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Althomali O. The Effect of Static Trial on Knee Adduction Moment During Walking. Cureus 2024; 16:e69157. [PMID: 39398754 PMCID: PMC11467820 DOI: 10.7759/cureus.69157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2024] [Indexed: 10/15/2024] Open
Abstract
Background and aim Sophisticated technologies in rehabilitation, such as three-dimensional gait analysis, allow for measuring kinematic and kinetic variables while performing activities. The first peak external knee adduction moment (EKAM) is considered an important outcome in individuals with knee osteoarthritis (OA) and has been shown to be affected by changes in foot position in static trials. The present study aimed to explore the variables in static trials that may lead to changes in the value of the EKAM while walking. Methods Twelve individuals participated in the current study and were asked to perform three static trials as follows: 20° toe-out, straight (0°), and 20° toe-in. The participants were asked to walk five trials (their own shoes and paces). The first peak EKAM was the main study outcome and was compared between conditions. Linear regression was used to investigate which variables in the static trials significantly predicted the magnitude of change in the EKAM while walking. Results The first peak EKAM significantly decreased by 8.2% while walking when changing the foot position in static trials from 20° toe-in to 20° toe-out. The magnitude of change in the EKAM was significantly (p<0.01) predicted by the magnitude of change in the knee joint frontal plane angle, shank transverse plane angle, ankle joint frontal plane angle, and hip joint frontal plane angle during static trials between 20° toe-in and 20° toe-out. The model was able to predict 94% of the variation in the EKAM due to changes in foot position during static trials. Conclusion Modifications in foot position during static trials led to a change in the first peak EKAM while walking. Researchers should focus on controlling the knee joint frontal plane angle, shank transverse plane angle, ankle joint frontal plane angle, and hip joint frontal plane angle during static trials when conducting longitudinal or crossover studies. Controlling these variables is necessary to reduce the likelihood of the EKAM being affected by static trials and to ensure that the EKAM changes in dynamic trials are not masked or increased by static trials.
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Affiliation(s)
- Omar Althomali
- Department of Physiotherapy, University of Hail, College of Applied Medical Sciences, Hail, SAU
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Robert-Lachaine X, Dessery Y, Belzile ÉL, Corbeil P. Knee braces and foot orthoses multimodal 3-month treatment of medial knee osteoarthritis in a randomised crossover trial. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38895856 DOI: 10.1002/ksa.12312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/27/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Immediate biomechanical and functional benefits of knee braces and lateral wedge foot orthoses (FO) are often reported on patients with medial knee osteoarthritis. However, the effectiveness of their combined use in a longer-term orthotic treatment remains unclear. The aim was to evaluate pain, function, comfort and knee adduction moment (KAM) during the stance phase of gait with three modalities of orthotic treatment. METHODS Twenty-two patients with knee osteoarthritis were analysed in a randomised crossover trial including a knee brace with valgus and external rotation functions (VER), FO and their combined use (VER + FO). Western Ontario and McMaster Universities scale (WOMAC) and Knee injury and Osteoarthritis Outcome Scores and KAM during gait were obtained before and after each orthotic treatment of 3 months. Repeated measures analyses of variance contrasted the factors orthosis (VER, FO, VER + FO), treatment (pre and post) and wear (without and with) on pain, function, comfort and KAM. RESULTS An interaction between orthosis and treatment on the WOMAC pain (effect size [ES] = 0.17) and a main effect on the pain visual analogue score (ES = 0.24) indicated that VER and VER + FO were more alleviating than FO. The three modalities of orthotic treatment significantly improved functional scores (ES > 0.2) and reduced discomfort (ES = 0.25). A significant multivariate interaction between orthosis and wear (ES = 0.73) showed that the KAM reduction while wearing the orthoses was more pronounced with the VER and VER + FO than the FO. CONCLUSION The VER-brace obtained more effectiveness than FO on pain and KAM after 3 months for medial knee osteoarthritis and the combined treatment did not substantially improve biomechanical and functional outcomes. LEVEL OF EVIDENCE Therapeutic study level I randomised crossover trial.
