PODIATRIC RESEARCH FROM THE UNITED KINGDOM

Examining the Validity of Selected

Measures of Foot Type
A Preliminary Study

Ian Mathieson, BSc(Hons)*

Dominic Upton, PhD†
Trevor D. Prior, BSc(Hons), FCPodS‡

The rationale that subtalar joint position, reflected by calcaneal align-

ment, determines foot morphology was used to formulate an approach to
examination of the validity of three measures of “foot type”: the Staheli
Arch Index, the Chippaux-Smirak Index, and navicular height. Each mea-
sure was calculated in five positions, progressively inverting from a ref-
erence position of maximal comfortable eversion. Pearson product mo-
ment correlations (Staheli Arch Index: r = 0.5; Chippaux-Smirak Index:
r = 0.6; and navicular height: r = 0.8) indicated that each measure pro-
gressively increased with inversion. The change in calcaneal position re-
quired to produce significant changes in each measure was investigated
using analysis of variance with Scheffé post hoc analysis. This analysis
revealed that changes of 15° and 20° were required to produce significant
differences in Chippaux-Smirak Index and Staheli Arch Index scores, re-
spectively, threatening their validity. Navicular height was sensitive to
smaller changes of 10° and thus displays greater sensitivity to changes
in calcaneal position than the footprint parameters tested. (J Am Podiatr
Med Assoc 94(3): 275-281, 2004)

“Foot type” is a general term used to describe vari-
ous anthropometric features of the foot thought to
provide clues regarding dynamic function.1 Despite
the existence of a substantial literature base investi-
gating the association between foot type and muscu-
loskeletal pathology,2-12 the true relationship between
the two remains unclear.13 An important factor im-
peding efforts to determine the true nature of this
relationship may be the absence of a valid and reli-
*Wales Centre for Podiatric Studies, University of Wales
Institute, Cardiff.
†University of Wales Institute, Cardiff.
‡City and Hackney Community NHS Trust, St Leonard’s
Primary Care Centre, London, England.
Corresponding author: Ian Mathieson, BSc(Hons), Wales
Centre for Podiatric Studies, University of Wales Institute,
Cardiff, Western Avenue, Cardiff CF5 2YB, Wales.
able measure with which to accurately classify foot
type.1, 13, 14 Although it is acknowledged that laborato-
ry-based analysis offers valid, reliable, and objective
quantification of foot function, the process is time-
consuming and expensive.14 Despite the recognized
limitations of simple clinical measures, their use is
widespread, perhaps owing to their relative advan-
tages in terms of cost and time.
Foot-type measures have been organized into
three general categories15: radiographic, anthropo-
metric, and footprint. Several radiographic measures
have been reported,16-18 but despite the advantage of re-
liability, cost and radiation exposure could be consid-
ered disadvantages. Anthropometric techniques have
focused on external measurement of arch height19-23
and are based on the theory that the medial longitu-

