Body mass and the movements of the midfoot


Each time the foot contacts the ground during walking, peak vertical ground reaction forces typically reaching 120% of body weight are generated (Novelgmbh, 1998). It has been estimated that an individual with a mass of 72 kg, walking 1mile, would be required to absorb 64.5 tonnes on each foot (Mann, 1982; Cavanagh, 1987). Considering the need to consistently withstand such a high load, it is not surprising that foot discomfort, pain and pathologies frequently occur (Dowling et al., 2004).

Feet are the body's base of support; they frequently endure high ground reaction forces generated during the activities of daily living. The longitudinal arch comprises of many bony structures and joints such as the 1st-3rd metatarsals, cuneiform, navicular, talus, calcaneus and one of the most important components of the longitudinal arch is the navicular. Although this arch comprises of bony articulations, ligaments and muscles, it is primarily the ligaments that support and stabilise the longitudinal arch, as well as acting as powerful energy-storing mechanisms (Jahss, 1982; Ker et al., 1987). Muscles provide secondary support by maintaining the arch during dynamic tasks. Ligaments rarely incur physiological fatigue and therefore offer a greater resistance to stress compared to muscles (Platzer, 1992). However, repeated excessive loading may stretch ligaments beyond their elastic limit, damaging soft tissues and increasing the risk of foot discomfort and subsequent development of foot pathologies.

It's important to find out if there is any correlation between body mass and the movements of the midfoot. During weight bearing, the arch profile changes to cope with the pressures of body mass. If there is excess movement of the navicular it could indicate a pronated foot type; this in turn can lead to other musculoskeletal complications, such as periostitis and medial knee pain, which were estimated to cost the NHS some £590 million per year (Cullen, 2005).

This study proposes to assess the movements of the navicular tuberosity by identifying it and then tracking its movement's, indicating the highest and lowest points during static and dynamic activity between a number of participants who vary in body mass and anthropometric variables.

Review of Literature:

Whilst many studies have acknowledged the anthropometric changes which are linked with people who are overweight and obese, there is a lack of research regarding the effects of body mass upon the musculoskeletal system. “Foot type” is currently used as a term to describe a variety of anthropometric features of the foot which are thought to provide clues regarding dynamic function (Mathieson et al., 1999). In spite of a wide-ranging literature base investigating the relationship between foot type and musculoskeletal pathology (Messier et al.,1988; Beckett et al 1992). The correct association between the two remains vague. A significant factor impeding efforts to resolve the true nature of this association may be the absence of a valid and reliable measure with which to accurately class foot type (Mathieson et al., 1999, Williams, 2000, Redmond et al. 2001).

The treatment of biomechanical related foot injuries is often a challenge for some practitioners. This may be due to insufficient information about how various parts of the foot move in relation to one another. The foot may be divided into three functional units: the rearfoot, the midfoot, and the first ray (Cornwall, 2002). Each of these units is a component of the medial longitudinal arch, which plays an important role in how the foot functions during weight bearing activities (Saltzman et al., 1995).

DeLacerda (1980) researched the involvement of a range of anatomic variables to the occurrence of shin splints in 82 females (Menz, 1998). Biomechanical observations were carried out on each subject, and the subjects then took part in a 13 week exercise program involving aerobics and cardiovascular exercise on a hard floor surface. The biomechanical conclusion for participants who consequently developed pain lateral to the anterior of the tibia were compared to the participants who did not, in order to find out which characteristics can be considered contributing factors in shin splints. A significant positive correlation was found between the “navicular differential” measurement and the incidence of shin splints (Menz, 1998).

Research suggested that navicular drop (ND) may be a more valid gauge of rearfoot motion than established frontal-plane measurements (Menz, 1998). Research conducted using radiographic techniques have publicised that the most important motion occurring within the rear foot complex during pronation/supination movements takes place at the talo-navicular joint. (Lundberga et al,1989; Winson et al., 1994). These results are in disagreement with the established understanding of rear foot motion, in which more focus has been paid to the talo-calcaneal joint. Menz (1998) suggested that in light of this change of importance, measurements taken from heel bisections must be regarded as having restricted validity.