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Affiliation(s)
- Xavier Robert-Lachaine
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Quebec, Canada
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada
| | - Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
| | - Étienne L Belzile
- Division de Chirurgie Orthopédique, CHU de Québec Université Laval, Quebec City, Quebec, Canada
- Département de Chirurgie, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Quebec, Canada
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Pathak P, Kim HS, Kim H, Park J, Lee G, Ahn J. Feasibility of mitigating out-toeing gait using compression tights with inward-directing taping lines. PLoS One 2023; 18:e0291914. [PMID: 37733749 PMCID: PMC10513335 DOI: 10.1371/journal.pone.0291914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 09/10/2023] [Indexed: 09/23/2023] Open
Abstract
Out-toeing gait may cause alterations in lower limb biomechanics that could lead to an increased risk of overuse injuries. Surgery and physical therapy are conventional methods for mitigating such gait, but they are costly and time-consuming. Wearable devices like braces and orthoses are used as affordable alternatives, but they apply non-negligible stress on the skin. Haptic feedback-delivering shoes were also recently developed, but they require actuators and power sources. The purpose of our study is to develop compression tights with inward directing taping lines that apply compression to lower limb muscles and segments to facilitate inward rotation of the foot, overcoming the drawbacks of previous methods. These compression tights were manufactured to fit the average height, leg length, hip girth, and waist girth of South Korean females in their twenties. The efficacy of these compression tights was evaluated by comparing walking kinematics and user satisfaction of 12 female dancers with an out-toeing gait under three conditions: wearing tights with taping lines, tights without taping lines, and basic bicycle shorts. The foot rotation angles and joint kinematics were recorded using a pressure-pad treadmill and motion capture system, respectively. Multiple pairwise comparisons revealed that the compression tights with inward-directing lines significantly reduced foot rotation angles (up to an average of 20.1%) compared with the bicycle shorts (p = 0.002 and 0.001 for dominant and non-dominant foot, respectively) or the compression tights without taping lines (p = 0.005 and p = 0.001 for dominant and non-dominant foot, respectively). Statistical parametric mapping revealed significant main effects of the tight type on joint kinematics. Also, t-tests revealed that the participants reported significantly higher ratings of perceived functionality and usability on the compression tights with inward-directing taping lines. In conclusion, we developed a comfortable and practical apparel-type wearable and demonstrated its short-term efficacy in mitigating out-toeing gait.
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Affiliation(s)
- Prabhat Pathak
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States of America
| | - Hye Suk Kim
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Hyunji Kim
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea
| | - Juyeon Park
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea
- Department of Fashion and Textiles, Seoul National University, Seoul, Republic of Korea
| | - Giuk Lee
- Department of Mechanical Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Jooeun Ahn
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea
- Institute of Sport Science, Seoul National University, Seoul, Republic of Korea
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Okamoto S, Ishii Y, Ishikawa M, Nakashima Y, Kamei G, Iwamoto Y, Hashizume T, Okada K, Takagi K, Takahashi M, Adachi N. The effect of gait modification on the response of medial meniscus extrusion during gait in patients with knee osteoarthritis. Gait Posture 2023; 102:180-185. [PMID: 37031628 DOI: 10.1016/j.gaitpost.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND An increase in medial meniscus extrusion during weight-bearing conditions is associated with the progression of medial knee osteoarthritis (OA). Toe-out gait modification has been known to reduce the knee adduction moment (KAM); however, its effect on reducing the increase in medial meniscus extrusion in patients with knee OA remains unclear. RESEARCH QUESTION To (1) evaluate the effect of toe-out gait on the increase in medial meniscus extrusion and the KAM in patients with medial knee OA and (2) investigate the synergetic effect of lateral wedge insoles in combination with toe-out gait in determining the most effective intervention for reducing medial meniscus extrusion during gait. METHODS Twenty-five patients with medial knee OA were enrolled in this study. Participants walked under four conditions: normal gait, toe-out gait, normal gait with lateral wedge insoles, and toe-out gait with lateral wedge insoles. Medial meniscus extrusion and KAM peaks during gait were measured using ultrasound and a three-dimensional motion analysis system in each condition. These parameters were compared among the four conditions using repeated measures analysis of variance. RESULTS The increase in medial meniscus extrusion and the second KAM peak were significantly lower in all interventions compared with those observed during normal gait. However, there was no significant difference among the interventions. SIGNIFICANCE This study suggested that toe-out gait reduces the increase in medial meniscus extrusion and is associated with the reduction of the second KAM peak. However, no synergistic effect of lateral wedge insoles and toe-out gait was observed.
