Differences in lower-extremity kinematics between the male military personnel with and without plantar fasciitis

The clinical and biomechanical effects of customized foot orthoses in individuals with plantar heel pain: A pre-post intervention study

BACKGROUND

Customized foot orthoses (CFOs) are often recommended for the management of plantar heel pain. However, there is a lack of information regarding lower limb and multi-segment foot motion during gait.

RESEARCH QUESTION

This study aimed to determine the effects of heat moulded CFOs on foot and lower limb kinematics when compared with prefabricated foot orthoses (PFOs) and wearing no orthoses (shod condition), and to determine the short-term effects of CFOs on pain intensity and foot function.

METHODS

The immediate effects of CFOs on the lower limb and multi-segment foot motion were assessed. Participants were then asked to use the CFOs for one month and foot pain, function, and temporal-spatial parameters were assessed at baseline and at one month follow up.

RESULTS

Thirty-five participants (22 females), aged 40.1 (10.5) years, with a mean duration of symptoms of 12.59 months were recruited. The symptomatic limbs showed a higher forefoot varus angle and greater rearfoot and forefoot corrections were required compared to the non-symptomatic limbs. When compared with PFOs and shod conditions, CFOs provided the least forefoot and knee motion in the transverse plane during contact phase (P < 0.05, d=0.844-1.720), least rearfoot motion in the coronal plane during midstance (P < 0.05, d=0.652), and least forefoot motion in the frontal plane, knee motion in the transverse plane, and hallux motion during the propulsive phase (P < 0.05, d=0.921-1.513). Significant improvements were seen for foot pain and function (P < 0.05, d=1.390-2.231) with significant increases in cadence and walking velocity after one month of CFO use (P < 0.05, d=0.315-0.353), and those most likely to respond had greater pain and less ankle eversion (P < 0.05, d=0.855-1.115).

SIGNIFICANCE

CFOs appear to improve pathological biomechanics associated with plantar heel pain. After one month follow up, the CFOs decreased pain intensity and increased foot function, and showed significant improvements in temporal and spatial parameters of gait.

Effects of customized insoles with medial wedges on lower extremity kinematics and ultrasonographic findings in plantar fasciitis persons

The customized insole is widely recommended as an effective intervention for pain reduction and foot function improvement in plantar fasciitis persons. However, it is unclear whether the additional correction of medial wedges could change the kinematics from the only insole. The objectives of this study were thus to compare customized insoles with and without medial wedges on lower extremity kinematics during gait and to determine the short-term effects of the customized insole with medial wedges on pain intensity, foot function, and ultrasonographic findings in plantar fasciitis persons. A within-subject, randomized, crossover design within motion analysis research laboratory was conducted among 35 persons with plantar fasciitis. Main outcome measures included joint motions of the lower extremity and multi-segment foot, pain intensity, foot function, and ultrasonographic findings. The customized insole with medial wedges produced less knee motion in the transverse plane and hallux motion in all planes during the propulsive phase than that without medial wedges (all p < 0.05). After the 3-month follow-up, the insoles with medial wedges decreased pain intensity and increased foot function. Abnormal ultrasonographic findings also decreased significantly after the 3-month treatment of insoles with medial wedges. Customized insoles with medial wedges seem superior to those without medial wedges on both multi-segment foot motion and knee motion during propulsion. Positive outcomes from this study supported the use of customized insoles with medial wedges as an effective conservative treatment in patients with plantar fasciitis.Trial registration: TCTR20210928006 (28/09/2021).

Thick shells and medially wedged posts increase foot orthoses medial longitudinal arch stiffness: an experimental study

BACKGROUND

Foot orthoses (FOs) are commonly prescribed devices to attenuate biomechanical deficits and improve physical function in patients with musculoskeletal disorders. It is postulated that FOs provide their effects through the production of reaction forces at the foot-FOs interface. An important parameter to provide these reaction forces is their medial arch stiffness. Preliminary results suggest that adding extrinsic additions to FOs (e.g., rearfoot posts) increases their medial arch stiffness. A better understanding of how FOs medial arch stiffness can be modulated by changing structural factors is necessary to better customise FOs for patients. The objectives of this study were to compare FOs stiffness and force required to lower the FOs medial arch in three thicknesses and two models (with and without medially wedged forefoot-rearfoot posts).

METHODS

Two models of FOs, 3D printed in Polynylon-11, were used: (1) without extrinsic additions (mFO), and (2) with forefoot-rearfoot posts and a 6^o medial wedge (FO6MW). For each model, three thicknesses (2.6 mm, 3.0 mm, and 3.4 mm) were manufactured. FOs were fixed to a compression plate and vertically loaded over the medial arch at a rate of 10 mm/minute. Two-way ANOVAs and Tukey post-hoc tests with Bonferroni corrections were used to compare medial arch stiffness and force required to lower the arch across conditions.

RESULTS

Regardless of the differing shell thicknesses, the overall stiffness was 3.4 times greater for FO6MW compared to mFO (p < 0.001). FOs with 3.4 mm and 3.0 mm thicknesses displayed 1.3- and 1.1- times greater stiffness than FOs with a thickness of 2.6 mm. FOs with a thickness of 3.4 mm also exhibited 1.1 times greater stiffness than FOs with a thickness of 3.0 mm. Overall, the force to lower the medial arch was up to 3.3 times greater for FO6MW than mFO and thicker FOs required greater force (p < 0.001).

CONCLUSIONS

An increased medial longitudinal arch stiffness is seen in FOs following the addition of 6^o medially inclined forefoot-rearfoot posts, and when the shell is thicker. Overall, adding forefoot-rearfoot posts to FOs is significantly more efficient than increasing shell thickness to enhance these variables should that be the therapeutic aim.

Can orthotic wedges change the lower-extremity and multi-segment foot kinematics during gait in people with plantar fasciitis?

BACKGROUND

Orthotic wedges with medial posting of the forefoot and rearfoot have been shown to be effective in controlling excessive foot pronation in people with plantar fasciitis (PF), however the best prescription remains unclear.

RESEARCH QUESTION

The aim of this study was to determine the biomechanical effects of two designs of orthotic wedges within a shoe on the hip, knee, rearfoot, and forefoot kinematics in individuals with PF.

METHODS

Thirty-five participants with PF were recruited. They were asked to walk under three randomized conditions; shod, shod with orthotic wedges with foot assessment technique 1 (W1), and shod with orthotic wedges from a new assessment technique (W2). Biomechanical outcomes included lower limb and multi-segment foot kinematics in each subphase of the stance gait, including contact phase, midstance phase, and propulsive phase.

RESULTS

Compared with shod, the W1 significantly increased rearfoot dorsiflexion, decreased peak forefoot dorsiflexion, and peak rearfoot eversion during the contact phase. In addition, W1 increased rearfoot inversion, decreased hallux dorsiflexion, and peak hallux dorsiflexion during the propulsive phase. For W2, the wedge significantly decreased peak knee internal rotation, decreased forefoot abduction, peak forefoot dorsiflexion, and peak rearfoot eversion during the contact phase. In addition, W2 increased rearfoot inversion, decreased hallux dorsiflexion, and decreased peak hallux dorsiflexion during the propulsive phase. When comparing W1 and W2, W1 showed greater rearfoot dorsiflexion during the contact phase.

SIGNIFICANCE

These findings suggest that the use of forefoot varus wedges, and the combination of forefoot and rearfoot varus wedges, can change the lower limb kinematics, the multi-segment foot kinematics estimated using markers fixed to the shoe, and the relative length of the plantar fascia which can be associated with a reduction in pain and symptoms during walking.