Diagnostic Tests:

One popular measurement currently being used by podiatrists is the navicular drop test. Brody (1982) was one of the earliest authors to discover that navicular drop could be a measure of foot pronation.

Navicular drop (ND) measurement is acquiring a reputation with clinicians and researchers for measuring midfoot mobility and may be an important assessment method for patients. A number of investigators together with Williams (2000), Saltzman (1995), Menz (1998) and Cornwall (1999) have recommended that the ND measurement might be the largest and dependable static clinical measure of foot pronation which at this time is accessible to clinicians. The ND measurement is defined as the difference in height of the most prominent portion of the navicular tuberosity while the subtalar joint is located in “neutral” (STJN) as compared with when the foot is positioned in a relaxed standing foot posture (RSFP) (Shrader et al, 2005).

Brody (1982) suggested that usual amount of ND is approximately 10 mm and those measurements over 15 mm characterize an uncharacteristic amount of foot pronation. Conversely, no explanation of the sample group was recorded, neither was the consistency of the technique. Mueller et al, (1993) assessed the consistency of a single assessor in the measurement of ND in 28 healthy participants. The average ND recorded was 7.4 mm, with reliability coefficients ranging from .77 to .82. From these results, the authors concluded that ND can be a dependable measurement of foot pronation, they also recommended that clinicians should consider orthotic alteration to control unnecessary movement of the navicular (Menz, 1998).

Weiner-Ogilvie (1998) compared three types of assessing foot position and established that navicular height showed the smallest amount of intratester and intertester variability. Picciano et al. (1993) reported reduced intertester reliability and reduced to reasonable intratester reliability of the ND technique; conversely, this study used two inexperienced technicians to conduct the measurements (Vinicombe et al., 2001).

Clinical measurement of ND has been established to be as suitable an indicator as radiographic arch-height indices and more significantly a suitable clinical predictor of dynamic rear foot motion. Cornwall and McPoil performed a biomechanical assessment on 18 healthy patients, and compared these results with the pattern of frontal plane rearfoot movement using dynamic video breakdown. Out of the 18 variables considered in the initial clinical assessment, only ND was notably related to the pattern of rearfoot motion. The traditional frontal-plane measurements were found to be poor predictors of rear foot motion (Menz, 1998).

Similar investigations conducted by Woodford- Rodgers et al (1994) and Loudon et al (1996) furthermore found ND to be considerably greater in individuals with anterior cruciate ligament damage compared with age-matched controls, this might propose that control of excessive ND by orthoses or taping be considered as a preventive measure for such injuries (Menz, 1998).

Studies have been conducted to understand the relationship between ND and potential sports injuries. One study conducted by Elliott (1990) looked at the relationship between ND and shin splints. The mean navicular differential measurement in the shin-splint group was 8.8 mm, as compared with a non shin splint group value of 5.4mm. They suggested that excessive foot pronation could be a contributory factor in the development of shin splints. This value can be evaluated in practise by observing sagittal plane movement of the navicular. Overuse injuries of the musculoskeletal system commonly occur when a structure experiences a large amount of repetitive forces, each force is below the acute injury threshold of the structure, this produces a collective fatigue over a prolonged period of time beyond the capabilities of the specific structure (Elliott, 1990; Stanish 1984).

In spite of the possible benefits of the ND measurement, it does have some significant limitations; it is proficient of measuring displacement only in the sagittal plane, while movement of the navicular in fact takes place in all three planes simultaneously (Cornwall, 1999; Mueller et al. 1993). Although the frontal plane motion of the navicular is small, the transverse plane element is larger and as a result may be clinically important. To tackle this, Menz (1998) considered the measurement of navicular drift to provide an indicator of the change in medial prominence of the talonavicular joint when the foot moves from a neutral to a resting position, but however, the reliability of navicular drift measurement has not been evaluated (Vinicombe et al., 2001).

