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113
Original scientific article                                       DOI: https://doi.org/10.35469/ak.2023.395
received: 2023-07-04          UDC: 796.322
FOOT POSTURE INDEX AND HIP JOINT ROTATION 
MOBILITY IN HANDBALL AND SOCCER PLAYERS
Tjaž BREZOV AR
1
, Matej DROBNIČ
2, 3
, Alan KACIN
1
1
 University of Ljubljana, Faculty of Health Sciences, Department of Physiotherapy
2 
University Medical Centre Ljubljana, Department of Orthopaedic Surgery 
3
 University of Ljubljana, Faculty of Medicine, Chair of Orthopaedics 
Correspondence author: 
Alan KACIN 
University of Ljubljana, Faculty of Health Sciences, Department of Physiotherapy, 
Zdravstvena pot 5, 1000 Ljubljana, Slovenia. 
Tel: +386 1 300 11 19 
E-mail: alan.kacin@zf.uni-lj.si
ABSTRACT
Purpose: To assess the foot posture and hip joint mobility of elite handball and 
soccer players and to investigate possible correlations between these measurements. 
Methods: We compared the differences in means of Foot Posture Index (FPI), pas-
sive hip internal (IR), and external (ER) rotation range of motion (ROM) between three 
groups of male subjects (17 handball players, 17 soccer players, and 16 non-athletes). 
The Kruskal-Walli’ s test and post-hoc pairwise comparison with the Mann-Whitney U 
test were used to determine the differences between the group means, and associations 
between variables were analyzed with Spearman’ s correlation coefficient. 
Results: No significant differences in the mean FPI were found between the soccer 
players (1.3 ± 2.9), handball players (0.7 ± 2.1), and the control group (1.7 ± 2.5) (p 
> 0.05). Similarly, no significant difference was found between the groups in the hip 
ER ROM. In contrast, a significantly lower (p < 0.05) hip IR ROM was observed in the 
soccer players (30.6° ± 5.3°) compared to the handball players (41.0° ± 8.1°) and the 
control group (41.1° ± 6.4°). A weak positive correlation was only observed between 
the FPI and hip IR ROM in the soccer players (ρ: 0.36, p = 0.035). 
Conclusions: Handball and soccer players show a tendency toward less pronated 
feet compared to non-athletes, but the differences are not significant and the mean FPI 
values are still within the range of normal foot posture. The range of hip IR seems to be 

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reduced in soccer players and weakly, but significantly and positively associated with 
the FPI value, which needs to be further investigated in future studies. 
Keywords: foot shape, hip mobility, soccer players, handball players
INDEKS DRŽE STOPALA IN GIBLJIVOST ROTACIJE KOLČNEGA 
SKLEPA PRI IGRALCIH ROKOMETA IN NOGOMETA
IZVLEČEK
Namen: Oceniti držo stopala in gibljivost kolčnega sklepa pri vrhunskih rokomet-
nih in nogometnih igralcih in raziskati mogoče povezave med temi merami. 
Metode: Primerjali smo razlike v povprečnem indeksu drže stopala (FPI) ter pa-
sivnega obsega giba zunanje (ZR) in notranje rotacije (NR) rotacije kolka med tremi 
skupinami moških preiskovancev (17 rokometašev, 17 nogometašev in 16 gibalno netre-
niranih). Za ugotavljanje razlik povprečji med skupinami smo uporabili test Kruskal-
Wallis in jih naknadno parno primerjali z U-testom Mann-Whitney. Za analizo poveza-
nosti spremenljivk je bil uporabljen Spearmanov koeficient korelacije. 
Rezultati: Ni bilo ugotovljenih statistično pomembnih razlik v povprečnem FPI (p > 
0,05) med skupino nogometašev (1,3 ± 2,9), rokometašev (0,7 ± 2,1) in kontrolno sku-
pino (1,7 ± 2,5). Prav tako nismo ugotovili pomembne razlike med skupinama glede ob-
sega giba ZR kolka. Nasprotno pa smo pri nogometaših (30,6° ± 5,3°) opazili značilno 
manjši (p < 0,05) obseg giba NR kolka v primerjavi z rokometaši (41,0° ± 8,1°) in 
kontrolno skupino (41,1° ± 6,4°). Šibko pozitivno korelacijo smo zaznali le med FPI in 
obsegom giba NR kolka pri nogometaših (ρ: 0,36, p = 0,035). 
Zaključki: Rokometaši in nogometaši kažejo težnjo po manj proniranih stopalih 
v primerjavi s športno netreniranimi posamezniki, vendar so razlike neznačilne in 
srednje vrednosti FPI še vedno znotraj mej normalne oblike stopal. Zdi se, da je pri 
nogometaših obseg notranje rotacije kolka zmanjšan ter šibko, vendar značilno in pozi-
tivno povezan z vrednostjo FPI, kar bi bilo v prihodnje smiselno podrobneje proučiti.
Ključne besede: oblika stopala, gibljivost kolka, nogometaši, rokometaši