Journal of the American Podiatric Medical Association • Vol 94 • No 3 • May/June 2004 275
dinal arch structure is important to dynamic func-
tion, which mechanical modeling has suggested to be
the case.24 Footprint measures, such as the Valgus
Index25 and the Arch Index,26 are based on the premise
that the footprint can respond to variations in the me-
dial longitudinal arch. The observation that changes
in footprint contact characteristics with variations in
arch height are restricted to the midfoot27 seems to
support the use of measures that directly compare
the midfoot with the forefoot (Chippaux-Smirak
Index28), the rearfoot (Staheli Arch Index29), or the
remainder of the print (Arch Index26). Whereas the
Arch Index involves calculation of area and is more
time-consuming, the Chippaux-Smirak and Staheli
Arch indices offer greater convenience by requiring
only width measurements. Figure 1 illustrates the
methods for calculating the Chippaux-Smirak Index
and the Staheli Arch Index.
The classification of subjects according to exami-
nation of the foot in a relaxed stance position is sup-
ported by various considerations. First, it has been
suggested that the frontal plane angulation of the cal-
caneus is an indication of the amount of compensa-
A that appropriate rotations about all three axes of the
B
C
Figure 1. Calculation techniques for the Chippaux-
Smirak and Staheli Arch indices. To calculate the
Chippaux-Smirak Index, a line is first drawn connect-
ing the most medial aspect of the first metatarsal and
the heel. A line (A) is drawn across the widest part of
the forefoot, and a line (B) is drawn across the narrow-
est part of the arch area. The Chippaux-Smirak Index
is calculated by dividing the former by the latter. The
Staheli Arch Index is calculated by drawing a line (C)
across the heel and a line (B) across the arch area,
and then dividing the latter by the former.
276 May/June 2004 • Vol 94 • No 3 • Journal of the American Podiatric Medical Association
tion taking place for any positional anomalies in the
lower limb.30, 31 Second, it has been repeatedly ob-
served that the relaxed position is closely related to
rearfoot motion during gait.32-34 In addition, compari-
son of the static frontal plane calcaneal angle and dy-
namic rearfoot motion has shown that the static po-
sition is a good predictor of the dynamic limit of
subtalar joint motion.35, 36
Biomechanical theory emphasizes the importance
of the rearfoot in determining dynamic foot function
and recognizes that alteration of subtalar joint posi-
tion produces changes in foot morphology. For ex-
ample, subtalar joint pronation, comprising talar ad-
duction and plantarflexion and visible as calcaneal
eversion, lowers the medial longitudinal arch, whereas
subtalar joint supination, comprising talar abduction
and dorsiflexion and visible as calcaneal inversion,
raises the arch.37 Frontal plane calcaneal motion of-
fers an insight into subtalar joint motion that is other-
wise impossible owing to the lack of surface anatom-
ical landmarks on the talus.36, 38 The link between
subtalar joint motion and arch morphology occurs by
virtue of the relationship between the tarsal bones,
described by Huson39 as a “constraint system,” in
which passive cooperation is imposed by articular
geometry and ligamentous connections. In such a
system, movement of one bone is associated with
predictable changes in the entire complex. Huson’s
discourse on this topic provides an important ana-
tomical basis for relationships previously described
by Elftman,40 Inman et al,41 and Manter,42 who stated
principal tarsal joints can bring the foot into a posi-
tion resembling flatfoot. This information suggests
that an important determinant of arch morphology is
subtalar joint position and that examination of the
frontal plane calcaneal angle provides the opportuni-
ty to gain insight into subtalar joint motion. One in-
terpretation of this information is that examination
of the sensitivity of measures of foot type to discrete
changes in subtalar joint position offers insight into
their validity.
This study aimed to investigate the validity of se-
lected measures of foot type by examining their sen-
sitivity to discrete alterations in subtalar joint orien-
tation, measured by assessing frontal plane calcaneal
alignment. The measures of foot type investigated
were the Staheli Arch Index, the Chippaux-Smirak
Index, and navicular height.
Materials and Methods
An opportunity sample of 20 subjects (15 women and
5 men) was recruited from a student population. The
study was explained to all participants, who subse-
quently gave informed consent and were debriefed
after taking part. The sample had a mean ± SD age of
21 ± 3 years, a mean ± SD height of 166.2 ± 8.3 cm,
and a mean ± SD weight of 68.9 ± 8.9 kg. All subjects
satisfied the following inclusion criteria: no history of,
or visually apparent, gait disturbance; no history of
trauma or surgery involving any part of the locomotor
system; no history of systemic illness that might influ-
ence gait; and no evidence of a limited subtalar joint
