title: Forefoot flexibility and medial tibial stress syndrome.
abstract: OBJECTIVE
  To investigate the association between medial tibial stress syndrome (MTSS) and morphology and flexibility of the foot arches.
  
  
  METHODS
  131 feet from 74 healthy subjects and 31 feet from 27 patients with MTSS were classified as normal feet (n=78 in 40 subjects), flat feet (n=53 in 34 subjects), or MTSS feet (n=31 in 27 patients). The medial longitudinal arch (MLA) ratio and the transverse arch length (TAL) were measured in both rearfoot and forefoot loading positions. The difference between the 2 positions indicated the flexibility of the MLA (diff-MLA ratio) and the transverse arch (diff- TAL).
  
  
  RESULTS
  The MLA ratio was higher in normal feet than MTSS feet or flat feet (15.1% vs. 12.8% vs. 12.3%, p<0.001). The diff-TAL was lower in MTSS feet than normal feet or flat feet (0.4% vs. 0.8% vs. 0.9%, p<0.001]). The 3 groups were comparable in terms of the diff-MLA ratio and the TAL. Respectively for the MLA ratio and the diff-TAL, the cut-off value was 11.9% and 0.61% based on the Youden index. The sensitivity, specificity, and odds ratio of the cut-off value were 0.4, 0.9, and 4.8 for the MLA ratio, and 0.6, 0.7, and 9.8 for the diff-TAL, respectively.
  
  
  CONCLUSIONS
  Decreased flexibility of the transverse arch and decreased MLA ratio are risk factors for MTSS. In contrast, the flexibility of the MLA and the height of the transverse arch were not risk factors for MTSS.
authors.affiliation: Graduate School of Health Science, Suzuka University of Medical Science, Japan & Department of Physical Therapy, Morinomiya University of Medical Sciences, Japan.
authors.forename: Shintarou
authors.initials: S
authors.lastname: Kudo
authors.affiliation: Department of Physiotherapy, Suzuka University of Medical Science, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hatanaka
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D005260:Female; D005413:Flatfoot / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D005545:Forefoot, Human / Q000503:physiopathology*; D006801:Humans; D008297:Male; D058923:Medial Tibial Stress Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D016017:Odds Ratio; D016059:Range of Motion, Articular / Q000502:physiology*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016474:Weight-Bearing / Q000502:physiology; D055815:Young Adult
keywords: foot; medial tibial stress syndrome