Citation

Tong JW, Kong PW. J. Orthop. Sports Phys. Ther. 2013; 43(10): 700-714.

Copyright

(Copyright © 2013, Orthopaedic Section and Sports Physical Therapy Section of the American Physical Therapy Association)

DOI

10.2519/jospt.2013.4225

PMID

23756327

Abstract

STUDY DESIGN: Systematic literature review with meta-analysis. OBJECTIVES: To investigate the association between non-neutral foot types (high arch and flat foot) and lower extremity and low back injuries, and to identify the most appropriate methods to use for foot classification. METHODS: A search of 5 electronic databases (PubMed, EMBASE, CINAHL, SPORTDiscus, and ProQuest Dissertation and Thesis), Google Scholar, and reference lists of included studies was conducted to identify relevant articles. The review included comparative cross-sectional, case control, and prospective studies that reported qualitative/quantitative associations between foot types and lower extremity and back injuries. Quality of the selected studies was evaluated and data synthesis for the level of association between foot types and injuries was conducted. A random-effects model was used to pool odds ratios (OR) and standardized mean differences (SMD) results for meta-analysis. RESULTS: Twenty-nine studies were selected and included for meta-analysis. A significant association between non-neutral foot types and lower extremity injuries was determined [OR (95% confidence intervals (CI) = 1.23 (1.11, 1.37); p < .001]. Foot posture index (FPI) [OR = 2.58 (1.33, 5.02); p < .01] and visual/physical examination [OR = 1.17 (1.06, 1.28); p < .01] were 2 assessment methods using distinct foot type categories that displayed significant association with lower extremity injuries. For foot assessment methods using a continuous scale, measurements of Lateral Calcaneal Pitch Angle [SMD = 1.92 (1.44, 2.39); p < .00001], Lateral Talo-Calcaneal Angle [SMD = 1.36 (0.93, 1.80); p < .00001], and Navicular Height (NH) [SMD = 0.34 (0.16, 0.52); p < .001] displayed significant effect sizes in identifying high arch foot, while Navicular Drop Test [SMD = 0.45 (0.03, 0.87); p < .05] and Relaxed Calcaneal Stance Position [SMD = 0.49 (0.01, 0.97); p < .05] for flat foot. Subgroup analyses revealed no significant associations for children with flat foot, cross-sectional studies, or prospective studies on high arch. CONCLUSION: High arch and flat-foot foot types are associated with lower extremity injuries but the strength of this relationship is low. Although FPI and visual/physical examination are methods that displayed significance, they are qualitative measures. Radiographic and NH measurements can delineate high arch foot effectively, with only anthropometric measures accurately classifying flat foot. LEVEL OF EVIDENCE: Prognosis, level 1b.J Orthop Sports Phys Ther, Epub 11 June 2013. doi:10.2519/jospt.2013.4225.

Language: en