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Bourke J, Munteanu S, Merza E, Garofolini A, Taylor S, Malliaras P. Efficacy of heel lifts for lower limb musculoskeletal conditions: A systematic review. J Foot Ankle Res 2024; 17:e12031. [PMID: 38878299 PMCID: PMC11296721 DOI: 10.1002/jfa2.12031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/23/2024] Open
Abstract
INTRODUCTION The objective of this systematic review is to determine the benefits and harms of heel lifts to any comparator for lower limb musculoskeletal conditions. METHODS Ovid MEDLINE, Ovid AMED, Ovid EMCARE, CINAHL Plus and SPORTDiscus were searched from inception to the end of May 2024. Randomised, quasi-randomised or non-randomised trials comparing heel lifts to any other intervention or no-treatment were eligible for inclusion. Data was extracted for the outcomes of pain, disability/function, participation, participant rating of overall condition, quality of life, composite measures and adverse events. Two authors independently assessed risk of bias and certainty of evidence using the GRADE approach at the primary time point 12 weeks (or next closest). RESULTS Eight trials (n = 903), investigating mid-portion Achilles tendinopathy, calcaneal apophysitis and plantar heel pain were included. Heel lifts were compared to exercise, ultrasound, cryotherapy orthotics, stretching, footwear, activity modification, felt pads and analgesic medication. No outcome was at low risk of bias and few effects (2 out of 47) were clinically important. Low-certainty evidence (1 trial, n = 199) indicates improved pain relief (55.7 points [95% CI: 50.3-61.1], on a 100 mm visual analogue scale) with custom orthotics compared to heel lifts at 12 weeks for calcaneal apophysitis. Very low-certainty evidence (1 trial, n = 62) indicates improved pain and function with heel lifts over indomethacin (35.5 points [95% CI: 21.1-49.9], Foot Function Index) at 12 months for plantar heel pain. CONCLUSIONS Few trials have assessed the benefits and harms of heel lifts for lower limb musculoskeletal conditions. Only two outcomes out of 47 showed clinically meaningful between group differences. However, due to very low to low certainty evidence we are unable to be confident in the results and the true effect may be substantially different. REGISTRATION PROSPERO registration number CRD42022309644.
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Affiliation(s)
- Jaryd Bourke
- Physiotherapy DepartmentSchool of Primary and Allied Health CareFaculty of Medicine Nursing and Health ScienceMonash UniversityClaytonVictoriaAustralia
| | - Shannon Munteanu
- Discipline of PodiatrySchool of Allied HealthHuman Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Eman Merza
- Physiotherapy DepartmentSchool of Primary and Allied Health CareFaculty of Medicine Nursing and Health ScienceMonash UniversityClaytonVictoriaAustralia
| | | | - Simon Taylor
- Institute for Health and Sport (IHES)Victoria UniversityMelbourneVictoriaAustralia
| | - Peter Malliaras
- Physiotherapy DepartmentSchool of Primary and Allied Health CareFaculty of Medicine Nursing and Health ScienceMonash UniversityClaytonVictoriaAustralia
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Bourke J, Munteanu S, Garofolini A, Taylor S, Malliaras P. Efficacy of heel lifts for mid-portion Achilles tendinopathy (the LIFT trial): study protocol for a randomised controlled trial. Trials 2024; 25:345. [PMID: 38790025 PMCID: PMC11127406 DOI: 10.1186/s13063-024-08185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 05/20/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Mid-portion Achilles tendinopathy is a common condition, characterised by localised Achilles tendon load-related pain and dysfunction. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. Heel lifts have also been advocated as a treatment for Achilles tendinopathy, but the efficacy and mechanism of action of this intervention is unclear. This proposal describes a randomised controlled trial comparing the effectiveness of heel lifts versus sham heel lifts for reducing pain associated with mid-portion Achilles tendinopathy, with an embedded biomechanical analysis. METHODS One hundred and eight men and women aged 18 to 65 years with mid-portion Achilles tendinopathy (who satisfy the inclusion and exclusion criteria) will be recruited. Participants will be randomised, using the website Sealed Envelope, to either a control group (sham heel lifts) or an experimental group (heel lifts). Both groups will be provided with education regarding acceptable pain levels to ensure all participants receive some form of treatment. The participants will be instructed to use their allocated intervention for at least 8 h every day for 12 weeks. The primary outcome measure will be pain intensity (numerical rating scale) at its worst over the previous week. The secondary outcome measures will be additional measures of Achilles tendon pain and disability, participant-perceived global ratings of change, function, level of physical activity and health-related quality of life. Data will be collected at baseline and the primary endpoint (week 12). Data will be analysed using the intention-to-treat principle. In addition, the acute kinetic and kinematic effects of the interventions will be examined at baseline in a subpopulation of the participants (n = 40) while walking and running using three-dimensional motion analysis. DISCUSSION The LIFT trial (efficacy of heeL lIfts For mid-portion Achilles Tendinopathy) will be the first randomised trial to compare the efficacy of heel lifts to a sham intervention in reducing pain and disability in people with Achilles tendinopathy. The biomechanical analysis will provide useful insights into the mechanism of action of heel lifts. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12623000627651 . Registered 7 June 2023.
