A systematic review of the effect of footwear, foot orthoses and taping on lower limb muscle activity during walking and running

Gait and muscle activity measures after biomechanical device therapy in subjects with ankle instability: A systematic review

INTRODUCTION

Health specialists suggest a conservative approach comprising non-pharmacological interventions as the initial course of action for individuals with repetitive ankle sprain due to ankle instability. This systematic review aimed to assess the effectiveness of biomechanical devices (Foot Orthoses, Ankle Orthoses, and Taping) on gait and muscle activity in individuals with ankle instability.

METHODS

A systematic search was performed on electronic databases, including PubMed, EMBASE, Clinical Trials.gov, Web of Science, and Scopus. The PEDro scoring system was used to evaluate the quality of the included studies. We extracted data from population, intervention, and outcome measures.

RESULTS

In the initial search, we found 247 articles. After following the steps of the PRISMA flowchart, only 22 reports met the inclusion criteria of this study. The results show that biomechanical device therapy may increase swing time, stance time, and step. Additionally, studies suggest that these devices can reduce plantar flexion, inversion, and motion variability during gait. Biomechanical devices have the potential to optimize the subtalar valgus moment, push-off, and braking forces exerted during walking, as well as enhance the activity of specific muscles including the peroneus longus, peroneus brevis, tibialis anterior, gluteus medius, lateral gastrocnemius, rectus femoris, and soleus.

CONCLUSION

Biomechanical devices affect gait (spatiotemporal, kinetic, and kinematic variables) and lower limb muscle activity (root mean square, reaction time, amplitude, reflex, and wave) in subjects with ankle instability.

Toward subtalar joint axis-driven computer-aided design and computer-aided manufacturing foot orthoses: Reliability of a noninvasive clinical scanning protocol

BACKGROUND

The subtalar joint axis (STJA) occupies a key role in the dynamics of the lower limb kinetic chain, and its location has a wide interindividual variability. It has been suggested that considering the STJA location when designing foot orthoses may help to apply the required mechanical dose. However, the evidence is more anecdotal than empirical.

OBJECTIVE

This study aimed to evaluate the reliability of the STJA digitization, a procedure combining the clinical determination of the functional STJA location and its subsequent 3-dimensional (3D) scanning.

STUDY DESIGN

Two examiners identified the posterior and anterior exit points of the functional STJA on the skin of 15 healthy participants using a clinical method in a repeated-measure design.

METHODS

A handheld 3D scanner was used to scan the feet and the skin markers. The 3D coordinates of the skin markers were subsequently quantified and (1) STJA digitization intratester within-session, (2) STJA digitization intratester between-session, and (3) STJA digitization intertester between-session reliabilities were evaluated.

RESULTS

When pooling all skin marker 3D coordinates, intraclass correlation coefficients (ICCs) for the STJA intratester within-session reliability ranged from 0.74 to 0.98. ICCs for the STJA digitization intratester between-session reliability ranged from 0.58 to 0.94. ICCs for the STJA digitization intertester reliability ranged from 0.56 to 0.81. Standard error of measurement for the mediolateral position of the talus marker (anterior exit point of the STJA) was substantially higher than that for the other coordinates.

CONCLUSIONS

Overall, the STJA digitization demonstrated a good intratester between-session reliability and may be used in a computer-aided design and computer-aided manufacturing workflow to create foot orthoses. However, further efforts should be considered to improve the scanning process and intertester reliability.

Biomechanical effects of foot orthoses on jump landing performance: A systematic review

Jumping is involved in a wide range of sports and activities, and foot orthoses (FO) are suggested to enhance performance and prevent injury. The aim of this systematic review was to investigate whether using FO with different modifications affects jump landing biomechanics and improves performance in healthy individuals. The search strategy included 7 databases that identified 19 studies. The study quality was evaluated using a modified Downs and Black index. The primary outcome measures were joint kinematics, kinetics, muscle activity, vertical jump height, and horizontal jump distance. Our findings indicated that incorporating arch support with a rearfoot post and softer forefoot region into FO may improve several biomechanical variables during jump landing activities. Improvements in vertical ground reaction force loading rates, knee and ankle kinematics, and muscle cocontraction during jumping with FO could enhance jumping performance. In addition, improvements in hip, knee, ankle, and tibial kinematics and vertical ground reaction force loading rates during landing could reduce impact forces and related injuries. Although a limited number of studies have addressed the effects of FO on vertical jump height and horizontal jump distance, inserting such FO inside shoes with optimum bending stiffness could facilitate jumping performance. A rigorous exploration of the effect and mechanism of FO designs on jumping performance could benefit jumping-related activities and prevent ankle and knee injuries.

