The Effect of Forefoot Varus on Postural

Stability
Stephen C. Cobb, MS, ATC, CSCS 1
Laurie L. Tis, PhD, ATC, FACSM 2
Benjamin F. Johnson, EdD 2
Elizabeth J. Higbie, PT, PhD, ATC 3

Study Design: Counterbalanced experimental design study comparing a group of subjects with The effect of chronic ankle in-
greater than or equal to 7° of forefoot varus (MFV) to a group with less than 7° of forefoot varus jury on PS has been researched
(LFV). more extensively than that of
Objectives: To investigate the effect of forefoot varus on single-limb stance postural stability (PS).
acute injury.1,2,19,25,36-38 Most inves-
Background: Impaired PS has been implicated as a potential risk factor for sustaining acute foot
and ankle injuries. The identification of variables that deleteriously affect PS may be important in
tigations have revealed significantly
the prevention of future injuries. impaired PS associated with func-
Methods and Measures: Postural stability of the MFV group (n = 20) and the LFV group (n = 12) tional instability, regardless of the
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was assessed during right and left single-limb stance and eyes-open and eyes-closed conditions. presence or absence of mechanical
Standard deviations of the x-axis and y-axis ground reaction forces measured via a force platform instability. 5,25,37,38 Furthermore,
were used to represent anteroposterior (AP) and mediolateral (ML) PS, respectively. The mean of 3 studies investigating the presence
successful 5-second trials of each testing condition was calculated and used for subsequent data of ankle mechanical instability, in
analysis using 3-way mixed-model ANOVAs with 1 between-subject and 2 within-subject factors.
the absence of functional instabil-
Copyright © 2004 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Results: The AP PS scores of the MFV group were significantly greater than those of the LFV group
(P⬍.05). ML PS scores, although higher in the MFV group, were not significantly different from ity, have not revealed significantly
those of the LFV group. Both groups had significantly greater AP and ML PS scores during the impaired PS.19
eyes-closed versus the eyes-open condition (P⬍.05). A factor that has not been inves-
Conclusions: The results suggest that the presence of greater than or equal to 7° of forefoot varus tigated extensively is the possibility
may significantly impair AP PS. The decreased stability associated with increased forefoot varus of the presence of impaired PS as
may be due to decreased joint congruity and consequently an increased reliance on soft tissue a precursor to initial injury, rather
structures for stability. J Orthop Sports Phys Ther 2004;34:79-85.
than the result of injury.3,26,36
Key Words: balance, foot structure, ground reaction force, postural control Tropp et al36 reported that sub-
Journal of Orthopaedic & Sports Physical Therapy®

jects with impaired preseason

stabilometric values (greater than

T
he study of postural stability (PS) has gained popularity in 2 SD above the group means),
RESEARCH
the sports medicine community in recent years due to the regardless of their history of in-
belief that impaired PS following injury may increase the jury, were at significantly greater
risk of reinjury. A number of studies have been performed risk of suffering ankle-related in-
investigating the effect of acute and chronic ankle joint jury during the upcoming season.
injury on PS.1,2,5,8,9,13,15,19,22,27,35-38 Several studies have revealed im- In a recent cohort study of high
paired PS following acute injury.13,15,21,27 Other investigations, however, school basketball players, athletes
have either not revealed significant impairments associated with acute with increased preseason postural
sprain, or have reported both significant and nonsignificant differences, sway velocity scores sustained a
REPORT

depending upon the parameter used to compute PS.8,35 significantly greater number of
ankle sprains during the subse-
quent season than those with low
1
Doctoral Student, Department of Kinesiology and Health, Georgia State University, Atlanta, GA. postural sway velocity scores.26
2
Associate Professor, Department of Kinesiology and Health, Georgia State University, Atlanta, GA. Contrary to the results of Tropp et
3
Associate Professor, Department of Physical Therapy, Georgia State University, Atlanta, GA. al36 and McGuine et al,26 a pro-
Approved by the Georgia State University Institutional Review Board for Protection of Human Subjects.
Send correspondence to Laurie L. Tis, Department of Kinesiology and Health, Georgia State University, spective study of 118 Division I
Atlanta, GA 30303. E-mail: ltis@gsu.edu athletes performed by Beynnon et

