A Quick Reference Guide for the Foot Posture Index

A patient comes to physical therapy reporting foot and ankle pain. You see some supination during static stance and gait, but you are not completely sure. Your colleague thinks the patient’s foot is slightly pronated. Who is right?

Knowing who is correct will help determine how you manage the patient. What can you do to have some objective information instead of relying solely on subjective opinions? Use the Foot Posture Index.

What is the Foot Posture Index?

The Foot Posture Index is a quick, reliable diagnostic tool that you can put into practice immediately after learning how to use it.1 With your patient standing in a relaxed, double limb stance position, make observations in various regions of the foot based on six criteria. After finishing the six observations, each criteria and the patient’s overall foot posture estimate are scored.

How do I perform the Foot Posture Index?

There are six criteria for the Foot Posture Index for the physical therapist to observe. They include:2

  • Talar head position
  • Supra and infra lateral malleolar curvature
  • Calcaneal frontal plane position
  • Prominence in the region of the talonavicular joint
  • Height and congruence of the medial longitudinal arch
  • Abduction/adduction of the forefoot on the rear foot

After the six observations are made, the physical therapist grades the patient’s foot in each of these positions. For each criterion, values of +1 or +2 are given for a pronated position, values of -1 or -2 are given for a supinated position and scores of zero are given for a neutral position. A final score is a number between -12 and +12, and the more negative the total number, the more supinated the foot is and the more positive the total number, the more pronated the foot is. A foot that is considered “normal” will have a value of 0 to +5.2

What do I do with the results of the Foot Posture Index?

The results of the Foot Posture Index help determine the appropriate interventions you may want to use with your patient, including strengthening, stretching, manual therapy or gait training. Also, although mixed evidence at best, orthotic prescription can be easier with the objective results of the Foot Posture Index. The results of the Foot Posture Index can help indicate which type of orthotic is necessary for your patient.

  1. Evans AM, Copper AW, Scharfbillig RW, Scutter SD, Williams MT. The reliability of the foot posture index and traditional measures of foot position. J Am Pod Med Assoc. 2003;93:203-213.
  2. Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: The Foot Posture Index. Clin Biomech. 2006;21:89-98.