Effects of foot orthoses on the biomechanics of the lower extremities in adults with and without musculoskeletal disorders during functional tasks: A systematic review

BACKGROUND

Foot orthoses are among the most commonly used external supports to treat musculoskeletal disorders. It remains unclear how they change the biomechanics of the lower extremities during functional tasks. This systematic review aimed to determine the effects of foot orthoses on primary outcomes (i.e., kinematics, kinetics and electromyography of the lower extremities) in adults with and without musculoskeletal disorders during functional tasks.

METHODS

A literature search was conducted for articles published from inception to June 2021 in Medline, CINAHL, SPORTDiscus, Cochrane libraries and PEDro electronic databases. Two investigators independently assessed the titles and abstracts of retrieved articles based on the inclusion criteria. Of the 5578 citations, 24 studies were included in the qualitative synthesis as they reported the effects of foot orthoses on the primary outcomes. Risk of bias of included studies was determined using the modified Downs and Black Quality Index.

FINDINGS

During low impact tasks, foot orthoses decrease ankle inversion and increase midfoot plantar forces and pressure. During higher impact tasks, foot orthoses had little effects on electromyography and kinematics of the lower extremities but decreased ankle inversion moments.

INTERPRETATION

Even though the effects of foot orthoses on the biomechanics of the lower extremities seem task-dependent, foot orthoses mainly affected the biomechanics of the distal segments during most tasks. However, few studies determined their effects on the biomechanics of the foot. It remains unclear to what extent foot orthoses features induce different biomechanical effects and if foot orthoses effects change for different populations.

Assessment of a New Lateral Cushioned Casting Orthosis: Effects on Peroneus Longus Muscle Electromyographic Activity During Running

Background:

Classical medial wedge (CMW) orthoses have been prescribed to treat overpronation foot pathologies in runners. The effects of a novel supination orthosis (NSO) on the surface electromyography (EMG) activity of the peroneus longus (PL) muscle during a complete cycle of running have yet to be tested.

Purpose/Hypothesis:

The purpose of this study was to compare the EMG activity of the PL in participants wearing CMW orthoses and NSOs versus neutral running shoes (NRS) during a full cycle of running gait. It was hypothesized that the PL muscle activity would be lower for the NSO compared with CMW or NRS.

Study Design:

Controlled laboratory study.

Methods:

Included were 31 healthy recreational runners of both sexes (14 male and 17 female; mean age, 38.58 ± 4.02 years) with a neutral Foot Posture Index and standard rearfoot-strike pattern. Participants ran on a treadmill at 9 km/h while wearing NSO (3-, 6-, and 9-mm thicknesses), CMW (3-, 6-, and 9-mm thicknesses), and NRS, for a total of 7 different conditions randomly selected, while the EMG signal activity of the PL was recorded for 30 seconds. Each trial was recorded 3 times, and the intraclass correlation coefficient (ICC) to test reliability of the measurements was calculated. The Wilcoxon pair to pair nonparametric test with Bonferroni correction was performed to analyze differences among the conditions.

Results:

The reliability of all assessments was almost perfect (ICC, >0.81). For both the CMW and NSO, regardless of thickness, the PL activity was statistically significantly lower compared with the NRS (P < .05 for all). For all CMW thicknesses, the PL activity was lower compared with the respective NSO thicknesses, with the 3-mm thickness having the largest difference (CMW_3mm, 18.63 ± 4.64 vs NSO_3mm, 20.78 ± 4.99 mV; P < .001).