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Affiliation(s)
- Jaryd Bourke
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
| | - Shannon Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | | | - Simon Taylor
- Institute for Health and Sport (IHES), Victoria University, Victoria, Australia
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
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Barr L, Richards J, Chapman GJ. Comparing the effectiveness of computer-aided design/computer-aided manufacturing (CAD/CAM) of insoles manufactured from foam box cast versus direct scans on patient-reported outcome measures: a protocol for a double-blinded, randomised controlled trial. BMJ Open 2024; 14:e078240. [PMID: 38569685 PMCID: PMC10989167 DOI: 10.1136/bmjopen-2023-078240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Custom insoles are a routine treatment for many foot pathologies, and the use of computer-aided design and computer-aided manufacturing (CAD/CAM) is well established within clinical practice in the UK. The method of foot shape capture used to produce insoles varies throughout orthotic services. This trial aims to investigate the effectiveness of two common shape-capture techniques on patient-reported outcomes in people who require insoles for a foot or ankle pathology. METHODS AND ANALYSIS This double-blinded randomised controlled trial will involve two intervention groups recruited from a National Health Service orthotic service. Participants will be randomly assigned to receive a pair of custom CAD/CAM insoles, manufactured either from a direct digital scan or a foam box cast of their feet and asked to wear the insoles for 12 weeks. The primary outcome measure will be the Foot Health Status Questionnaire (FHSQ) pain subdomain, recorded at baseline (immediately after receiving the intervention), 4, 8 and 12 weeks post intervention. Secondary outcome measures will include FHSQ foot function and foot health subdomains recorded at baseline, 4, 8 and 12 weeks. The Orthotic and Prosthetic User Survey Satisfaction with Device will be recorded at 12 weeks. The transit times associated with each arm will be measured as the number of days for each insole to be delivered after foot shape capture. Tertiary outcome measures will include participant recruitment and dropout rates, and intervention adherence measured as the daily usage of the insoles over 12 weeks. The change in FHSQ scores for the subdomains and insole usage will be compared between the groups and time points, and between group differences in time in transit, cost-time analysis and environmental impact will be compared. ETHICS AND DISSEMINATION Ethical approval was obtained from the Health Research Authority, London Stanmore Research Ethics Committee (22/LO/0579). Study findings will be submitted for publication in peer-reviewed journals, conference presentations and webinars. TRIAL REGISTRATION NUMBER NCT05444192.
