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Alsaafin N, Saad N, Mohammad Zadeh SA, Hegazy FA. Effect of Different Foot Orthosis Inverted Angles on Walking Kinematics in Females with Flexible Flatfeet. J Multidiscip Healthc 2023; 16:2613-2623. [PMID: 37693854 PMCID: PMC10492546 DOI: 10.2147/jmdh.s420003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/16/2023] [Indexed: 09/12/2023] Open
Abstract
Background Although the inverted technique was shown to be more effective compared to other orthotic designs for the treatment of flatfeet, the biomechanical mechanisms underlying the therapeutic effect of the inverted angle orthoses is still unclear. Therefore, the aim of this study was to examine the effect of different inverted angles of foot orthoses on walking kinematics in females with flexible flatfeet. Methods Thirty-one female adults with flexible flatfeet aged 18-35 years old participated in this study. Kinematic data of the hip, knee, and ankle were collected via BTS motion-capture system during walking under three test conditions in random order: with shoes only; with 15° inverted orthoses; and with 25° inverted orthoses. Results Compared to the shoes only condition, both the 15° and 25° inverted orthotic conditions significantly decreased the maximum ankle plantarflexion angle during loading response, maximum ankle dorsiflexion angle during mid-stance, maximum ankle external rotation angle, and maximum ankle internal rotation angle. The maximum ankle plantarflexion angle at toe-off showed a significant decrease with the 25° inverted angle orthosis compared to both the 15° inverted angle and shoes only conditions. No significant differences were found in the knee kinematic variables, maximum hip extension angle, and maximum hip adduction angle between test conditions. Conclusion Using inverted orthoses at 15° and 25° inverted angles resulted in significant changes in ankle joint kinematics during walking in female adults with flexible flatfeet. A 25° inverted angle orthosis significantly decreased ankle plantarflexion during push-off, potentially impacting gait mechanics. This suggests that a smaller inverted angle may be more effective for managing flexible flatfeet in female adults.
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Affiliation(s)
- Nour Alsaafin
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Nabil Saad
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Shima A Mohammad Zadeh
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Fatma A Hegazy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Pascual Huerta J, Trincado Villa L, Palacio Fernández L. Efecto de las ortesis plantares rígidas a medida en la fasciopatía plantar compresiva: serie de casos prospectiva. REVISTA ESPAÑOLA DE PODOLOGÍA 2022. [DOI: 10.20986/revesppod.2022.1647/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sánchez-Gómez R, Romero-Morales C, Gómez-Carrión Á, Zaragoza-García I, Martínez-Sebastián C, Ortuño-Soriano I, Gómez-Lara A, De la Cruz-Torres B. Assessment of a New Lateral Cushioned Casting Orthosis: Effects on Peroneus Longus Muscle Electromyographic Activity During Running. Orthop J Sports Med 2021; 9:23259671211059152. [PMID: 34917693 PMCID: PMC8669125 DOI: 10.1177/23259671211059152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/24/2021] [Indexed: 12/02/2022] Open
Abstract
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 (CMW3mm, 18.63 ± 4.64 vs NSO3mm, 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.
