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Validity of footprint analysis to determine flatfoot using clinical diagnosis as the gold standard in a random sample aged 40 years and older.

Pita-Fernández S, González-Martín C, Seoane-Pillado T, López-Calviño B, Pértega-Díaz S, Gil-Guillén V - J Epidemiol (2014)

Bottom Line: Multivariate regression was performed.Informed patient consent and ethical review approval were obtained.Sensitivity values were 89.8% for Clarke's angle, 94.2% for the Chippaux-Smirak index, and 81.8% for the Staheli index, with respective positive likelihood ratios or 9.7, 2.1, and 2.0.

View Article: PubMed Central - PubMed

Affiliation: Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña.

ABSTRACT

Background: Research is needed to determine the prevalence and variables associated with the diagnosis of flatfoot, and to evaluate the validity of three footprint analysis methods for diagnosing flatfoot, using clinical diagnosis as a benchmark.

Methods: We conducted a cross-sectional study of a population-based random sample ≥ 40 years old (n = 1002) in A Coruña, Spain. Anthropometric variables, Charlson's comorbidity score, and podiatric examination (including measurement of Clarke's angle, the Chippaux-Smirak index, and the Staheli index) were used for comparison with a clinical diagnosis method using a podoscope. Multivariate regression was performed. Informed patient consent and ethical review approval were obtained.

Results: Prevalence of flatfoot in the left and right footprint, measured using the podoscope, was 19.0% and 18.9%, respectively. Variables independently associated with flatfoot diagnosis were age (OR 1.07), female gender (OR 3.55) and BMI (OR 1.39). The area under the receiver operating characteristic curve (AUC) showed that Clarke's angle is highly accurate in predicting flatfoot (AUC 0.94), followed by the Chippaux-Smirak (AUC 0.83) and Staheli (AUC 0.80) indices. Sensitivity values were 89.8% for Clarke's angle, 94.2% for the Chippaux-Smirak index, and 81.8% for the Staheli index, with respective positive likelihood ratios or 9.7, 2.1, and 2.0.

Conclusions: Age, gender, and BMI were associated with a flatfoot diagnosis. The indices studied are suitable for diagnosing flatfoot in adults, especially Clarke's angle, which is highly accurate for flatfoot diagnosis in this population.

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Related in: MedlinePlus

Measurement of Clarke’s angle, the Chippaux-Smirak index, and the Staheli index
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fig01: Measurement of Clarke’s angle, the Chippaux-Smirak index, and the Staheli index

Mentions: The pedograph footprints were obtained by placing a reticulated piece of rubber sheeting, tensed and impregnated with ink, between the subject’s foot and a piece of stretched paper. In order to obtain the footprint, a footprint ink mat was used (podograph). To study the footprint by pedograph, three footprint measurements were used: Clarke’s angle, the Chippaux-Smirak index, and the Staheli arch index6,8 (Figure 1). Clarke’s angle is obtained by calculating the angle of a first medial tangential line that connects the medial edges of the first metatarsal head and the heel, and the second line that connects the first metatarsal head and the acme of the medial longitudinal arch concavity.11 The Chippaux-Smirak index is defined as the ratio of the length of line B, a line parallel to A at the narrowest point on the foot arch, to the length of line A, the maximum width at the metatarsals (B/A × 100, %).11 Finally, the Staheli arch index is the ratio of the length of line B to the length of line C, the maximum width of the heel area (B/C × 100, %).11


Validity of footprint analysis to determine flatfoot using clinical diagnosis as the gold standard in a random sample aged 40 years and older.

Pita-Fernández S, González-Martín C, Seoane-Pillado T, López-Calviño B, Pértega-Díaz S, Gil-Guillén V - J Epidemiol (2014)

Measurement of Clarke’s angle, the Chippaux-Smirak index, and the Staheli index
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310876&req=5

fig01: Measurement of Clarke’s angle, the Chippaux-Smirak index, and the Staheli index
Mentions: The pedograph footprints were obtained by placing a reticulated piece of rubber sheeting, tensed and impregnated with ink, between the subject’s foot and a piece of stretched paper. In order to obtain the footprint, a footprint ink mat was used (podograph). To study the footprint by pedograph, three footprint measurements were used: Clarke’s angle, the Chippaux-Smirak index, and the Staheli arch index6,8 (Figure 1). Clarke’s angle is obtained by calculating the angle of a first medial tangential line that connects the medial edges of the first metatarsal head and the heel, and the second line that connects the first metatarsal head and the acme of the medial longitudinal arch concavity.11 The Chippaux-Smirak index is defined as the ratio of the length of line B, a line parallel to A at the narrowest point on the foot arch, to the length of line A, the maximum width at the metatarsals (B/A × 100, %).11 Finally, the Staheli arch index is the ratio of the length of line B to the length of line C, the maximum width of the heel area (B/C × 100, %).11

Bottom Line: Multivariate regression was performed.Informed patient consent and ethical review approval were obtained.Sensitivity values were 89.8% for Clarke's angle, 94.2% for the Chippaux-Smirak index, and 81.8% for the Staheli index, with respective positive likelihood ratios or 9.7, 2.1, and 2.0.

View Article: PubMed Central - PubMed

Affiliation: Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña.

ABSTRACT

Background: Research is needed to determine the prevalence and variables associated with the diagnosis of flatfoot, and to evaluate the validity of three footprint analysis methods for diagnosing flatfoot, using clinical diagnosis as a benchmark.

Methods: We conducted a cross-sectional study of a population-based random sample ≥ 40 years old (n = 1002) in A Coruña, Spain. Anthropometric variables, Charlson's comorbidity score, and podiatric examination (including measurement of Clarke's angle, the Chippaux-Smirak index, and the Staheli index) were used for comparison with a clinical diagnosis method using a podoscope. Multivariate regression was performed. Informed patient consent and ethical review approval were obtained.

Results: Prevalence of flatfoot in the left and right footprint, measured using the podoscope, was 19.0% and 18.9%, respectively. Variables independently associated with flatfoot diagnosis were age (OR 1.07), female gender (OR 3.55) and BMI (OR 1.39). The area under the receiver operating characteristic curve (AUC) showed that Clarke's angle is highly accurate in predicting flatfoot (AUC 0.94), followed by the Chippaux-Smirak (AUC 0.83) and Staheli (AUC 0.80) indices. Sensitivity values were 89.8% for Clarke's angle, 94.2% for the Chippaux-Smirak index, and 81.8% for the Staheli index, with respective positive likelihood ratios or 9.7, 2.1, and 2.0.

Conclusions: Age, gender, and BMI were associated with a flatfoot diagnosis. The indices studied are suitable for diagnosing flatfoot in adults, especially Clarke's angle, which is highly accurate for flatfoot diagnosis in this population.

Show MeSH
Related in: MedlinePlus