Normative Value of Footline Test in Physiotherapty Students. A Cross-Sectional Study

Bachelor Thesis, 2020

22 Pages

Siyona Dushing (Author)




1.1 Introduction
1.2 Need for study
1.3 Aim
1.4 objectives
1.5 Research question

2.1 Review of Literature

3.1 Material and Methods
3.2 Procedure
3.3 Measurement

3.5 result

5.1 Discussion
5.2 Limitations
5.3 Recommendations
5.4 Conclusion
5.5 References



I take this wonderful opportunity to thank all the “Hands” who have joined together to make this project successful.

It is a proud privilege to express my overwhelming sense of gratitude to my esteemed, learned teacher and Guide DR DEEPAK ANAP, PROFESSOR, DVVPF ’ S COLLEGE OF PHYSIOTHERAPY,

AHMEDNAGAR, for his initiation, blessings, able guidance, constant encouragement and continuous supervision, without which it would not have been possible for me to take up this task. His academic insight, deep personal interest in patient care are a source of inspiration to all those who have had the privilege to work with him. His constant endeavour to strive for the best is a source of inspiration to all of us.

I thank all teachers of COPT, who immensely helped and rendered their valuable advice, precious time, knowledge and relevant information regarding my study.

Also, I would like to appreciate the help of my classmates of Fourth B.P.Th and My Junior Friends, who provided me a useful suggestion for the successful completion of my study.

I would like to thank my study participants without whom this project could not have been possible Last but not the least I bow down to my parents whose blessings, love, affection, and encouragement have always been a catalyst in all walks of my life and without whose support, I would not have been where I am today.



1. FLT: Foot line test
2. MTP: Metatarsophalangeal joint
3. BMI: Body mass index
4. RA: rheumatoid arthritis
5. PFPS: patellofemoral pain syndrome
6. ICC: interclass correlation coefficients



A large variety of methods have been developed to classify the foot based on structure and alignment. Foot line test is one among them use to find out the influence of load carriage and musculoskeletal injuries may be associated with an increased vertical ground reaction force. It helps to understand that the position of the medial prominence of the navicular, in a Mediolateral direction, would provide additional relevant information describing the amount of pronation. the aim of this study is to find out the normative values of foot line test in physiotherapy students and to find out its correlation with BMI and correlation between foot length and height of physiotherapy students. METHODS: It’s a cross-sectional study in which 60 subjects are included with free of a foot injury and musculoskeletal problem to lower limb. PROCEDURE: With participants in the standing position the first MTP joint and navicular tuberosity was marked on the paper. Foot line test was drawn in MTP joint and navicular tuberosity. RESULT: Results shows that normative values for the right foot were ranging from -5 to +8 while that for the left foot was ranging from 0 to 5 in males. The normative values for the right foot were ranging -3 to +3 while that for the left foot was ranging from 0 to 4 in females. The correlation between BMI and right foot was positively correlated for the left foot it was negatively correlated. Correlation between foot length and height is positively correlated. CONCLUSION: The study result shows that the normative value of males is significant with the right foot which is found to be ranging from -5 to 8 and for females ranging from 0 to 5. For left foot correlation of BMI is negatively correlate while normative values for males is ranging from -3 to 4 and for females, its 0 to 4.correlation of foot length and person height is positively correlated and correlation of BMI is positively correlated with the right foot, negatively correlate with the left foot.

KEYWORDS: Foot line test, Metatarsophalangeal joint, Body mass index, Flat foot



The feet are the foundation of our bodies, and they assist us in some of the most basic functions of living. Through activities of living, the feet can change structurally over time, causing a misalignment of the feet such as flat foot, pes planus and cavus. In addition, the feet are susceptible to infections—including bacterial, fungal, and viral infections. Systemic illnesses can also affect and change the feet, which can limit daily activity and quality of life.

Foot assessment is a common approach in clinical practice for classifying foot type with a view to identifying possible etiological factors relating to injury and prescribing therapeutic interventions.1 This assessment forms the basis of foot evaluation, their structural alignment, or position of the foot, is used to infer characteristics of dynamic foot function, and theoretically establish injury mechanisms leading to pathology. This model of foot function is primarily derived from the work of Root et al who proposed static assessment measures to enable clinicians to identify deviations from an ideological ‘normal’ foot2.