range of motion, as determined by clinical assessment.
The Musgrave Footprint system (Musgrave Sys-
tems, Ltd, Llangollen, North Wales) was used to col-
lect a series of five static footprints of the right foot,
which was the dominant limb of all participants. The
Musgrave platform was embedded midway along an
8-m walkway. Two plates were embedded in the
walkway, but only the first was used. All measure-
ments were performed by the lead investigator (I.M.).
Each subject had the tuberosity of the navicular
marked with a fine felt-tip pen. They were then asked
to stand barefoot behind the first plate on the walk-
way and to take a step forward to place the right foot
in the center of the plate. The left foot was brought
alongside the right, and the subject was allowed to
vary the position of the left until a comfortable stance
position was attained. The subject was then asked to
maximally pronate the right subtalar joint by inter-
nally rotating the limb while consciously maintaining
the upper body in a stable position. Subjects were
asked to pronate until they felt resistance and not to
forcibly pronate to discomfort. Once in the maximal-
ly pronated position, a reference line was applied to
the posterior aspect of the calcaneus perpendicular
to the supporting surface using a tractograph set at
90° and placed flat on the supporting surface. The
Musgrave system was activated to record data for 1
sec, and the distance of the tuberosity of the navicu-
lar from the ground was measured using a ruler. This
technique represents a variation of the technique re-
ported by Sell et al43 in that direct measurements
were taken instead of marking the height of the tube-
rosity on a piece of paper for measuring later. Al-
though measurements of navicular height could have
been recorded with greater precision using any one of
various pieces of equipment, a ruler is widely avail-
able and simple to use. The subject was then asked to
externally rotate the limb slowly until the calcaneal
reference line was 5° inverted from the maximally pro-
nated position, measured using a protractor. Again,
this position was maintained, the Musgrave system
was activated to record, and the height of the navicu-
lar was measured. This procedure was repeated until
the height of the navicular and the images of the
Journal of the American Podiatric Medical Association • Vol 94 • No 3 • May/June 2004
plantar surface of the foot were recorded in three
further positions: 10°, 15°, and 20° inverted from
maximal pronation. The investigator was positioned
posterior to the participant when viewing and mea-
suring the calcaneus and medially when viewing and
measuring the navicular to reduce error associated
with parallax.
Images of the plantar surface of the foot were
used to calculate the Staheli Arch and Chippaux-Smi-
rak indices using a technique previously established
as reliable.1 The influence of incremental changes in
subtalar joint motion on each measure was then in-
vestigated to determine the nature of any relation-
ships.
Results
Examination of 20 subjects in five separate positions
resulted in a total of 100 footprints and 100 measure-
ments of navicular height. Analysis sought to identify
the influence of incremental changes of 5° calcaneal
inversion on each measure of foot type.
Pearson product moment correlation coefficients
were calculated to identify any trends, and the re-
sults suggested a tendency for each measure to in-
crease in value with progressive inversion. Correla-
tions of 0.5, 0.6, and 0.8 were returned for the Staheli
Arch Index, the Chippaux-Smirak Index, and navicu-
lar height, respectively. Although these correlations
are all significant at the P < .01 level, navicular height
correlates best with calcaneal motion. Correlations
are displayed in Figure 2.
Although correlations suggested a tendency for
foot-type measure values to increase with progressive
inversion, further analysis was required to determine
whether significant increases occurred with adjacent
5° increments or were related only to increments of
greater than 5°. Analysis of variance (ANOVA) with
Scheffé post hoc analysis was used to investigate this
issue. First, ANOVA revealed that significant differ-
ences existed between all calcaneal positions for all
measures (Staheli Arch Index: F4 = 7.154; Chippaux-
Smirak Index: F4 = 16.324; and navicular height: F4 =
35.323; P < .001 for all).
Scheffé post hoc analysis sought to identify exact-
ly where the differences identified by ANOVA lay to
determine the incremental change required to pro-
duce significant differences. Analysis of the statisti-
cal significance of differences associated with all
possible increments of 5°, 10°, 15°, and 20° revealed
that 10° of calcaneal inversion produced significant
differences in navicular height, whereas significant
differences in the Chippaux-Smirak and Staheli Arch
indices were associated with 15° and 20° of calcaneal
277
 A caneus had moved a significant amount. Figure 3
shows the cumulative effect on navicular height of
1-
progressively increasing subtalar joint inversion and
SAI Score

