Adult-Acquired Flatfoot Deformity and Age-Related Differences in Foot and Ankle Kinematics During the Single-Limb Heel-Rise Test

摘要

STUDY DESIGN: Cross-sectional laboratory study.OBJECTIVE: To compare single-limb heel-rise performance and foot-ankle kinematics between persons with stage 2 adult-acquired flatfoot deformity (AAFD) and healthy controls.BACKGROUND: The inability to perform a single-limb heel rise is considered a positive functional diagnostic test for AAFD. However, which foot motions contribute to poor performance of this task are not known.METHODS: Fifty individuals participated in this study, 20 with stage 2 AAFD (mean +/- SD age, 57.6 +/- 11.3 years), and 15 older participants (age, 56.8 +/- 5.3 years) and 15 younger participants (age, 22.2 +/- 2.4 years) without AAFD as control groups. Forefoot (sagittal plane) and rearfoot (sagittal and frontal planes) kinematics were collected using a 3-D motion analysis system. Heel-rise performance (heel height) and kinematics (joint angles, excursions) were evaluated. One-way and 2-way analyses of variance were used to examine differences in heel-rise performance and kinematics between groups.RESULTS: Individuals with AAFD and older controls demonstrated lower heel-rise height than those in the younger control group (Pu3c.001). Persons with AAFD demonstrated higher degrees of first metatarsal dorsiflexion (Pu3c.001), lower ankle plantar flexion (Pu3c.001), and higher subtalar eversion (P = .027) than those in the older control group. Persons with AAFD demonstrated lower ankle excursion (Pu3c.001) and first metatarsal excursion (Pu3c.001) than those in the older control group, but no difference in subtalar excursion (P = .771).CONCLUSION: Persons with stage 2 AAFD did not achieve sufficient heel height during a single-leg heel rise. Both forefoot and rearfoot kinematics in the sagittal plane, as opposed to the frontal plane, contributed to the lower heel height in participants with stage 2 AAFD. Older controls demonstrated lower heel-rise height than younger controls, indicating that clinical expectations of heel-rise performance may need to be adjusted for age.