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INTRODUCTION
The foot and ankle complex provides a kinetic link between the ground 
and the lower extremity that is essential for gait and other activities of daily 
living (Brockett & Chapman, 2016). Its pathological biomechanics could al-
ter the mechanism of the proximal joints of the lower extremity, especially 
the knee and hip joints (Gross, 1995), the effect of which is enhanced during 
athletic activities. There is evidence that increased foot pronation causes me-
chanical changes in the lower extremities that may overload the knee and hip 
(Mei, Gu, Xiang, Baker, & Fernandez, 2019). People with foot pronation also 
show a greater range of motion (ROM) in the barbell squat, with increased 
flexion in the hip, knee, and ankle joints, as well as greater hip adduction 
causing knee valgus, which is associated with hip internal rotation (Lu, Li, 
Rong, Baker, & Gu, 2022).
Both handball and soccer involve high-intensity activities such as run-
ning, jumping, cutting, sprinting, lateral and backward movements (Drust, 
Atkinson & Reilly, 2007; Michalsik, Aagaard & Madsen, 2015), which place 
a great load on the lower extremities, especially the ankles. Dayakidis and 
Boudolos (2006) point out that cutting maneuvers and reversal movements 
generate relatively large forces in the vertical and mediolateral directions as-
sociated with the supination of the hindfoot, which can lead to an increased 
risk of ankle sprains. Ankle injuries are one of the most common types of 
injuries in both handball and soccer (Kolokotsios, Drousia, Koukoulithras, & 
Plexousakis, 2021; Martín-Guzón et al., 2022). Most of these injuries involve 
lateral sprains resulting in a tear of the anterior talofibular ligament (Fong, 
Hong, Chan, Yung, & Chan, 2007). Repetitive movement patterns typical of 
a particular sport may result in altered static and dynamic foot behavior, with 
one foot type predominating over the other. There is evidence that swim-
mers and volleyball players have a tendency toward the more pronated foot 
type (De Groot et al., 2012; Lopezosa-Reca, Gijon-Nogueron, Garcia-Paya, 
& Ortega-Avila, 2018) and handball players have a tendency toward the supi-
nated foot type (Martínez-Nova et al., 2014), while no predominant foot type 
has been found in soccer players (Lopezosa-Reca et al., 2018).
Non-optimal lower leg mechanics in situations where the entire lower ex-
tremity is heavily loaded with body weight, such as fast cutting maneuvers and/
or landing on one foot, may therefore affect both the ankle and hip joints. How-
ever, there is a considerable lack of published studies on this topic. The results 
of L’Hermette, Polle, Tourny-Chollet, and Dujardin (2006) show that years of 
frequent handball training can have a negative impact on hip mobility.

