Intrinsic foot muscle size can be measured reliably in weight bearing using ultrasound imaging

The intrinsic foot muscles (IFMs) are important contributors to optimal foot function. While assessment of IFM morphology using ultrasound imaging in non-weight bearing has been established, this does not evaluate the foot in its primary functional position of weight bearing.

Is ultrasound imaging a reliable and clinically feasible method of measuring IFM morphology in weight bearing, do these measures differ to those from non-weight bearing and are they associated with participant characteristics?

Ultrasound images were obtained by a single rater from twenty-four healthy participants on two occasions, one week apart. Images were taken in weight bearing (bilateral stance) and non-weight bearing (seated). Cross-sectional area and thickness of the abductor hallucis muscle, and dorsoplantar thickness of the muscles of the first interstitium were measured from acquired images. A second rater also acquired images at the first session. Participant characteristics included age, height, weight, sex, foot posture and foot mobility.

Measurements of IFM morphology demonstrated high reliability within and between test sessions, as well as between raters (ICCs > 0.8). Our findings suggest that changes of 10-18% could be considered to exceed measurement error. Larger IFM size was related to larger body size (taller, heavier), foot posture (longer foot, higher arch, wider midfoot) and male sex.

This study is the first to describe a reliable and clinically feasible method of measuring IFM morphology in weight bearing. These measurements could be used in future studies to assess IFM morphology in patient populations and to evaluate the effect of intervention. Body size and foot posture explained between 20 and 41% of the variance in measurements and should be considered when comparing IFM morphology between individuals. The establishment of reliable measurements in weight bearing provides a crucial step towards the future evaluation of IFM function using ultrasound imaging.