Influence of Bilateral and Unilateral Flatfoot on Pelvic Alignment

Authors: Mohamed Taher Eldesoky, Enas Elsayed Abutaleb

Abstract:

Background: The change in foot posture can possibly generate changes in the pelvic alignment. There is still a lack of evidence about the effects of bilateral and unilateral flatfoot on possible changes in pelvic alignment. The purpose of this study was to investigate the effect of flatfoot on the sagittal and frontal planes of pelvic postures. Materials and Methods: 56 subjects, aged 18–40 years, were assigned into three groups: 20 healthy subjects, 19 subjects with bilateral flexible second-degree flat foot, and 17 subjects with unilateral flexible second-degree flat foot. 3D assessment of the pelvis using the formetric-II device was used to evaluate pelvic alignment in the frontal and sagittal planes by measuring pelvic inclination and pelvic tilt angles. Results: ANOVA test with LSD test were used for statistical analysis. Both Unilateral and bilateral second degree flatfoot produced significant (P<0.05) pelvic anteversion, in comparison to the healthy subjects (P<0.05). But the bilateral flatfoot subjects seemed to have more anteversion than the unilateral subjects. Unilateral flatfoot caused a significant (P<0.05) lateral pelvic tilt in the direction of the affected side in comparison to the healthy and bilateral flatfoot subjects. Conclusion: The bilateral and unilateral second degree flatfoot changes pelvic alignment. Both of them lead to increases of pelvic anteversion while the unilateral one caused lateral pelvic tilt toward the affected side. Thus, foot posture should be considered when assessing patients with pelvic misalignment and disorders.

Keywords: Bilateral flatfoot, foot posture, pelvic alignment, unilateral flatfoot.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1107806

References:

