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The effect of foot structure and functional stability on the gait pattern of the foot
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Type
Thesis
Author
Ho, Malia Tsai Djun
Supervisor
Tan, John Cher Chay
Abstract
Running is one of the more popular forms of exercise. Statistics have shown that up to 85% of runners experience running related foot injuries every year. Some of these injuries have been attributed to excessive movements of the foot as well as high loading forces on the foot during running. These running gait deviations have been associated with mal-aligned foot structure.
The mal-aligned foot structure, such as flat feet and high arched feet, is believed to be structurally ‘unstable’ compared to the normal arched foot. They are also believed to exhibit running gait deviations that are pre-cursors to running related foot injuries.
However, recent studies have failed to show consistent evidence that individuals with a mal-aligned foot structure exhibited excessive foot movements and higher loading forces. Therefore, foot structure alone cannot fully account for these running related foot injuries. There is currently no consensus on what else causes these injuries and how to best prevent them.
It has been suggested that good functional stability can ‘protect’ the mal-aligned foot from injuries. Functional stability is defined in this study as ‘the ability of the individual to continually move the line of gravity back to within the base of support in order to maintain a balanced, upright body position.’ An individual with a mal-aligned foot structure but with good functional stability may be better to control the position of the foot, thereby producing a running gait pattern similar to a normal arched foot.
However, no study has been done to investigate the effect of foot structure and functional stability on running gait patterns of the foot.
The objectives of this present study was to determine the effect of foot structure on functional stability, the effect of foot structure on running gait pattern, the effect of functional stability on running gait pattern and also the combined effect of foot structure and functional stability on the running gait patterns of the foot. In addition, to support the findings, this study also investigated the effect on running gait pattern when foot structure and functional stability was augmented by the use of low-Dye taping.
This thesis consists of four studies. Study One evaluated the intra-tester reliability in assessing foot structure using the Foot Posture Index (FPI) score. (High arched FPI score = -12 to -1, Normal arched FPI score = 0 to +6, Flat foot FPI Score = +7 to +12). Functional stability was assessed using the Modified Romberg’s Test with the outcome criteria based on the Balance Error Scoring System (BESS). (Functionally Stable Balance Error Score = 0 – 2, Functionally Unstable Balance Error Score = 3 and more). Study Two was a feasibility study including 19 subjects to guide the methodology adopted for Study Three. In Study Three, 69 subjects had their foot structure, functional stability and running gait assessed. Multiple-regression was used to investigate the effect of independent variables (foot structure and functional stability) on the dependant kinematic and kinetic variables of running gait. Study Four analyzed the effect of taping on foot structure, functional stability and running gait. A separate group of 22 subjects with normal arched (n=15) and flat feet (n=29) were recruited. A paired t-test was first used to compare the foot structure, functional stability and running gait variables before and after taping. Then, a 3x2 mixed Anova was used to study the differences between the flat foot stable (n=13), normal unstable (n=15) and flat foot unstable (n=16) groups and between conditions (taped and untaped).
The main findings of Study One concluded that the assessor was reliable in performing the tests of FPI and BESS. Study Two affirmed the appropriate sample size, running speed and frame rate capture. It was also found that gender was not an intervening factor when collecting running data. Study Three concluded that individuals with flat feet were more functional unstable than those with high arched feet. Foot structure affected running gait kinematics significantly. Better functional stability reduced total rearfoot eversion and midfoot dorsiflexion. This is of clinical importance as improving functional stability could potentially protect the foot from injuries such as plantar fasciitis which is associated with excessive rearfoot and midfoot movements. Finally, Study Four showed that application of foot taping improved foot structure but had no effect on functional stability. Taping also reduced rearfoot eversion significantly during running.
The mal-aligned foot structure, such as flat feet and high arched feet, is believed to be structurally ‘unstable’ compared to the normal arched foot. They are also believed to exhibit running gait deviations that are pre-cursors to running related foot injuries.
However, recent studies have failed to show consistent evidence that individuals with a mal-aligned foot structure exhibited excessive foot movements and higher loading forces. Therefore, foot structure alone cannot fully account for these running related foot injuries. There is currently no consensus on what else causes these injuries and how to best prevent them.
It has been suggested that good functional stability can ‘protect’ the mal-aligned foot from injuries. Functional stability is defined in this study as ‘the ability of the individual to continually move the line of gravity back to within the base of support in order to maintain a balanced, upright body position.’ An individual with a mal-aligned foot structure but with good functional stability may be better to control the position of the foot, thereby producing a running gait pattern similar to a normal arched foot.
However, no study has been done to investigate the effect of foot structure and functional stability on running gait patterns of the foot.
The objectives of this present study was to determine the effect of foot structure on functional stability, the effect of foot structure on running gait pattern, the effect of functional stability on running gait pattern and also the combined effect of foot structure and functional stability on the running gait patterns of the foot. In addition, to support the findings, this study also investigated the effect on running gait pattern when foot structure and functional stability was augmented by the use of low-Dye taping.
This thesis consists of four studies. Study One evaluated the intra-tester reliability in assessing foot structure using the Foot Posture Index (FPI) score. (High arched FPI score = -12 to -1, Normal arched FPI score = 0 to +6, Flat foot FPI Score = +7 to +12). Functional stability was assessed using the Modified Romberg’s Test with the outcome criteria based on the Balance Error Scoring System (BESS). (Functionally Stable Balance Error Score = 0 – 2, Functionally Unstable Balance Error Score = 3 and more). Study Two was a feasibility study including 19 subjects to guide the methodology adopted for Study Three. In Study Three, 69 subjects had their foot structure, functional stability and running gait assessed. Multiple-regression was used to investigate the effect of independent variables (foot structure and functional stability) on the dependant kinematic and kinetic variables of running gait. Study Four analyzed the effect of taping on foot structure, functional stability and running gait. A separate group of 22 subjects with normal arched (n=15) and flat feet (n=29) were recruited. A paired t-test was first used to compare the foot structure, functional stability and running gait variables before and after taping. Then, a 3x2 mixed Anova was used to study the differences between the flat foot stable (n=13), normal unstable (n=15) and flat foot unstable (n=16) groups and between conditions (taped and untaped).
The main findings of Study One concluded that the assessor was reliable in performing the tests of FPI and BESS. Study Two affirmed the appropriate sample size, running speed and frame rate capture. It was also found that gender was not an intervening factor when collecting running data. Study Three concluded that individuals with flat feet were more functional unstable than those with high arched feet. Foot structure affected running gait kinematics significantly. Better functional stability reduced total rearfoot eversion and midfoot dorsiflexion. This is of clinical importance as improving functional stability could potentially protect the foot from injuries such as plantar fasciitis which is associated with excessive rearfoot and midfoot movements. Finally, Study Four showed that application of foot taping improved foot structure but had no effect on functional stability. Taping also reduced rearfoot eversion significantly during running.
Date Issued
2016
Call Number
QM549 Ho
Date Submitted
2016