Journal of Orthopaedic & Sports Physical Therapy 79

 al3 did not reveal anteroposterior (AP) maximum
sway angle to be associated with risk of ankle injury.
Although no generalizations can be drawn from
the results of these studies, they do emphasize the
need for further research into the possible influence
of other anatomic factors on PS. If impaired PS is a
risk factor for acute injury, identification of variables
that adversely affect PS may be important for injury
prevention. This need is further emphasized by the
findings of a study by Tropp et al37 that not only
revealed pathological stabilometry scores, which were
associated with an increased risk of suffering acute
injury, in 62% of the subjects tested with functional
instability, but also in 22% of the subjects tested with
no history of ankle joint injury or instability.
An area that has not been researched extensively is
the influence of foot structure on PS.17 Root et al31
have suggested that the presence of non–weight-
bearing frontal-plane foot postures, such as forefoot
varus (FV), rearfoot varus, plantar-flexed fifth ray, or
ankle joint equinus result in increased compensatory
foot pronation during weight bearing. Increased
pronation during weight bearing is accomplished
through excessive mobility of the subtalar joint (STJ)
and midtarsal joint (MTJ), leading to decreased
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osseous stability in the foot and an inadequately rigid
foot during weight bearing.31 It may be hypothesized
that the excessive mobility of the foot during weight
bearing caused by the compensatory hypermobility of
the STJ and MTJ may create an unstable base of
Copyright © 2004 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
support that may translate to impaired PS. To date,
only 1 study has investigated the potential relation-
ship between foot structure and PS.17 In a study
investigating PS in subjects classified with pes planus,
rectus, or cavus foot structures, Hertel et al17 revealed
increased center of pressure (COP) sway area in
subjects with pes cavus foot structures compared to
those with pes rectus foot structures. They did not,
however, reveal any differences in either COP sway
Journal of Orthopaedic & Sports Physical Therapy®
area or average COP sway velocity between subjects
with pes planus foot structures compared to those
with pes rectus foot structures. The study classified
foot structure based on a combination of non–weight-
bearing rearfoot and forefoot measures; however,
there was a large degree of variability in both foot
measures within the groups. This variability may have
TABLE 1. Descriptive data (mean ± SD [range]) of foot measurements for both groups included in the study.
More Forefoot Varus
Right
Forefoot varus (degrees) 9.0 ± 1.3
(7.0 - 12.0)
Navicular drop (mm) 13.1 ± 4.8
(5.0 - 25.0)
Rearfoot valgus (degrees) 9.8 ± 2.3
(7.0 - 15.0)
80
contributed to a lack of significant differences be-
tween the individuals with pes planus foot structure
and the individuals with other foot structures.
The purpose of the current study, therefore, was to
investigate the effect of what could be considered a
large degree of FV on PS. Although there is currently
no universally agreed upon magnitude of FV that
constitutes an ‘‘excessive’’ degree, greater than or
equal to 7° was chosen for the current study.
METHODS
Participants
Thirty-two apparently healthy participants with no
history of acute or chronic foot/ankle injury or
functional ankle instability within the last 6 months
volunteered for the study. The participants with
greater than or equal to 7° of bilateral FV (MFV)
consisted of 11 male and 9 female volunteers (mean
age ± SD, 29.0 ± 8.4 years; mean height ± SD, 148.1 ±
6.6 cm; mean weight ± SD, 654.0 ± 97.4 N) (Table 1).
Participants with less than 7° of bilateral FV (LFV)
consisted of 5 male and 7 female volunteers (mean
age ± SD, 25.8 ± 6.0 years; mean height ± SD, 148.3 ±
7.1 cm; mean weight ± SD, 734.9 ± 193.6 N). Prior to
testing, participants provided written informed con-
sent in accordance with the institutional guidelines of
Georgia State University and the equipment and
procedures of the study were explained.
Foot Measurements
Forefoot varus was assessed with the participant in
a prone non–weight-bearing position according to the
method established by Root et al30 as modified by
Elveru et al.7 Volunteers with forefoot valgus were not
included in the study. The same researcher per-
formed the forefoot measurements 3 times for each
foot.29 The average of the 3 measurements for each
foot was recorded for each participant (Table 1).
Although not used to classify groups, or for data
analysis, navicular drop24 and standing rearfoot
varus/valgus18 measurements were assessed as repre-
sentative measures of the compensatory increased
mobility at the MTJ and STJ associated with the
presence of increased FV (Table 1).
Less Forefoot Varus
Left Right Left
8.7 ± 1.5 4.6 ± 1.1 3.7 ± 1.5
(7.0 - 12.0) (3.0 - 6.0) (2.0 - 6.0)
11.9 ± 4.2 9.7 ± 4.1 9.0 ± 3.6
(7.0 - 22.0) (4.0 - 16.0) (5.0 - 18.0)
9.5 ± 2.2 6.4 ± 1.6 5.4 ± 2.2
(7.0 - 14.0) (4.0 - 9.0) (3.0 - 10.0)
J Orthop Sports Phys Ther • Volume 34 • Number 2 • February 2004
 Instrumentation
An AMTI biomechanics force platform (SN 3943;
Advanced Mechanical Technology, Inc., Newton, MA)
sampling at 120 Hz was used to measure
3-dimensional ground reaction forces (GRFs) be-
tween the participant’s foot and the force platform.