[1] R. Pinto, T. Souza, R. Trede, R.N. Kirkwood, E.M. Figueiredo, S.T. Fonseca, “Bilateral and unilateral increases in calcaneal eversion affect pelvic alignment in standing position,”Mannul Therapy, 13(6), 2008, pp.513-519.
[2] C.J. Snijders, A. Vleeming, R. Stoeckart, “Transfer of lumbosacral load to iliac bones and legs. 1: biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise,” Clinical Biomechanics, 8, 1993, pp.285–94.
[3] B. Gurney,” Leg length discrepancy,” Gait and Posture, 15, 2002, pp.195–206.
[4] H.J. Haight, D.L Dahm, J. Smith J, D.A. Krause, “Measuring standing hindfoot alignment: reliability of goniometric and visual measurements,” Archives of Physical Medicine and Rehabilitation, 86, 2005, pp.571– 575.
[5] S. Khamis, Z. Yizhar, “Effect of feet hyperpronation on pelvic alignment in a standing position,” Gait and Posture, 25(1), 2007, pp.127–134.
[6] B. Rothbart, L. Estabrook, “Excessive pronation: a major biomechanical determinant in the development of chondromalacia and pelvic lists,” Journal of Manipulative and Physiological Therapeutics, 11, 1988, pp.373–379.
[7] H. Son, “The Effect of Backpack Load on Muscle Activities of the Trunk and Lower Extremities and Plantar Foot Pressure in Flatfoot,” J Phys Ther Sci, 25(11), 2013, pp. 1383–1386.
[8] M.J. Hessert, M. Vyas, J. Leach, K. Hu, L. Lipsitz, V. Novak, “ Foot pressure distribution during walking in young and old adults,” BMC Geriatr, 5,2005: 8-12.
[9] J. Legaye, G. Duval-Beaupere, J. Hecquet, C. Marty, “Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves,” European Spine Journal, 7, 1998,pp. 99–103.
[10] J. Stephen, S Sheldon,” Current Concept Review: Acquired Adult Flatfoot Deformity,” Foot & ankle international, 27(1) 2006, pp. 367- 372.
[11] M.S. Lee, J.V. Vanore, J.L. Thomas, A.R. Catanzariti, G. Kogler, S.R. Kravitz, S.J. Miller, S.C. Gassen, “Clinical Practice Guideline Adult Flatfoot Panel. Diagnosis and treatment of adult flatfoot,” J Foot Ankle Surg., 44(2) 2005, pp. 78-113.
[12] C. Lee, M. Kim, M. Cho, “The Relationship between Balance and Foot Pressure in Fatigue of the Plantar Intrinsic Foot Muscles of Adults with Flexible Flatfoot.,” Journal of Physical Therapy Science, 24(8), 2012, pp.699-701.
[13] S.P. Messier, K.A. Pittala, “Etiologic factors associated with selected running injuries,” Med Sci Sports Exerc., 20(25), 1988, pp.501-505.
[14] J.E. Lee, G.H. Park G, Y.S. Lee Y, M.K. Kim,” A Comparison of Muscle Activities in the Lower Extremity between Flat and Normal Feet during One-leg Standing,” J Phys Ther Sci. 25(9) 2013,pp.1059–1061.
[15] G.A. Arangio, K.L. Reinert, E.P. Salathe, “A biomechanical model of the effect of subtalar arthroereisis on the adult flexible flat foot,” Clin Biomech (Bristol, Avon), 19, 2004, pp. 847–852
[16] P. Levinger, G. Murley, C. Barton C, M. Cotchett, S. McSweeney, H., “A comparison of foot kinematics in people with normal- and flat-arched feet using the Oxford Foot Mode,” Gait & Posture, 32(4), 2010, pp.519- 523.
[17] D. Williams, I. McClay, J. Hamill, T. Buchanan, “Lower extremity kinematic and kinetic differences in runners with high and low arches,” J Appl Biomech17,, 2001, pp.153–163.
[18] J. Tweed, J. Campbell, S. Avil, “Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners,” J Am Podiatr Med Assoc, 98, 2008, pp.436–444.
[19] R. Botte, “An interpretation of the pronation syndrome and foot types of patients with low back pain,” J Am Podiatry Assoc, 71(5), 1981, pp.:243-253.
[20] D. Levine, M. Whittle, “The effects of pelvic movement on lumbar lordosis in the standing position,” J Orthop Sports Phys Ther, 24, 1996, pp.130–135
[21] M. Aebi, “The adult scoliosis,” European Spine Journal, 14, 2005, pp.925-948.
[22] J. McPartland, R. Brodeur, R. Hallgren, “Chronic neck pain, standing balance, and suboccipital muscle atrophy: A pilot study,” J Manip Physiol Therap, 20, 1997, pp. 24- 29.
[23] R.R. Botte, “An interpretation of the pronation syndrome and foot types of patients with low back pain,” Journal of the American Podiatry Association,71(5), 1981,pp.243–253,
[24] P.A. Rockar, “The subtalar joint: anatomy and joint motion,” Journal of Orthopaedic and Sports Physical Therapy, 21(6), 1995, pp.361–72.
[25] N. Abdel-Raoof, D. Kamel, S. Tantawy, “Influence of second-degree flatfoot on spinal and pelvic mechanics in young females,” International Journal of Therapy and Rehabilitation, 20(9), 2013, pp.428–434.
[26] A. Vora, S. Haddad, “Diagnosis and management of acquired flat foot,” The journal of musculoskeletal medicine, 20(4), 2003, pp.375-380.
[27] N, Gould, “Evaluation of the hyperpronation and pes planus in adults,” Clin. Orthop, 181, 1983, pp.37-45.
[28] T. Chi, B. Toolan, B. Sangeorzan, S. Hansen, “The lateral column lengthening and medial column stabilization procedures,”Clin Oethop Relat Res, 365,1999,pp. 81–90.
[29] L. Hackenberg, E. Hierholzer, W. Potzl, C. Gotze, U. Liljenqvist, “Rasterstereographic back shape analysis in idiopathic scoliosis after anterior correction and fusion,” Clinical Biomech,18,2003,pp. 1-8.
[30] R. Schafer, “Clinical Biomechanics: Musculoskeletal Actions and Reactions,” 2nd ed. Baltimore, Williams & Wilkins; 2000, pp. 732-740.
[31] K. Duval, T. Lam, D. Sanderson,” The mechanical relationship between the reafoot, pelvis and low-back,” Gait & Posture, 32(4), 2010;, pp.637- 640.
[32] M. Mueller, K. Maluf, “Tissue adaptation to physical stress: a proposed “physical stress theory” to guide physical therapist practice, education, and research,” Physical Therapy, 82, 2002, pp.383–403.
[33] N. Egund, T. Olsson, H. Schmid, G. Selvik, “Movements in the sacroiliac joints demonstrated with roentgen stereophotogrammetry,” Acta Radiol Diagn (Stockholm), 19, 1978, pp. 833–846.
[34] K. Farokhmanesh, T. Shirzadian, M. Mahboubi, M. Shahri, “Effect of Foot Hyperpronation on Lumbar Lordosis and Thoracic Kyphosis in Standing Position Using 3-Dimensional Ultrasound-Based Motion Analysis System,” Global Journal of Health Science, 6(5), 2014, pp.254- 260.
[35] A. Shirazi-Adl, G. Drouin, “Load-bearing role of facets in a lumbar segment under sagittal plane loadings,” Journal of Biomechanics, 20, 1987, pp. 601–613.
[36] E.L. Steinberg, E. Luger, R. Arbel, A. Menachem, S. Dekel, “A comparative roentgenographic analysis of the lumbar spine in male army recruits with and without lower back pain,” Clinical Radiology,58, 2003, pp.985–989.