Kinematic analysis quantifies reaching characteristics and provides objective information about the motor strategies associated with goal-oriented tasks.
Objective
Clinically, the foot posture index-6 (FPI-6) and Clarke’s angle (CA) are widely utilized to assess static foot posture; however, due to scarcity of scientific evidence, clinicians continue to debate the validity and diagnostic accuracy of these measures in children and adolescents. This study aimed to evaluate and compare the validity and diagnostic accuracy of the FPI-6 and CA in determining adolescents’ flexible flatfoot between ages of 12 and 18 years, considering radiographic investigation as a reference standard measure.
Design
Cross-sectional study.
Setting
Governmental hospitals.
Participants and Methods
A sample of 460 people (920 feet) with flexible flatfoot between the ages of 12 and 18 (15.23 ± 0.84 years) was enrolled in the study. The findings of the investigated measures were compared to the reference standard radiographic measure and plotted on the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was determined as a measure of FPI-6 and CA diagnostic accuracy. Intra-rater reliability, sensitivity, specificity, predictive values, and likelihood ratios of FPI-6 and CA were calculated and compared. The post-test probability of flatfoot was determined using the Fagan nomogram.
Results
CA had a substantially higher intra-rater reliability (ICC=0.99) than the FPI-6 (ICC=0.96), with p-value of 0.001. CA has greater sensitivity (98%) than FPI-6, as well as a superior specificity (99%), positive predictive value (98%), negative predictive value (98.9%), positive likelihood ratio (97), and a lower negative likelihood ratio (0.02). CA had such an area under ROC curve of 0.98 with a 95% confidence interval of 0.95–1.00, while FPI-6 had an area under ROC curve of 0.80 with a 95% confidence interval of (0.77–0.85).
Conclusion
FPI-6 and Clarke’s angle are both valid and diagnostically accurate clinical tests for flatfoot detection, with Clarke’s angle outperforming FPI-6 in adolescents aged 12 to 18 years with a normal BMI.
Background: Normalized truncated navicular height (NTNH) is a non-invasive, easy to perform, and simple clinical measure of static foot posture. However, its sensitivity and specificity in evaluation of the static foot posture in children have not been investigated yet. Objective: To investigate the intra-rater reliability, sensitivity, and specificity of NTNH in evaluation of the static foot posture in children using radiographic measure as a gold standard measure. Methods: A cross-sectional study of a random sample of 300 school children aged 6–12 years old. Intra-rater reliability, minimal detectable change, sensitivity, and specificity of NTNH were investigated. NTNH as a clinical measure of static foot posture was calculated and compared to the radiographic measure and displayed on the receiver operating characteristic (ROC) curve. Results: NTNH demonstrated an intra-rater reliability of [Formula: see text]. The sensitivity and specificity of NTNH were 88.1% and 99.5%, respectively. The optimal cutoff point for the diagnosis of flat foot using NTNH in children aged 6–12 years is NTNH [Formula: see text]. Conclusion: NTNH is a sensitive and specific measure of static foot posture in the children aged 6–12 years. It is recommended to be used as a screening measure of static foot posture in children as it is easy, simple to perform, and a non-invasive clinical measure.
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