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The aim of this study was therefore to investigate foot posture and hip joint 
mobility in elite handball and soccer players. Two main objectives were set: 1) 
to find differences in the Foot Posture Index (FPI) and in the hip rotation ROM 
among the two groups of athletes and the group of non-athletes, and 2) to find 
possible correlations between the FPI and hip rotation ROM.
METHODS
Participants
The study was conducted with a sample of 50 male participants from three 
different groups. The handball group consisted of 17 professional handball play-
ers (22.4 ± 3.6 years, 185.7 ± 4.7 cm, 85.7 ± 9.2 kg), the soccer group of 17 pro-
fessional soccer players (25.9 ± 4.1 years, 183.8 ± 5.0 cm, 78.1 ± 5.9 kg), and 
the control group consisted of 16 non-athletes (25.4 ± 4.1 years, 181.9 ± 5.4 cm, 
86.8 ± 12.6 kg) who were only sporadically engaged in recreational physical 
activity. The participants in the soccer and handball groups were top athletes 
who completed at least two training sessions per day on most days of the week 
and took part in at least one match per week.
Subjects who had lower limb injuries, pain, or swelling at the time of meas-
urement or who had undergone lower limb surgery in the last three months 
were not eligible to participate in the study.
The handball players were members of the Trimo Trebnje handball club and 
the soccer players were members of the Olimpija Ljubljana soccer club. In the 
control group, the sample was drawn at random. Participants were included 
who were willing to cooperate and whose age corresponded to that of the other 
groups. Only people who were not involved in organized sports activities were 
included in the control group. The study was approved by the National Medi-
cal Ethics Committee of the Republic of Slovenia (No.: 0120-375/2017/3, date 
approved: 13.11.2017) and carried out in accordance with the Declaration of 
Helsinki. Each participant was required to sign a written informed consent be-
fore participating in this study.

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Foot Posture Assessment
The Foot Posture Index (FPI) was used to assess the anatomical and mor-
phological properties of both feet in a weight-bearing position according to the 
original instructions for the use of the tool (Redmond, 2005). Each foot was 
evaluated separately by a physiotherapist skilled in the use of the FPI tool. 
During the assessment, the subject stood in a relaxed bilateral position on firm 
ground in a well-lit room. The investigator assessed all six clinical criteria of 
the FPI (Redmond, 2005):
1. Talar head palpation, 2. Supra and infra lateral malleolar curvature, 3. Cal-
caneal frontal plane position, 4. Prominence in the region of the talonavicular 
joint, 5. Congruence of the medial longitudinal arch, 6. Abduction/adduction of 
the forefoot on the rearfoot. Each criterion was valued with one of the follow-
ing values: -2 (highly supinated), -1 (supinated), 0 (neutral), +1 (pronated), +2 
(highly pronated), and summated to calculate the FPI value for each foot, rang-
ing from -12 (highly supinated) to +12 (highly pronated) (Redmond, 2005). 
The assessment of each subject took approximately 2 minutes to complete. FPI 
values ranging from +1 to +7 were considered normal (Redmond, Crane & 
Menz, 2008).
Measurements of the Hip Joint External and Internal Rotation 
Bilateral measurements of passive hip external (ER) and internal rotation 
(IR) range of motion (ROM) were performed according to a standard proto-
col using a universal goniometer (Jakovljević & Hlebš, 2011). The subject lay 
prone on an examination table, with the hip in a neutral position (0°) and the 
knee flexed at 90°. The center of the goniometer was placed over the basis of 
the patella, its stationary arm parallel to the floor, and the moving arm aligned 
with the longitudinal axis of the tibia. The leg was passively rotated inward 
and outward three times by the examiner. The subject’s pelvis was manually 
stabilized against the table by a second examiner to prevent it from tilting and 
to detect the anatomical limit of joint motion. 

