Foot orthoses custom-made by vacuum forming on the non-load-bearing foot: preliminary results in male children with calcaneal apophysitis (Sever's disease)

A Sternoclavicular Joint-Specific Plate for the Displaced Medial-End Clavicle Fracture

Objectives

This study aimed to introduce a sternoclavicular joint (SCJ)-specific plate for the treatment of medial-end clavicle fracture and evaluate the clinical and radiological results of this method.

Methods

From January 2006 to December 2020, 31 patients with displaced medial-end clavicle fractures were included in this study, with 8 patients with accompanying SCJ dislocation. Abduction and forward elevation of the shoulder, the Visual Analogue Scale (VAS), and the American Shoulder and Elbow Surgeons Score (ASES) were used for evaluation before index surgery and at the latest follow-up.

Results

After an average of 98.5 (range, 13 to 171) months, the mean VAS significantly decreased from 6.8 ± 1.0 preoperatively to 0.9 ± 0.8 at the latest follow-up (P < 0.001). The mean ASES score significantly increased from 34.3 ± 7.8 preoperatively to 90.2 ± 4.9 at the latest follow-up (P < 0.001). The mean abduction of the shoulder significantly increased from 72.1 ± 6.6 preoperatively to 169.5 ± 8.5 at the latest follow-up (P < 0.001). The mean forward elevation of the shoulder significantly increased from 97.1 ± 11.0 preoperatively to 163.1 ± 11.5 at the latest follow-up (P < 0.001). The union of all fractures was achieved, and all implants were removed. No loose or breakage of implants was observed. No vascular or nerve damage occurred during the operation.

Conclusions

This SCJ-specific plate provided excellent long-term results for the treatment of displaced medial-end clavicle fractures and was an alternative implant for medial-end clavicle fractures with or without small or comminuted medial fragments, especially those associated with SCJ dislocation.

Effects of custom-made insoles on foot pressure redistribution, gait parameters, and pain in calcaneal apophysitis-a pretest and posttest study

BACKGROUND

Calcaneal apophysitis is a self-limiting disorder that often affects adolescents with a high level of activity and leads to increased pain severity, impairments in gait parameters, and poor health-related quality of life.

OBJECTIVE

To investigate the combination of custom-made insoles and exercise on foot pressure distribution, spatial-temporal gait parameters, and pain intensity in patients with calcaneal apophysitis.

STUDY DESIGN

A one-group pretest-posttest design.

METHODS

Forty patients, aged between 8 and 15 years, diagnosed with calcaneal apophysitis, were included in this study. Patients were asked to use the custom-made insoles and to perform a home exercise program for 3 days a week. The duration of treatment was 4 weeks. The pain severity was evaluated with the Visual Analog Scale. The spatial-temporal gait parameters and foot pressure distribution were assessed with the Zebris FDM-THM-S treadmill system before and after the treatment.

RESULTS

At posttreatment assessment, there were significant changes in step length, stance phase percentage, swing phase percentage, and gait speed (P < 0.05), except step width and cadence (P > 0.05). Moreover, significant differences were found in forefoot, midfoot, and rearfoot pressure distribution (P < 0.05). There was also a significant decrease in pain intensity during activity compared to the pretreatment (P < 0.05).

CONCLUSION

Our study results suggest that the combination of the custom-made insoles and exercise program created improvements in spatial-temporal gait parameters and foot pressure distribution by reducing the pain severity.

Effectiveness of Custom-Made Foot Orthoses vs. Heel-Lifts in Children with Calcaneal Apophysitis (Sever’s Disease): A CONSORT-Compliant Randomized Trial

The aim of the present research was to determine the effectiveness of relieving calcaneal apophysitis pain using “off-the-shelf” heel-lifts and custom-made orthotics. Two intervention modalities were evaluated and compared in a 12-week follow-up trial. Inclusion criteria included 9- to 12-year-old children diagnosed with calcaneal apophysitis. Children were randomly stratified into treatment A (custom-made polypropylene foot orthoses) and treatment B (“off-the-shelf” heel-lifts) groups. Treatment effectiveness was measured by algometry and the visual analogical scale (VAS). A total of 208 patients were included. The treatment A group showed an increase in threshold algometry of 53.4% (95% CI 47.1% to 59.7%) and a decrease in VAS of −68.6% (95% CI −74.5% to −62.7%) compared with the treatment B group (p < 0.001). Calcaneal apophysitis pain perception was improved in both groups, but children who used custom-made foot orthoses showed a greater improvement.