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Affiliation(s)
- Rubén Sánchez-Gómez
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Álvaro Gómez-Carrión
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Ignacio Zaragoza-García
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain.,Care Research Group (Invecuid), 12 de Octubre Hospital Institute of Health Research (imas12), Madrid, Spain
| | - Carlos Martínez-Sebastián
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Ismael Ortuño-Soriano
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Arturo Gómez-Lara
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
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Desmyttere G, Hajizadeh M, Bleau J, Leteneur S, Begon M. Anti-pronator components are essential to effectively alter lower-limb kinematics and kinetics in individuals with flexible flatfeet. Clin Biomech (Bristol, Avon) 2021; 86:105390. [PMID: 34044295 DOI: 10.1016/j.clinbiomech.2021.105390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Foot orthoses are commonly used to correct for foot alterations and especially address excessive foot pronation in individuals with flatfeet. In recent years, 3D printing has taken a key place in orthotic manufacturing processes as it offers more options and can be patient specific. Hence, the purpose of this study was to evaluate whether stiffness of 3D printed foot orthoses and a newly designed rearfoot posting have an effect on lower limb kinematics and kinetics in individuals with flatfeet. METHODS Nineteen patients with flexible flatfeet were provided two pairs of customized 3D printed ¾ length orthotics. Foot orthoses were of different stiffness and could feature a rearfoot posting, consisting of 2-mm carbon fiber plate. Lower limb kinematics and kinetics were computed using a multi-segment foot model. One-way ANOVAs using statistical non-parametric mapping, refined by effect sizes, were performed to determine the magnitude of the effect between conditions. FINDINGS Foot orthoses stiffness had little effect on midfoot and forefoot biomechanics. Reductions in midfoot eversion and forefoot abduction were observed during short periods of stance with rigid foot orthoses. Adding the posting had notable effects on rearfoot kinematics and on the ankle and knee kinetics in the frontal plane; it significantly reduced the eversion angle and inversion moment at the ankle, and increased the knee abduction moment. INTERPRETATION Using an anti-pronator component is more effective than increasing foot orthoses stiffness to observe a beneficial impact of foot orthoses on the control of excessive foot pronation in individuals with flatfeet.
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Affiliation(s)
- Gauthier Desmyttere
- École de Kinésiologie et des Sciences de l'Activité Physique, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada.
| | - Maryam Hajizadeh
- Institut de Génie Biomédical, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada
| | - Jacinte Bleau
- Institut de Génie Biomédical, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada
| | - Sébastien Leteneur
- Université Polytechnique Hauts-de-France, UMR 8201 - LAMIH - Laboratoire d'Automatique de Mécanique et d'Informatique Industrielles et Humaines, F-59313 Valenciennes, France
| | - Mickael Begon
- École de Kinésiologie et des Sciences de l'Activité Physique, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada; Laboratoire Orthopédique Médicus, 2520 Boul. St-Joseph, Montréal, QC H1Y 2A2, Canada
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Akuzawa H, Imai A, Iizuka S, Matsunaga N, Kaneoka K. Tibialis posterior muscle activity alteration with foot orthosis insertion measured by fine-wire electromyography. FOOTWEAR SCIENCE 2021. [DOI: 10.1080/19424280.2021.1893835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Hiroshi Akuzawa
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Atsushi Imai
- Faculty of Health and Medical Sciences, Aichi Shukutoku University, Aichi, Japan
| | - Satoshi Iizuka
- Department of Sports Science, Japan Institute of Sport Sciences, Tokyo, Japan
| | - Naoto Matsunaga
- Waseda Institute for Sport Sciences, Waseda University, Saitama, Japan
- General Education Core Curriculum Division, Seigakuin University, Saitama, Japan
| | - Koji Kaneoka
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Mozafaripour E, Seidi F, Minoonejad H, Mousavi SH, Bayattork M. Can lower extremity anatomical measures and core stability predict dynamic knee valgus in young men? J Bodyw Mov Ther 2021; 27:358-363. [PMID: 34391258 DOI: 10.1016/j.jbmt.2021.02.004] [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: 10/18/2020] [Revised: 01/27/2021] [Accepted: 02/28/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Dynamic knee valgus (DKV) is a risk factor for lower extremity injuries such as anterior cruciate ligament and patellofemoral pain syndrome. Purpose of the current study was to investigate the relationship between lower extremity anatomical measures (LEAM) and core stability with DKV during the single-leg squat. METHODS Thirty healthy men aged between 18 and 28 years participated in this cross-sectional biomechanical study.DKV was assessed using a 6-camera motion analysis system during a single-leg squat task. Anteversion of hip, hip internal and external rotation, Q-angle, knee hyperextension, tibial torsion, tibia vara, plantar arch index, and core stability were measured using standard clinical procedures. To predict DKV, a multiple linear regression model was used. RESULT The stability index negatively and plantar arch index positively predicted greater DKV during the single-leg squat task (P = 0.001 and P = 0.09, respectively). Research variables together predicted 82% of the variance in DKV (F(4,26) = 28.09, p < 0.001). However, relationships between other variables and DKV were not found. CONCLUSION The core stability index and plantar arch index were associated with observed DKV during the single-leg squat. These results suggested that proximal and distal variables to the knee should be considered when evaluating individuals who present DKV during the single-leg squat.
