Hegedus Eric J, Cook Chad, Fiander Christopher, Wright Alexis
Doctor of Physical Therapy Division, Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC 27710, USA.
Physiother Res Int. 2010 Sep;15(3):160-6. doi: 10.1002/pri.459.
Debate surrounds the theory that foot structure, and more specifically, the attitude of the midfoot as typified by the longitudinal arch, is associated with complaints of pain and injuries of the lower extremity. Recently, two simple clinical measures of arch height, the arch ratio (AR) and the longitudinal arch angle (LAA), have been reported as valid and reliable in the literature. The LAA has been found to approximate the lowest point of the arch during walking and running while the main strengths of the AR are that the measure takes into account foot size and arch mobility. We modified the AR so that the modified AR (mAR) would be measured in a similar fashion as the LAA to investigate if this new measure, which would account for foot size, correlated well with an established measure (LAA) that estimated the behaviour of the arch with walking and running. Also, we hoped to contribute to the literature correlating longitudinal arch height with pain - numeric pain rating scale - and dysfunction - Lower Extremity Functional Scale (LEFS) and Single Assessment Numeric Evaluation (SANE).
Thirty-five subjects for this prospective correlational study were recruited from a community based outpatient practice that was part of a tertiary care academic medical centre. Reliability and validity of our investigator and of the mAR was first examined. We then examined the correlation of the clinical classification of arch height (high, normal, or low) produced by these two measures with each other. We also explored the correlation of multiple measures of dysfunction and pain with arch height.
Intrarater reliability and validity of the LAA showed an intraclass correlation (ICC) of 0.978 and Pearson's correlation coefficient (PCC) of 0.885, respectively. Intrarater reliability and validity of the mAR showed an ICC of 0.961 and PCC of 0.827, respectively. The LAA and our new measure, the mAR, were correlated with each other. The self-report measures of general health and activity level were significantly positively correlated (PCC = 0.598). Also significant and positively correlated were the LEFS and the SANE (PCC = 0.617), two measures of function.
Pain and dysfunction may be positively correlated but longitudinal arch height does not predict either pain or dysfunction.
围绕足部结构，尤其是以纵弓为代表的中足姿态与下肢疼痛及损伤主诉相关这一理论存在争议。最近，文献报道了两种简单的足弓高度临床测量方法，即足弓比率（AR）和纵弓角度（LAA），它们有效且可靠。研究发现，LAA可近似步行和跑步时足弓的最低点，而AR的主要优势在于该测量方法考虑了足部大小和足弓活动度。我们对AR进行了改良，使改良后的AR（mAR）能以与LAA类似的方式进行测量，以研究这种新的、能考虑足部大小的测量方法是否与一种已确立的、用于估计步行和跑步时足弓行为的测量方法（LAA）具有良好的相关性。此外，我们希望为将纵弓高度与疼痛（数字疼痛评分量表）以及功能障碍（下肢功能量表[LEFS]和单项评估数字评价[SANE]）相关联的文献做出贡献。
本前瞻性相关性研究的35名受试者来自一家作为三级医疗学术医学中心一部分的社区门诊。首先检验了我们的研究者及mAR的信度和效度。然后，我们检验了这两种测量方法得出的足弓高度临床分类（高、正常或低）之间的相关性。我们还探讨了功能障碍和疼痛的多种测量指标与足弓高度的相关性。
LAA的评分者内信度和效度分别显示组内相关系数（ICC）为0.978，皮尔逊相关系数（PCC）为0.885。mAR的评分者内信度和效度分别显示ICC为0.961，PCC为0.827。LAA与我们的新测量方法mAR相互关联。一般健康状况和活动水平的自我报告测量指标显著正相关（PCC = 0.598）。功能的两种测量指标LEFS和SANE也显著正相关（PCC = 0.617）。
疼痛和功能障碍可能呈正相关，但纵弓高度并不能预测疼痛或功能障碍。