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Statistical Analysis
Descriptive statistics with means and standard deviations were used to pre-
sent the demographic characteristics of the groups. The normality of the data 
distribution was tested using the Shapiro-Wilk test. Since a great majority of 
the measured parameters were not normally distributed, the non-parametric 
Kruskal-Wallis test (K-W test) was used to analyze differences in the means of 
the three groups. In case of an overall significant difference, a post-hoc pairwise 
comparison of means was made using the Mann-Whitney U test. Spearman’s 
correlation coefficient (ρ) was calculated to evaluate the association between 
the FPI values and the hip rotational ROM (IR and ER). The significance level 
was set at p < 0.05 for a two-tailed test. All the values are presented as mean ± 
standard deviation, unless stated otherwise.
RESULTS
The data on the basic characteristics of the sample (age, body height, and 
weight) and all the measured parameters exhibited non-normal distribution 
(p < 0.05), except for the FPI values in the control group (p > 0.05). The soc-
cer group had a significantly lower body weight compared to the handball 
(p = 0.024) and control (p = 0.033) groups, whereas no significant differences 
were detected among the groups for age and body height (Table 1). 
Table 1: Basic characteristics of the sample
Variable
Handball
(n=17)
Soccer 
(n=17)
Control group
(n=16)
K-W test
(p-value)
Age (years) 22.4 ± 3.6 25.9 ± 4.1 25.4 ± 4.1 p = 0.076
Height (cm) 185.7 ± 4.7 183.8 ± 5.0 181.9 ± 5.4 p = 0.142
Weight (kg) 85.7 ± 9.2 78.1 ± 5.9* 86.8 ± 12.6 p = 0.011
Legend: * – Significantly different from both the control and handball groups at p < 0.05
The mean FPI values and hip ROMs for all the groups are presented in Ta-
ble 2. The highest mean FPI was obtained in the control group (1.7 ± 2.5) and 
the lowest in the handball group (0.7 ± 2.1). There were no significant differ -
ences between the three groups (p = 0.450). 

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Table 2: Mean values of FPI and hip rotation range of motion
Handball 
group
Soccer group Control group
K-W test
(p-value)
FPI value
(min / max)
0.7 ± 2.1
(-4 / +7)
1.3 ± 2.9
(-3 / +8)
1.7 ± 2.5
(-3 / +6)
0.450
Hip joint IR
(min / max)
41.0° ± 8.1°
(25° / 60°)
* 30.6° ± 5.3°
(20° / 45°)
41.1° ± 6.4°
(30° / 60°)
< 0.001
Hip joint ER
(min / max)
39.9° ± 7.1°
(25° / 50°)
39.4° ± 7.0°
(25° / 50°)
42.2° ± 5.4°
(30° / 50°)
0.294
Legend: FPI – Foot Posture Index, IR – internal rotation, ER – external rotation, * – different from the 
control group and handball group at p < 0.001
Table 3: Mean Foot posture Index values by criterion
Criterion
Handball 
group
Soccer group Control group
K-W test
(p-value)
Talar head 
palpation
0.03 ± 0.17* 0.38 ± 0.54 0.19 ± 0.53 0.008
Curves above/
below LM
0.21 ± 0.58 0.32 ± 0.58 0.34 ± 0.54 0.628
Inversion/
eversion 
calcaneus
-0.03 ± 0.57 0.09 ± 0.56 0.25 ± 0.61 0.153
Prominence 
TNJ
0.03 ± 0.38 -0.06 ± 0.48
#
0.28 ± 0.57 0.016
Congruence 
MLA
0.00 ± 0.64 0.00 ± 0.94 0.19 ± 0.53 0.534
Abd/add 
forefoot/
rearfoot
0.47 ± 0.61 0.59 ± 0.65 0.44 ± 0.50 0.659
Legend: LM – lateral malleolus, TNJ – talonavicular joint, MLA – medial longitudinal arch, 
ABD – abduction, ADD – adduction, * – statistically significant difference vs. the Soccer group 
(p < 0.05), # – statistically significant difference vs. the Control group (p < 0.05)
However, there was a significant difference between the groups in the inter -
nal rotation ROM (p < 0.001). The pairwise comparison showed significantly 
lower internal rotation ROM in the group of soccer players (30.6° ± 5.3°) com-
pared to both the handball group (p < 0.001) and the control group (p < 0.001). 