Foot orthoses for people with rheumatoid arthritis, involving quantitative and qualitative outcomes: protocol for a randomised controlled trial

INTRODUCTION

Rheumatoid arthritis (RA) involves changes to foot structure and function, and there is an association between RA and foot pain. This pain affects those patient's physical activity and experience of daily living. While there is clinical evidence for the value of foot orthoses (FO) on foot pain, there is a wide range of FO available and there is little evidence on the relative benefits of one orthoses type over another, especially in terms of their impact on physical activity and associated well-being. The aim of this study is to compare physical activity, general and foot health and foot health experiences in people with RA when wearing three different types of FO.

METHODS AND ANALYSIS

A randomised controlled trial with three arms will compare the effects of (1) custom FO made using a direct adaptation technique, (2) custom FO made through a digital design and production process and (3) prefabricated orthoses. The primary outcome is physical activity measured using a GENEActiv bracelet. Secondary outcomes will be pain, function and disability and associated foot and general health evaluated using existing questionnaires. Semistructured interviews will identify patients' experiences of the orthoses and living with RA.

ETHICS AND DISSEMINATION

The study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía ethical committee (SPAR-001). The results will be disseminated regardless of the magnitude or direction of effect.

TRIAL REGISTRATION NUMBER

NCT03170947; Pre-results.

The Effectiveness of Personalized Custom Insoles on Foot Loading Redistribution during Walking and Running

The objective of this study was to investigate the effectiveness of different hardness of personalized custom insoles on plantar pressure redistribution in healthy young males during walking and running. Six males participated in the walking and running test (age: 24±1.6 years, weight: 67.9±3.6 kg, height: 175.5±4.7 cm). All subjects were instructed to walk and run along a 10m pathway wearing two different hardness insoles (i.e., hard custom insoles (CHI) and soft custom insole (CSI)) and control insole (CI) at their preferred speed. Peak pressure, mean pressure, maximum force, pressure-time integral were collected to analyze using SPSS. The plantar pressure of forefoot and medial midfoot were significantly increased and of lateral forefoot and lateral midfoot were decreased by both kinds of custom insoles in running tests. While the CHI significantly increased plantar pressure of the medial forefoot compared with the CSI and CI both in walking and running tests. The custom insoles showed significantly higher plantar pressure on medial midfoot. But CSI seems better than CHI because of redistributing the plantar pressure by increasing the plantar pressure of whole forefoot. Moreover, CSI showed significantly lower plantar pressure than CI and CHI at lateral midfoot during running test. The CHI causes significant high pressure at medial forefoot (MF), which may raise the risk of forefoot pain.

Effectiveness of foot orthoses in patients with rheumatoid arthritis related to disability and pain: a systematic review and meta-analysis

BACKGROUND

Epidemiological studies consistently report a 90% prevalence of foot pain. Mechanical and other non-pharmacological interventions such as orthoses and footwear can play an important role in managing foot pathology in patients whose systemic disease is controlled. The effectiveness of treatment with insoles has been examined in various randomised controlled trials, which have reported immediate clinical improvements, with reduced foot pain and disability and enhanced functionality. The aim of this systematic review is to determine the effectiveness of foot orthoses in patients with rheumatoid arthritis (RA), in comparison with other treatments, in terms of enhanced disability and reduced pain.

METHODS

A systematic review and meta-analysis was conducted of a number of randomised controlled trials focusing on patients with RA. The search was conducted in Cochrane, CINAHL, PubMed, EMBASE, SCOPUS and Cuiden, by means of an independent peer review. The Mesh terms and fields used were foot, ankle, joint, RA, foot, orthosis, insole and foot orthosis.