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Affiliation(s)
- Saeko Okamoto
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Ishii
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Masakazu Ishikawa
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yuko Nakashima
- Department of Musculoskeletal Ultrasound in Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Goki Kamei
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshitaka Iwamoto
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takato Hashizume
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Okada
- Ultrasound Business Operations, Healthcare Business Headquarters, KONICA MINOLTA, INC, Tokyo, Japan
| | - Kazuya Takagi
- Ultrasound Business Operations, Healthcare Business Headquarters, KONICA MINOLTA, INC, Tokyo, Japan
| | - Makoto Takahashi
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Althomali OW, Starbuck C, Alarifi S, Alsaqri KK, Mohammad WS, Elsais WM, Jones R. The effect of foot position during static calibration trials on knee kinematic and kinetics during walking. Gait Posture 2023; 99:133-138. [PMID: 36435067 DOI: 10.1016/j.gaitpost.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/14/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gait analysis has been used extensively for computing knee kinematics and kinetics, in particular, in healthy and impaired individuals. One variable assessed is the external knee adduction moment (EKAM). Variations in EKAM values between investigations may be caused by changes in static standing position, especially foot placement angles which may increase or reduce any differences seen. PURPOSE OF THE STUDY The current study aimed to explore the influence of static trial foot position on knee kinematic and kinetic variables during walking. METHODS Twelve healthy male participants completed three different static standing trials; 1) 20-degrees toe-in, 2) 0° and 3) 20-degrees toe-out before walking at their own pace during a lower limb kinematics and kinetics assessment. First and second peak EKAM was compared between static foot position trials, as well other knee kinematic and kinetic outcomes. Repeated measures ANOVA was used with post hoc pairwise comparison to determine the differences between static foot position trials. RESULTS The first peak of EKAM was significantly smaller in the 20o toe-out angle, than the 20o toe-in angle (p = 0.04-8.16% reduction). Furthermore, significant changes were found in peak knee kinematics and kinetics variables (adduction angle, external rotation angle, knee flexion moment external rotation moment, abduction angle and internal rotation angle) in the different positions. CONCLUSION Modification in static foot position between study visits may result in changes especially in the 1st peak EKAM and other kinematics and kinetics variables during walking. Therefore, standardisation of static foot position should be utilised in longitudinal studies to ensure changes in EKAM are not masked or accentuated between assessments.
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Affiliation(s)
- Omar W Althomali
- Department of Physiotherapy, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia.
| | - Chelsea Starbuck
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK; The Manchester Institute of Health and Performance, Manchester, UK; Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, UK
| | - Saud Alarifi
- Department of Physiotherapy, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Khalid K Alsaqri
- Department of Physiotherapy, College of Applied Medical Sciences, University of Ha'il, Ha'il, Saudi Arabia
| | - Walaa S Mohammad
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia; Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walaa M Elsais
- Physical Therapy Department, College of Allied Medical Sciences, Isra University, Amman, Jordan
| | - Richard Jones
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK; The Manchester Institute of Health and Performance, Manchester, UK
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The Effect of Lateral Wedge Insole on Gait Variability Assessed Using Wearable Sensors in Patients with Medial Compartment Knee Osteoarthritis. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:6172812. [PMID: 36698847 PMCID: PMC9870677 DOI: 10.1155/2023/6172812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023]
Abstract
Background Lateral thrust seen in people with medial compartment knee osteoarthritis can cause dynamic knee instability and poor postural control during gait cycles. A lateral wedge insole can reduce the lateral thrust and may have a favorable effect on gait variability, which in turn may indicate gait instability improves. The aim of this study was to investigate the effect of lateral wedge insole on gait variability in knee osteoarthritis patients. Method We involved 15 symptomatic knee osteoarthritis patients who were provided with lateral wedge insole and 13 healthy asymptomatic volunteers as the control group. The gait variability was evaluated as the coefficient of variation of stride, stance, and swing duration based on acceleration monitoring using a wearable sensor. The lateral thrust was estimated as the lateral acceleration peak on the shank sensor. These measurements were performed without lateral wedge insole (baseline), immediately with lateral wedge insole (T0) at the initial office visit and one month after intervention (T1). Result Our data showed that the stance duration coefficient of variation and lateral thrust at T1 in the knee osteoarthritis group, were significantly decreased compared to the baseline values and these values were identical to those in the control group. Conclusion The lateral wedge insole reduces dynamic knee instability and could improve gait variability in medial compartment knee osteoarthritis.