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A comparison of the six individual clinical criteria of the FPI showed that 
there were significant differences between the groups for the talar head palpa-
tion (p = 0.008) and the prominence of the talonavicular joint (p = 0.016) (Ta-
ble 3). The pairwise comparison showed significant differences in the promi-
nence of the talonavicular joint between the control group and the soccer group 
(p = 0.017), and in the position of the talar head between the soccer group and 
the handball group (p = 0.006).
For soccer players, a weak but significant positive correlation was found 
between the FPI values and IR (ρ: 0.36, p = 0.035) (Figure 1). No significant 
correlations were found between any other variables. 
Figure 1: Spearman’ s correlation coefficients (ρ) between the FPI value and 
internal hip rotation range of motion in soccer players
DISCUSSION
Our results show that the mean FPI of the soccer players and their non-
athlete peers is within the expected normal range (from +1 to +7) for their age 
(Redmond et al., 2008), while handball players are on the left edge, with a ten-

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dency toward a more supinated foot type. However, the observed group differ-
ences were not significant. The soccer players had a significantly lower ROM 
of hip internal rotation than the other two groups, which was also weakly but 
significantly positively correlated with their FPI values. However, no signifi-
cant correlation was found between the FPI and hip rotation ROM in handball 
players and non-athletes.
Compared to the main normative values of the FPI (Redmond et al., 2008), 
all our participants had lower mean FPI values (i.e. less pronation) than ex-
pected as has been shown to be the case in the healthy non-athletic adult popu-
lation (aged 18-59 years; mean FPI = 4). The reason for this cannot be fully 
established, but some reasonable assumptions can be made. Based on the FPI 
data published by Scott, Menz, and Newcombe (2007) showing lower foot pro-
nation in young adults (aged 20.9 ± 2.6 years; FPI = 2.54 ± 2.35) than in older 
people (aged 80.2 ± 5.7 years; FPI = 4.14 ± 3.86), it could be hypothesized that 
the lower foot pronation in our sample is due to their younger age. However, the 
more representative normative data from Redmond et al. (2008) do not support 
this hypothesis. On the contrary, their data show that the FPI scores exhibit a 
U-shaped relationship with age, i.e., greater foot pronation in minors under the 
age of 18 (mean FPI = 6) and again at older ages (mean FPI = 5) (Redmond et 
al., 2008). Thus, a more plausible explanation for the difference could be the 
difference in training status, as our sample consisted of elite athletes, whereas 
the normative data of Redmond et al. (2008) was based on a sample of non-ath-
letes. It appears that the FPI decreases toward a less pronated or even supinated 
foot posture in people with different foot pathologies (Redmond et al., 2008). 
Since soccer and handball players are exposed to the daily overloading of their 
feet during their sporting activities, they might develop a pre-pathological de-
crease in foot pronation. This could also be the case in our control group, whose 
activity level we do not know exactly. Although the subjects did not exercise 
several times a week, their activity level was most likely higher than the aver-
age of the non-athlete population used in Redmond et al. (2008). In addition, 
there may be other unknown specific characteristics of our control group that 
we did not identify but that influenced the FPI results.
Although not significant, both the soccer and handball players showed a 
tendency to have less pronated feet than the control group. Handball players 
even showed a tendency to a supinated foot posture, while the other two groups 
showed a tendency to a more normal (i.e. slightly pronated) foot posture, which 
is almost consistent with the published FPI data from different sports (Table 4), 
including handball (Martínez-Nova et al., 2014) and soccer players (Lopezo-
sa-Reca et al., 2018). Martínez-Nova et al. (2014) speculated that this could 