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Affiliation(s)
- Laura Barr
- Orthotic Department, Gartnavel General Hospital, Glasgow, UK
- Allied Health Research unit, University of Central Lancashire, Preston, UK
| | - Jim Richards
- Allied Health Research unit, University of Central Lancashire, Preston, UK
| | - Graham J Chapman
- Allied Health Research unit, University of Central Lancashire, Preston, UK
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Relph N, Greaves H, Armstrong R, Prior TD, Spencer S, Griffiths IB, Dey P, Langley B. Running shoes for preventing lower limb running injuries in adults. Cochrane Database Syst Rev 2022; 8:CD013368. [PMID: 35993829 PMCID: PMC9394464 DOI: 10.1002/14651858.cd013368.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Lower-limb running injuries are common. Running shoes have been proposed as one means of reducing injury risk. However, there is uncertainty as to how effective running shoes are for the prevention of injury. It is also unclear how the effects of different characteristics of running shoes prevent injury. OBJECTIVES To assess the effects (benefits and harms) of running shoes for preventing lower-limb running injuries in adult runners. SEARCH METHODS We searched the following databases: CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus and SPORTDiscus plus trial registers WHO ICTRP and ClinicalTrials.gov. We also searched additional sources for published and unpublished trials. The date of the search was June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs involving runners or military personnel in basic training that either compared a) a running shoe with a non-running shoe; b) different types of running shoes (minimalist, neutral/cushioned, motion control, stability, soft midsole, hard midsole); or c) footwear recommended and selected on foot posture versus footwear not recommended and not selected on foot posture for preventing lower-limb running injuries. Our primary outcomes were number of people sustaining a lower-limb running injury and number of lower-limb running injuries. Our secondary outcomes were number of runners who failed to return to running or their previous level of running, runner satisfaction with footwear, adverse events other than musculoskeletal injuries, and number of runners requiring hospital admission or surgery, or both, for musculoskeletal injury or adverse event. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility and performed data extraction and risk of bias assessment. The certainty of the included evidence was assessed using GRADE methodology. MAIN RESULTS We included 12 trials in the analysis which included a total of 11,240 participants, in trials that lasted from 6 to 26 weeks and were carried out in North America, Europe, Australia and South Africa. Most of the evidence was low or very low certainty as it was not possible to blind runners to their allocated running shoe, there was variation in the definition of an injury and characteristics of footwear, and there were too few studies for most comparisons. We did not find any trials that compared running shoes with non-running shoes. Neutral/cushioned versus minimalist (5 studies, 766 participants) Neutral/cushioned shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with minimalist shoes (low-certainty evidence) (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.59 to 1.01). One trial reported that 67% and 92% of runners were satisfied with their neutral/cushioned or minimalist running shoes, respectively (RR 0.73, 95% CI 0.47 to 1.12). Another trial reported mean satisfaction scores ranged from 4.0 to 4.3 in the neutral/ cushioned group and 3.6 to 3.9 in the minimalist running shoe group out of a total of 5. Hence neutral/cushioned running shoes may make little or no difference to runner satisfaction with footwear (low-certainty evidence). Motion control versus neutral / cushioned (2 studies, 421 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral / cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.92, 95% CI 0.30 to 2.81). Soft midsole versus hard midsole (2 studies, 1095 participants) Soft midsole shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with hard midsole shoes (low-certainty of evidence) (RR 0.82, 95% CI 0.61 to 1.10). Stability versus neutral / cushioned (1 study, 57 participants) It is uncertain whether or not stability shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral/cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.49, 95% CI 0.18 to 1.31). Motion control versus stability (1 study, 56 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with stability shoes because the quality of the evidence has been assessed as very low certainty (RR 3.47, 95% CI 1.43 to 8.40). Running shoes prescribed and selected on foot posture (3 studies, 7203 participants) There was no evidence that running shoes prescribed based on static foot posture reduced the number of injuries compared with those who received a shoe not prescribed based on foot posture in military recruits (Rate Ratio 1.03, 95% CI 0.94 to 1.13). Subgroup analysis confirmed these findings were consistent between males and females. Therefore, prescribing running shoes and selecting on foot posture probably makes little or no difference to lower-limb running injuries (moderate-certainty evidence). Data were not available for all other review outcomes. AUTHORS' CONCLUSIONS Most evidence demonstrates no reduction in lower-limb running injuries in adults when comparing different types of running shoes. Overall, the certainty of the evidence determining whether different types of running shoes influence running injury rates was very low to low, and as such we are uncertain as to the true effects of different types of running shoes upon injury rates. There is no evidence that prescribing footwear based on foot type reduces running-related lower-limb injures in adults. The evidence for this comparison was rated as moderate and as such we can have more certainty when interpreting these findings. However, all three trials included in this comparison used military populations and as such the findings may differ in recreational runners. Future researchers should develop a consensus definition of running shoe design to help standardise classification. The definition of a running injury should also be used consistently and confirmed via health practitioners. More researchers should consider a RCT design to increase the evidence in this area. Lastly, future work should look to explore the influence of different types or running shoes upon injury rates in specific subgroups.