allows visualization of the actual differences between

adjacent positions throughout the range of motion in-
vestigated. Each column, therefore, equates with a 5°
change in alignment.
0 5 10 15 20 25
Calcaneal Input Position (°)
Discussion

B Numerous researchers interested in the relationship

between foot type and pathology have chosen to char-
100 -
acterize foot type using measures based on morphol-
ogy. The purpose of this study was to examine the
CSI Score

validity of three morphologic measures previously

described in the literature and representative of mea-
sures that have been used for clinical and research
purposes. The approach adopted was based on two
0 5 10 15 20 25 assumptions. First, it assumes that the subtalar joint
Calcaneal Input Position (°) is the key joint in the rearfoot, exerting a consider-
able influence on morphology, and that frontal plane
calcaneal alignment offers some insight into true
C subtalar joint motion (otherwise impossible to deter-
80 - mine owing to the lack of surface markings on the
Navicular Height (mm)

talus). The use of such a “proxy” gold standard for in-

60 -
40 -
20 -
0 5 10 15
Calcaneal Input Position (°)
Figure 2. Relationship between calcaneal position
and the three foot-type measures: Staheli Arch Index
(SAI) (r = 0.5; P < .01) (A), Chippaux-Smirak Index
(CSI) (r = 0.6; P < .01) (B), and navicular height
(r = 0.8; P < .01) (C).
inversion, respectively. Scheffé analysis, therefore,
revealed that the origin of the differences detected by
ANOVA were restricted to changes of greater than 5°
for all measures and that the sensitivity of each mea-
sure differed.
Clinical interpretation of these results can be aided
by considering the actual change in foot-type mea-
sure value associated with each incremental change
in calcaneal alignment. Table 1 displays, for each
measure, the actual change associated with each in-
cremental change, together with the 95% confidence
interval (CI). These data suggest that a change in na-
vicular height of 7.8 mm (95% CI, 6.2–9.4 mm) would
need to be measured clinically to be sure that the cal-
vestigation of validity when an absolute measure is
unavailable is endorsed,44, 45 and thus the approach
could satisfy the demands of face (subjective assess-
ment of relevance and appropriateness of procedure)
and predictive criterion (comparison with a proxy
20 25 gold standard) validity. Second, it assumes that a 5°
change in frontal plane calcaneal alignment repre-
sents significant subtalar joint motion, capable of
perceptibly changing foot morphology. The exact
range of subtalar joint motion has been suggested to
be 5° to 11° using a computed tomography tech-
nique46 and 30° based on clinical measurement.47
These values suggest that a 5° change in calcaneal
alignment represents a substantial proportion of the
joint’s reported range of motion.
Although correlations between all measures and
calcaneal position achieve the level required for sig-
nificance, the correlation is low for the footprint mea-
sures and does not reflect a strong relationship. This
conclusion is supported by the Scheffé analysis,
which reveals that changes of 15° (for the Chippaux-
Smirak Index) and 20° (for the Staheli Arch Index)
are required to produce significant differences in
measure values. This information suggests that dif-
ferent feet could have been classified as the same in
studies using these measures, even considering that
the real difference required to produce significant
differences probably lies between the significant and
nonsignificant values (10° and 15° for the Chippaux-