Foot line test is a simple technique and uses less instrumentation to assess for foot alignment. It gives variable information regarding foot position.

There is a large number of tests available but the exact relationship between foot morphology and injury development is not known. Many authors found the position of the medial prominence of the navicular, in a mediolateral direction, would provide additional relevant information describing the amount of pronation. However, there is no such test found to measure the position of the medial prominence of the navicular in a mediolateral direction exists.

To the author's knowledge literature is lacking on the normative value of FLT as the structure of foot varies from person to person and also from countries to countries we must know the values for our population This study plays an important role in calculating the normative values hence this study was undertaken with an aim of to find out the normative value of FLT and correlation between foot line and BMI also between foot length and height.


1. Christoffer Brush (2007) conducted a study on "Reliability and Normative Values of the Foot Line Test: A Technique to Assess Foot Posture". One hundred thirty subjects with a mean foot size 44 (41-50 European size) participated. Two examiners, blinded to each other's measurements, measured the right foot of the subjects twice and the left foot once. The position of the most medial aspect of the navicular in the Mediolateral direction was projected vertically onto a piece of paper placed under the subject's foot and compared to the position of the forefoot and hindfoot to obtain the FLT value. They concluded that FLT is a reproducible technique to assess foot posture.
2. Redmond AC(2005) conducted a study on "The foot posture index: user guide and manual". He assesses the foot in 6 different ways. Assessment done was talar head palpation, supra- infra malleolar curve curvature, calcaneal position, bulging of Talonavicular region, the height of medial longitudinal arch, abduction and adduction of the foot. He concluded that whether the foot is pronated, supinated or neutral in position.
3. George Prudden conducted a study on "Biomechanical Assessment of Foot and Ankle", they studied to find out three-foot types; high arch, normal neutral foot and flat foot, in which they measure the medial longitudinal arch which is in between 1310 to 1520. They also performed the navicular drop test, forefoot angle and ROM and arch height index.
4. George S Murley (2009) conducted a study on “A protocol for classifying normal-and flat-arched foot posture for research studies using clinical and radiographic measurements”. The foot posture of ninety-one asymptomatic young adults was assessed using two clinical measurements (normalized navicular height and arch index) and four radiological measurements taken from anteroposterior and lateral x-ray’s (talus-second metatarsal angle, Talonavicular coverage angle, calcaneal inclination angle and calcaneal-first metatarsal angle). Normative foot posture values were taken from the literature and used to recruit participants with normal arched feet. They concluded that this foot screening protocol provides a coherent strategy for researcher planning to recruit participants with normal- and flat-arched feet. However, further research is required to determine whether foot posture variations in the sagittal, transverse or both planes provide the best descriptor of the flat foot.
5. George S Murley conducted a study on “To develop a foot screening protocol to distinguish between participants with normal- and flat-arched feet” who would then subsequently be recruited into a series of laboratory-based gait studies. There are Thirty-two participants were recruited to the normal-arched study, 31 qualified for the flat-arched study and 28 participants were classified as having neither normal-or flat-arched feet and were not suitable for either study. The values obtained from the two clinical and four radiological measurements established two clearly defined foot posture groups. Correlations among clinical and radiological measures were significant (p < 0.05) and ranged from r = 0.24 to 0.70. Interestingly, the clinical measures were more strongly associated with the radiographic angles obtained from the lateral view
6. Narita Bhattacharjee, MonaliGoswami conducted study on ‘’Footprint analysis and prevalence of flatfoot’’ The study was carried out among 160 pre-school children (80 boys and 80 girls), aged 3 to 6 years The foot morphology measurements conducted on the footprints were: Foot length, Ball of foot length, Foot breadth diagonal, Heel breadth, etc. are measured and the conclusion that the bilateral asymmetry is not present among the studied participants. Boys and girls foot significantly differ for foot breadth Morphological horizontal measurements of the foot are higher among the boys than girls and it increases with each age-group Significant difference exists between the foot dimensions of underweight, healthy and overweight participants The results thus provide a podium for intricate studies in the future. With the identification of flatfoot, the prognosis can be provided to families and societies for the rectification of flatfoot among the children at an early age.