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Affiliation(s)
- Nicola Relph
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | | | - Ross Armstrong
- Institute of Health, University of Cumbria, Carlisle, UK
| | - Trevor D Prior
- Podiatric Surgery, Homerton University Hospital, London, UK
| | - Sally Spencer
- Health Research Institute, Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | | | - Paola Dey
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Ben Langley
- Department of Sport & Physical Activity, Edge Hill University, Ormskirk, UK
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Effects of orthotic insole on gait patterns in children with mild leg length discrepancy. Gait Posture 2022; 93:191-197. [PMID: 35182985 DOI: 10.1016/j.gaitpost.2022.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Leg length discrepancy (LLD) is commonly associated with compensatory gait strategies leading to musculoskeletal disorders of the lower extremity and lumbar spine. Orthotic insole (OI) is considered as a conservative treatment for patients with mild LLD, especially for children. However, the restoration of normal gait when wearing OI with foot lift are still poorly understood. RESEARCH QUESTION What are the immediate effects of OI on the gait patterns in children with mild LLD? METHODS Gait data and plantar pressure data were collected for 12 children with mild anatomical LLD in barefoot and OI conditions. Paired t-test was performed to determine the changes in gait between these two conditions, and also the symmetry between limbs in the same condition for spatiotemporal, kinematic, and kinetic variables. RESULTS Children with mild LLD showed an immediate gait improvement confirmed by increased step length and velocity, decreased peak plantar pressure in both limbs with OI. Additionally, the significant between-limb differences disappeared for peak ankle dorsiflexion, hip adduction, pelvis upward obliquity and also second peak plantar pressure with OI, which improved gait symmetry. SIGNIFICANCE This study provides a better understanding of the immediate effect of OI with foot lift on biomechanical changes in gait, which identify that OI with foot lift could be a potential therapeutic option for children with mild structural LLD to improve gait metrics.
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Campbell TM, Ghaedi B, Tanjong Ghogomu E, Ramsay T, Welch V. Shoe and heel lifts for leg length inequality in adults with musculoskeletal conditions. Hippokratia 2021. [DOI: 10.1002/14651858.cd014456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- T Mark Campbell
- Physical Medicine and Rehabilitation; Elisabeth Bruyère Hospital; Ottawa Canada
| | - Bahareh Ghaedi
- Physical Medicine and Rehabilitation; Bruyere Research Institute; Ottawa Canada
| | | | - Timothy Ramsay
- Clinical Epidemiology Program; Ottawa Hospital Research Institute; Ottawa Canada
| | - Vivian Welch
- Methods Centre; Bruyère Research Institute; Ottawa Canada
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Zhang X, Liu Y. The Application Value of MRI in the Training and Physical Rehabilitation of Gastrocnemius with Acute Sports Injury. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4107743. [PMID: 34621502 PMCID: PMC8492242 DOI: 10.1155/2021/4107743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to analyze the magnetic resonance imaging (MRI) signs of acute gastrocnemius injury and to provide the basis for clinical diagnosis. Thirty-two patients with acute gastrocnemius muscle injury (19 males and 13 females, aged 18-63 years, mean 46 years) were recruited, and MRI scans were performed. The results showed that all the lesions of calf gastrocnemius were detected in 32 patients, including first-degree injury in 15 cases, second-degree injury in 15 cases, and third-degree injury in 2 cases. MRI can display the location and pathological changes of acute gastrocnemius injury, providing good imaging data for clinical diagnosis and treatment.
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Affiliation(s)
- Xingwei Zhang
- Northeast Normal University, Jilin 130000, China
- Department of Medical Imaging Technology, North University of Nationalities, Yinchuan 750030, Ningxia Hui Autonomous Region, China
| | - Yunfa Liu
- Northeast Normal University, Jilin 130000, China
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Rabusin CL, Menz HB, McClelland JA, Evans AM, Malliaras P, Docking SI, Landorf KB, Gerrard JM, Munteanu SE. Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial. Br J Sports Med 2020; 55:486-492. [PMID: 32988930 DOI: 10.1136/bjsports-2019-101776] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To compare the efficacy of in-shoe heel lifts to calf muscle eccentric exercise in reducing pain and improving function in mid-portion Achilles tendinopathy. METHODS This was a parallel-group randomised superiority trial at a single centre (La Trobe University Health Sciences Clinic, Discipline of Podiatry, Melbourne, Victoria, Australia). One hundred participants (52 women and 48 men, mean age 45.9, SD 9.4 years) with clinically diagnosed and ultrasonographically confirmed mid-portion Achilles tendinopathy were randomly allocated to either a (1) heel lifts (n=50) or (2) eccentric exercise (n=50) group. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 12 weeks. Differences between groups were analysed using intention to treat with analysis of covariance. RESULTS There was 80% follow-up of participants (n=40 per group) at 12 weeks. The mean VISA-A score improved by 26.0 points (95% CI 19.6 to 32.4) in the heel lifts group and by 17.4 points (95% CI 9.5 to 25.3) in the eccentric exercise group. On average, there was a between-group difference in favour of the heel lifts for the VISA-A (adjusted mean difference 9.6, 95% CI 1.8 to 17.4, p=0.016), which approximated, but did not meet our predetermined minimum important difference of 10 points. CONCLUSION In adults with mid-portion Achilles tendinopathy, heel lifts were more effective than calf muscle eccentric exercise in reducing pain and improving function at 12 weeks. However, there is uncertainty in the estimate of effect for this outcome and patients may not experience a clinically worthwhile difference between interventions. TRIAL REGISTRATION NUMBER ACTRN12617001225303.