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be due to the constant rotations/pivoting and lateral displacements that cause 
inversion moments in the knee and hip joints of handball players. As shown 
in Table 4, there are large differences in FPI between sports. The difference 
is most pronounced in swimmers with highly pronated feet (FPI = 6.5 ± 2.0, 
Table 4). The intensity and pattern of mechanical loading on the feet of swim-
mers are the opposite of the forces generated in the feet of handball players or 
soccer players. Swimming is a non-weight-bearing activity under conditions of 
reduced gravity with essentially non-existent longitudinal compressive forces 
in the foot, which significantly reduces the need for muscle activity in the lower 
leg and foot. Liebenberg et al. (2011) have shown this by measuring the EMG 
amplitude of the lower limb muscles during running, which decreased linearly 
with the decrease in body weight transferred to the lower limbs.
Table 4: FPI values in various sports practitioners reported in the literature
Study Sport Age Mean FPI
Kuo & Liu, 2017
basketball, volleyball, 
badminton, tennis
22.0 ± 3.0 3.5 ± 3.0
Cherati et al., 2016 futsal 22.1 ± 3.6
right foot: 4.9 ± 2.9
left foot: 4.7 ± 3.1
Martínez-Nova et al., 
2014
basketball 32.1 ± 8.9 3.9 ± 4.1
running 40.2 ± 7.3 2.9 ± 2.8
handball 21.8 ± 3.2 -0.4 ± 6.9
Lopezosa-Reca et al., 
2020
basketball 22.5 ± 3.9 2.7 ± 3.1
De Groot et al., 2012 volleyball 26.0 ± 5.5 4.0 ± 3.5
Lopezosa-Reca et al., 
2018
swimming 17.2 ± 1.7 6.5 ± 2.0
soccer 17.3 ± 1.0 2.3 ± 1.7
Handball players have been shown to have an increased risk of hip joint 
damage due to the repetitive and intense loading of the joint beyond the physi-
ological limits of the cartilage that occurs in handball (L’Hermette et al., 2006). 
It has been shown that retired handball players (age 44.9 ± 4.7 years) have a 
lower ROM of the hip IR (16° ± 8°) compared to non-athletes of the same age 

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(IR = 23° ± 4°), most likely due to osteoarthritic changes in the hip joint caused 
by years of handball training (L’Hermette et al., 2006). We found no differ-
ence in hip rotation ROM in handball players compared to non-athletes, but 
our sample was much younger compared to participants in the study conducted 
by L’Hermette et al. (2006). However, we found a significantly lower ROM of 
passive IR of the hip in soccer players who are also exposed to specific over-
loads of the hip joint during soccer (Nunome, Asai, Ikegma, & Sakurai, 2002). 
Frequent lateral side-foot kicks, where the ball is kicked with the medial side of 
the foot, may cause repetitive exaggerated hip external rotation moments in the 
final phase of the kicks. This requires chronic overactivity, high muscle tone, 
and shortness of the external rotators of the hip, which can lead to a reduction of 
the internal rotation ROM and can have a long-term negative effect on the hip 
joint. The repetitive nature of movements that are specific to handball can lead 
to long-term alterations in the hip ROM, i.e. lower flexion and internal rotation 
and higher abduction, extension, and external rotation, and have been shown to 
have a strong association with an increased risk of developing premature hip 
OA in retired handball players (L’Hermette et al., 2006). Furthermore, lower 
hip internal and external rotation ROM have been shown to increase the risk of 
adductor strain in professional soccer players (Ibrahim, Murrell & Knapman, 
2007).
A direct comparison of the ROM values of hip rotation among different 
studies is complicated not only by the age difference of the samples, but also by 
differences in hip position during goniometric measurements. Hip goniometry 
performed in the prone position with the hip extended has been reported to 
yield higher values than measurements performed in the seated position with 
the hip flexed (Han, Kubo, Kurosawa, Maruichi, & Maruyama, 2015; Hollman, 
Burgess & Bokermann, 2003). The review of data from some other studies, 
presented in Table 5, shows significant variability in the ROM of hip rotations 
acquired in a seated or supine position in athletes of different ages, so no clear 
conclusion can be drawn in this regard.
In the present study, no significant correlations were found between the FPI 
and hip rotation ROM, except for a weak but significant positive correlation 
between the FPI and hip internal rotation in soccer players. This is consistent 
with the findings of Souza, Pinto, Trede, Kirkwood, and Fonseca (2010), which 
suggest that there is a temporal coupling of rearfoot pronation with hip IR dur-
ing walking. The fact that the pronation of the foot was only associated with hip 
IR in soccer players who also exhibited reduced ROM of the IR suggests that 
the tightness of the hip external rotators may have some influence on foot posi-
tion. Coaches, kinesiologists, and physiotherapists should pay more attention 