Conclusion:

Both CMW and NSO produced reduced EMG activity of the PL muscle; therefore, they can be prescribed to treat overpronation pathologies without associated PL strain concerns. In addition, the NSO saved the enhancement material placed on the medial-rear side of CMW, making it easier to wear sports shoes.

Clinical Relevance:

Knowing the safety of CMW and NSO will aid in understanding treatments for overpronation pathologies.

The immediate effects of foot orthosis geometry on lower limb muscle activity and foot biomechanics

Foot orthoses (FOs) are used to treat clinical conditions by altering the external forces applied to the foot and thereafter the forces of muscles and tendons. However, whether specific geometric design features of FOs affect muscle activation is unknown. The aim of this study was to investigate if medial heel wedging and increased medial arch height have different effects on the electromyography (EMG) amplitude of tibialis posterior, other muscles of the lower limb and the kinematics and kinetics at the rearfoot and ankle. Healthy participants (n = 19) walked in standardised shoes with i) a flat inlay; ii) a standard shape FOs, iii) standard FOs adjusted to incorporate a 6 mm increase in arch height, iv) and standard FOs adjusted to incorporate an 8° medial heel wedging and v) both the 6 mm increase in arch height and 8° increase in medial wedging. EMG was recorded from medial gastrocnemius, peroneus longus, tibialis anterior and in-dwelling tibialis posterior muscles. Motion and ground reaction force data were collected concurrently. Tibialis posterior EMG amplitude reduced in early stance with all FOs (ηp² = 0.23-1.16). Tibialis posterior EMG amplitude and external ankle eversion moment significantly reduced with FOs incorporating medial wedging. The concurrent reduction in external eversion moment and peak TP EMG amplitude in early stance with medial heel wedging demonstrates the potential for this specific FOs geometric feature to alter TP activation. Medial wedged FOs could facilitate tendon healing in tibialis posterior tendon dysfunction by reducing force going through the TP muscle tendon unit.

Biomechanical effects of foot orthoses with and without a lateral bar in individuals with cavus feet during comfortable and fast walking

Background/purpose

The biomechanical effects of foot orthoses (FOs) with and without a lateral bar compared to a control condition during walking at different speeds are still unknown. The objective of this study was to compare the biomechanical effects of functional FOs with and without a lateral bar to a control condition during comfortable walking in individuals with cavus feet and determine if their effects change at a fast speed.

Methods

Fifteen individuals with cavus feet (age: 25.3 ± 5.8 yrs) walked under two experimental conditions (FOs with and without a lateral bar) and a control condition (shoes only) at comfortable (CW) and fast (FW) speeds. The outcome measures were ankle and knee angles and gluteus medius, vastus lateralis, gastrocnemius lateralis, gastrocnemius medialis, peroneus longus and tibialis anterior electromyography (EMG) amplitudes during the stance phase of walking and were compared between the FOs and a control condition using one-dimensional statistical parametric mapping.

Results

During CW, both FOs decreased ankle dorsiflexion and increased knee extension angles compared to no FOs. FOs with a lateral bar also decreased peroneus longus EMG amplitudes. During FW, FOs with and without a lateral bar decreased ankle dorsiflexion angles compared to no FOs.

Conclusion

Both types of FOs had different effects on the biomechanics of the lower limb compared to a control condition. The decreased peroneus longus EMG amplitudes during CW in individuals with cavus feet could have important clinical implications in other populations, such as individuals with painful cavus feet. The orthoses only affected the ankle dorsiflexion angles at a fast speed and no EMG amplitude or knee kinematics effects were observed. Further studies assessing the ankle kinematics and kinetics effects of these orthoses are needed to improve our understanding of their mechanism of action and inform future efficacy trials.

The "Journal of Functional Morphology and Kinesiology" Journal Club Series: PhysioMechanics of Human Locomotion

We are glad to introduce the Third Journal Club of Volume five, the third issue. This edition is focused on relevant studies published in the last years in the field of PhysioMechanics of Human Locomotion, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the Sports Medicine and Movement Sciences seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.