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Affiliation(s)
- Chantel L Rabusin
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia .,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Angela M Evans
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Peter Malliaras
- Department of Physiotherapy, Monash University Faculty of Medicine Nursing and Health Sciences, Frankston, Victoria, Australia
| | - Sean I Docking
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Karl B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - James M Gerrard
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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Savva C, Kleitou M, Efstathiou M, Korakakis V, Stasinopoulos D, Karayiannis C. The effect of lumbar spine manipulation on pain and disability in Achilles tendinopathy. A case report. J Bodyw Mov Ther 2020; 26:214-219. [PMID: 33992247 DOI: 10.1016/j.jbmt.2020.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/08/2020] [Accepted: 08/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND/PURPOSE Cervical and thoracic spine manipulation has been found to reduce tendon pain and disability in lateral epicondylalgia and rotator cuff tendinopathy. Based on these findings, the application of lumbar spine manipulation may also provide similar improvements in Achilles tendinopathy (AT). Therefore, the purpose of this study was to evaluate the effect of lumbar spine manipulation on pain and disability in a patient experiencing AT. CASE DESCRIPTION A 44 years old male ex-football player presented with a 20-year history of persistent Achilles tendon pain (ATP) consistent with AT diagnosis. The patient attended 12 treatment sessions receiving a high-velocity, low amplitude lumbar spine manipulation. Outcome measures were collected at baseline, 2 weeks, 4 weeks, 3 months and 6 months and included pain in visual analogue scale, the American Orthopedic Foot and Ankle Score, the 36-Item Short Form Health Survey and the Victorian Institute of Sport Assessment-Achilles questionnaire. Pressure pain threshold was also assessed using an electronic pressure algometer. OUTCOMES Improvement in all outcome measures was noted 6-months post intervention. Outcome measures indicated substantial improvements in both the patient's pain and disability. The patient was able to perform activities of daily living without difficulties, suggesting higher level of function and quality of life at 6-months post initial evaluation. CONCLUSION These findings have demonstrated the positive effects of lumbar spine manipulation on ATP and disability. Further studies, specifically clinical trials investigating the effect of lumbar spine manipulation or combining this technique with exercises and functional activities are suggested.
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Affiliation(s)
- Christos Savva
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus.
| | - Michalis Kleitou
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
| | - Michalis Efstathiou
- Department of Life and Health Science, 46 Makedonitissas Avenue, Engomi, University of Nicosia, Cyprus
| | | | - Dimitris Stasinopoulos
- Department of Physiotherapy, 11521, Aleksandras Avenue, University of West Attica, Athens, Greece
| | - Christos Karayiannis
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
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Kurien AJ, Senthilvelkumar T, George J, Kumar V, Rebekah G. Heel lift improves walking ability of persons with traumatic cauda equina syndrome-a pilot experimental study. Spinal Cord Ser Cases 2020; 6:16. [PMID: 32184382 DOI: 10.1038/s41394-020-0266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/29/2020] [Accepted: 02/29/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Non-randomized within-subject experimental study. OBJECTIVE To determine whether the addition of the 1 cm heel lift to the footwear improves the walking ability of the persons with Cauda Equina Syndrome (CES). SETTING Department of Physical Medicine and Rehabilitation, Christian Medical College, India. METHODS Fourteen people with bilateral plantar flexor weakness following traumatic CES (mean age 43.7 years) were recruited for the study. Their walking speed, stride length, cadence, and time taken to complete Timed Up and Go (TUG) were measured using footwear with back straps. Then, the 1 cm heel lift was attached to the sole of the footwear. After sufficient practice, all the parameters were reassessed to find out the effectiveness of the heel lift. RESULTS With the 1 cm heel lift, the participants walked 0.13 m/s (95% CI, 0.08-0.17) faster than their regular footwear. They were able to complete the TUG test 2.6 s (95% CI, 1.4-3.7) earlier than before. There was an increase of 5.2 in. in stride length (95% CI, 2.9-9) and an eight steps increase in cadence (95% CI, 4.9-11.3) observed after the heel lift. CONCLUSIONS This pilot study has demonstrated that addition of 1 cm heel may be effective in improving the walking performance of persons with Cauda Equina Syndrome. Future studies should investigate the kinetic and kinematic changes of this modification using a randomized controlled trial study design.
