Measurement of the medial longitudinal arch in sudanese and its effect by gender and weight. new

1. NATIONAL UNIVERSITY- SUDAN
FACULTY OF GRADUATE STUDIES AND SCIENTIFIC RESEARCH
Measurement of the medial longitudinal arch in Sudanese and its effect by
gender and weight
A Thesis Submitted to the National University-Sudan for Partial Fulfillment of
M.Sc. in Clinical Human Anatomy
By:
Almawsiley Alsayed Alnour
MBBS
Supervisor:
Dr. Randa A. Hadi Diab
Assistant Professor of Anatomy
February 2019

3. Table of content
Table title Page No.
Dedication III
Acknowledgment IV
Abstract (in English) V
Abstract (in Arabic) VII
Content VIII
Abbreviation 0
Chapter one
Introduction 1
Objective 1
Justification 2
Hypothesis 2
Timeline 3
Chapter Two
Literature review 4
Chapter three

4. Material and methods 17
Chapter four
Results 22
Chapter five
Discussion 35
Chapter six
Conclusion 38
Recommendation 39
Chapter seven
References 40

5. Dedication
Give thanks to my mother, father and brothers, my God protect them and
care for them. All those who helped me in the search and stood with me and
thanks to God before and after. Allah knows about our knowledge, and we
called him to benefit by what we taught and increased in our knowledge and
concluded with His Seal of Happiness.

6. ACKNOWLEDGEMENT
First of all I would like to thank Dr. Randa A. Hadi for her kindness and for
supervising me on my thesis. Also I thank Professor Qurashi Mohammed Ali. Mr.
Kamal’s office was always open whenever I encountered a problem or had a
question about my research or my writing. I would also like to thank the experts
who participated in the validation of this research project Dr.MOHAMED ESSA of
the experts who participated without their participation and emotional
involvement, the verification survey could not be conducted successfully. I would
also like to admit the Department of Medical Science of the Department of
Anatomy as the second reader of this dissertation, and I am very grateful for its
very valuable comments on this thesis.
Finally, I would like to express my deep gratitude to my parents for providing me
with constant support and encouragement throughout my years of study and during
the research process and writing this letter. This achievement would not have been
possible.
Thank you

7. Abstract
The arch of the foot is important for the transfer of force and shock absorption in
movement and jump and even stand. The foot has three arcs. The inner and outer
lateral arc and the single crossbow.
Each brace has a bone, musculoskeletal, ligament, and blood-feeding component.
When athletes are specific, the foot brace is important for running, stopping, and
absorbing shock. The current literature is not clear regarding the best method of
determining medial longitudinal arch (MLA) height.
Differences in MLA height can significantly alter lower extremity biomechanics;
therefore, an accurate and reproducible assessment of arch height is essential for
clinical evaluation and future research. The goal of this project was to determine
the reliability of common arch height measurement techniques. Methods: Foot
length, truncated foot length, navicular height, and dorsal height, were obtained
from healthy volunteers
In the study, I was also collected information of weight, height, height of the inner
bow, foot length, and length of the foot circumference, gender or gender for
Sudanese society members and analyzed the data analysis program)SPSS). The
result was the effect of the inner longitudinal arch of the foot was clear with
weight, the type and length where the arches of the men were found slightly higher
than the women and the foot length also longer in men.
The arch of the foot is the real carrier of weight on the ground and bears the total
weight of the body of the two-role movement cycle
The foot brace of the weight-bearing is applied to the movement of the individual
and shock absorption and loss of the arch of the foot leads to the interruption of
blood reaching the foot. All children born with flat foot that become arched. Above
it are two types of flat foot, hereditary and acquired with shocks and weight gain.

