Hannah L Jarvis1
Christopher J Nester
Richard K Jones
Anita Williams
Peter D Bowden
Abstract
Background
There is no consensus on which protocols should be used to assess foot and lower limb
biomechanics in clinical practice. The reliability of many assessments has been questioned by
previous research. The aim of this investigation was to (i) identify (through consensus) what
biomechanical examinations are used in clinical practice and (ii) evaluate the inter-assessor
reliability of some of these examinations.
Methods
Part1: Using a modified Delphi technique 12 podiatrists derived consensus on the
biomechanical examinations used in clinical practice. Part 2: Eleven podiatrists assessed 6
participants using a subset of the assessment protocol derived in Part 1. Examinations were
compared between assessors.
Results
Clinicians choose to estimate rather than quantitatively measure foot position and motion.
Poor inter-assessor reliability was recorded for all examinations. Intra-class correlation
coefficient values (ICC) for relaxed calcaneal stance position were less than 0.23 and were
less than 0.14 for neutral calcaneal stance position. For the examination of ankle joint
dorsiflexion, ICC values suggest moderate reliability (less than 0.61). The results of a random
effects ANOVA highlight that participant (up to 5.7°), assessor (up to 5.8°) and random (up
to 5.7°) error all contribute to the total error (up to 9.5° for relaxed calcaneal stance position,
up to 10.7° for the examination of ankle joint dorsiflexion). Kappa Fleiss values for
categorisation of first ray position and mobility were less than 0.05 and for limb length
assessment less than 0.02, indicating slight agreement.
Conclusion
Static biomechanical assessment of the foot, leg and lower limb is an important protocol in
clinical practice, but the key examinations used to make inferences about dynamic foot
function and to determine orthotic prescription are unreliable.
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