RESULTS

Of the initial 118 studies considered, 5 were included in the final systematic review and meta-analysis. These five studies had enrolled a total of 301 participants, with follow-up periods ranging from 4 to 36 months. Although the use of orthoses seems to alleviate foot pain, our meta-analysis did not reveal statistically significant differences between control and intervention groups regarding long- and short-term pain relief and/or reduced disability.

CONCLUSIONS

Foot orthoses can relieve pain and disability and enhance patients, but no significant differences were found between control and intervention groups.

Effect produced on ground reaction forces by a prefabricated, weight-bearing and non-weight-bearing foot orthosis in the treatment of pronated foot: Pilot study

BACKGROUND

The aim of this study is to explore the changes in ground reaction force (GRF) produced by custom-made weight-bearing and nonweight-bearing foot orthoses and by a prefabricated foot orthosis, in the control of the pronated foot.

METHODS

Thirty-nine participants were recruited. All were in good health, aged 18 to 25 years, and presented pronated foot. Three different types of foot orthosis were studied: prefabricated, weight-bearing, and nonweight-bearing.

RESULTS

No significant differences were observed in the phases of the gait cycle between the prefabricated, the weight-bearing, and the nonweight-bearing foot orthoses.

CONCLUSIONS

Neither prefabricated insoles nor custom-made orthoses (weight-bearing or nonweight-bearing) modified GRF.

Foot posture development in children aged 5 to11 years: A three-year prospective study

BACKGROUND

The paediatric flatfoot is a common presentation but it is unclear whether the condition will resolve on its own as the child gets older or whether treatment is required. Therefore, the study objective was to evaluate paediatric foot posture, and anthropometry, in children at two time points, three years apart.

MATERIAL AND METHODS

A sample of 1032 healthy children (505 boys, 527 girls; aged 5-11 years) was recruited for foot posture index (FPI) and anthropometry assessment (weight, height and body mass index, BMI). Assessment was repeated when the children were aged 8 years to 14 years. Paired t-tests, Anova, frequency tables and a multiple regressions were conducted.

RESULTS

Initially, approximately 70% had a neutral FPI range, 20% pronated, 3% highly pronated, and 4% supinated. Initial mean FPI was 3.6 ± 2.8, being higher in boys 3.7 ± 2.8 than in girls 3.4 ± 2.7 (p = 0.034). All FPI categories changed over time, with supinated and neutral FPI increased by 19.5% and 4.7% respectively. In contrast, pronated and highly pronated FPI reduced by 10.6% and 55.6% respectively. Regression showed only 1% FPI change was explained by increased height. FPI scores were significantly reduced after three years (3.57 to 3.33; p < 0.001).

CONCLUSION

Children's foot posture shifts toward neutral as age increases. There is minimal relationship with weight, height or BMI. Appreciation of developing foot posture could reduce over diagnosis and unnecessary treatment of paediatric flatfeet.

Assessment of the kinesiotherapy's efficacy in male athletes with calcaneal apophysitis

BACKGROUND

The aim of the present study was to assess the efficacy of kinesiotherapy used for treating various disorders in athletes on pain and pedal functions in patients with calcaneal apophysitis.

METHODS

This prospective randomized controlled study included 22 patients with calcaneal apophysitis aged 8 to 16 years presenting with heel pain among junior athletes of a professional football club. The patients were randomly grouped into two groups, with one group receiving sham tape only and the other kinesio tape. American Orthopedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scores were recorded before and after the treatment.

RESULTS

The preoperative VAS score of the kinesio tape was 7, and AOFAS score was 62.4; the corresponding figures of the sham group were 6.81 and 70.5, respectively. The kinesio-tape group had a better AOFAS scores at 1st and 3rd month (p < 0.05). Posttreatment AOFAS score was 99.7 ± 0.9 for the kinesio-tape group and 97.4 ± 3.9 for the sham-tape group. Posttreatment VAS score was 0.1 ± 0.3 for the kinesio-tape group and 0.4 ± 0.5 for the sham-tape group (p > 0.05).

