom 59 (mean age 8.03±0.89years) practised soccer 3 times a week and had a positive Physical Activity Questionnaire for Adolescents (PAQ-A) score, while a further 56 (mean age 7.96±0.87years) did not perform any additional physical activity and had a negative PAQ-A score. A foot posture analysis, based on the foot posture index (FPI), the valgus index, the orientation of the subtalar joint (STJ) and the Q angle of the knee, was carried out. RESULTS: For the group of soccer players, the following results were obtained: FPI 4.79±2.38 (R) and 3.95±2.31 (L); valgus index 13.56°±1.66° (R) and 13.42°±1.48° (L); STJ test 79% pronated; Q angle 13.13°±2.06° (R) and 13.18°±1.93° (L). For the non-players, the corresponding values were: FPI 3.62±2.82 (R) and 3.74±2.77 (L); valgus index 12.76°±1.71° (R) and 12.84°±1.72° (L); STJ test 50% pronated; Q angle 13.87°±3.01° (R) and 13.86°±2.94° (L). CONCLUSION: There is a degree of difference between the two groups, but the values do not vary greatly from those considered normal for this age group. Any alterations in this respect can be assumed to be caused at older ages than those analysed.

Structural Changes in the Lower Extremities in Boys Aged 7 to 12 Years Who Engage in Moderate Physical ActivityAn Observational Longitudinal Study.

BACKGROUND: Physical activity in children may provide health benefits. We sought to consider the practice of soccer as a possible major factor in the development of the lower limb. The study is based on 3-year data for a group of children who practice this sport. METHODS: For 3 years we monitored 53 children who practiced soccer 3 times a week and had engaged in 2 years of continuous sports activity. Their mean ± SD age was 8.49 ± 2.01 years in the first year. Each year, Foot Posture Index, valgus index, subtalar joint axis, and Q angle for the knee were analyzed. RESULTS: The mean ± SD Foot Posture Index scores ranged from 5.38 ± 1.79 in the right foot and 4.49 ± 1.67 in the left foot in the first year to 4.64 ± 2.51 and 4.34 ± 2.26, respectively, in the third year. The valgus index for the same period ranged from 14.05° ± 1.51° (right) and 13.88° ± 1.46° (left) to 13.09° ± 1.28° and 13.07° ± 1.07°, respectively. In the knee, the Q angle ranged from 12.83° ± 1.98° (right) and 12.74° ± 1.68° (left) to 13.17° ± 1.45° and 13.26° ± 1.46°, respectively. In the subtalar joint, the changes were 37.73% right and 30.19% left between the first and third years toward a neutral subtalar joint axis. CONCLUSIONS: These results show that although playing soccer might cause structural changes in the lower limb, these alterations should not be considered harmful because they may be influenced by age as well.