Influence of Bilateral and Unilateral Flatfoot on Pelvic Alignment

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.




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.