DISCUSSION

Conservative treatment modalities are preferentially used for its treatment. Kinesiotherapy is one of the treatment methods for the apophysitis. In the literature, our study is the first prospective randomized trial on the efficacy of kinesio taping in calcaneal apophysitis.

CONCLUSIONS

Although kinesio taping can be effectively used for the restoration of ankle functions of athletes with calcaneal apophysitis, its role in pain is limited. Since it lacks serious side effects, it can be used in combination with or as an alternative to pharmacological treatment in this patient group.

Influence of custom-made and prefabricated insoles before and after an intense run

Each time the foot contacts the ground during running there is a rapid deceleration that results in a shock wave that is transmitted from the foot to the head. The fatigue of the musculoskeletal system during running may decrease the ability of the body to absorb those shock waves and increase the risk of injury. Insoles are commonly prescribed to prevent injuries, and both custom-made and prefabricated insoles have been observed to reduce shock accelerations during running. However, no study to date has included a direct comparison of their behaviour measured over the same group of athletes, and therefore great controversy still exists regarding their effectiveness in reducing impact loading during running. The aim of the study was to analyse the acute differences in stride and shock parameters while running on a treadmill with custom-made and prefabricated insoles. Stride parameters (stride length, stride rate) and shock acceleration parameters (head and tibial peak acceleration, shock magnitude, acceleration rate, and shock attenuation) were measured using two triaxial accelerometers in 38 runners at 3.33 m/s before and after a 15-min intense run while using the sock liner of the shoe (control condition), prefabricated insoles and custom-made insoles. No differences in shock accelerations were found between the custom-made and the control insoles. The prefabricated insoles increased the head acceleration rate (post-fatigue, p = 0.029) compared to the control condition. The custom-made reduced tibial (pre-fatigue, p = 0.041) and head acceleration rates (pre-fatigue and post-fatigue, p = 0.01 and p = 0.046) compared to the prefabricated insoles. Neither the stride nor the acceleration parameters were modified as a result of the intense run. In the present study, the acute use of insoles (custom-made, prefabricated) did not reduce shock accelerations compared to the control insoles. Therefore, their effectiveness at protecting against injuries associated with elevated accelerations is not supported and remains unclear.

The effects of custom-made foot orthosis using the Central Stabilizer Element on foot pain

BACKGROUND

Foot orthoses have been applied for the management of lower limb disorders, mainly for those who develop foot pain. The Central Stabilizer Element (CSE) is a new element that contains the midfoot laterally when a plantar insole is manufactured.

OBJECTIVES

To determine the effect on foot pain of adding the Central Stabilizer Element during the manufacturing process of foot orthosis, and to describe the proportions of Central Stabilizer Element in terms of width and length of this element.

STUDY DESIGN

A clinical study.

METHODS

A sample comprising 130 patients (57 males and 73 females) with foot pain was recruited for this study, with the patients having supinated, neutral, pronated and overpronated feet. All the patients received a custom-made foot orthosis with the Central Stabilizer Element. The Central Stabilizer Element was made of resins of polyvinyl chloride, and is a device insert in foot orthosis that contains the midfoot laterally to control pronation and supination movements. Perceived patient's foot pain was collected using a Visual Analog Scale at baseline, 15, 60 and 90 days after treatment.

RESULTS

A statistically significant decrease was found after foot orthosis application at all times in all foot types. There was a statistically significant correlation between all the ratio proportions according to foot posture (Foot Posture Index scores), except for heel length proportion.

CONCLUSIONS

The Central Stabilizer Element, applied at midfoot level of a custom-made foot orthoses through a directly mould technique, can reduce foot pain, when a previous foot posture status is considered.

CLINICAL RELEVANCE

The Central Stabilizer Element can be of interest for those professionals who are involved in the manufacturing process of foot orthosis, throughout the control of an excesive pronated or a supinated foot condition that is provoking foot pain.