BMR Medicine. Open Access Scientific Publisher ABSTRACT. KEY WORDS-: BMI, Foot print, Vernier calliper, Navicular height.

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1 Open Access Scientific Publisher Research Article A STUDY TO CORRELATE CLINICALLY VALIDATED NORMALIZED TRUNCATED NAVICULAR HEIGHT TO BRODY'S NAVICULAR DROP TEST IN CHARACTERIZING MEDIAL ARCH OF THE FOOT R.M.B.Dilrukshi Rajakaruna, Watson Arulsingh, Joseph Oliver Raj, Mukesh Sinha Alva s College of Physiotherapy and Resear h Center, Mood idri D.K.,India Correspondence should be addressed to Watson Arulsingh Received March 20, 2015; Accepted April 2, 2015; Published May 5, 2015; Copyright: 2015 Watson Arulsingh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cite This Article: Rajakaruna, R.M.B.D., Arulsing, W., Oliver Raj, J., Sinha, M., (2015). A study to correlate clinically validated normalized truncated navicular height to brody's navicular drop test in characterizing medial arch of the foot.. 21(1), pp.1-7 ABSTRACT Background-: Understanding foot motion in locomotion is essential for clinicians in order to make right diagnosis and appropriate rehabilitation measures. The medial longitudinal arch is the primary shock absorber and load bearing structure of the foot. To measure medial arch height, upto date navicular drop test and truncated navicular heights are proven well to be a validated and reliable one among foot print indices used clinically. But association between these two variables is not explored. Objective-: To investigate the association of truncated navicular height to brody's navicular drop test in characterizing medial arch of the foot. Methodology-: It is a cross sectional study. For this purpose, the right and left feet of 28 subjects between the age of (15 female, 13 male) who fit into inclusion criteria were measured by using the plantar surface foot prints and measuring the navicular height to truncated foot length as well as brody s navicular drop test to establish a mean and standard deviation. Data was collected and analysed by chi-square test to correlate the mean values obtained from these two tools. Results-: SPSS 16 version was used to analyse the data. When chi-square test was used to correlate the mean values obtained from each tools, revealed with X2 = 296.3, p = 3.25 for the right foot with r value of and X2 = 332, p = for the left foot with r value of Conclusion-: It is concluded that two clinical tools used here in characterising the foot arch have shown fair correlation to one another. KEY WORDS-: BMI, Foot print, Vernier calliper, Navicular height. 1 INTRODUCTION The medial longitudinal arch is the primary shock absorber and load bearing structure of the foot. Without this arched configuration, large forces at the foot would exceed the physiological weight bearing capabilities of the tarsal bones [6].

2 Medial longitudinal arch consists of calcaneus, talus, navicular, 3 cuneiforms and 1 st 2 nd 3 rd metatarsals. This medial arch of the foot is characterised as high arched, normal arched and low arched for some clinical considerations and also carries value for stratifying samples in research purpose. Measurement of navicular position may provide more useful information about the function of the foot during locomotion as well. Radiographic measurements are the gold standard validated tool [4] to characterizing arch of the foot. Owing to cost concern, ray exposure and various concern clinical validated tool was sought as alternative yet validated and reliable tool. Upto date, to measure the medial arch height clinically, navicular drop test (NDT) and normalized truncated navicular height (NTNH) were proven well to be validated [1,11] and reliable tools among all foot print indices used. But their concurrent validity between these two tools was not explored. METHODOLOGY It is a cross sectional study which was carried out on right and left feet of 28 healthy subjects (15 female, 13 male). All subjects were collegiate students, screened by using the plantar surface foot prints and measuring the navicular height to truncated foot length as well as brody s navicular drop test. Subjects were included if they were healthy individual between the age group of 18-25, both male and female. Subjects were excluded if there is recent injury and fracture of lower limb, spinal disc problem with any neurological deficits, any congenital deformity or any acquired deformities of the lower limb and inflammatory arthritis. Alvas institutional ethical board approval was obtained. Consent was taken before administering tests on participants. PPROCEDURE Deng et al 2010 has reported excellent inter-rater reliability (ICC) of and intra-rater reliability (ICC) of for the measurement of navicular height in standing [3] [8] [9] [10] for the performance of the NDT. George S Murley found normalised navicular height to have strongest association with radiographic angles compared to other clinical measures he correlated [1]. Through the normalized truncated navicular height and Brody s navicular drop test which are recognized as a reliable and validated clinical tools to characterize the arch of the foot as well as an alternative method for radiological classification of arch, up to date the concurrent validity of these two clinical tools are not yet explored. This study was aimed to investigate the concurrent validity of truncated navicular height to brody's navicular drop test in characterising medial arch of the foot. MATERIALS USED Figure 1 i. Scale ii. Pencil iii. Pen iv. Graph sheet v. Index cards vi. Vernier calliper vii. Ink tray Figure: 1 Verbal advertisement Participants selected based on selection criteria Brody s navicular drop test and normalized truncated navicular height administered on the subjects Institutional Ethical clearance have been obtained from Alva s College of Physiotherapy Data Analysis 2 To measure normalized truncated navicular height (NTNH), Subjects were made to stand bearing equal weight on both legs. Then they were asked to keep both the legs in ink filled tray placed in front of them and foot prints were taken into the graph sheets. Truncated foot length was measured using the foot print of the graph