8. ‫البحث‬ ‫مستخلص‬
‫اقو‬ ‫تعد‬‫ا‬‫الحركة‬ ‫في‬ ‫الصدمات‬ ‫وامتصاص‬ ‫القوة‬ ‫لنقل‬ ‫مهمه‬ ‫القدم‬ ‫س‬‫وحت‬ ‫والقفز‬‫ى‬‫ثالث‬ ‫بالقدم‬ ‫يوجد‬ . ‫الوقوف‬
‫اقو‬‫ا‬‫وحيد‬ ‫عرضي‬ ‫وقوس‬ ‫والخارجي‬ ‫الداخلي‬ ‫الطولي‬ ‫.القوس‬ ‫س‬.
‫ل‬ ‫مهم‬ ‫القدم‬ ‫قوس‬ ‫يعد‬ ‫تحديدا‬ ‫الرياضين‬ ‫.عند‬ ‫دموية‬ ‫وتغذيه‬ ‫واربطة‬ ‫وعضلي‬ ‫عظمي‬ ‫مكون‬ ‫قوس‬ ‫لكل‬‫ل‬‫ركض‬
‫الصدمات‬ ‫وامتصاص‬ ‫والتوقف‬
‫جمعنا‬ ‫الدراسة‬ ‫.في‬ ‫للفرد‬ ‫والنوع‬ ‫والطول‬ ‫بالوزن‬ ‫القدم‬ ‫قوس‬ ‫يتاثر‬‫وارتفاع‬ ‫والطول‬ ‫الوزن‬ ‫عن‬ ‫معلومات‬
‫القدم‬ ‫وطول‬ ‫الداخلي‬ ‫القوس‬‫القدم‬ ‫محيط‬ ‫وطول‬.‫والجنس‬‫تحليل‬ ‫ببرنامج‬ ‫وحللت‬ ‫السوداني‬ ‫المجتمع‬ ‫الفراد‬
.‫البيانات‬
‫تاثر‬ ‫النتيجة‬ ‫فكانت‬‫بالوزن‬ ‫للقدم‬ ‫الداخلي‬ ‫الطولي‬ ‫القدم‬ ‫قوس‬,‫واضحة‬..‫م‬‫ع‬‫حيث‬ ‫والطول‬ ‫النوع‬ ‫مع‬ ‫بسيط‬ ‫تغير‬
‫اعلي‬ ‫الرجال‬ ‫اقواس‬ ‫وجدت‬‫م‬ ‫بقليل‬‫النساء‬ ‫ن‬,‫و‬‫عند‬ ‫اطول‬ ‫ايضا‬ ‫القدم‬ ‫طول‬‫الرجال‬.
‫االرض‬ ‫علي‬ ‫للوزن‬ ‫الحقيقي‬ ‫الناقل‬ ‫القدم‬ ‫قوس‬ ‫يعد‬.‫الحركة‬ ‫دوره‬ ‫اثنا‬ ‫لجسم‬ ‫الكلي‬ ‫الوزن‬ ‫ويتحمل‬
‫الي‬ ‫يودي‬ ‫القدم‬ ‫قوس‬ ‫وخسران‬ ‫الصدمات‬ ‫وامتصاص‬ ‫الفرد‬ ‫حركه‬ ‫علي‬ ‫يوثر‬ ‫الزايد‬ ‫للوزن‬ ‫القدم‬ ‫قوس‬ ‫تعرض‬
.‫للقدم‬ ‫الدم‬ ‫وصول‬ ‫انقطاع‬‫كل‬‫القدم‬ ‫شكل‬ ‫يتغير‬ ‫السن‬ ‫في‬ ‫التقدم‬ ‫مع‬ ‫مسطح‬ ‫بقدم‬ ‫يولدون‬ ‫االطفال‬‫يكون‬ ‫علية‬
‫وراثي‬ ‫المسطحة‬ ‫القدم‬ ‫من‬ ‫نوعان‬ ‫هناك‬.‫ا‬‫الزايد‬ ‫والوزن‬ ‫الصدمات‬ ‫مع‬ ‫ومكتسب‬.

9. Abbreviations
 A & P—anatomy and physiology
 AMA—against medical advice
 AP—apical pulse
 approx.—approximately
 aq—aqueous
 ARDS—acute respiratory distress syndrome
 AS—left ear
 ASA—aspirin
 bil, bilateral—both sides
 BK—below knee
 BKA—below the knee amputation
 Dx—diagnosis
 Fx—fracture
 ft—foot
 ht—height
 Hx—history
 MRI—magnetic resonance imagery
 MS—morphine sulfate, multiple sclerosis
 MVA—motor vehicle accident
 OPD—outpatient department
 OR—operating room
 ord—orderly
 ORTH—orthopedics
 ortho—correct, right (bones)
 MLA –MEDIAL LONGTUDNAL ARCH
 CF-CERCUMFRANCE OF FOOT
 w/c—wheelchair
 WNL—within normal limits
 wt—weight
 y/o—year(s) old
 lt—left

10.  IV—intravenous
Chapter One
1 Introduction
1.1 Background
1.2 Objective
1.2.1 General objective
1.2.2 Specific objective
1.3 Justification
1.4 Hypothesis
1.5 Timeline

11. 1 Introduction:
1.1 Background:
The medial longitudinal arch (MLA) height of the foot is associated with various
injuries, diseases, and disability of lower extremities, including anterior cruciate
ligament injuries (1, 2),
medial tibial stress syndrome
The foot is one of the most important interaction parts of the body with the ground
in upright posture. The structure of the foot is critical to affect the load absorbed by
the bones in the foot and the force transferred to proximal components of lower
extremity when performing exercise with weight bearing on foot. Medial
longitudinal arch is the largest arch of the foot and the most important arch of the
foot from a clinical point of view. The bony shape, the ligaments of the foot, and
the muscular tones all play an important role in supporting the arches plantar
fasciitis(3)
rheumatoid arthritis(4)
, and cavus foot deformity(5)
The feet are flexible structures of bones, joints, muscles, and soft tissues that let us
stand upright and perform activities like walking, running, and jumping. The feet
are divided into three sections:
 The forefoot contains the five toes (phalanges) and the five longer bones
(metatarsals).
 The midfoot is a pyramid-like collection of bones that form the arches of the
feet. These include the three cuneiform bones, the cuboid bone, and the
navicular bone.
 The hindfoot forms the heel and ankle. The talus bone supports the leg bones
(tibia and fibula), forming the ankle. The calcaneus (heel bone) is the largest
bone in the foot.