278 May/June 2004 • Vol 94 • No 3 • Journal of the American Podiatric Medical Association
Table 1. Summary of Changes in Foot-Type Measure Values with 5°, 10°, 15°, and 20° Changes in Calcaneal Position
Measure
Staheli Arch Index score
Chippaux-Smirak Index score
Navicular height (mm)
Abbreviation: CI, confidence interval.
aIncrement is associated with a statistically significant difference in measure value.
Smirak Index and 15° and 20° for the Staheli Arch
Index). Although the clinical significance of a 5°
change in calcaneal alignment is essentially un-
known, the failure of these measures to respond pre-
dictably to a 10° change in alignment suggests that
they demonstrate weak precision (defined as the
ability to detect small changes in the attribute44) and
cannot differentiate between what could be reason-
ably claimed to be significantly different subtalar
joint positions.
Navicular height displayed greater sensitivity to
changes in calcaneal position (Pearson r = 0.8), with
changes in calcaneal alignment of 10° being associated
with significant changes. The true change in calcaneal
alignment required to produce a significant difference
will, in reality, be between the nonsignificant (5°)
and significant (10°) levels. Cornwall and McPoil48
conducted a study of the dynamic relationship be-
tween triplanar navicular and frontal plane calcaneal
motions and found a significant correlation of 0.94,
suggesting a strong relationship. The discrepancy be-
tween the correlation returned in the present, static
study (r = 0.8) and the dynamic correlation48 (r = 0.9)
10 -
Change in Navicular Height (mm)
8-
6-
4-
2-
0-
MP–5°
Figure 3. Mean change in navicular height associ-
ated with subtalar joint inversion change in 5° incre-
ments from maximal pronation (MP) to 20° inversion.
Error bars represent SD.
Journal of the American Podiatric Medical Association • Vol 94 • No 3 • May/June 2004
Mean (95% CI) Change
5° Increments 10° Increments 15° Increments 20° Increments
0.7 (–0.5–0.2) 0.16 (0.02–0.3) 0.2 (0.1–0.3) 0.3 (0.2–0.4)a
5.9 (–1.1–12.9) 10.9 (–0.3–21.5) 22.7 (10.9–34.6)a 34.8 (25.2–44.4)a
3.2 (2.3–4.2) 7.8 (6.2–9.4)a 12.9 (11.2–14.6)a 18.2 (16.1–20.3)a
may be explained by the work of Cavanagh et al.49
They found a limited relationship between 27 radio-
graphic measures of foot structure and dynamic plan-
tar pressures and concluded that the dynamics of gait
were likely to exert a major influence.
Although navicular height, measured simply as the
vertical height of the navicular in relaxed stance, has
been discussed,50 it is also used in a second measure,
navicular drop.51-53 Navicular drop is the measure-
ment of vertical movement of the navicular as the
subtalar joint is moved from the neutral to the relaxed
calcaneal stance position. This measure seems valu-
able, as it directly attempts to quantify the amount of
compensatory motion taking place, which Root et
al47 suggested to be important. As opposed to a mea-
sure of static structure, the dynamics of gait are more
likely to be reflected in a measure based on static
compensatory motion, given that the dynamics of
gait have been suggested as important.49 This would
allow the foot to be easily assigned to one of the
three categories of compensation presented by Root
et al47: excessive pronation, excessive supination,
and restricted motion. This assertion is supported by
the relationship between the relaxed calcaneal stance
position and dynamic rearfoot motion32-34 and by the
correlation with maximal dynamic eversion.35, 36