Future Research:

A restriction with the measurement of navicular drop is the determination of what amount of drop should be considered as “abnormal.” Brody (1982), Beckett et al (1992) and Mueller et al (1993) respectively propose values of 15, 13, and 10 mm as abnormal; however, this approach is flawed, as it does not take into account the size of the foot being assessed. A navicular drop of 15 mm may be considered excessive on a small foot but relatively insignificant on a larger foot. To overcome this I have come up with a normalized navicular drop reading which is the navicular drop divided by the participant's foot length. This reading will take into account the participant's foot length so this reading will dismiss the foot length variable.

Obesity is on the increase in the UK (Department of Health, 2010) each year the percentage of adults and children being classified as obese ever increases. Research into the potential knock on affects of obesity on foot function is important in order to reduce potential injury and the cost to the NHS and inevitably the tax payers.

Also further research is necessary to establish a category of navicular drop “index,” which is the amount of navicular drop considered normal or abnormal relative to the size of the foot the measurement is taken from. Additional research is warranted to further refine these techniques and improve the scientific credibility of foot posture evaluation (Vinicombe, 2000).


This study is to determine if there is any correlation between anthropometric variables such as body mass and navicular drop. Where many more people are undertaking physical exercise this study is to identify whether increased body mass can alter the biomechanics of the foot which could potentially lead to injury.

Hypothesis: - Increased body mass will create a significantly positive correlation with navicular drop.

Null hypothesis: - There is no correlation between body mass and navicular drop.


A sample of 31 subjects were recruited who had volunteered after seeing poster advertisements throughout the health club. These participants were then asked to sign a consent form (appendix 1), a Par-Q form (appendix 2) and read the information sheet about the study (appendix 3) to make sure all inclusion criteria were met.

The participants were then asked to place their foot on a piece of paper whilst sitting in order for it to be drawn around and to obtain a foot length and foot width measurement. These measurements were taken from the centre of the heel to the longest toe and then from the widest part of the foot (appendix 4). From this sitting position the static navicular drop (ND) measurement was taken. ND is the difference in navicular height in millimetres from standing sub-talar joint neutral to standing relaxed foot posture.

The prominent aspect of the navicular was marked and the subjects instructed to stand on a hard, elevated surface with feet a comfortable shoulder width apart and toes pointing forward.

Static Measurements:

Subtalar joint neutral was identified by asking the subject to pronate and supinate the foot and ankle while the examiner, using the thumb and the forefinger, palpated the anterior medial and anterior lateral head of the talus for symmetry (Sandra et al., 2006). In this position, the distance from the mark on the navicular to the floor was measured using a straight ruler (mm) to obtain the navicular height in the subtalar joint neutral foot position. The subject was then instructed to relax the foot and evenly distribute the weight between the left and right feet. In this position, we measure the distance between the mark on the navicular and the floor to obtain the navicular height in the standing relaxed foot posture (Sandra et al., 2006).

After the static measurement was obtained the participant's height was recorded to the nearest millimetre by using a wall mounted height measuring device for accurate readings. This was done with the patient standing facing away from the wall with their feet shoulder width apart and bare footed. Knee height was also collected at this time by measuring from the distal pole of the patella directly down to the floor.

With this data we can start to calculate the participant's body mass index (BMI) by using the Tanita TBF 310 GS portable body composition analyzer. Body mass will be measured to the nearest 0.01 kg while the participants stand motionless on the body composition analyzer. BMI will then be calculated automatically by the machine. Due to its ease of measurement and calculation, BMI is the most widely used diagnostic tool to identify weight problems within a population, usually whether individuals are underweight, overweight or obese. Once calculated each subject's BMI will then be used to put the subject into one of the three classifications. An example print out of the Tanita body composition analyzer is in appendix 5.

The three BMI group's participants will be classified in


from 18.5 to 25


from 25 to 30

Obese Class 1

from 30 to 35

\mathrm{BMI} = \frac{\mbox{weight} \ \mbox{(kg)}}{\mbox{height}^2 (\mathrm{m^2})}

Other anthropometric measurements were taken by having the participant sat upright with the knee flexed at 90degrees on a therapy couch. From this position it was possible to measure calf circumference and quadriceps circumference from the mid section of the widest part of the muscle.