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Affiliation(s)
- Esmaeil Mozafaripour
- Health and Sports Medicine Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Foad Seidi
- Health and Sports Medicine Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
| | - Hooman Minoonejad
- Health and Sports Medicine Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Seyed Hamed Mousavi
- Health and Sports Medicine Department, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Mohammad Bayattork
- Sport Sciences and Physical Education, Faculty of Humanities Science, University of Hormozgan, Bandar Abbas, Iran
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Braga UM, Mendonça LD, Mascarenhas RO, Alves COA, Filho RGT, Resende RA. Effects of medially wedged insoles on the biomechanics of the lower limbs of runners with excessive foot pronation and foot varus alignment. Gait Posture 2019; 74:242-249. [PMID: 31574408 DOI: 10.1016/j.gaitpost.2019.09.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 09/06/2019] [Accepted: 09/21/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Excessive foot pronation during running in individuals with foot varus alignment may be reduced by medially wedged insoles. RESEARCH QUESTION This study investigated the effects of a medially wedged insole at the forefoot and at the rearfoot on the lower limbs angles and internal moments of runners with excessive foot pronation and foot varus alignment. METHODS Kinematic and kinetic data of 19 runners (11 females and 8 males) were collected while they ran wearing flat (control condition) and medially wedged insoles (insole condition). Both insoles had arch support. We used principal component analysis for data reduction and dependent t-test to compare differences between conditions. RESULTS The insole condition reduced ankle eversion (p = 0.003; effect size = 0.63); reduced knee range of motion in the transverse plane (p = 0.012; effect size = 0.55); increased knee range of motion in the frontal plane in early stance and had earlier knee adduction peak (p = 0.018; effect size = 0.52); reduced hip range of motion in the transverse plane (p = 0.031; effect size = 0.48); reduced hip adduction (p = 0.024; effect size = 0.50); reduced ankle inversion moment (p = 0.012; effect size = 0.55); and increased the difference between the knee internal rotation moment in early stance and midstance (p = 0.012; effect size = 0.55). SIGNIFICANCE Insoles with 7˚ medial wedges at the forefoot and rearfoot are able to modify motion and moments patterns that are related to lower limb injuries in runners with increased foot pronation and foot varus alignment with some non-desired effects on the knee motion in the frontal plane.
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Affiliation(s)
- Uiara M Braga
- Universidade Federal do Vale do Jequitinhonha e Mucuri, Department of Physical Therapy, Rodovia MGT 367 - KM 583/5000, Campus Diamantina, Alto do Jacuba, 39100 000, Diamantina, MG, Brazil.
| | - Luciana D Mendonça
- Universidade Federal do Vale do Jequitinhonha e Mucuri, Department of Physical Therapy, Rodovia MGT 367 - KM 583/5000, Campus Diamantina, Alto do Jacuba, 39100 000, Diamantina, MG, Brazil.
| | - Rodrigo O Mascarenhas
- Universidade Federal do Vale do Jequitinhonha e Mucuri, Department of Physical Therapy, Rodovia MGT 367 - KM 583/5000, Campus Diamantina, Alto do Jacuba, 39100 000, Diamantina, MG, Brazil.
| | - Carolina O A Alves
- Universidade Federal de Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Avenida Antônio Carlos 6627, Campus Pampulha, Pampulha, 31270-901, Belo Horizonte, MG, Brazil.
| | - Renato G T Filho
- Universidade Federal do Vale do Jequitinhonha e Mucuri, Department of Physical Therapy, Rodovia MGT 367 - KM 583/5000, Campus Diamantina, Alto do Jacuba, 39100 000, Diamantina, MG, Brazil.
| | - Renan A Resende
- Universidade Federal de Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Avenida Antônio Carlos 6627, Campus Pampulha, Pampulha, 31270-901, Belo Horizonte, MG, Brazil.