12. Muscles, tendons, and ligaments run along the surfaces of the feet, allowing the
complex movements needed for motion and balance. The Achilles tendon connects
the heel to the calf muscle and is essential for running, jumping, and standing on
the toes.
The foot has three arches: two longitudinal (medial and lateral) arches
and one anterior transverse arch. They are formed by the tarsal and metatarsal
bones, and supported by ligaments and tendons in the foot.
Their shape allows them to act in the same way as a spring, bearing the weight of
the body and absorbing the shock produced during locomotion. The flexibility
conferred to the foot by these arches facilitates functions such as walking and
running.
In this article, we examine the anatomy of the arches of the foot – their bony and
ligamentous structure, the supporting tendons, and their clinical correlations.
There are two longitudinal arches in the foot – the medial and lateral arches. They
are formed between the tarsal bones and the proximal end of the metatarsals.
Medial Arch
The medial arch is the higher of the two longitudinal arches. It is formed by the
calcaneus, talus, navicular, three cuneiforms and first three metatarsal bones It is
supported by The MLA has an important role as shock absorber for mechanical
shock and load during walking and for body weight during static movement. It has
a protective role not only in foot ankle joints but also in osteoarthritis of the knee
and hip and in soft tissue injuries near the proximal lower extremities (16)
 Muscular support: The tibialis posterior muscle (TPM) originates from the
interosseous membrane, the posterolateral tibia, and the posteromedial
fibula; passes through the rear of medial malleolus; and connects with the

13. lower inner surface of the navicular, cuneiform, and cuboid bones and the
base of the 2–5 metatarsal bones. It serves as a functional factor for the
MLA and has a role in inversion and plantar flexion of the foot and elevation
of the medial longitudinal arch.(27)
Although the plantar intrinsic foot
muscles and the extrinsic foot muscles are widely thought to be associated
with formation of the foot arch, electrical activity of these muscles is
undetectable when weight is applied on the knee in a sitting position. The
TPM is unable to sufficiently compensate for insufficiency of the arch under
sectioning of the spring ligament complex. Therefore, the spring ligament
complex is considered the major stabilizer of the arch and not the TPM(10)
 Ligamentous support: Plantar ligaments (in particular the long plantar,
short plantar and plantar calcaneonavicular ligaments), medial ligament of
the ankle joint.
 Bony support: Shape of the bones of the arch.
 Other: Plantar aponeurosis.
Lateral Arch
The lateral arch is the flatter of the two longitudinal arches, and lies on the ground
in the standing position. It is formed by the calcaneus, cuboid and 4th and 5th
metatarsal bones. It is supported by:
 Muscular support: Fibularis longus, flexor digitorum longus, and the
intrinsic foot muscles. Moreover, toe flexor strength has been reported to be
associated with the foot arch, and it is recognized that short foot exercises
for intrinsic muscles of the foot to improve the MLA in flatfoot result in
improved results in the arch height index(11)
 Ligamentous support: Plantar ligaments (in particular the long plantar,
short plantar and plantar calcaneonavicular ligaments).
 Bony support: Shape of the bones of the arch.
 Other: Plantar aponeurosis.

14. Fig 1 – Supporting structures of the foot arches.
Transverse Arch
The transverse arch is located in the coronal plane of the foot. It is formed by the
metatarsal bases, the cuboid and the three cuneiform bones. It has:
 Muscular support: Fibularis longus and tibialis posterior.
 Ligamentous support: Plantar ligaments (in particular the long plantar,
short plantar and plantar calcaneonavicular ligaments) and deep transverse
metatarsal ligaments.
 Other support: Plantar aponeurosis.
 Bony support: The wedged shape of the bones of the arch.
Clinical Relevance – Pes Cavus
Pes cavus is a foot condition characterised by an unusually high medial
longitudinal arch. It can appear in early life and become symptomatic with
increasing age. Due to the higher arch, the ability to shock absorb during walking
is diminished and an increased degree of stress is placed on the ball and heel of the
foot.
Consequently, symptoms will generally include pain in the foot, which can radiate
to the ankle, leg, thigh and hip. This pain is transmitted up the lower limb from the

15. foot due to the unusually high stress placed on the hindfoot during the heel strike
of the gait cycle
Causes of pes cavus can be idiopathic, hereditary, due to an underlying congenital
foot problem such as club foot, or secondary to neuromuscular damage such as in
poliomyelitis.
The condition is generally managed by supporting the foot through the use of
special shoes or sole cushioning inserts. Reducing the amount of weight the foot
has to bear, via overall weight loss can also improve the symptoms. MLA height in
children has been reported to be correlated with overweight, obesity, and genu
valgum, which also causes
Flatfoot(12–13).
However, little has been reported on the association between MLA
height and digitus minimus varus.
Fig 2 – Pes cavus, an abnormally high longitudinal arch.
Clinical Relevance: Pes Planus (Flat Footed)
Pes planus is a common condition in which the longitudinal arches have been
lost. Arches do not develop until about 2-3 years of age, meaning flat feet during
infancy is normal.

