****Association Between Foot Type and Lower Extremity Injuries: Systematic Literature Review with Meta-Analysis****** Authors: Tong JWK & Kong PW Background Information: There are 3 major structural categories for the human foot based on the height of the medial longitudinal arch: high arch (HA), normal/neutral arch (NA) and low arch/flat footed (FF). A variety of systems exist to classify foot structure and alignment, including, but not limited to, radiographic measurements, qualitative and semi-quantitative visual appraisal, direct anthropometric measurements, foot print analysis and analysis of captured images. To date, no real concrete evidence has been published regarding the best way to analyze foot arch height. Recently, clinicians, trainers and members of the general public have become greatly interested in this topic, due to the belief that non-neutral foot morphology could lead to poor foot function, which could in turn lead to lower extremity injury (1, 2). However, formal reviews of the literature have provided conflicting evidence. It remains unclear whether one’s foot type is associated with incidence of lower extremity injury and which assessment method is most accurate to determine foot shape. Therefore, the focus of this review was to provide an evidence-based summary on whether or not one’s foot type is associated with their incidence of lower extremity injury, and to determine the most appropriate method for assessing foot type. A number of lower extremity injuries were considered for this analysis, including: •Stress fractures •Knee pain •ACL injury •Foot pain •Heel pain •Plantar fasciitis •Ankle sprain •Achilles tendinitis or rupture •Iliotibial band syndrome •Patellofemoral syndrome •Blisters •Medial tibial stress syndrome •Foot Accident •Rheumatoid arthritis •Hip, knee or general arthritis •General lower extremity injury or pain Pertinent results include: •A significant association was found between non-neutral foot type (HA and FF) and lower extremity injuries across all foot-type classification methods in studies that classified foot type based on distinct categories (i.e. high arch or flat footed). •The collection of pooled studies which assessed foot type with continuous variables showed that non-neutral foot types tended to significantly favor groups of subjects presenting with lower extremity injury. •There was a near-significant effect favoring an association between a flat footed structure and more severe injury. Subgroup Analysis: Age group of subjects •The association between HA and FF foot types and lower extremity injuries was significant, with a medium level of heterogeneity for subjects 18 years and older. For subjects younger than 18, there was a significant effect only in those subjects with a tendency toward an HA; these studies showed medium-to-high heterogeneity Clinical Application & Conclusions: HA or FF types, when compared to a neutral foot type (NF), are associated with lower extremity injury (OR = 1.23 – a low odds ratio). Additionally, in those studies reporting foot assessment as continuous measures, both HA and FF foot types showed significant effect sizes in subjects who presented with lower extremity injuries. Of significant note is the fact that subjects aged 18 years and older with non-neutral foot types consistently presented with a tendency toward lower extremity injury. On the other hand, subjects younger than 18 years of age with a tendency toward a high arch foot type had a significant association with lower extremity injury. The authors surmise that perhaps children and adolescents’ feet are still developing, and appear flatter and more adaptable in order to accommodate for impending external factors that might cause injury. In conclusion, both HA and FF foot types are significantly associated with lower extremity injury. In conclusion, both HA and FF foot types are significantly associated with lower extremity injury.
Posted on: Mon, 03 Mar 2014 22:03:29 +0000
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