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Han K, Bae K, Levine N, Yang J, Lee JS. Biomechanical Effect of Foot Orthoses on Rearfoot Motions and Joint Moment Parameters in Patients with Flexible Flatfoot. Med Sci Monit 2019; 25:5920-5928. [PMID: 31393860 PMCID: PMC6698090 DOI: 10.12659/msm.918782] [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: 11/24/2022] Open
Abstract
Background The effect of foot orthoses in terms of kinematics and kinetics during walking could be affected on different geometrical designs. Therefore, the purpose of this study was to compare the biomechanical and clinical effects of 3 different insoles on rearfoot motion (RFM) and ankle joint moment parameters. Material/Methods Twenty eight university students with flexible flatfoot were recruited for this study, and each participant was asked to wear 3 different insoles: normal insole without arch support function, type A insole with only arch support function, and type B insole with both arch support and cushion pads for shock absorbing functions. Three-dimensional motion analysis was performed to compute the ranges and peak orientation angles of RFM and ankle joint moment parameters. Results The type A and type B insoles exhibited significantly smaller peak everted position and evertor moment than the normal insole. Also, the type A insole showed significantly smaller range of rearfoot motion in the longitudinal axis and the length of MA (moment arm) in the mediolateral axis than the normal insole. Conclusions The use of the type A insole using arch support function was induced to promote a cautious gait pattern associated with a relatively lower potential risk compared to the normal insole. The type A and type B insoles could be important to positively reduce the possibility of injury. Also, the smaller length of MA in the type A insole might have a contribution to the decrease of ankle joint evertor moment.
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Affiliation(s)
- KiHoon Han
- Department of Kinesiology (Biomechanics Laboratory), Silla University, Busan, South Korea
| | - Kangho Bae
- Department of Kinesiology (Biomechanics Laboratory), Silla University, Busan, South Korea
| | - Nicholas Levine
- Department of Kinesiology (Biomechanics Laboratory), Texas Woman's University, Denton, TX, USA
| | - JungOk Yang
- Department of Kinesiology (Biomechanics Laboratory), Silla University, Busan, South Korea
| | - Joong-Sook Lee
- Department of Kinesiology (Biomechanics Laboratory), Silla University, Busan, South Korea
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Mo S, Leung SH, Chan ZY, Sze LK, Mok KM, Yung PS, Ferber R, Cheung RT. The biomechanical difference between running with traditional and 3D printed orthoses. J Sports Sci 2019; 37:2191-2197. [DOI: 10.1080/02640414.2019.1626069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Shiwei Mo
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Sam H.S. Leung
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Hong Kong
| | - Zoe Y.S. Chan
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Louis K.Y. Sze
- Persona Surgical Modelling, Hong Kong Science Park, Hong Kong
| | - Kam-Ming Mok
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Hong Kong
| | - Patrick S.H. Yung
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Hong Kong
| | - Reed Ferber
- Faculties of Kinesiology and Nursing, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Running Injury Clinic, University of Calgary, Calgary, Alberta, Canada
| | - Roy T.H. Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Hong Kong
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Desmyttere G, Hajizadeh M, Bleau J, Begon M. Effect of foot orthosis design on lower limb joint kinematics and kinetics during walking in flexible pes planovalgus: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2018; 59:117-129. [PMID: 30227277 DOI: 10.1016/j.clinbiomech.2018.09.