16. Fig 3 – Pes planus, an abnormally flattened longitudinal arch.
Because the arches are formed, in part, by the tight tendons of the foot, damage to
these tissues through direct injury or trauma can cause pes planus. However in
some people, the arches never formed during development. All typically
developing children are born with flexible flat feet, progressively developing a
medial longitudinal arch during the first decade of life(14 15)
For most individuals, being flat-footed causes few, if any, symptoms. In children it
may result in foot and ankle pain, whilst in adults the feet may ache after
prolonged activity.
Treatment, if indicated, generally involves the use of arch-supporting inserts for
shoes.
Based on the structure of the medial longitudinal arch, three types of the foot have
been proposed:
(1) Normally aligned or normal foot,
(2) Low arched or pronated foot, or pes planus,
(3) High arched or supinated foot, or pes caves.
Normally aligned foot is defined as the foot in which the bisection of the posterior
surface of the calcaneus is perpendicular to the ground and its arch height is within
normal range. Pronated foot is defined as the foot in which the calcaneus is everted
and its arch is low or absent. Supinated foot is defined as the foot in which the
calcaneus is inverted and its arch is high. The for the people with pronated foot
during walking. Despite these provocative data, there still remains little agreement
on how to classify MLA structure. Multiple techniques have been reported.

17. Practically all have been used to assess arch height on healthy subjects without foot
pathology. Indirect approaches have included footprint (1718)
and photographic (19 20)
analysis. Direct methods have included anthropometric (21 22)
and radiographic (23 24
25 26)
techniques.
The arch structure might be associated supinated foot is more rigid with limited
shock absorption ability, prone to higher stress underneath the heel and more force
passing to the tibia and femur. The pronated foot, with a greater ground contact
area, is more flexible, leading to the load to be absorbed by the musculoskeletal
structures of the foot. A higher plantar pressure on midfoot was observed with
different injury patterns.
Williams et al. Reported that high-arched runners exhibited more bony, ankle and
lateral injuries but low-arched runners revealed a higher risk of soft tissue, knee
and medial injuries. Several methods have been used to define and categorize arch
structure. Visual observation has been proved to be unreliable. Footprint measures
could not describe the bony characteristics properly. However, they could be used
to assess the arch dynamically and have been used to provide the arch change in
children from six to seventeen years old to understand the foot growth and mature
in morphology.
Possible mechanism of sport injury. However, most of these techniques reported
in literatures for measuring foot arch were limited to static standing condition and
is not easy or allowed to measure arch height change during dynamic sport
activities. Three-dimensional motion analysis with surface reflective marker
placements has been widely used to estimate the joint motions in sports.
Therefore, the purposes of this study were to measure the foot arch changes in
standing relate weight and dynamic sport activities with motion analysis system,
and to compare the biomechanical differences of the foot arch between level
walking, vertical jumping and sprint start . However, it is reported that toe flexor
strength in children is not correlated with foot arch height and that foot arch ..
Previous studies have arrived at differing or unclear results due to differences
between patients and healthy subjects, based on the age and gender of subjects.
Therefore, the present study was designed to normalize age and health status and
examine factors influencing MLA height.(27)

18. height did not decrease even due to experimentally fatigued abductor halluces and
flexor hallucis brevis muscles, which are considered to be associated with toe
flexor strength(6,7)
MLA height in children has been reported to be correlated with overweight,
obesity, and genu valgum, which also causes
Flatfoot(8,9)
. However, little has been reported on the association between MLA
height and digitus minimus varus. Previous studies have arrived at differing or
unclear results due to differences between patients and healthy subjects, based on
the age and gender of subjects. Therefore, the present study was designed to
normalize age and health status and examine factors influencing MLA height.

19. Radiographic parameters defining the medial longitudinal arch of the foot,
measured on a standing lateral x-ray. Abbreviations: CA-MT1, Calcaneal-lst
metatarsal angle; CAI, caicaneal inclination; H, arch height; L, arch length.