The navicular drop test was originally proposed as
a measure believed to offer advantages over evalua-
tion of the neutral and relaxed calcaneal stance posi-
tions, which have been associated with reliability
problems.54 This measure does seem to offer addi-
tional information compared with measures based
exclusively on static posture. The ability of static
measures to predict at least a proportion of dynamic
function would seem to be a prerequisite to their use.
Given the imperfect correlation between navicular
drop and calcaneal motion of 0.8 to 0.9 (derived from
5°–10° 10°–15° 15°–20°
the present study and that of Cornwall and McPoil48),
it seems that measuring one is not quite the same as
measuring the other, and there are probably several
factors, including subtalar axis orientation and liga-
mentous/capsular laxity, that determine the precise
279
relationship between rearfoot and midfoot motion.
The use of skin markings, which may not precisely
reflect underlying bone movement, may also influ-
ence the relationship. Sell et al43 found measurements
of compensation recorded using the calcaneus and
the navicular to be associated with acceptable relia-
bility, although the calcaneal method was associated
with higher intraclass correlations, a lower SEM, and
smaller CIs. Improved reliability over measurement
of the neutral and relaxed calcaneal stance positions
may be explained by the use of a calcaneal bisection,
which essentially acted as an arbitrary reference line,
although placement of the subtalar joint in its neutral
position is still required. This information suggests
that a better method of classifying foot type may be
to examine static compensatory motion at the calca-
neus and navicular.
Conclusion
Measures of foot type calculated from static foot-
prints display a limited ability to respond to discrete
changes in subtalar joint position. This finding sug-
gests that such measures have a limited ability to ac-
curately classify subjects for research purposes (poten-
tially leading to inappropriate groupings) and cannot
be recommended. This questions the value of studies
that have used such measures. Measurements based
on static estimation of compensation, using the cal-
caneus and the navicular, seem to demonstrate po-
tential, offering insight into dynamic motion as op-
posed to static position. These techniques provide
the opportunity to investigate the relationship be-
tween the three classes of compensation proposed
by Root et al47 (excessive pronation, excessive supi-
nation, and restricted motion) and musculoskeletal
pathology.
Acknowledgment. Declan O’Doherty, MD, and
Richard Callaghan, DPodM, for reviewing the manu-
script. This study was supported by Health Profes-
sions Wales, Cardiff.
References
1. M ATHIESON I, U PTON D, B IRCHENOUGH A: Comparison of
footprint parameters calculated from static and dy-
namic footprints. The Foot 9: 145, 1999.
2. M ESSIER SP, P ITTALA KA: Etiologic factors associated
with selected running injuries. Med Sci Sports Exerc
20: 501, 1988.
3. B ECKETT ME, M ASSIE DL, B OWERS KD, ET AL : Incidence
of hyperpronation in the ACL injured knee: a clinical
perspective. J Athlet Train 27: 58, 1992.
4. C OWAN DN, J ONES BH, R OBINSON JR: Foot morphologic
280 May/June 2004 • Vol 94 • No 3 • Journal of the American Podiatric Medical Association
characteristics and risk of exercise-related injury. Arch
Fam Med 2: 773, 1993.
5. WOODFORD-ROGERS B, CYPHERT L, DENEGAR CR: Risk fac-
tors for anterior cruciate ligament injury in high school
and college athletes. J Athlet Train 29: 343, 1994.