7. Armin Abtahian, Sina Farzan conducted study on’’ the prevalence of flatfoot in high school children.’’ the study was done on 400 high school students were randomly selected individuals who do not have foot arch while standing are considered as flatfeet and those for whom jack test becomes negative, who have the lack of flatness of feet arch while raising hallux, are considered as hard feet. They conclude that probably the lower rate of prevalence in the study is due to the higher ages of individuals and this can indicate that with the increase of age, the prevalence of flatfeet is reduced and this suggests the hypothesis that most of flatfeet cases in childhood are treated without any therapy as the individual grows up.
8. Mr Qureshi Haroon Rasheed, Dr Sachin.B.Pagare conducted study on ‘’ Effect of Flat Foot Deformity on Selected Physical Fitness Components in school going children’’ subject were selected purposively from a different school, ranged from 9 to 14 years of age. the study was done n 40 school-going children in which 20 students with foot pathology and 20 students have a normal foot, for that Footprint wet test was used to detect flat foot deformity. Conclude that the mean score for bow legs was 3.6 and for knock knee 4.4 was reported. In the examined subject, it was found that 20% of the subjects had a postural deformity.
9. Michael Khazzam, Jason T. Long, Richard M. Marks, Gerald F. Harris they conducted a study on’’ Kinematic Changes of the Foot and Ankle in Patients with Systemic Rheumatoid Arthritis and Forefoot Deformity''. The purpose of this study was to examine specific changes in segmental foot motion in patients with RA as compared to persons without foot/ankle pathology. This was a cross-sectional, descriptive study consisting of 22 preoperative adult patients (29 feet) diagnosed with RA and 25 adult patients with no known foot pathologyComparison of temporal parameters between RA and Control subjects showed significant differences overall walking speed was reduced from 1.12 m/s to 0.89 m/s. RA walking speed was found to be 80% of the Control walking speed. Stance time in the RA patients was prolonged from 62% to 66%, stride length was shortened from 1.28 m to 0.96 m, and cadence was increased from 104.4 steps/min to 104.8 steps/min. Differences in walking speed, stance duration, and stride length were statistically significant.
10. David I. Somers, lady A. Hanso, Connie M. Kedzierski, Kristen I. Nestor, Krista Y. Quinlivan, they conducted a study on ‘’The Influence of Experience on the Reliability of Goniometric and Visual Measurement of Forefoot Position.’’. This measurement is also frequently made by visual estimation. The purpose of this investigation was to directly examine the reliability of goniometric and visual estimation of forefoot position measurements when experienced, and inexperienced testers perform the evaluation n. Two clinicians (2 10 years experience) and two physical therapy students were recruited as testers. Ten subjects (20-3 1 years old), free from pathology, were measured. Each foot was evaluated twice with the goniometer and twice with visual estimation by each tester. Intraclass correlation coefficients (ICC) and coefficients of variation method error were used as estimates of reliability. There was no dramatic difference in the intratester or intertester reliability between experienced and inexperienced testers, regardless of the evaluation used. Estimates of intratester reliability (ICC 2, I), when using the goniometer, ranged from 0.08 to 0.78 for the experienced examiners and from 0.16 to 0.65 for the inexperienced examiners. When using visual estimation, ICC (2, 1) values ranged from 0.51 to 0.76 for the experienced examiners and 0.53 to 0.57 for the inexperienced examiners. The estimate of intertester reliability flCC (2,2)l for the goniometer was 0.38 for the experienced examiners and 0.42 for the inexperienced examiners. When using visual estimation, ICC (2,2) values were 0.81 for the experienced examiners and 0.72 for the inexperienced examiners. Although experience does not appear to influence forefoot position measurements, of the two evaluation techniques, the visual estimation may be more reliable.


Excerpt out of 22 pages


Normative Value of Footline Test in Physiotherapty Students. A Cross-Sectional Study
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ISBN (eBook)
ISBN (Book)
Foot line test, Physiotherapy, Foot research
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Siyona Dushing (Author)Dr. Deepak Anap (Author), 2020, Normative Value of Footline Test in Physiotherapty Students. A Cross-Sectional Study, Munich, GRIN Verlag,


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