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Table 5: Range of motion of the internal (IR) and external (ER) hip rotation in various sports practitioners
Study Group Age (years) Body position IR Hip Joint ER Hip Joint
Hogg et al., 2018
basketball 19.4 ± 1.3 prone 28.7° ± 9.5° 39.9° ± 12.7°
cross-country 
skiing
32.6° ± 7.2° 28.5° ± 6.2°
golf 27.9° ± 7.7° 34.3° ± 6.0°
soccer 26.2° ± 8.4° 35.3° ± 12.9°
softball / baseball 29.4° ± 6.9° 34.5° ± 6.4°
tennis 26.6° ± 8.9° 43.0° ± 11.6°
Hollman et al., 
2003
running 36.6 ± 12.1
prone 50.3° ± 6.1° 43.0° ± 8.3°
sitting 43.8° ± 4.7° 33.1° ± 5.2°
Kouyoumdjian et 
al., 2012
general population 39.1 ± 10.8
prone 35.3° ± 11.9° 41.8° ± 10.2°
sitting 37.9° ± 8.4° 40.7° ± 7.6°
López-Valenciano 
et al., 2019
soccer 25.5 ± 5 prone 47.1° ± 8.0° 49.9° ± 9.8°

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Tjaž BREZOV AR, Alan KACIN: FOOT POSTURE INDEX AND HIP JOINT ROTATION MOBILITY IN HANDBALL AND SOCCER PLAYERS ..., 113–128
to the mobility of hip rotation in soccer players and take preventive measures to 
reduce the overuse of the external rotators.
Methodological Limitations and Suggestions for Future Research
Some methodological limitations of our study need to be considered when 
interpreting our results. First, all the differences in FPI observed between the 
three subject groups were not significant, so no firm conclusions can be drawn 
about the influence of a particular sport on foot posture. Secondly, the small 
sample size hinders statistical power and thus reduces the sensitivity for de-
tecting small changes in the mean values or weak correlations between the 
measured parameters. In future studies, larger and more representative sam-
ples should be drawn from different sports clubs. To increase the sensitivity for 
detecting correlations between hip ROM and foot posture, the sample should 
also include participants with pathological foot posture. Third, only goniomet-
ric measurements of the passive rotational ROM with the hip extended were 
used, which may not be fully representative of functional hip motion. In future 
studies, active ROM measurements should be used in both seated (with flexed 
hip) and prone positions and, if possible, combined with more complex biome-
chanical analyses of the hip, knee, ankle, and foot ROM during sport-specific 
activities. In addition, information on the use of orthotic insoles by athletes to 
correct their feet should be systematically collected and used as a covariate in 
future studies, as their influence on foot posture may be significant.
CONCLUSIONS
No significant differences were found in the Foot Posture Index between 
handball players, soccer players, and non-athletes. Handball and soccer players 
show a tendency toward less pronated feet compared to non-athletes, but the 
differences are not significant and the mean FPI values are still within the range 
of normal foot posture. The soccer players had significantly less hip internal 
rotation than the other two groups, which was also weakly but significantly and 
positively correlated with their FPI values. These results may serve as a guide 
for future studies of subgroups of athletes with pronounced postural defects 
of the feet. As it has previously been shown that a limited internal rotation of 
the hip joint also increases the risk of hip adductor injuries, further research is 
needed in this regard. Future studies should also use measurements of the ac-

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tive hip ROM or even more complex biomechanical analyses of the hip, knee, 
ankle, and foot ROM during sport-specific movement patterns.
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