Dynamic Measurements:

In order to start the dynamic data collection a Life Fitness CPO95T treadmill was used. Participants were required to walk at a safe, self selected speed for a duration of 6 minutes, 5 minutes of this will be used as a warm up, then without warning so participants do not alter their steps, video will be taken for 5 consecutive steps.

To obtain the footage for the dynamic test data, a digital video camera was used and the footage streamed into a laptop containing Quintic biomechanics 9.03 v17 software which allowed us to save the footage and measure ND. The camera was mounted perpendicular to the sagittal plane at the level of the foot on the treadmill. In the foreground was placed an object of known length which was a 15cm ruler which used for calibration purposes, and then the distance we measured will be accurate. To measure the ND the exact points of contact which were being looking at needed to be determined, these were:

Highest point = the instant the forefoot makes contact with the treadmill deck which is the onset of foot flat.

Lowest height = we will roll the video on until we see the navicular start to rise and then go one frame back from that point.

Ethics approval from was completed and handed into the ethics panel prior to commencing of this research of which approval was granted (appendix 6). Before the study starts it was made clear that participants can withdraw from the study at any time without giving any reason and any data already collected will be destroyed.During the initial screening, participants were given full details of what will happen during the study. The research conducted did not cause the participants any harm, breach their rights or involve them in financial expenditure. Participants in the research give their voluntary consent in order for them to be used in the study and their details, information and study results will not be shared to any other people according to the data protection act 1998.

All data collected will conform to data protection legislation; any information obtained from a research participant is confidential. All data forms are anonymous with no personal data obtained from participants. Names were changed, also any details that might make the person easily identifiable. The computer and software are password protected. Once the study has been completed all files obtained from the data collection on the Quintic system and computer will be destroyed.


A sample size of 31 was recruited and comprised of 13 males and 18 females to take part in the study with a wide range of anthropometric variables part of the data can be seen in table 1.

Basic Descriptives



Mean (SD)


Age (years)

39.3 (± 14.4)


Height (cm)

167 (± 7.5)


BMI (kg/m2)

25.43 (± 4.2)


Table 1: Shows data collected for age, height and BMI

All subjects were recruited at random via poster advertisement at the Nuffield Health Fitness and Wellbeing Centre in Swindon (poster in appendix 7). Permission has been granted by the General Manager for the data collection to take place over the Christmas period (a letter of correspondence is in appendix 8 & 9) The sample would not be biased due to a large range of individuals using the facilities (over 3000 individuals), especially with regards to body mass. Due to the sensitive nature of using “body mass” in recruiting participants, the word “anthropometric” will be used to in order not to cause offence.

Sample-Inclusion Criteria:

All subjects will have signed a consent form and Par-Q (physical activity readiness questionnaire). To be included in the investigation participants must be of age 18 years or older and all participants taking part will have met the following criteria:

1) No history of congenital deformity in the lower extremity or foot

2) No previous history of lower extremity or foot fractures

3) No systemic diseases that could affect lower extremity or foot posture

4) No history of trauma or pain to either foot, lower extremity, or lumbosacral region at least 12 months prior to the start of the study

5) No past surgery to the lower limb, foot or ankle

6) Be able to walk on a treadmill at a safe, comfortable self selected speed for five minutes.

7) Be able to fill out all paper work to a satisfactory standard in order to give consent to participate.

Participants will have not exercised within the last 24hours to ensure fatigue cannot affect measurements.

Apparatus and/or Materials:

The apparatus involved in the study included a Lifefitness COP95T Treadmill which allowed me to collect dynamic data to a Acer Laptop with Quintic biomechanics 9.03 v17 software installed, which was linked to a Sony Digital camera via a IEEE 1394 fire wire cable to enable live image streaming.