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Robert-Lachaine X, Dessery Y, Belzile ÉL, Corbeil P. Knee braces and foot orthoses multimodal treatment of medial knee osteoarthritis. Gait Posture 2022; 96:251-256. [PMID: 35709608 DOI: 10.1016/j.gaitpost.2022.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee braces and lateral wedge foot orthoses are two treatment options recommended for medial knee osteoarthritis, but the combination of both of them could further improve their effectiveness. RESEARCH QUESTION The aim was to evaluate whether the combination of lateral wedge foot orthoses with two types of knee brace enhances the biomechanical effects and pain relief during the stance phase of gait while maintaining comfort. METHODS Ten patients with medial knee osteoarthritis were fitted with a standard valgus brace, an unloader brace with valgus and external rotation functions, and 7° lateral wedge foot orthoses. The pain relief, comfort, kinematics and kinetics of the lower limb were measured during walking without orthotics, with the combined and with the isolated treatments. RESULTS The valgus and external rotation brace significantly reduced the knee adduction moment and allowed more knee flexion both in isolation and in combination to foot orthoses compared to the valgus brace or without treatment. Pain relief was not significant with the different orthotic treatment modalities. The valgus brace and combined treatment with either brace significantly increased the discomfort level, whereas the valgus and external rotation brace or foot orthoses in isolation did not induce significant discomfort. SIGNIFICANCE Amongst the tested orthotic treatment modalities, the valgus and external rotation brace obtained better biomechanical outcomes while maintaining comfort. The combined treatment with foot orthoses enhanced the effectiveness of the valgus brace, however foot orthoses may be unnecessary with the valgus and external rotation brace.
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Affiliation(s)
- Xavier Robert-Lachaine
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada; Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, QC, Canada
| | - Yoann Dessery
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Étienne L Belzile
- Division de Chirurgie Orthopédique, CHU de Québec Université Laval, Quebec City, QC, Canada; Département de Chirurgie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Philippe Corbeil
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada.
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Li B, Zhang X. The dynamic characteristics of the center of pressure for toe-out gait: implications for footwear design. JOURNAL OF LEATHER SCIENCE AND ENGINEERING 2022. [DOI: 10.1186/s42825-022-00088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Toe-out gait is often used as a conservative technique to reduce knee adduction moment, which has been targeted to modify knee osteoarthritis progression. The center of pressure (COP) can not only be used to evaluate gait stability, but is also more reliable and practical than local plantar pressures as it does not depend on accurate foot zone divisions. However, to the authors’ knowledge, few study has reported the influence of the foot progression angle on the dynamic characteristics of the COP.
Research question
The aim of the study was to investigate the effects of the deliberately toe-out gait on the COP trajectory and stability during walking in healthy individuals.
Methods
Thirty healthy young adults were asked to walk along an 8-m walkway. A Footscan 1 m pressure plate was used to measure the center of pressure during walking.
Results
Compared to the normal gait, the COP of the toe-out gait shifted laterally during the initial contact phase, and shifted laterally and anteriorly during the forefoot contact phase. The mean anterior–posterior velocity of COP reduced by 0.109 m/s during the foot flat phase and the duration of the foot flat phase and forefoot push off phase increased by 4.5% and reduced by 7.0%, respectively.