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/15/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Foot orthoses are commonly used for the management of excessive foot pronation in people with pes planovalgus. However, results are inconsistent due to variability in orthosis geometrical designs. This systematic review with meta-analysis aimed to classify and investigate the effects of foot orthoses, based on their design, in terms of lower limb kinematics and kinetics in people with pes planovalgus. METHODS Electronic databases were searched up until August 2017. Peer-reviewed journal studies including adult participants with flexible pes planovalgus and reporting kinematics and kinetics effects of foot orthoses during walking were included and classified based on the orthosis design. Eleven studies were retained and assessed according to methodological (mean 76.1%; range [63.2%-84.2%] - high) and biomechanical (mean 71.6%; range [44.4%-100%] - moderate) qualities. Meta-analysis was performed by calculating the effect size, using standardized mean differences, between control and orthotics conditions. FINDINGS Meta-analysis revealed less rearfoot eversion with the use of foot orthoses including medial forefoot or both forefoot and rearfoot posting. However, no significant effect of foot orthoses with arch support and neutral rearfoot posting to control excessive foot pronation were found. In terms of kinetics, none of the foot orthoses showed effects. INTERPRETATION Using medial posting is the most effective foot orthotic feature to reduce the peak rearfoot eversion and to control excessive foot pronation. Nevertheless, heterogeneity between study protocols contributes to the low evidences of foot orthoses effects on kinematics and kinetics during walking in people with pes planovalgus.
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Affiliation(s)
- Gauthier Desmyttere
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval H7N 0B6, QC, Canada.
| | - Maryam Hajizadeh
- Institut de Génie Biomédical, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval H7N 0B6, QC, Canada
| | - Jacinte Bleau
- Laboratoire Orthopédique Médicus, 5135 10e avenue, Montréal H1Y 2G5, QC, Canada
| | - Mickael Begon
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval H7N 0B6, QC, Canada; Institut de Génie Biomédical, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval H7N 0B6, QC, Canada
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Phillips RD. A Response to "A Novel Treatment Approach to Over-Pronation Dysfunction: A Follow-Up". J Am Podiatr Med Assoc 2017; 107:573-575. [PMID: 29252014 DOI: 10.7547/17-053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Robert D. Phillips
- Department of Podiatry, Orlando Veterans Affairs Medical Center, 13800 Veterans Way, Orlando, FL 32827. (E-mail: )
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Wahmkow G, Cassel M, Mayer F, Baur H. Effects of different medial arch support heights on rearfoot kinematics. PLoS One 2017; 12:e0172334. [PMID: 28257426 PMCID: PMC5336196 DOI: 10.1371/journal.pone.0172334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/03/2017] [Indexed: 12/11/2022] Open
Abstract
Background Foot orthoses are usually assumed to be effective by optimizing mechanically dynamic rearfoot configuration. However, the effect from a foot orthosis on kinematics that has been demonstrated scientifically has only been marginal. The aim of this study was to examine the effect of different heights in medial arch-supported foot orthoses on rear foot motion during gait. Methods Nineteen asymptomatic runners (36±11years, 180±5cm, 79±10kg; 41±22km/week) participated in the study. Trials were recorded at 3.1 mph (5 km/h) on a treadmill. Athletes walked barefoot and with 4 different not customized medial arch-supported foot orthoses of various arch heights (N:0 mm, M:30 mm, H:35 mm, E:40mm). Six infrared cameras and the `Oxford Foot Model´ were used to capture motion. The average stride in each condition was calculated from 50 gait cycles per condition. Eversion excursion and internal tibia rotation were analyzed. Descriptive statistics included calculating the mean ± SD and 95% CIs. Group differences by condition were analyzed by one factor (foot orthoses) repeated measures ANOVA (α = 0.05). Results Eversion excursion revealed the lowest values for N and highest for H (B:4.6°±2.2°; 95% CI [3.1;6.2]/N:4.0°±1.7°; [2.9;5.2]/M:5.2°±2.6°; [3.6;6.8]/H:6.2°±3.3°; [4.0;8.5]/E:5.1°±3.5°; [2.8;7.5]) (p>0.05). Range of internal tibia rotation was lowest with orthosis H and highest with E (B:13.3°±3.2°; 95% CI [11.0;15.6]/N:14.5°±7.2°; [9.2;19.6]/M:13.8°±5.0°; [10.8;16.8]/H:12.3°±4.3°; [9.0;15.6]/E:14.9°±5.0°; [11.5;18.3]) (p>0.05). Differences between conditions were small and the intrasubject variation high. Conclusion Our results indicate that different arch support heights have no systematic effect on eversion excursion or the range of internal tibia rotation and therefore might not exert a crucial influence on rear foot alignment during gait.
