A Narrative Review on the Tests Used in Biomechanical Functional Assessment of the Foot and Leg: Diagnostic Tests of Deformities and Compensations

Abstract

Background: To date, scientific literature has not as yet come up with any review showing the diagnostic tests used for functional assessment of the foot and leg. Methods: A literature review was conducted of electronic databases (MEDLINE, PEDro, DOAJ, BioMed Central, PLOS, and Centre for Reviews and Dissemination at the University of York) up to December 8, 2018. The biomechanical tests, which have adequate supportive literature, were divided into qualitative tests that provide a dichotomy/trichotomy-type answer to clinical diagnostic questions; semiquantitative tests that provide numerical data to clinical diagnostic questions; and quantitative tests that record continuous numerical data (in analogue or digital form). Results: These tests produce a useful functional evaluation model of the foot and leg for different purposes: evaluation of lower limb deficits or abnormalities in healthy patients and in athletes (in sports or other physical activities); assessment of tissue stress syndromes caused by pathomechanics; evaluation of lower limb deficits or abnormalities in rheumatic disease and diabetic foot patients; and to determine the appropriate functional or semifunctional foot orthotic therapy and therapeutic path used in gait rehabilitation. Conclusions: Many of these tests have adequate diagnostic reliability and reproducibility and therefore can be considered diagnostic. Few of these are validated, and some have initiated the validation process by determining their sensitivity and specificity. The widespread use of these tools in clinical practice (diagnosis of function) lacks scientific evidence and in-depth analysis of their limitations.dichotomy / trichotomy type answer to clinical-diagnostic questions; Semi-quantitative tests that provide numerical data to clinical-diagnostic questions; Quantitative tests that record continuous numerical data (in analogue or digital form). These tests produce a useful functional evaluation model of the foot and leg for different purposes: • evaluation of lower limb deficits or abnormalities in healthy patients and in athletes (in sports or other physical activities); • assessment of tissue stress syndromes caused by pathomechanics; • evaluation of lower limb deficits or abnormalities in rheumatic disease and diabetic foot patients; • determine the appropriate functional or semi-functional foot orthotic therapy and therapeutic path used in gait rehabilitation. Many of these tests have adequate diagnostic reliability and reproducibility, therefore, these can be considered diagnostic. Few of these are validated and some have initiated the validation process by determining their sensitivity and specificity. The widespread employment of these tools in clinical practice (diagnosis of function) lack scientific evidence and in depth analysis of their limitations.