ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 790

Biomechanical Function Agrees with Clinical Implications of  Foot Disorders in a Population-Based Study

Thomas J. Hagedorn1, Alyssa B. Dufour2, Jody L. Riskowski3, Howard J. Hillstrom4, Virginia A. Casey1 and Marian T. Hannan5, 1Institute for Aging Research, Hebrew SeniorLife, Boston, MA, 2Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School & Beth Israel Deaconess Medical Center, Boston, MA, 3Institute for Aging Research, Hebrew SeniorLife & Harvard Medical School, Boston, MA, 4Rehabilitation, Hospital Special Surgery (HSS), New York, NY, 5Institute for Aging Research, Hebrew SeniorLife, Dept. of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Foot and Gait Disorders

Session Type: Abstract Submissions (ARHP)

Background/Purpose:

Foot disorders are thought to be associated with foot structure and function. However, no population-based studies have objectively evaluated this question. Insights into the relations of foot structure and function with specific foot disorders may further our understanding of their impact. The purpose of this study was to evaluate the relation of foot disorders to foot structure and function in a population-based study. 

Methods:

The Framingham Foot Study is a cross-sectional population-based study of ambulatory adults (aged 36-100) examined from 2002-08. A podiatric-trained examiner performed a validated foot exam to record presence of specific foot disorders (hallux valgus, hammer toes, claw toes, hallux rigidus, plantar fasciitis, Morton’s neuroma, tailor’s bunion, and overlapping toes). A Tekscan Matscan pressure mat was used to collect loading data from each foot while walking, and during bipedal standing. From these data, center of pressure excursion index (CPEI), a measure of foot function during walking, and modified arch index (MAI), a measure of foot structure while standing, were calculated for each foot. Participants with valid foot pressure and examination data were included in this analysis. Feet in the top and bottom 20% of CPEI values were classified as supinators and pronators respectively; the middle 60% was the referent. High-arch feet were defined as the bottom 20% of MAI values, while low-arch feet were defined as the top 20%; referent was the middle 60%. Logistic regression, using generalized estimation equations to account for correlations between feet, was used to estimate odds ratios and 95% confidence intervals between foot function, structure and each foot disorder.

 

Results:

There were 3145 participants contributing 5517 feet (Table 1). Hallux valgus and hammer toes were the most common foot disorders. Prevalence of hallux valgus and overlapping toes was higher among pronators, while prevalence of hallux valgus and hallux rigidus was lower among supinators (Table 2). Low arches were associated with a higher prevalence of Morton’s neuroma and hammer toes.

Conclusion:

Foot structure and function were related to prevalence of specific foot disorders in this population. The results are in agreement with biomechanical theory of and clinical implications from specific foot disorders. However, these cross-sectional data cannot confirm a causal relation. These results underscore the utility of clinical input in understanding the relations between foot structure, function, and disorders and may provide insights for interventions to improve function.

Table 1. Population characteristics and prevalence of foot disorders in the study sample. Prevalence by foot (N=5517)

Characteristic

Mean ± Std Dev

 

Age (years)

66.2 ± 10.5

 

BMI (kg/m2)

28.3 ± 5.5

 

Weight (lbs)

174.1 ± 39.3

 

Height (in)

65.5 ± 3.9

 

Foot Disorder

Prevalence N (%)

 

Hallux Valgus

1472 (26.3)

 

Hammer Toes

894 (16.2)

 

Morton’s Neuroma

439 (8.0)

 

Overlapping Toes

294 (5.3)

 

Tailor’s Bunion

197 (3.6)

 

Plantar Fasciitis

177 (3.2)

 

Hallux Rigidus

173 (3.1)

 

Claw Toes

74 (1.3)

 

Table 2. Odds ratios and 95% confidence intervals for GEE analysis of foot structure, function, and disorders.

Foot Function (defined by CPEI)

Foot Structure (defined by MAI)

Pronator

Supinator

Low Arch

High Arch

Hallux Valgus

1.15 (1.01, 1.30)*

0.78 (0.69, 0.89)†

0.95 (0.83, 1.10)

0.95 (0.83, 1.09)

Hammer Toes

0.91 (0.78, 1.05)

0.93 (0.79, 1.09)

1.33 (1.14, 1.57)†

0.99 (0.83, 1.19)

Morton’s Neuroma

0.83 (0.66, 1.06)

0.97 (0.77, 1.23)

1.29 (1.01, 1.65)*

1.15 (0.90, 1.47)

Overlapping Toes

1.48 (1.15, 1.91)†

0.99 (0.75, 1.32)

1.27 (0.96, 1.69)

1.03 (0.77, 1.38)

Tailor’s Bunion

1.07 (0.79, 1.46)

0.80 (0.60, 1.07)

1.19 (0.85, 1.69)

1.17 (0.88, 1.55)

Plantar Fasciitis

0.98 (0.68, 1.41)

1.22 (0.89, 1.68)

1.16 (0.79, 1.69)

1.10 (0.75, 1.61)

Hallux Rigidus

1.17 (0.92, 1.48)

0.58 (0.41, 0.83)†

1.24 (0.93, 1.65)

0.86 (0.59, 1.25)

Claw Toes

1.06 (0.67, 1.69)

0.85 (0.49, 1.47)

0.84 (0.49, 1,44)

0.79 (0.42, 1.50)

* 0.01 < p < 0.05

† p < 0.01

Disclosure:

T. J. Hagedorn,
None;

A. B. Dufour,
None;

J. L. Riskowski,
None;

H. J. Hillstrom,
None;

V. A. Casey,
None;

M. T. Hannan,
None.

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