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      A comparison of foot posture and walking performance in patients with mild, moderate, and severe adolescent idiopathic scoliosis

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          Abstract

          Background

          Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. However, the underlying mechanisms linking spinal curvature in AIS to foot characteristics and walking performance remain unclear.

          Objective

          This study aimed to compare walking performance between adolescents with mild, moderate, and severe scoliosis and matched healthy peers with foot posture as covariates.

          Methods

          This cross-sectional study of 96 adolescents was conducted between April 2020 to October 2020 in China, with 32 healthy peers in the control group and 64 patients in the AIS group. Foot posture and morphology, plantar pressure distribution, and gait characteristics were analyzed. One-way analysis of variance with Bonferroni correction and a post hoc comparison of the mean differences between the different groups was performed. Multiple analyses of covariance adjusted for age, sex, body mass index, foot posture index (FPI), arch index (AI), and walking speed were performed.

          Results

          Of the 64 adolescents with scoliosis, 18 had mild AIS, 32 had moderate AIS, and 14 had severe AIS. The AI and FPI were much higher in the moderate and severe AIS groups (p = 0.018) and the severe AIS group (p<0.001), respectively, than in the control group. The severe AIS group had advanced and longer midstance (p = 0.014) and delayed propulsion phase (p = 0.013) than the control group. Patients with moderate and severe AIS had asymmetrical gait periods in the left and right limbs (p<0.05). Significant differences in the center-of-pressure excursion index (CPEI) were found between the moderate and severe AIS and control groups (p = 0.003).

          Conclusion

          Moderate and severe AIS significantly influenced walking performance; however, no significant differences were observed between adolescents with mild AIS and healthy controls. Thus, early intervention could target the prevention of specific functional deficits and prevent it from progressing to a severe state.

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          Most cited references46

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          Adolescent idiopathic scoliosis.

          Jack C Y Cheng, René Castelein, Winnie Chu … (2015)
          Adolescent idiopathic scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle - a measure of spinal curvature - of ≥10(°). AIS affects between 1% and 4% of adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.
          Article 0 comments Cited 169 times – based on 0 reviews     Review now
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            Normative values for the Foot Posture Index

            Anthony C. Redmond, Yvonne Z Crane, Hylton B. Menz (2008)
            Background The Foot Posture Index (FPI) is a validated method for quantifying standing foot posture, and is being used in a variety of clinical settings. There have however, been no normative data available to date for comparison and reference. This study aimed to establish normative FPI reference values. Methods Studies reporting FPI data were identified by searching online databases. Nine authors contributed anonymised versions of their original datasets comprising 1648 individual observations. The datasets included information relating to centre, age, gender, pathology (if relevant), FPI scores and body mass index (BMI) where available. FPI total scores were transformed to interval logit scores as per the Rasch model and normal ranges were defined. Comparisons between groups employed t-tests or ANOVA models as appropriate and data were explored descriptively and graphically. Results The main analysis based on a normal healthy population (n = 619) confirmed that a slightly pronated foot posture is the normal position at rest (mean back transformed FPI raw score = +4). A 'U' shaped relationship existed for age, with minors and older adults exhibiting significantly higher FPI scores than the general adult population (F = 51.07, p < 0.001). There was no difference between the FPI scores of males and females (2.3 versus 2.5; t = -1.44, p = 0.149). No relationship was found between the FPI and BMI. Systematic differences from the adult normals were confirmed in patients with neurogenic and idiopathic cavus (F = 216.981, p < 0.001), indicating some sensitivity of the instrument to detect a posturally pathological population. Conclusion A set of population norms for children, adults and older people have been derived from a large sample. Foot posture is related to age and the presence of pathology, but not influenced by gender or BMI. The normative values identified may assist in classifying foot type for the purpose of research and clinical decision making.
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              The arch index: A useful measure from footprints

              Peter Cavanagh, Mary Rodgers (1987)
              Article 0 comments Cited 81 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Feilong Zhu: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Qianqin Hong: Role: Data curationRole: Investigation
                Xiaoqi Guo: Role: Data curationRole: Writing – review & editing
                Dan Wang: Role: Formal analysisRole: Investigation
                Jie Chen: Role: Methodology
                Qian Zhu: Role: Methodology
                Chong Zhang: Role: Methodology
                Wei Chen:
                ORCID: https://orcid.org/0000-0003-4871-0573
                Role: ConceptualizationRole: ValidationRole: VisualizationRole: Writing – review & editing
                Ming Zhang:
                ORCID: https://orcid.org/0000-0002-3734-446X
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: ValidationRole: VisualizationRole: Writing – review & editing
                Arezoo Eshraghi: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 17 May 2021
                Publication date Collection: 2021
                Volume: 16
                Issue: 5
                Electronic Location Identifier: e0251592
                Affiliations
                [1 ] The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
                [2 ] Department of Rehabilitation Medicine, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
                West Park Healthcare Centre, CANADA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0003-4871-0573
                https://orcid.org/0000-0002-3734-446X
                Article
                Publisher ID: PONE-D-20-35578
                DOI: 10.1371/journal.pone.0251592
                PMC ID: 8128255
                PubMed ID: 33999943
                SO-VID: f68ae18e-171b-416e-b9cf-e27be559e47b
                Copyright © © 2021 Zhu et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 25 November 2020
                Date accepted : 28 April 2021
                Page count
                Figures: 3, Tables: 4, Pages: 16
                Funding
                Funded by: Jiangsu Provincial Medical Youth Talent
                Award ID: QNRC2016376
                Award Recipient :
                ORCID: https://orcid.org/0000-0002-3734-446X
                This research was funded by the Jiangsu Provincial Medical Youth Talent ( http://kxjst.jiangsu.gov.cn/) (grant number QNRC2016376). Ming Zhang is responsible for this. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Legs
                Subject: Feet
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Legs
                Subject: Feet
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Biological Locomotion
                Subject: Gait Analysis
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Cognitive Science
                Subject: Cognitive Neuroscience
                Subject: Motor Reactions
                Subject: Postural Control
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Cognitive Neuroscience
                Subject: Motor Reactions
                Subject: Postural Control
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Biological Locomotion
                Subject: Walking
                Subject: Computer and Information Sciences
                Subject: Artificial Intelligence
                Subject: Research and Analysis Methods
                Subject: Mathematical and Statistical Techniques
                Subject: Statistical Methods
                Subject: Analysis of Variance
                Subject: Physical Sciences
                Subject: Mathematics
                Subject: Statistics
                Subject: Statistical Methods
                Subject: Analysis of Variance
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Legs
                Subject: Feet
                Subject: Toes
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Legs
                Subject: Feet
                Subject: Toes
                Custom metadata
                Data Availability All relevant data are within the paper and its supporting information files.

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