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Affiliation(s)
- Gunnar Wahmkow
- University outpatient clinic, University of Potsdam, Department of Sports Medicine, Am Neuen Palais 10, Haus 12, Potsdam, Germany
- * E-mail:
| | - Michael Cassel
- University outpatient clinic, University of Potsdam, Department of Sports Medicine, Am Neuen Palais 10, Haus 12, Potsdam, Germany
| | - Frank Mayer
- University outpatient clinic, University of Potsdam, Department of Sports Medicine, Am Neuen Palais 10, Haus 12, Potsdam, Germany
| | - Heiner Baur
- University outpatient clinic, University of Potsdam, Department of Sports Medicine, Am Neuen Palais 10, Haus 12, Potsdam, Germany
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, Bern, Switzerland
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Powell DW, Andrews S, Stickley C, Williams DB. High- compared to low-arched athletes exhibit smaller knee abduction moments in walking and running. Hum Mov Sci 2016; 50:47-53. [DOI: 10.1016/j.humov.2016.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 10/08/2016] [Accepted: 10/09/2016] [Indexed: 11/16/2022]
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14
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Griffiths IB, Spooner SK. Foot orthoses research: identifying limitations to improve translation to clinical knowledge and practice. Br J Sports Med 2016; 52:350. [PMID: 27789429 DOI: 10.1136/bjsports-2016-096269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 11/04/2022]
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15
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The Influence of a Prefabricated Foot Orthosis on Lower Extremity Mechanics During Running in Individuals With Varying Dynamic Foot Motion. J Orthop Sports Phys Ther 2016; 46:749-55. [PMID: 27494054 DOI: 10.2519/jospt.2016.6253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study, cross-sectional. Background Orthotic prescription is often based on the premise that the mechanical effects will be more prominent in individuals with greater calcaneal eversion. Objective To compare the effects of a prefabricated foot orthosis on lower extremity kinematics and kinetics between recreational athletes with high and low calcaneal eversion during running. Methods Thirty-one recreational athletes were included in this study. Three-dimensional kinematic and kinetic data were collected while running with and without a foot orthosis. Participants were grouped based on the degree of calcaneal eversion during the running trials relative to a standing trial (dynamic foot motion). The effects of the orthosis on the frontal and transverse plane angles and moments of the hip and knee were compared between the 10 participants with the greatest and least amount of dynamic foot motion. Results There were no significant interactions (group by orthotic condition) for any of the kinematic or kinetic variables of interest. Conclusion The effects of an orthosis on the mechanics of the hip and knee do not appear to be dependent on an individual's dynamic foot motion. J Orthop Sports Phys Ther 2016;46(9):749-755. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6253.
