A protocol for classifying normal- and flat-arched foot posture for research studies using clinical and radiographic measurements

Background: There are several clinical and radiological methods available to classify foot posture in research, however there is no clear strategy for selecting the most appropriate measurements. Therefore, the aim of this study was to develop a foot screening protocol to distinguish between participants with normal- and flat-arched feet who would then subsequently be recruited into a series of laboratory-based gait studies. Methods: The foot posture of ninety-one asymptomatic young adults was assessed using two clinical measurements (normalised navicular height and arch index) and four radiological measurements taken from antero-posterior and lateral x-rays (talus-second metatarsal angle, talonavicular coverage angle, calcaneal inclination angle and calcaneal-first metatarsal angle). Normative foot posture values were taken from the literature and used to recruit participants with normal-arched feet. Data from these participants were subsequently used to define the boundary between normal-and flat-arched feet. This information was then used to recruit participants with flat-arched feet. The relationship between the clinical and radiographic measures of foot posture was also explored. Results: Thirty-two participants were recruited to the normal-arched study, 31 qualified for the flat-arched study and 28 participants were classified as having neither normal-or flat-arched feet and were not suitable for either study. The values obtained from the two clinical and four radiological measurements established two clearly defined foot posture groups. Correlations among clinical and radiological measures were significant (p < 0.05) and ranged from r = 0.24 to 0.70. Interestingly, the clinical measures were more strongly associated with the radiographic angles obtained from the lateral view. Conclusion: This foot screening protocol provides a coherent strategy for researchers planning to recruit participants with normal-and flat-arched feet. However, further research is required to determine whether foot posture variations in the sagittal, transverse or both planes provide the best descriptor of the flat foot.