For anthropometric measurements I used an anatomical tape measure and a therapy couch which allowed me to take these measurements with ease, I also used a ruler for static ND; for height measurements a height measurer which was fixed to the wall was used. BMI readings were taken using a Tanita TBF 310 GS portable body composition analyzer.

Pilot Study:

A pilot study was conducted to assess the smooth running of gathering the data. This pilot study enabled the assessment of the use-ability of the equipment. This was needed as previous experience was limited. This allowed a run through of the data collection process four times. In this time the camera position for focus was checked, lighting setup was checked and a logical sequence for which each measurement will be taken allowing maximum efficiency in the time period allowed. It also provided a rough time scale for how long each participant will take for the data to be collected. Each participant took approximately 15minutes to complete.


At the start of each data collection session, each participant was given an outline of the procedure of what was going to be undertaken. Each participant was given a consent form to read and sign before any participation was undertaken. Once all the forms had been completed, the static measurements were undertaken; whilst taking the measurements the participant was informed for the reason why that measurement was necessary in order to reassure them. Once the static measurements were completed, the dynamic video capture was taken by instructing the participant to walk on a treadmill at a safe self selected speed, before the participant got on the treadmill a small demonstration was conducted by myself to show the participant what i expected of them. After the right foot has been recorded the camera was then moved to capture the left foot.

The space provided by the health club to conduct my study was a large space located in the lounge area of the club. To aid with privacy 6ft blue screens were places along the entire length of the lounge so privacy could be upheld at all times. This area provided enough space to have a treadmill; table and therapy couch to conduct the research.

Data Analysis:

Basic descriptive statistics will be used to describe the sample recruited. Anthropometric factors will be categorised and dynamic foot function will be summarised using mean and 95% confidence intervals. If appropriate an ANOVA will then be used to determine if there are significant differences in dynamic foot function between groups. Correlations will be displayed graphically and appropriate coefficients calculated to provide insight to key associations.


The sample of 31 participants comprised of 13 males and 18 females. Key demographics are shown in table 2. From these participants 15 we categorized into the healthy section of the body mass index, 10 were overweight and six were classed as obese. It is no surprise to find more individuals from the possible sample were categorised with a healthy BMI being that they volunteered to take part from a health and fitness club.




Mean (SD)


Age (years)

39.3 (± 14.4)


Height (m)

167 (± 7.5)


BMI (kg/m2)

25.43 (± 4.2)


Table 2: Shows key demographics for all 31 participants.

The data in table 3 shows the values for ND throughout all participants with a mean of around 8.2mm which supports Brodys (1982) research where he suggests that dynamic ND should be approximately 10mm. The results in this table show that ND increases when the foot is dynamic which in turn increases ground reaction forces with increases loads stressing the foot structure.

Foot Function:



Mean (SD)


Static Navicular Drop, Left (mm)

5.33 (±2.21)


Static Navicular Drop, Right (mm)

5.0 (±2.07)


Dynamic Navicular Drop, Left (mm)



Dynamic Navicular Drop, Right (mm)

8.51 (±3.28)


Table 3: Showing mean and range ND for all 31 participants.


From the data collected and the analysis conducted on the ND values, there is evidence to show that body mass can increase the amount of ND. This is supported by the results of the ANOVA being less then p=0.0022 on every test (where p<0.05), and therefore statistically significant. Therefore the hypothesis; ‘increased body mass will create a significantly positive correlation with navicular drop', has been accepted.


The aim of this study was to investigate if there is any relationship between navicular drop and increased body mass. By conducting this study I was able to support my hypothesis that increased body mass will create a significantly positive correlation with navicular drop.

This research has to potential to lead to further studies on the subject of ND and body mass where they can address the certain limitations and restrictions of this study to improve the validity of the results. This study and further studies have to potential to help develop an accurate clinical tool which practitioners can rely on.

However, there are a number of flaws within this study. The study does not take into account the movement of the skin while the dynamic data was collected. When the foot makes contact with the floor, the skin can move and stretch which can change the position of the markers on the navicular tuberosity giving false readings.

Although with potential flaws the results from the data showed a consistent positive correlation with ND.