6. BUSSEUIL C, FREYCHAT P, GUEDJ EB, ET AL: Rearfoot-fore-
foot orientation and traumatic risk for runners. Foot
Ankle Int 19: 32, 1998.
7. FREYCHAT P, BELLI A, CARRET JP, ET AL: Relationship be-
tween rearfoot and forefoot orientation and ground re-
action forces during running. Med Sci Sports Exerc 28:
225, 1996.
8. D UFFEY MJ, M ARTIN DF, C ANNON DW, ET AL : Etiologic
factors associated with anterior knee pain in distance
runners. Med Sci Sports Exerc 32: 1825, 2000.
9. M C C RORY JL, M ARTIN DF, L OWERY RB, ET AL : Etiologic
factors associated with Achilles tendinitis in runners.
Med Sci Sports Exerc 31: 1374, 1999.
10. I LAHI OA, K OHL HW: Lower extremity morphology and
alignment and risk of overuse injury. Clin J Sport Med
8: 38, 1998.
11. WEN DY, PUFFER JC, SCHMALZRIED TP: Lower extremity
alignment and risk of overuse injuries in runners. Med
Sci Sports Exerc 29: 1291, 1997.
12. C OWAN DN, J ONES BH, F RYKMAN PN, ET AL : Lower ex-
tremity morphology and risk of overuse injury among
male infantry trainees. Med Sci Sports Exerc 28: 945,
1996.
13. W ILLIAMS DS, M C C LAY IS: Measurements used to char-
acterize the foot and the medial longitudinal arch: re-
liability and validity. Phys Ther 80: 864, 2000.
14. R EDMOND A, B URNS J, O UVRIER RA, ET AL : An initial ap-
praisal of the validity of a criterion based, observa-
tional clinical rating system for foot posture: Static and
Dynamic Classification of the Foot Meeting 2001, An-
napolis, MD. J Orthop Sports Phys Ther 31: 160, 2001.
15. COWAN DN, ROBINSON JR, JONES BH, ET AL: Consistency
of visual assessment of arch height among clinicians.
Foot Ankle Int 15: 213, 1994.
16. MCCLAY IS, BRAY J: The subtalar angle: a proposed mea-
sure of rearfoot structure. Foot Ankle Int 17: 499, 1996.
17. KALEN V, BRECHNER A: Relationship between adolescent
bunions and flatfeet. Foot Ankle Int 8: 331, 1988.
18. PRICHASUK S, SUBHADRABANDHU T: The relationship of pes
planus and calcaneal spur to plantar heel pain. Clin Or-
thop 306: 192, 1994.
19. K ERNOZEK TW, R ICARD MD: Foot placement angle and
arch type: effect on rearfoot motion. Arch Phys Med
Rehabil 71: 988, 1990.
20. SALTZMAN CL, NAWOCZENSKI DA, KYLE DT: Measurement
of the medial longitudinal arch. Arch Phys Med Reha-
bil 76: 45, 1995.
21. NACHBAUER W, NIGG BM: Effects of arch height of the foot
on ground reaction forces in running. Med Sci Sports
Exerc 24: 1264, 1992.
22. NIGG BM, COLE GK, NACHBAUER W: Effects of arch height
of the foot on angular motion of the lower extremities
in running. J Biomech 26: 909, 1993.
23. OGON M, ALEKSIEV AR, POPE MH, ET AL: Does arch height
affect impact loading at the lower back level in run-
ning? Foot Ankle Int 20: 263, 1999.
24. SIMKIN A, LEICHTER I: Role of the calcaneal inclination in
the energy storage capacity of the human foot: a biome-
chanical model. Med Biol Eng Comp 28: 149, 1990.
25. R OSE GK: “Pes Planus,” in Disorders of the Foot and
Ankle: Medical and Surgical Management, 2nd Ed, ed
by MH Jahss, p 892, WB Saunders, Philadelphia, 1991.
26. C AVANAGH PR, R ODGERS MM: The Arch Index: a useful
measure from footprints. J Biomech 20: 547, 1987.
27. Q AMRA SR, D EODHAR SD, J IT I: Podographical and met-
rical study for pes planus in a northwestern Indian pop-
ulation. Hum Biol 52: 435, 1980.
28. FORRIOL F, PASCUAL J: Footprint analysis between three
and seventeen years of age. Foot Ankle Int 11: 101, 1990.
29. STAHELI LT, CHEW DE, CORBETT M: The longitudinal arch:
a survey of eight hundred and eighty-two feet in normal
