‘Normality’ versus ‘pathology’: an alternative conceptual framework

During clinical assessment of the pathological foot, force and pressure patterns produced during gait and standing are measured and compared with those from so-called 'normal' populations. This is based on the theory that for each variable there exists a 'normal' range of values, and that values outside this range may indicate pathology. However, individuals differ in a great number of anthropometric and physiological ways; even in the same individual no two footsteps are the same. This article discusses the meaning of normality in relation to the pathological foot and presents an alternative theory, i.e. that 'normal' values represent those that fall between a series of loci, each locus representing a specific pathology. It suggests that research focusing on establishing force, pressure and movement values associated with the pathological foot may prove more productive than the current approach of comparison with 'normal' values.