sheets that has been taken. FIGURE 2 a,b,c,d illustrate the procedure. (TFL- perpendicular distance from the 1st MTP joint to the most posterior aspect of the heel) Fig: 2a.

32 High arch Formula of calculating normalized truncated navicular height (NTNH) NTNH= H/L H- height of the navicular tuberosity from ground L - truncated foot length As per these values foot arches

Subjects were made to sit in the comfortable position in height matched chair with feet placed flat on the ground the subtalar joint neutral position was obtained with palpation method [Figure 3a,

3 sheets that has been taken. FIGURE 2 a,b,c,d illustrate the procedure. (TFL- perpendicular distance from the 1st MTP joint to the most posterior aspect of the heel) Fig: 2a. Navicular height (N) Fig: 2c H (mm) Fig: 2d Fig: 2b.Truncated foot length (L) Arch of the feet were classified as [1] L (mm) i. values < 0.21 Low arch ii. values Normal arch iii. values > 0.32 High arch Formula of calculating normalized truncated navicular height (NTNH) NTNH= H/L H- height of the navicular tuberosity from ground L - truncated foot length As per these values foot arches were classified. BRODY S NAVICULAR DROP TEST Here the height of the navicular tuberosity is measured in neutral and relaxed stance positions, and the amount of excursion was measured. Subjects were made to sit in the comfortable position in height matched chair with feet placed flat on the ground the subtalar joint neutral position was obtained with palpation method [Figure 3a, 3b]. The position of navicular tuberosity was marked on the index card. Subjects were made to stand with the full weight bearing through the lower limbs equally and the subtalar joint neutral position was achieved during pronation and supination of subtalar joint as the medial and lateral aspect of the head of the talus become prominent respectively Figure 4. Then the position of the navicular tuberosity was marked on the same index card [Figure 5] and the difference was calculated [Figure 6a, 6b]. 3

4 In Sitting Fig: 3a Marking navicular tuberosity Fig: 3b Measuring height with index card In Standing Fig: 4 Determination of subtalar neutral position Fig: 5 Measuring height with index card in standing 4 MD 53 Volume 21 Issue

As per these values foot arches were classified. RESULTS SPSS 16 version was used to analyse data. Chi-square test was used to correlate the mean values obtained from these two tools.

5 Fig: 6a Measuring difference of measures in sitting to standing Fig: 6b. Calculating the difference by using the vernier calliper Arch of feet were classified as follows [2] 0-5 mm high arch 5-10 mm normal arch >10 mm low arch. As per these values foot arches were classified. RESULTS SPSS 16 version was used to analyse data. Chi-square test was used to correlate the mean values obtained from these two tools. Demographic data of participants are given in table1. X2 = 296.3, p = 3.25 for the right foot with r value of [table 2 a,b]. X2 = 332, p = 0.33 for the left foot with r value of [table 3 a,b]. Table 1 Demographic data of participants N Minimu m Maximu m Mean Std. Deviation BMI Age Valid N (listwise) 28 Table 2a, Left foot to left foot correlation of NTNH to NDT Value df Asymp. Sig. (2-sided) Pearson Chi-Square a Likelihood Ratio Linear-by-Linear Association N of Valid Cases 28 5