20. 1.2 Objectives:
1.2.1 General Objective:
The present study aimed to determine the relationship between weight and gender
to confidence of MLR in Sudanese population and there is Multiple methods exist
for measuring the height of the MLA; therefore, it is important to develop a
standard set of measurements to be used when foot type is used as a variable in
research studies or when making a clinical diagnosis.
1.2.2 Specific objective:
To analyze the differences between age, gender and laterality in Sudanese
population related to medial longitudinal arch of foot and develop a standard set of
measurements
1.3Justifications:
Analyses the differences between age, gender, Wight and laterality to provide
evidence for clinical diagnosis and treatment of diseases related to foot in a
Sudanese population. Results of studies indicate that MLR relate to weight is
quite variable in different ethnic populations. Up to date, there is no study in the
literature investigating the relationship between MLR and weight
1.4 Hypothesis:
The theory is based on the inner bow of the foot affected by the weight, height and
gender of the individual. To test the theory we selected from the community
samples and applied measurements of length, weight, foot length and foot
circumference at the center and analyzed the inputs by statistical analysis to prove
the theory presented in Sudanese society All data were expressed as mean ±
standard deviation. Pearson’s correlation analysis was applied .

21. 1.5 Timeline:
The duration and time management for each structure of the research is estimated
according to the time-table in table 1.
Activity 22/2_22/
4
22/4_22/
5
22/5_22/
7
22/7_22/
8
22/8_22/
9
22/9_22/1
0
Proposal &
Literature
Review
Methodolog
y & Protocol
Measuremen
t
Analysis
Research
Writing
Deadline
Table 1: Time-table for Estimated Timeline of Detailed Activities.
Start date: 22/2/2018, Deadline: 22/10/2018

22. Chapter Two
2 Literature review
2.1 BACKGROUND ANATOMY
2.3.1 Clinical evaluation
2.4 Deformation of the medial
longitudinal arch
2.4.1 Purpose Medial longitudinal
arch
2.4.2 The measurement of the
medial longitudinal arch

23. 2 Literature review:
Medial longitudinal arch (MLA) height is associated with various injuries and
diseases and
gender differences, if any. This study aimed to examine factors affecting the MLA
height associated with gender differences in healthy subjects with no orthopedic
disorders. This study included 36 healthy adults (19 males, 17 females) mean age,
21.8 ± 3.6 years; body mass index, 21.1 ± 2.0 kg/m2). Their height, body weight,
foot length, muscle strength of the tibialis posterior muscle (TPM), toe-gripping
strength, hallux valgus angle, inversion microdactylia angle, angle of leg–heel
alignment, femoro-tibial angle, and navicular height were measured. Correlation
between the ratio of arch height and other measurement parameters was examined.
In females, the ratio of arch height was significantly positively correlated with
muscle strength of the TPM and toe-gripping strength and negatively correlated
with the hallux valgus angle and the leg-heel alignment, whereas in males, only a
positive correlation between the ratio of arch height and muscle strength of the
TPM was observed. These results reveal that etiological mechanisms determining
MLA height are different between males and females. Overall, the present results
indicate that further studies identifying causes of MLA height variation must
include gender-based analysis.(27)
The purpose of the present study was to evaluate and compare rearfoot alignment
and medial longitudinal arch indices during static postures in runners with and
without symptoms and histories of PF. The results indicated that all groups
demonstrated similar rearfoot valgus misalignments. However, the plantar medial
longitudinal arch indices were higher for both the PF groups (PFS and PFH),
compared to the controls, but no differences were found between the PF groups.
The similarity of the valgus misalignments for runners
differences regarding the valgus misalignments of the calcaneus or the variables
related to the peaks, times and movement excursions of calcaneal eversion in a
group of female runners with PF histories. However, they emphasized the
importance of studies which investigated pain symptoms, which could have
invariably affected the results. In the present study, the aspects of pain were

24. considered and, as a result, it was observed that valgus misalignments remained the
same for the PF and control groups. It was expected that the symptom of pain
would lead to less support on the medial heel as an analgesic strategy during
bipedal standing positions. Consequently, the reduction in weight bearing on this
region of the calcaneus would decrease the effects on the rearfoot
with PFS and PFH corroborated the findings of Pohl et al.,15 who, besides doing
static evaluations, also performed dynamic analyses during running. They did not
find
valgus. However, similarly to controls, the presence of pain in the symptomatic
runner group was not enough to reduce natural support that caused this static
valgus rearfoot behavior(28)
edial longitudinal arch was being re-structured and, thus, the differences between
the present results, in which the subjects in the PF groups received treatments over
a shorter period of time (mean= 6 months). Based on these findings, the relevance
of this study was
that it attempted to clarify that the presence of pain did not affect rearfoot
misalignments and plantar medial longitudinal arch configurations of runners with
PF. Wearing et al.19 observed that pain symptoms promoted adaptations in the
foot roll-over mechanisms during gait in individuals with PF. However, Ribeiro et
al.54 observed that pain symptoms did not promote any adaptations in foot roll-
over mechanisms during running in recreational runners with PF. In the present
study, the evaluations were carried out in bipedal static support and did not find
any effects of pain on plantar arch shapes or rearfoot alignments. It is important to
note that the elevated architecture of the plantar arch in runners with PF could lead
to greater strain on the plantar fascia during static and, mostly, dynamic activities,
such as running, because of the repetitive foot impacts with the ground during
practice. Chronically, these stresses could cause micro-traumas in the plantar fascia
and probably lead to the progression of symptoms, or even to the onset of PF. A
limitation of this study was that dynamic analyses of
the rearfoot and midfoot were not included; thus, future studies are necessary for a
better understanding of PF in runners. Regarding the plantar arch, studies
evaluating interventions employing wedges, functional bandages and other