The x-axis, y-axis, and z-axis of the force platform
correspond with the AP, mediolateral (ML), and
vertical forces, respectively. An AMTI SGA6-4 ampli-
fier (Advanced Mechanical Technology, Inc., Newton,
MA) with a 10.5-Hz second-order critically damped
filter processed the raw force data. The Peak Perfor-
mance Motus System software package (Peak Perfor-
mance Technologies, Inc., Englewood, CO) was used
to compute ground reaction forces in N. A macro was
written in Microsoft Excel to normalize the ground
reaction force data to body mass20 to allow compari-
sons between individuals. The macro also calculated
average means and standard deviations of the mul-
tiple trials for each condition and position. The
averaged standard deviations of the forces along the
x-axis and y-axis were representative of AP and ML PS
scores, respectively. The use of force measures has
been established as valid and reliable for the quantifi-
cation of PS.8,11,12,20
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Procedures
Prior to testing, participants were weighed on the
force platform. Postural stability was then assessed
Copyright © 2004 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
without shoes during right and left single-limb stance
positions under eyes-open and eyes-closed condi-
tions.5,8
The procedures followed the guidelines established
by Goldie et al12 as a reliable means of using force
measures to assess single-limb stance PS. A longitudi-
nal line was placed on the force platform to control
foot position.34 The participant aligned the foot to be
tested such that the longitudinal line bisected the
Journal of Orthopaedic & Sports Physical Therapy®
calcaneus and the first and second metatarsals. The
subjects were then instructed to flex the non–weight-
bearing limb at the hip and knee and cross their
arms over their chest. During eyes-open conditions,
participants focused on a mark placed at eye level
approximately 10 m in front of them. Once balanced,
participants provided a verbal signal at which time
data collection was initiated. During the eyes-closed
condition, participants assumed the test position,
closed their eyes, and gave a verbal signal of their
readiness when they felt balanced. Following their
verbal acknowledgment of readiness, subjects were
instructed to attempt to maintain their position as
motionless as possible while avoiding bringing the
non–weight-bearing limb in contact with either the
ground or the weight-bearing limb. They were also
instructed not to use their arms for balancing. If
balance was lost, the participants were instructed to
resume the initial testing position as quickly as
J Orthop Sports Phys Ther • Volume 34 • Number 2 • February 2004
possible. In the case of non–weight-bearing limb
ground contact, the trial was not used for data
analysis. In the case of a missed trial, a second
attempt was given prior to moving on to the next
trial. If the second attempt also failed, no data were
recorded for the trial. Testing was conducted in a
quiet, darkened room to limit auditory and visual
influences.21,32
Both groups performed four 5-second trials for
each of the following conditions: (1) eyes-open right-
leg stance, (2) eyes-closed right-leg stance, (3) eyes-
open left-leg stance, and (4) eyes-closed left-leg
stance. The use of 5-second trials has been estab-
lished as valid and reliable for the assessment of PS
during single-limb positions and eyes-closed condi-
tions.12 The 5-second protocol has also been used
recently in studies investigating the effects of acute
ankle sprain14 and the effect of rear-foot orthotics16
on PS. The order of testing conditions was counter-
balanced to control for any learned effect and
fatigue. One practice trial prior to testing was allowed
to familiarize participants with the procedure. The
standard deviation of the ML and AP GRF from 3
successful trials of each condition and position were
averaged and used for data analysis.12 The average of
3 instead of 4 trials had to be used for data analysis
because all of the participants were not able to
complete 4 successful trials. For those participants
that did complete 4 successful trials, 1 trial was
randomly removed and the remaining 3 were aver-
aged.
Data Analysis
Intraclass correlation coefficients (ICC3,1) were cal-
culated to evaluate the intratester reliability for the
FV measurements. Prior to combining males and
females into 1 group, separate 1-way multivariate
analysis of variances (MANOVAs) were performed to
investigate gender differences. Two 3-way mixed-
model analysis of variances (ANOVAs), with 1
between-subject (group) factor and 2 within-subject
(foot, eyes) factors, were used to investigate differ-
RESEARCH
ences in mean AP and ML PS scores. The signifi-
cance level for all statistical analysis was set at P⬍.05.
Partial eta squares (␩2) were computed to facilitate
interpretation of the clinical meaningfulness of the
results. The partial ␩2s were interpreted based on
Cohen4 recommendations of small (0.01), medium
(0.06), and large (0.14) effects.
REPORT
RESULTS
Intraclass Correlations
ICCs for the right and left foot FV measurements
were 0.942 and 0.958, respectively. Both ICCs suggest
good intratester reliability between forefoot measure-
ment trials for each foot.
81
 0.065 MFV Anteroposterior Postural Stability
LFV
0.060 No significant interactions were revealed (P⬎.05)
(Table 2). A significant within-subject main effect for
Force/Body Mass