6 Table : 2b, Right foot to right foot correlation of NTNH to NDT Symmetric Measures Value Asymp. Std. Error a T b Sig. Interval by Pearson's R c Interval Ordinal by Spearman c Ordinal Correlation No. of Valid Cases 28 Table 3a, Left foot to left foot correlation of NTNH to NDT Chi-Square Tests Value df Asymp. Sig. (2-sided) Pearson Chi-Square a Likelihood Ratio Linear-by-Linear Association N of Valid Cases 28 Table : 3b Left foot to left foot correlation of NTNH to NDT Symmetric Measures Value Asymp. Std. Error a T b Sig. Interval by Pearson's R c Interval Ordinal by Spearman c Ordinal Correlation N of Valid Cases 28 6 DISCUSSION This study has found fair negative correlation between Brody s navicular drop test (NDT) to Normalized truncated navicular height values (NTNH) in characterising the foot arch. Hence one can also use any of these two clinical tools interchangeably to classify arch of the foot. For normalised truncated navicular height measurement, Ink, tray, metal scale, graph sheets measurement of navicular height, determining truncated foot length and then numerical calculations required. But for navicular drop test index card, vernier calliper, navicular height measurement sitting, standing and calculator were required. Subtalar neutral position was obtained for evaluation with each tool. While considering materials and cosmetics concerns one can go with navicular drop test here in characterising the foot arch preferred to NTNH and NDT is preferably easy to practise in clinics with minimal maintenance cost. As for the foot length influence on navicular height, still controversy exists in that area 6,12. Hence more research is needed to shed more light in that. Considering this fact, truncated navicular height might be superior to navicular drop test. CONCLUSION It is concluded that the clinical tools used here in characterising the foot arch have shown fair correlation to one another. CLINICAL IMPLICATION Both tools can be used interchangeably in characterizing the arch of foot clinically. Considering key factors, authors recommend classifying arch of foot clinically with navicular drop test to NTNH. REFERENCES [1]. George S Murley, Hylton B Menz2 and Karl B Landorf. A protocol for classifying normal- and flatarched foot posture for research studies using clinical and radiographic measurements.journal of Foot and Ankle Research [2]. Sabrina Jayne Charlesworth and StineMagistad Johansen. Navicular drop test. user guide and manual [3]. Evan Thomas Navicular drop test

7 [4]. Michael B Pohl and Lindsay Farr. A comparison of foot arch measurement reliability using both digital photography and calliper methods. Pohl and Farr Journal of Foot and Ankle Research [5]. Dorsey S Williams and Irene S McClay. Measurements Used to Characterize the Foot and the Medial Longitudinal Arch: Reliability and Validity. PHYS THER [6]. Umesh Adhikari, Watson Arulsingh, Ganesh Pai and Joseph Oliver Raj. Normative values of Navicular drop test and the effect of demographic parameters.annals of Biological Research, [7]. Sell KE, Verity TM, Worrell TW, Pease BJ, Wigglesworth J. Two measurement techniques for assessing subtalar joint position: a reliability study. J Orthop Sports Phys Ther [8]. Shultz SJ, Nguyen AD, Windley TC, Kulas AS, Botic TL, Beynnon BD. Intratester and intertester reliability of clinical measures of lower extremity anatomic characteristics: Implications for multicenter studies. Clin J Sport Med [9]. Deng J, Joseph R, Wong CK. Reliability and validity of the sit-to-stand navicular drop test: Do static measures of navicular height relate to the dynamic navicular motion during gait? Journal of Student Physical Therapy Research [10]. Mueller MJ, Host JV, Norton BJ. Navicular drop as a composite measure of excessive pronation. J Am Podiatr Med Assoc [11]. Robert kunn Nicole M Bennett, Alicia D Validity of Brody s navicular test; Logan college of Chiropractic, Chesterfield;Missouri [12]. Rasmus G Nielsen, Michael S Rathleff, Ole H Simonsen and Henning Langberg; Determination of normal values for navicular drop during walking: a new model correcting for foot length and gender; Journal of Foot and Ankle Research, 2:12 doi: / , MD 53 Volume 21 Issue

The relationship between navicular height and the incidence of self-reported ankle and knee injuries : a grant proposal

The University of Toledo The University of Toledo Digital Repository Master s and Doctoral Projects The relationship between navicular height and the incidence of self-reported ankle and knee injuries