25. physical therapy resources are necessary for a better understanding of the
mechanical effects on the plantar medial longitudinal arch configurations in
individuals with PF.
Runners with symptoms or histories of PF did not differ
in their rearfoot valgus alignment but showed increases in
longitudinal medial plantar arches during bipedal static support, regardless of the
presence of pain.(28)
Although clinical evidence suggests a causal relationship
between arch structure and musculoskeletal injury
patterns, biological variations in soft-tissue structures effect the accuracy of arch-
height measurements. Medial longitudinal arch (MLA) structure was assessed
clinically and radiographicaUy in 100 consecutive patients with foot problems.
Intraclass correlation coefficients were calculated for three radiographic parameters
and three anthropometric parameters of the MLA. Intrarater and interrater
reliability estimates for the radiographic measurements were uniformly excellent.
Intrarater reliability coefficients were higher than interrater coefficients for the
three tested anthropometric parameters. The strengths of associations between
anthropometric and radiographic data were assessed with Pearson correlation
coefficients. The clinically determined ratio of navicular height-to-foot length
correlated most closely with the radiographic indices of MLA structure.(29)
The height of the MLA has been one of the primary criteria for classification of
foot structures. Clinical measurements of arch height typically describe the vertical
height of some bony or soft-tissue landmark of the foot with respect to the
horizontal surface. However, the biological variations in bony and soft-tissue shape
of the foot present difficulties with accurate identification and palpation of these
landmarks. This raises concern regarding the reliability and validity of these
measurements. In this study we assessed the reliability and validity of
three noninvasive clinical parameters of arch height. Our choice of the noninvasive
clinical techniques was based on previous work of Cureton t7 and Hawes and
colleagues. 2° We decided to use the caliper technique described by Hawes and
colleagues, rather than the sandbox technique of Cureton because of the caliper's
inherent simplicity, ease of use, and accuracy. In addition to the arch-height

26. parameter described by Hawes and colleagues, we measured the height of two
bony landmarks commonly used to assess MLA.(29)
In summary, we conducted a
study evaluating the reliability and validity of arch height measurement techniques
using a large population of patients with foot difficulties. Clinical values were
compared with radiographic indices of arch height. All measurements were taken
by experienced examiners using the same assessment tools on standing patients.
The findings of our study suggest that clinical or anthropometric measurements
yield reliable and valid first order approximations of MLA structure. Of the three
noninvasive techniques tested, the best anthropometric parameter to characterize
MLA structure was the navicular height-to-foot length ratio.(29)
In females, the ratio of arch height was significantly positively correlated with
muscle strength of the TPM and toe-gripping strength and negatively correlated
with the hallux valgus angle and the leg-heel alignment, whereas in males, only a
positive correlation between the ratio of arch height and muscle strength of the
TPM was observed. [Conclusion] These results reveal that etiological mechanisms
determining MLA height are different between males and females. Overall, the
present results indicate that further studies identifying causes of MLA height
variation must include gender-based analysis.(27)
Values of plantar pressure reaction, mean and maximum dynamic peak pressure
between all group pairs were statistically significant (P b 0.05). The plantar
pressure reaction appeared at the load of 960 N in the medial arch of the
unoperated foot, compared with 1080 N after subtalar arthrodesis, 1200 N after
talonavicular arthrodesis, 1080 N after calcaneocuboid arthrodesis, 1320 N after
double arthrodesis, and 1560 N after triple arthrodesis. The plantar pressure
reaction appeared at the load of 360 N in the lateral arch of the unoperated foot,
compared with 600 N after subtalar arthrodesis, 600 N after talonavicular
arthrodesis, 840 N after calcaneocuboid arthrodesis, 960 N after double
arthrodesis, and 1440 N after triple arthrodesis. Interpretation: The triple
arthrodesis provided the highest support to both arches; the double arthrodesis
appeared to be similar to talonavicular arthrodesis in supporting the medial arch
and similar to calcaneocuboid arthrodesis in supporting the lateral arch; subtalar
arthrodesis was less effective in supporting both arches.(30)