0.055 eyes-open versus eyes-closed conditions (F1,30 =

71.317, P⬍.001, partial ␩2 = 0.704) revealed PS scores
0.050 in both the MFV and LFV groups to be significantly
higher during eyes-closed versus eyes-open condi-
0.045 tions. A significant between-subject main effect for
group (F1,30 = 5.956, P = .021, partial ␩2 = 0.166)
0.040 revealed PS scores of the MFV group to be signifi-
cantly higher than those of the LFV group (Figure
0.035 1). No significant within-subject foot main effect was
Right Left revealed (P⬎.05) (Figure 1).

FIGURE 1. Group-by-foot anteroposterior postural stability (mean ±

SE). The more forefoot varus (MFV) group exhibited significantly Mediolateral Postural Stability
greater postural stability scores compared to the less forefoot varus
(LFV) group (P⬍.05). No significant difference was found between No significant interactions were revealed (P⬎.05)
feet.
(Table 2). A significant within-subject main effect for
eyes-open versus eyes-closed conditions (F1,30 =
0.085 MFV 92.601, P⬍.001, partial ␩2 = 0.755) revealed PS scores
LFV
to be significantly higher in both the MFV and LFV
0.080
groups during eyes-closed compared to eyes-open
conditions. Although PS scores were higher in the
Force/Body Mass

0.075
MFV group compared to the LFV group, the differ-
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ences were not statistically significant (F1,30 = 3.152 ,

0.070
P = .086, partial ␩2 = 0.095) (Figure 2). No significant
within-subject foot main effect (P⬎.05) was revealed
0.065
(Figure 2).
Copyright © 2004 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

0.060
DISCUSSION
0.055
Right Left
Before discussing the potential role of FV in the
differences between the MFV and LFV groups in the
FIGURE 2. Group-by-foot mediolateral postural stability (mean ±
current study, the differences in the age (mean age ±
SE). Postural stability scores of the more forefoot varus (MFV) group
were greater than those of the less forefoot varus (LFV) group, SD for MFV, 29.0 ± 8.4 years; mean age ± SD for LFV,
however, the differences were not statistically significant (P⬎.05). 25.8 ± 6.0 years) and body weight (mean body weight
No significant difference was found between feet. ± SD for MFV, 654.0 ± 97.4 N; mean body weight ±
Journal of Orthopaedic & Sports Physical Therapy®

SD for LFV, 734.0 ± 193.6 N) between groups should

Gender Differences
No significant differences between males and fe-
males were revealed for AP or ML PS during either
eyes-open (P = .082) or eyes-closed (P = .130)
conditions. Genders were therefore combined in the
MFV and LFV groups.
be addressed. Although the ages of the 2 groups were
somewhat different, previous studies have only re-
TABLE 2. More forefoot varus (MFV) group and less forefoot
varus (LFV) group postural stability scores. Data are the average
(±SD) of the standard deviation of the ground reaction forces
(normalized to body mass, F/BM) for 3 trials.
Conditions MFV LFV