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Affiliation(s)
- Akhil John Kurien
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thangavelu Senthilvelkumar
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India.
| | - Jacob George
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vanjeeth Kumar
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
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Jin H, Xu R, Wang S, Wang J. Use of 3D-Printed Heel Support Insoles Based on Arch Lift Improves Foot Pressure Distribution in Healthy People. Med Sci Monit 2019; 25:7175-7181. [PMID: 31549689 PMCID: PMC6777389 DOI: 10.12659/msm.918763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background 3D-printed insoles are widely used. This study was conducted to test a customized three-dimensional (3D)-printed heel support insole based on arch lift and to investigate whether the pressure distribution on the sole was improved while maintaining foot function. Material/Methods The design was based on a 3D plantar contour scanning modeling technique. Thirty healthy male participants walked along a 10-m track under 3 self-controlled interventions. A customized 3D-printed heel support insole based on arch lift was inserted into the socks for the experimental condition A. For condition B, a customized 3D-printed heel-supporting insole was inserted into the socks, and a standardized pre-made heel-supporting insole was inserted into the socks as a control (condition C). We used the Footscan® pressure plate to measure the plantar parameters in the forefoot contact and foot flange phases in each condition. Results Compared with condition B and the control condition, the peak pressure under the heel was significantly lower in condition A (P<0.05), and the peak pressure in the midfoot region was not significantly increased (P>0.05). Conclusions The biomechanical properties of the customized 3D-printed heel support are better than those of the traditional heel support insole, especially when there is a need for an additional increase in heel height. Patients do not decrease midfoot motion function while using this customized insole.
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Affiliation(s)
- Hui Jin
- Department of Pain Medicine, Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Rui Xu
- Norman Bethune College of Medicine, Jilin University, Changchun, Jilin, China (mainland)
| | - Shuxin Wang
- Norman Bethune College of Medicine, Jilin University, Changchun, Jilin, China (mainland)
| | - Jincheng Wang
- Orthopedic Medical Center, Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
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Relph N, Greaves H, Armstrong R, Gichuru P, Prior TD, Griffiths IB, Spencer S, Dey P, Langley B. Running shoes for preventing lower limb running injuries in adults. Hippokratia 2019. [DOI: 10.1002/14651858.cd013368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Nicola Relph
- Edge Hill University; Faculty of Health and Social Care; Ormskirk UK
| | - Henrike Greaves
- Liverpool John Moores University; Tom Reilly Building, Byrom Street, Liverpool UK L3 3AF
| | - Ross Armstrong
- Edge Hill University; Department of Sport & Physical Activity; St Helens Road Ormskirk UK L39 4QP
| | - Phillip Gichuru
- Edge Hill University; Faculty of Health and Social Care; Ormskirk UK
| | - Trevor D Prior
- Homerton University Hospital; Podiatric Surgery; Homerton Row London UK E9 6SR
| | - Ian B Griffiths
- Pure Sports Medicine; Level 2 Cabot Place West Canary Wharf London London UK E14 4QT
| | - Sally Spencer
- Edge Hill University; Postgraduate Medical Institute; St Helens Road Ormskirk Lancashire UK L39 4QP
| | - Paola Dey
- Edge Hill University; Faculty of Health and Social Care; Ormskirk UK
| | - Ben Langley
- Edge Hill University; Department of Sport & Physical Activity; St Helens Road Ormskirk UK L39 4QP
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