27. The first being that the use of the term normal in relation to foot posture is
misleading in the categorisation of the paediatric foot, as indeedflat foot posture is
a typical finding at specific ages; flat equals normal. The second conclusion of
importance being that the foot posture of the developing child is indeed age
dependent and has been shown to change over time. Finally, no firm conclusion
could be reached as to which age the foot posture of children ceases to develop
further, specifically the medial longitudinal arch, as no two foot measures are
comparable. Future research needs to consider the development of guidelines
which provide direction on how to measure the paediatric foot, using valid and
reliable assessment tools to ensure prevalence reports are appropriate and
translatable(31)
also Runners with symptoms or histories of PF did not differ in rearfoot valgus
misalignments, but showed increases in the longitudinal plantar arch during
bipedal static stance, regardless of the presence of pain symptoms(28)

28. Chapter Three
3 Material and methods
3.1 Study design and duration
3.2 Study area and population
3.3 Inclusion criteria
3.4 Exclusion criteria
3.5 Study sample
3.6 Research tools and procedures
3.7 Protocol of measurement
3.8 Data collection techniques

29. 3 materials and methods:
3.1. Study Design and Duration:
This study is an analytic observational cross sectional study. It was done between
April 2018 to august 2018 and it has been approved by ethical committee
3.2. Study Area and Population:
This study it was conducted in Khartoum area. It was carried in different Sudanese
ethnic groups (ages 20 to 50 years).
3.3. Inclusion Criteria:
Sudanese healthy volunteers, with no history of arthritis or any bone diseases
3.4. Exclusion Criteria:
Foot trauma
Foot abnormality
Foot deformaty
3.5 Study Sample:
The study sample 25 males and 25 females.
3.6. Research Tools and Procedures:
Calculated as weight (kg) height by (m). Navicular height was measured as the
distance of the navicular tuberosity from the floor surface, and foot length was
measured as the distance from the rear edge of the heel to the tip of the longest of
the first and second toes.(cm)
i used research tools and data collection as longitudinal meter and weight scale and
a measure scale for measuring the height of the foot arch. We used the statistical
analysis program to analyze mathematical data group
Weight measuring device, Measuring tape, spss

30. Chapter Four
4 Results

31. Result
GENDER variation Correlation between foot arch ratio and other
parameters
fig.r1
Fre
qu
enc
y
Percen
t
Valid
Percent Cumulative Percent
Vali
d
Male 25 49.0 49.0 49.0
female
25 51.0 50.0 50.0
Total
50 100.0 100.0

32. Weight Correlation between male subjects and female
H=105kg, l=45 kg
fig.r2
(MLA) Correlation between male subjects and female
H=27cm, l=22cm
fig.r3
0
20
40
60
80
100
120
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49
0
5
10
15
20
25
30
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49

33. Length Correlation between male subjects and female
H=190cm ,l=148cm
fig.r4
0
20
40
60
80
100
120
140
160
180
200
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49

34. (NBH) Correlation between male subjects and female
H=10cm, l=6cm
fig.r5
0
2
4
6
8
10
12
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49

35. (CF) Correlation between male subjects and femal
H=27, L22 cm
fig.r6
0
5
10
15
20
25
30
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49

36. To (mlal) ;(nbh) and (cf) variation Correlation between male subjects
and female
Descriptive Statistics
N Minimum Maximum Mean Std. Deviation
MLA
L
male
25
24.625
0
.62987 .12857
femal
e
25
24.108
0
1.07932 .21586
NBH
male 25 8.2167 1.31733 .26890
femal
e
25 8.0000 1.14564 .22913
CF male
25
24.629
2
.60898 .12431
femal
e
25
24.260
0
1.00125 .20025
fig.r7
fig.r8
Independent Samples Test
2.037 47 .047 .5170 .25384
.615 47 .541 .2167 .35226
1.551 47 .128 .3692 .23796
Equal variances
assumed
Equal variances
assumed
Equal variances
assumed
MLAL
NBH
CF
t df Sig. (2-tailed)
Mean
Difference
Std. Error
Difference
t-test for Equality of Means

37. To (mlal) ;(nbh) and (cf) variation Correlation between male subjects
and female
Correlation between weight and (mlal)
fig. 9
Correlation between weight and (NBH )
fig.r10
Correlations
1 .183
. .203
50 50
.183 1
.203 .
50 50
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
WEIGHT
MLAL
WEIGHT MLAL
Correlations
1 -.544**
. .000
50 50
-.544** 1
.000 .
50 50
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
WEIGHT
NBH
WEIGHT NBH
Correlation is significant at the 0.01 level (2-tailed).**.