children and adults. J Bone Joint Surg Am 69: 426, 1987.
30. A NTHONY RJ: The Manufacture and Use of the Func-
tional Foot Orthosis, Karger, London, 1991.
31. PHILPS JW: The Functional Foot Orthoses, 2nd Ed, Chur-
chill Livingstone, Edinburgh, 1995.
32. W RIGHT DG, D ESAI SM, H ENDERSON WH: Action of the
subtalar and ankle-joint complex during the stance
phase of walking. J Bone Joint Surg Am 46: 361, 1964.
33. M C P OIL TG, C ORNWALL MW: Relationship between neu-
tral subtalar joint position and pattern of rearfoot mo-
tion during walking. Foot Ankle Int 15: 141, 1994.
34. P IERRYNOWSKI MR, S MITH SB: Rear foot inversion/ever-
sion during gait relative to the subtalar joint neutral
position. Foot Ankle Int 17: 406, 1996.
35. MCPOIL TG, CORNWALL MW: Relationship between 3 static
angles of the rearfoot and the pattern of rearfoot mo-
tion during walking. J Orthop Sports Phys Ther 23: 370,
1996.
36. T ORBURN L, P ERRY J, G RONLEY JK: Assessment of rear-
foot motion: passive positioning, one-legged standing,
gait. Foot Ankle Int 19: 688, 1998.
37. N ESTER CJ: Rearfoot complex: a review of its interde-
pendent components, axis orientation and functional
model. The Foot 7: 86, 1997.
38. R OOT ML, O RIEN W, W EED JH: Normal and Abnormal
Function of the Foot, Clinical Biomechanics Corp, Los
Angeles, 1977.
39. H USON A: “Functional Anatomy of the Foot,” in Disor-
ders of the Foot and Ankle: Medical and Surgical Man-
agement, 2nd Ed, ed by MH Jahss, p 409, WB Saunders,
Philadelphia, 1991.
Journal of the American Podiatric Medical Association • Vol 94 • No 3 • May/June 2004
40. ELFTMAN H: The transverse tarsal joint and its control.
Clin Orthop 16: 41, 1960.
41. INMAN VT, RALSTON HJ, TODD F: “Human Locomotion,” in
Human Walking, 2nd Ed, ed by J Rose, J Gamble, p 1,
Williams & Wilkins, Baltimore, 1994.
42. MANTER JT: Movements of the transverse tarsal joints.
Anat Rec 80: 397, 1941.
43. S ELL KE, V ERITY TM, W ORRELL TW, ET AL : Two mea-
surement techniques for assessing subtalar joint posi-
tion: a reliability study. J Orthop Sports Phys Ther 19:
162, 1994.
44. BOWLING A: Research Methods in Health: Investigating
Health and Health Services, Open University Press,
Philadelphia, 1997.
45. D ALY LE, B OURKE GJ: Interpretation and Uses of Med-
ical Statistics, 5th Ed, Blackwell Science, Oxford, 2000.
46. PEARCE TJ, BUCKLEY RE: Subtalar joint movement: clin-
ical and computed tomography scan correlation. Foot
Ankle Int 20: 428, 1999.
47. ROOT ML, ORIEN W, WEED JH, ET AL: Biomechanical Ex-
amination of the Foot, Vol 1, Clinical Biomechanics
Corp, Los Angeles, 1971.
48. C ORNWALL MW, M C P OIL TG: Relative movement of the
navicular bone during normal walking. Foot Ankle Int
20: 507, 1999.
49. CAVANAGH PR, MORAG E, BOULTON AJM, ET AL: The rela-
tionship of static foot structure to dynamic foot func-
tion. J Biomech 30: 243, 1997.
50. S ALTZMAN CL, N AWOCZENSKI DA, T ALBOT KD: Measure-
ment of the medial longitudinal arch. Arch Phys Med
Rehabil 76: 45, 1995.
51. BRODY DM: Techniques in the evaluation and treatment
of the injured runner. Orthop Clin North Am 13: 541,
1982.
52. MUELLER MJ, HOST JV, NORTON BJ: Navicular drop as a
composite measure of excessive pronation. JAPMA 83:
198, 1993.
53. P ICCIANO AM, R OWLANDS MS, W ORRELL T: Reliability of
open and closed kinetic chain subtalar joint neutral po-
sitions and navicular drop test. J Orthop Sports Phys
Ther 18: 553, 1993.
54. K EENAN A: A clinician’s guide to the practical implica-
tions of the recent controversy of foot function. Aus-
tralas J Podiatr Med 31: 87, 1997.
281