None of the volunteers had previous injuries which could be aggravated by taking part in the study; every person who volunteered to take part in the study met the inclusion criteria which meant we didn't have to turn anyone away. It just so happened each volunteer approached and enquired about the study before going ahead and doing their own personal workouts which would mean they couldn't take part due to any issues of fatigue affecting the results.

Study Imitations:

Nearly every research study has some sort of limitation. One limitation that needs to be considered in this study is the human error with regards to the marking of the navicular tuberosity. As this mark is measuring a small vertical movement if the mark was not correct it will affect the overall result. Palpating the most prominent aspect of the navicular tuberosity and marking in a manual manner could lead to slight discrepancies between marks from one investigator to the next.

The amount of participants which took part in this study was 31; this number compared to most research studies is fairly limited. An increased sample size would be beneficial to the study to demonstrate a higher percentage of the population. This small sample size would reduce the power of this study and therefore the validity of using the results to make assumptions for the further population would not be recommended. Also the time frame to collect the data had an impact on the participant numbers; I only have a total of 10hours at the health club to conduct my data collection. If i was able to extend this time then i could of had a greater and more varied sample size. There was some concern that the representativeness of the sample size would be limited because the sample was taken from a health club which could be unrepresentative of the general public and also as the sample were selected on a voluntary basis. However it appears from the sample individuals used in this investigation that this did not seem too much of an issue as there were a variety of BMI values.

Another limitation would be the video camera used to collect the dynamic data. The camera used had a basic specification with a maximum frames per second (FPS) of 30-40. The result of this was that the image quality was compromised making data collection off the video difficult. A better option would be a high speed camera with a FPS speed of 100-150 which would give a better image quality and more accurate readings.

Suggestions for Further Research:

This study would not be complete if it did not have the potential to initiate further research to progress the profession. There are a number of ways in which this particular study could be improved and expanded.

The affect of anthropometric variables on foot posture needs to understood to have successful results in clinical biomechanics. Clinical evaluation of foot posture needs to be scientifically credible, reliable and valid techniques need to be developed such as a ND index to look at body mass influences on foot posture. Measurements taken from the navicular tuberosity have limited validity, as they might indicate the affect of altered foot position on the talo-navicular joint, the major contributor of pronation and supination of the foot (Lundberg et al. 1989, Winson et al. 1994). Still further research into the validity of the measurement of ND is needed to create a reliable clinical tool.

To confirm the use of ND, additional studies should be undertaken to create normative values of talo-navicular motion during gait and to investigate the relationship between abnormal talo-navicular joint motion and lower extremity pathology (Menz 1998). Once this has been recognized, research will need to be performed to associate clinical measurement of ND with dynamic function. The failure of static measurements to foresee dynamic function has been a main restriction of anthropometric and clinical assessment, merely because the foot is subjected to a vast amount of different kinetic influences. Nevertheless, modern work suggests that clinical foot measurements performed with the subject in single-limb stance provides a more valid indication of foot position during gait than in double-limb stance (Mc Poil 1996). Additional investigations into the clinical measurement of ND should therefore utilize the single-limb stance reference position.

The results of this study demonstrate that the measurement of ND is only somewhat reliable, due to the large error ranges associated with the measurements. This further research can assist podiatry clinicians in assessing the usefulness of ND measurements within practice.


This study demonstrates that there is a strong possibility that body mass can influence ND to some degree but further research is necessary to improve the techniques of measuring ND and improve the scientific reliability of the foot posture assessment. The techniques used to measure ND need to be refined further and properly understood in order to apply them to clinical practise. From my research this appeared to be the first study which has normalized ND with foot length, even by doing this the data shows a strong correlation of ND with increased body mass further supporting the original hypothesis.

The ultimate objective of this research is to work in the direction of injury prevention by identifying potential problems before they result in injury, taking a pro-active rather than a re-active stance. However in order to do this further research is recommended with greater numbers of participants from a more diverse selection group to give greater reliability and validity of the results and ensure they are representative of the population as a whole.


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