38. Correlation between weight (cf)
Fig. 11
Correlations long and (MLAL)
fig.r12
Correlations OF LONG TO NBH
fig.r13
Correlations
1 .171
. .235
50 50
.171 1
.235 .
50 50
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
WEIGHT
CF
WEIGHT CF
Correlations
1 .235
. .101
50 50
.235 1
.101 .
50 50
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
LONG
MLAL
LONG MLAL
Correlations
1 .157
. .276
50 50
.157 1
.276 .
50 50
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
LONG
NBH
LONG NBH

39. Correlations OF LONG AND CF
fig.r14
(MLAL) (NHH) and (CF) weight, long, variation Correlation
fig.r15
Data are expressed as mean ± SD. *Significant difference p<0.05. **Significant
difference p<0.01.
Correlations
1 .130
. .368
50 50
.130 1
.368 .
50 50
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
LONG
CF
LONG CF
Correlations
1 .247 .183 -.544** .171
. .083 .203 .000 .235
50 50 50 50 50
.247 1 .235 .157 .130
.083 . .101 .276 .368
50 50 50 50 50
.183 .235 1 -.077 .810**
.203 .101 . .597 .000
50 50 50 50 50
-.544** .157 -.077 1 -.023
.000 .276 .597 . .874
50 50 50 50 50
.171 .130 .810** -.023 1
.235 .368 .000 .874 .
50 50 50 50 50
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
WEIGHT
LONG
MLAL
NBH
CF
WEIGHT LONG MLAL NBH CF
Correlation is significant at the 0.01 level (2-tailed).**.

40. A total of 49 participants completed all measurements in this study. The male and
female participant characteristics, mean
Value of the arch height ratio, and values of the 5th
parameters potentially
influencing MLA height are shown in fig.r15 and fig.r6. Correlation analysis in
male subjects (fig .r11) showed that ratio of arch height in was significantly
positively correlated relative to body weight fig .r11 (-544). No significant
correlations were found between ratio of arch height and any of the other
parameters. In contrast, correlation analysis in subjects (FC) showed that ratio
was significantly positively correlated with (MLAL) fig r14 (+810). No significant
correlations were found between ratio of arch height and any of the other
parameters

41. Chapter Five
5 Discussion

42. Discussion:
The study aims to know the change of the arch of the foot with weight, length, type
and the impact of the foot arc by weight. I found the effect clear, which confirms
the change of height of the bow with the weight. The real transfer of weight on the
light is done by the bowels. I found the effect with the weight clear and logical
The purposes of measurements correlated with navicular height and normalized
navicular height (navicular height divided by foot length). All of the f
measurements demonstrated acceptable inter-rater reliability,
Previous studies have repeated the measurements either directly after the initial
measurement or within 2 days. In contrast, the current study requested that initial
measurement only.
All of the correlations between navicular heights of the foot measurements were
statistically significant controversial with body weight as in fig.r15 -544
All of the correlations between foot (CF) and the foot measurements (MLAL) were
statistically significant asfig.r15 as 810
All of the correlations between navicular height and the foot measurements were
statistically significant. The same was true for the correlations between the foot
measurements and the normalized navicular height. The navicular height (fig.r6)
was most highly10cm correlated with the arch and had the lowest 6cm
Measure bony anatomy of the foot was validated to a radiographic image,
indicating that the navicular height and normalized navicular height used in this
study are reflective of the bony anatomy of the foot. Based on the results of this
study, it does not appear that foot measurements are well correlated with navicular
height, which often is considered to be a good measure of arch height and therefore
foot morphology. In addition
In this study the foot measurements correlated only slightly with actual navicular
height, which indicates that perhaps the foot of a subject is dependent on factors
other than arch height, such as in fig.r15. Therefore, when discussing foot

43. morphology, whether for a clinical diagnosis, assessment of injury risk factors, or
for research studies that use arch height as a variable, it appears that a standardized
scale of navicular height or normalized navicular height would be the most
appropriate method of assessing foot morphology.
A standardized method would allow for improved collaboration between
physicians and researchers and would help further elucidate the effects of arch
height on risk factors for various injuries and pathologic conditions of the foot,
ankle, lower extremity, and axial spine. In addition, a standardized method of
assessing arch height would allow easier comparison to previously published
literature. Future work in this area needs to be pursued to determine the most
reliable and potentially the most effective method of measuring and reporting arch
height and foot morphology, either with a combination of measurements or
through a combination of measurements and clinical assessment

44. Chapter six
Conclusion and
Recommendation

45. CONCLUSIONS
We sought to evaluate the influence of obesity level on the medial longitudinal
arch (MLA) of the foot in 18- to 35-year-old . METHODS The study group
consisted of 50 (25 girls and 25 men). All of the pt were subjected to podoscopic
foot examination and measurement of weight, height, weight,
In almost all of the age groups, high-arched foot was the most common disorder.
High-arched foot was more common in girls than in men, and boys displayed a
higher percentage of flatfoot. Also, sex-related differences were more prominent in
men.
There was a strongly positive correlation between obesity level and MLA in the
examined group.
These results suggest that the type of foot arch is influenced by parameters such as
age, sex, and obesity level. High-arched foot seemed to be the most frequent
pathologic abnormality in the examined group navicular high most bone affected,
which was predominant in men and obese women, diminished with age. High-
arched foot was a more common in men type than flatfoot regardless of obesity
level assessed on the basis of body mass index . Weight loss is important and
recommended to relieve pressure on the arch of the foot And maintain an ideal
weight.

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