Significance
Compared to the normal gait, the findings of this study suggest that biomechanical alteration of foot under our experimental conditions may decrease gait stability and increase forefoot load during toe-out walking. The situation may be improved by well-designed footwear or custom-made insole and the biomechanics analysis method can be used to test the efficacy of therapeutic footwear or insole for individuals with deliberately toe-out walking.
Graphical Abstract
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Schelhaas R, Hajibozorgi M, Hortobágyi T, Hijmans JM, Greve C. Conservative interventions to improve foot progression angle and clinical measures in orthopedic and neurological patients - A systematic review and meta-analysis. J Biomech 2021; 130:110831. [PMID: 34741811 DOI: 10.1016/j.jbiomech.2021.110831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 01/03/2023]
Abstract
To establish the comparative effects of conservative interventions on modifying foot progression angle (FPA) in children and adults with orthopaedic and neurological disease was the main aim of the literature review. Pubmed, Embase, Cinahl, and Web of Science were systematically searched for studies evaluating the effects of conservative interventions on correcting the FPA. The study protocol was registered with PROSPERO (CRD42020143512). Two reviewers independently assessed studies for inclusion and quality. Studies that assessed conservative interventions that could have affected the FPA and objectively measured the FPA were included. Within group Mean Differences (MD) and Standardized Mean Differences (SMDs) of the interventions were calculated for the change in FPA and gait performance (walking speed, stride/step length) and clinical condition (pain). Intervention effects on FPA were synthesized via meta-analysis or qualitatively. 41 studies were identified. For patients with knee osteoarthritis gait training interventions (MD = 6.69° and MD = 16.06°) were significantly more effective than mechanical interventions (MD = 0.44°) in modifying the FPA towards in-toeing (p < 0.00001). Increasing or decreasing the FPA significantly improved pain in patients with medial knee OA. Results were inconclusive for the effectiveness of gait training and mechanical devices in patients with neurological diseases. Gait feedback training is more effective than external devices to produce lasting improvements in FPA, reduce pain, and maintain gait performance in patients with medial knee OA. However, in neurological patients, the effects of external devices on improvements in FPA depends on the interaction between patient-specific impairments and the technical properties of the external device.
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Affiliation(s)
- Reslin Schelhaas
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands
| | - Mahdieh Hajibozorgi
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Tibor Hortobágyi
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Christian Greve
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands.
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Foot characteristics and mechanics in individuals with knee osteoarthritis: systematic review and meta-analysis. J Foot Ankle Res 2021; 14:24. [PMID: 33771204 PMCID: PMC8004391 DOI: 10.1186/s13047-021-00462-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Foot characteristics and mechanics are hypothesized to affect aetiology of several lower extremity musculoskeletal conditions, including knee osteoarthritis (KOA). The purpose of this systematic review was to identify the foot characteristics and mechanics of individuals with KOA. Methods Five databases were searched to identify relevant studies on foot characteristics and mechanics in people with KOA. Meta-analyses were performed where common measures were found across included studies. Included studies were evaluated for data reporting quality using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist. Results Thirty-nine studies were included in this systematic review. Two studies reported participants with KOA had statistically significantly (P < 0.05) more pronated foot postures than those without. Meta-analyses for foot progression angle (FPA) and peak rearfoot eversion angle found no difference between those with and without KOA (FPA mean difference:-1.50 [95% confidence interval − 4.20-1.21]; peak rearfoot eversion mean difference: 0.71 [1.55–2.97]). Conclusion A more pronated foot posture was noticed in those with KOA. However, it was not possible to establish a relationship between other foot characteristics or mechanics in people with KOA due to heterogeneity between the included study and limited number of studies with similar measurements. There is need for identifying common measurement techniques and reporting metrics when studying the foot in those with KOA.
