ATA ELVAN, İBRAHİM ENGİN ŞİMŞEK, MEHMET ALPHAN ÇAKIROĞLU, Salih ANGIN

Association of quadriceps angle with plantar pressure distribution, navicular height and calcaneo-tibial angle

Objective: The aim of study was to analyze the association between Quadriceps Angle (QA) and plantarpressure, navicular height (NH), and calcaneo-tibial angle (CTA).Methods: A total of 64 volunteers (mean age: 22.25 ± 2.54 (range:19e33)) participated in this crosssectional study. EMED-m (Novel GmbH, Germany) electronic pedobarograph was employed for dynamicplantar pressure measurement using two step protocol. The angle between the vertical axis of calcaneusand the long axis of Achilles tendon for CTA. The height of navicular tubercle from the ground wasmeasured while the subject was standing on both feet for NH. QA was measured while the subject wasstanding in a relaxed posture where both feet bearing equal weight.Results: There were significant negative correlations between QA and maximum force (MxF) under the4th. metatarsal head (MH4). The QA was also significantly correlated with MxF and force-time integral(FTI) under the bigtoe (BT). FTI under the 3rd. metatarsal head (MH3), MH4 and 5th. metatarsal head(MH5) were significantly negatively correlated with QA. Pressure-time integral (PTI) under the MH4 andMH5 were found to be significantly negatively correlated with QA. A significant correlation was also foundbetween QA and NH (p < 0.0001), whilst there was no correlation between QA and CTA. Regressionanalysis showed that NH was appeared as the major contributor for the QA (b ¼ 0.49, p < 0.001) in thedynamic condition, followed by BT-FTI (b ¼ 0.37, p < 0.001) and MH5-MxF (b ¼ 0.21, p < 0.037).Conclusion: These findings may imply that the NH which can at least be controlled by appropriate shoeinserts may affect QA. This way, loading pattern of both plantar region and whole lower extremity maybe altered.

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Nguyen A-D, Boling MC, Levine B, Shultz SJ. Relationships between lower extremity alignment and the quadriceps angle. Clin J Sport Med. 2009;19(3): 201e206.

Mizuno Y, Kumagai M, Mattessich SM, et al. Q-angle influences tibiofemoral and patellofemoral kinematics. J Orthop Res. 2001;19(5):834e840.

Kraus VB, Vail TP, Worrell T, McDaniel G. A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. Arthritis Rheumatol. 2005;52(6):1730e1735.

Silva DDO, Briani RV, Ferrari D, Pazzinatto MF, Arag~ ao FA, Azevedo FMd. Q angle and subtalar pronation are not good predictors for pain and function in subjects with patellofemoral pain syndrome. Fisioterapia e Pesquisa. 2015;22(2):169e175.

Brattstrom H. Shape of the intercondylar groove normally and in recurrent € dislocation of patella: a clinical and x-ray anatomical investigation. Acta Orthop Scand. 1964;35(Suppl. 68):1e148.

Mueller M, Host J, Norton B. Navicular drop as a composite measure of excessive pronation. J Am Podiat Med Assoc. 1993;83(4):198e202.

Barton CJ, Levinger P, Crossley KM, Webster KE, Menz HB. The relationship between rearfoot, tibial and hip kinematics in individuals with patellofemoral pain syndrome. Clin Biomech. 2012;27(7):702e705.

Wilson T, Kitsell F. Is the Q-angle an absolute or a variable measure? Physiotherapy. 2002;88(5):296e302.

Ilahi OA. Lower extremity morphology and alignment and risk of overuse injury. Clin J Sport Med. 1998;8(1):38e42.

Tiberio D. The effect of excessive subtalar joint pronation on patellofemoral mechanics: a theoretical model. J Orthop Sports Phys Ther. 1987;9(4):160e165.

Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003;33(11):639e646.

Way MC. Effects of a thermoplastic foot orthosis on patellofemoral pain in a collegiate athlete: a single-subject design. J Orthop Sports Phys Ther. 1999;29(6):331e338.

Taunton J, Ryan M, Clement D, McKenzie D, Lloyd-Smith D, Zumbo B. A prospective study of running injuries: the Vancouver Sun Run “In Training” clinics. Br J Sports Med. 2003;37(3):239e244.

McKean KA, Manson NA, Stanish WD. Musculoskeletal injury in the masters runners. Clin J Sport Med. 2006;16(2):149e154.

Braz RG, Carvalho GA. Relationship between quadriceps angle (Q) and plantar pressure distribution in football players. Revista brasileira de fisioterapia (Sao Carlos (Sao Paulo, Brazil)). 2010;14(4):296e302.

Morag E, Cavanagh P. Structural and functional predictors of regional peak pressures under the foot during walking. J Biomech. 1999;32(4): 359e370.

Young CC, Niedfeldt MW, Morris GA, Eerkes KJ. Clinical examination of the foot and ankle. Prim Care. 2005;32(1):105e132.

Pfeiffer M, Kotz R, Ledl T, Hauser G, Sluga M. Prevalence of flat foot in preschool-aged children. Pediatrics. 2006;118(2):634e639.

Woodford-Rogers B, Cyphert L, Denegar CR. Risk factors for anterior cruciate ligament injury in high school and college athletes. J Athl Train. 1994;29(4): 343e346.

Menz HB. Two feet, or one person? Problems associated with statistical analysis of paired data in foot and ankle medicine. Foot. 2004;14(1):2e5.

Nester C. The relationship between transverse plane leg rotation and transverse plane motion at the knee and hip during normal walking. Gait Posture. 2000;12(3):251e256.

Reischl SF, Powers CM, Rao S, Perry J. Relationship between foot pronation and rotation of the tibia and femur during walking. Foot Ankle Int. 1999;20(8): 513e520.

Tillman M, Bauer J, Cauraugh J, Trimble M. Differences in lower extremity alignment between males and females: potential predisposing factors for knee injury. J Sports Med Phys Fitness. 2005;45(3):355e359.

Piazza SJ. Mechanics of the subtalar joint and its function during walking. Foot Ankle Clin. 2005;10(3):425e442.

Highlander P, Sung W, Weil L. Subtalar arthroereisis. Clin podiat Med Surg. 2011;28(4):745e754.

Reilly KA, Barker KL, Shamley D, Sandall S. Influence of foot characteristics on the site of lower limb osteoarthritis. Foot Ankle Int. 2006;27(3):206e211.

Shih Y-F, Chen C-Y, Chen W-Y, Lin H-C. Lower extremity kinematics in children with and without flexible flatfoot: a comparative study. BMC Musculoskelet Disord. 2012;13(1):31e39.

Dileep KS, Harish Krishna, Mohammed Rameez P. Correlation of rearfoot angle to Q-angle in patellofemoral pain syndrome: a prospective study. Int J Res Orthop. 2017;3(4):688e691.

Bellchamber T, van den Bogert AJ. Contributions of proximal and distal moments to axial tibial rotation during walking and running. J Biomech. 2000;33(11):1397e1403.