Foot Measurements Eyes open

Right limb AP 0.038 ± 0.011 0.034 ± 0.008
Means, standard deviations, and ranges of the FV, Right limb ML 0.049 ± 0.016 0.044 ± 0.008
Left limb AP 0.041 ± 0.017 0.033 ± 0.008
navicular drop, and standing rearfoot angle measures
Left limb ML 0.048 ± 0.018 0.042 ± 0.008
are reported in Table 1. In addition to the increased Eyes closed
degree of FV, which was used to classify the MFV and Right limb AP 0.075 ± 0.031 0.059 ± 0.019
LFV groups, the MFV group also exhibited compensa- Right limb ML 0.104 ± 0.048 0.083 ± 0.023
tory STJ and MTJ mobility as evidenced by the Left limb AP 0.072 ± 0.021 0.055 ± 0.012
Left limb ML 0.099 ± 0.031 0.081 ± 0.024
greater navicular drop and standing rearfoot angle
measures compared to the LFV group. Abbreviations: AP, anteroposterior; ML, mediolateral.

82 J Orthop Sports Phys Ther • Volume 34 • Number 2 • February 2004

 vealed age-related PS changes on the low (less than
14 years of age) and high (greater than 50 years of
age) ends of the age spectrum33; therefore, age-
related changes in PS would not be expected in the
current study. Similarly, the difference in body weight
between groups was accounted for by the normaliza-
tion of the GRFs to BM and, therefore, would not be
expected to influence the between-group differences
in the current study.
The statistically significant higher AP PS scores in
the MFV group compared to the LFV group suggest
that an individual with a greater amount of FV may
have less sagittal-plane stability than those with a
lesser amount of FV. The MFV group also demon-
strated greater ML PS scores, suggesting less frontal-
plane stability as well; however, the difference was not
statistically significant. Based on the recommenda-
tions of Cohen4 for interpreting partial ␩2, the effect
sizes for AP and ML PS were large and medium,
respectively, suggesting that the differences between
the groups may be clinically relevant.
There are several factors related to increased FV
that may adversely affect PS. Stability at the STJ is
provided by osseous and soft tissue supports. Osseous
support is provided by contacts between the talus and
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calcaneus, while soft tissue support is provided by
muscles of the deep posterior compartment of the
shank and the medial ankle/foot ligaments.6 Al-
though the majority of STJ stability is normally
Copyright © 2004 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
provided by the osseous supports, if FV is excessive,
the increased mobility of the foot joints results in
decreased joint congruity.6,31 The loss of joint con-
gruity may require increased muscle activity and stress
on the medial ligamentous structures to maintain
stability.6,18,23,31 The increased stress placed upon the
muscular and ligamentous structures may provide less
stability and may contribute to the impaired PS
revealed in the MFV group. In addition to increased
Journal of Orthopaedic & Sports Physical Therapy®
mobility at the STJ, excessive mobility may also occur
at the MTJ to compensate for the increased FV.31
Increased mobility at the MTJ and STJ in the current
study may be evidenced by the greater navicular drop
measures and weight-bearing rearfoot valgus angles in
the MFV group (Table 1).
Hypermobility of the STJ and MTJ may be detri-
mental to PS during single-limb stance because even
static standing requires constant neurological and
muscular adjustments and counter adjustments in an
attempt to contain the center of gravity (COG) line
within the base of support.38 A lateral shift or
posterior shift in the COG line will result in supina-
tion of the foot, while a medial or anterior shift will
result in pronation.31 The presence of excessive
mobility at the STJ and MTJ and decreased osseous
stability, therefore, may result in an unstable base,
upon which the muscular corrections to
disequilibrium are made.
J Orthop Sports Phys Ther • Volume 34 • Number 2 • February 2004
A somewhat unexpected finding of the study was
the statistically significant difference between the LFV
and MFV groups in the AP but not ML direction.
Because FV is primarily a frontal-plane foot posture,
the largest between-group difference was expected in
frontal-plane stability. There are several factors, how-
ever, that may have played a role in the statistically
significant AP but not ML differences between the
MFV and LFV groups. The number of subjects in the
study may have limited the power of the study to
reveal statistically significant ML differences. A sec-
ond factor may be related to the triplanar orientation
of the STJ and MTJ axes, which may result in
compensatory motion and hypermobility in all 3
cardinal planes during weight bearing, even in the
presence of a primarily frontal-plane foot posture,
such as FV.31 A final factor may be related to the
dimensions of the foot. During single-limb stance, the
stability limits are the length and width of the foot in
the AP and ML directions, respectively. Because the
length of the foot is much greater than the width, it
may be possible for greater instability to exist in the
AP direction before balance is lost. The width of the
foot may not offer enough margin of error before