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Chen YL, Sari RK, Liao YH, Lin WC. Optimal Span between Feet of Public Squat Toilet Based on Anthropometric Data and Squatting Stability Assessment. Healthcare (Basel) 2021; 9:healthcare9010042. [PMID: 33466362 PMCID: PMC7824858 DOI: 10.3390/healthcare9010042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 12/02/2022] Open
Abstract
Sitting toilets are preferred globally because they afford a relatively comfortable posture. However, squat toilets are among the most common toilets in numerous public areas because of their advantages, including personal hygiene, easy cleaning, and health benefits. This study attempted to determine optimal toilet design parameters and recruited 50 Taiwanese and 50 Southeast Asian women and collected span between feet (SBF) data for participants squatting in their most comfortable posture, and also surveyed maximum outer width (MOW) data of 28 public squat toilets in Taipei. Finally, we compared the squatting stability levels of 40 female participants (20 Taiwanese and 20 Southeast Asians) who squatted for 2 min at comfortable SBF and MOW-based SBF values. The results revealed that the minimum and maximum SBFs of Taiwanese were 14.52 cm and 18.40 cm, and that of Southeast Asians were 15.64 cm and 20.40 cm, respectively. No significant difference was observed in the SBFs between the two groups was observed. The mean (range) MOW of the surveyed toilets was 27.7 (27–29) cm. Analysis of variance results showed no difference in stability between the two SBFs. This implies that the comfortable SBF (i.e., 16 cm between the participants’ heels) was narrower than the MOW, as commonly used, indicating that the comfortable SBF can be considered as an optimal toilet width parameter because of its constant stability.
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Affiliation(s)
- Yi-Lang Chen
- Department of Industrial Engineering and Management, Ming Chi University of Technology, New Taipei 24301, Taiwan; (R.K.S.); (Y.-H.L.); (W.-C.L.)
- Department of Industrial Design, Chang Gung University, Touyuan 33302, Taiwan
- Correspondence:
| | - Resy Kumala Sari
- Department of Industrial Engineering and Management, Ming Chi University of Technology, New Taipei 24301, Taiwan; (R.K.S.); (Y.-H.L.); (W.-C.L.)
- Program Study of Industrial Engineering, Universitas Pahlawan Tuanku Tambusai, Riau 28412, Indonesia
| | - Ying-Hua Liao
- Department of Industrial Engineering and Management, Ming Chi University of Technology, New Taipei 24301, Taiwan; (R.K.S.); (Y.-H.L.); (W.-C.L.)
| | - Wei-Cheng Lin
- Department of Industrial Engineering and Management, Ming Chi University of Technology, New Taipei 24301, Taiwan; (R.K.S.); (Y.-H.L.); (W.-C.L.)
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Comparing walking biomechanics of older females in maximal, minimal, and traditional shoes. Gait Posture 2021; 83:245-249. [PMID: 33197860 DOI: 10.1016/j.gaitpost.2020.10.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a degenerative joint disease that affects millions of individuals each year. Several biomechanical variables during walking have been identified as risk factors for developing knee OA, including the peak external knee adduction moment (KAM) and the knee flexion angle at initial contact. Many interventions have been studied to help mitigate these risk factors, including footwear. However, it is largely unknown how varying shoe cushioning may affect walking biomechanics related to knee OA risk. RESEARCH QUESTION What is the effect of maximally and minimally cushioned shoes on walking biomechanics compared to a traditionally cushioned shoe in older females? METHODS Walking biomechanics in three shoes (maximal, traditional, minimal) were collected on 16 healthy females ages 50-70 using an 8-camera 3D motion capture system and two embedded force plates. Key biomechanical variables related to knee OA disease risk were compared between shoes using repeated measures ANOVAs. RESULTS The KAM was significantly larger in the maximal shoe (p = 0.005), while the knee flexion angle at initial contact was significantly larger in both the maximal and minimal shoe compared to the traditional shoe (p = .000). Additionally, the peak knee flexion angle (p = .000) and the loading rates of the vertical ground reaction force were (instantaneous: p = 0.001; average: p = .010) were significantly higher in the minimal shoe. SIGNIFICANCE While these results are specific to the shoes used in this study, clinicians should exercise caution in prescribing maximal or minimal shoes to females in this age group who may be at risk of knee OA given these results. Research is needed on the effect of these shoes in patients with knee OA.
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