balance is lost to distinguish between groups. It is
also possible that individuals compensate with in-
creased sagittal-plane motion during single-limb
stance due to the greater length of the foot versus its
width, and because the muscles controlling AP mo-
tion are stronger than those controlling ML motion.
It should be noted, however, that although signifi-
cantly greater PS scores were revealed in the MFV,
there are several questions both with respect to PS
and injury risk, as well as PS and foot structure that
require further investigation. Although Tropp et al36
and Mcguine et al26 have revealed impaired PS as a
risk factor for sustaining acute injury, no threshold
for what should be considered ‘‘impaired’’ stability
has been identified. Furthermore, Beynnon et al3
failed to show a significant relationship between
maximum AP postural sway angle and risk of ankle
injury.
RESEARCH
A related question involves the degree of FV
necessary to increase the magnitude of PS. Although
participants in the current study with at least 7° FV
had significantly poorer PS compared to those with
less than 7° of FV, subjects with pes planus foot
structures in the Hertel et al17study were not signifi-
cantly less stable compared with subjects with rectus
foot structures. Several reasons may exist for the
REPORT
inconsistency between the results of the current study
and the Hertel et al17 study. First, 2 different param-
eters were used to quantify PS. In a study investigat-
ing different COP parameters, Friden et al8 revealed
both significant and nonsignificant results using the
same data depending upon the parameter used to
represent stability. Hertel et al17 measured PS using
COP excursion area and average excursion
83
 velocity. The current study utilized force measures,
which are representative of reactions to accelerations
of the center of mass. Second, it has been suggested
that the rate of change of position, or velocity, may
be more representative of stability than changes in
position alone.10,11,28,33 Geurts et al10 and Goldie et
al11 have suggested that the postural control system
may function more to reduce the velocity and accel-
eration of the body mass than absolute displacement.
Therefore, increased excursion alone may not always
be indicative of instability.28 The inclusion of a
time-dependent variable, such as a root-mean-square
COP velocity or force measures, may be more repre-
sentative of stability. Although the Hertel et al17 study
did include a COP velocity parameter, it was an
average excursion velocity (excursion/total time),
which may not represent the changes that occurred
throughout the trial.28 Also, the Hertel et al17 study
used a resultant COP and did not distinguish be-
tween AP and ML directions, which also may be
important.28 This last point may be further empha-
sized by the statistically significant AP but not ML PS
differences between groups in the current study. It is
possible that a resultant COP measure may have
masked this difference.
Another factor contributing to the differing results
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may have been the degree of FV present in the
subjects. There may be a threshold of FV that must
be exceeded before a lesser ability to maintain
single-limb balance becomes evident. It is important
to note that although the current study revealed a
Copyright © 2004 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
significant difference in a group with at least 7° of FV
versus a group with less than 7° of FV, it does not
necessarily mean that 7° is that threshold. Further
study to investigate the degree of FV at which PS
becomes affected is warranted.
Another consideration is the possibility of the
presence of other variables or foot postures that may
also deleteriously affect PS. The presence of other
foot postures such as rearfoot varus, a plantar-flexed
Journal of Orthopaedic & Sports Physical Therapy®
fifth ray, or ankle joint equinus have also been
associated with increased pronation during weight
bearing.31 Although the presence of 1 or more of the
previously mentioned foot postures may also deleteri-
ously affect PS, they were not the focus of the current
investigation. However, because STJ and MTJ com-
pensation for all of the above postures is increased
pronation, they may be hypothesized to have similar
effects on PS, as does the presence of increased FV.
CONCLUSION
The results of this study suggest poorer PS in the
AP direction in subjects with greater than or equal to
7° of FV compared to subjects with less than 7° of FV.
The increased mobility required at the STJ and MTJ
to compensate for the increased FV may result in a
less stable base of support upon which to balance.
Further research investigating the effect of foot
84
structure on PS is needed before any generalizations
regarding a potential increased risk of sustaining
acute injury can be made. Other areas of research
that need to be studied further include the effect of
shoes or other forms of support on PS in persons
with increased amount of FV.
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5. Cornwall MW, Murrell P. Postural sway following
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