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16
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Neal BS, Barton CJ, Gallie R, O'Halloran P, Morrissey D. Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: A systematic review and meta-analysis. Gait Posture 2016; 45:69-82. [PMID: 26979886 DOI: 10.1016/j.gaitpost.2015.11.018] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/14/2015] [Accepted: 11/28/2015] [Indexed: 02/02/2023]
Abstract
Patellofemoral pain (PFP) is the most prevalent running pathology and associated with multi-level biomechanical factors. This systematic review aims to guide treatment and prevention of PFP by synthesising prospective, observational and intervention studies that measure clinical and biomechanical outcomes in symptomatic running populations. Medline, Web of Science and CINAHL were searched from inception to April 2015 for prospective, case-control or intervention studies in running-related PFP cohorts. Study methodological quality was scored by two independent raters using the modified Downs and Black or PEDro scales, with meta-analysis performed where appropriate. 28 studies were included. Very limited evidence indicates that increased peak hip adduction is a risk factor for PFP in female runners, supported by moderate evidence of a relationship between PFP and increased peak hip adduction, internal rotation and contralateral pelvic drop, as well as reduced peak hip flexion. Limited evidence was also identified that altered peak force and time to peak at foot level is a risk factor for PFP development. Limited evidence from intervention studies indicates that both running retraining and proximal strengthening exercise lead to favourable outcomes in both pain and function, but only running retraining significantly reduces peak hip adduction, suggesting a possible kinematic mechanism. Put together, these findings highlight limited but coherent evidence of altered biomechanics which interventions can alter with resultant symptom change in females with PFP. There is a clear need for high quality prospective studies of intervention efficacy with measurement of explanatory mechanisms.
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Affiliation(s)
- Bradley S Neal
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Pure Sports Medicine, London, United Kingdom
| | - Christian J Barton
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Pure Sports Medicine, London, United Kingdom; Complete Sports Care, Melbourne, Australia; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Rosa Gallie
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom
| | - Patrick O'Halloran
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, United Kingdom; Physiotherapy Department, Barts Health NHS Trust, London, United Kingdom.
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17
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Garbalosa JC, Elliott B, Feinn R, Wedge R. The effect of orthotics on intersegmental foot kinematics and the EMG activity of select lower leg muscles. Foot (Edinb) 2015; 25:206-14. [PMID: 26362236 DOI: 10.1016/j.foot.2015.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Persons with exertional related leg pain are managed using orthoses. This study aimed to determine the effectiveness of two orthoses in altering foot motion and muscle activity in symptomatic individuals. METHODS 52 subjects with lower extremity pain complaints of a non-traumatic, mechanical origin received one of two orthoses. Foot kinematics and EMG activity were recorded while treadmill walking in 3 footwear conditions. The peak EMG activity of the sandal and sandal orthotic trials (normalized to peak barefoot values) and foot motion during 4 subphases of stance were obtained. Using a multivariate multilevel model via linear mixed models, the effect of orthoses within these phases on motion and EMG was determined. RESULTS An effect of orthotic type was not present for any of the rearfoot or forefoot motions (p>.10). A significant effect of footwear and orthotic type on first ray motion (p<.05) during subphases 2 and 4 was seen. During subphase 4 an interaction effect between footwear condition and orthotic type on tibialis posterior EMG activity (p=.036) was present. CONCLUSION Orthoses are unable to control rear or midfoot motion but appear to control first ray motion and during late stance, affect tibialis posterior muscle activity. Public trials registry number: NCRT02143947.
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Affiliation(s)
- Juan C Garbalosa
- Motion Analysis Laboratory, Quinnipiac University, Hamden, CT, United States; Department of Physical Therapy, Quinnipiac University, Hamden, CT, United States.
| | - Bruce Elliott
- Motion Analysis Laboratory, Quinnipiac University, Hamden, CT, United States
| | - Richard Feinn
- Frank H Netter, MD, School of Medicine, Quinnipiac University, Hamden, CT, United States
| | - Ryan Wedge
- Motion Analysis Laboratory, Quinnipiac University, Hamden, CT, United States; Department of Physical Therapy, Quinnipiac University, Hamden, CT, United States
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18
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The Effects of Orthotic Intervention on Multisegment Foot Kinematics and Plantar Fascia Strain in Recreational Runners. J Appl Biomech 2015; 31:28-34. [DOI: 10.1123/jab.2014-0086] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chronic injuries are a common complaint in recreational runners. Foot orthoses have been shown to be effective for the treatment of running injuries but their mechanical effects are still not well understood. This study aims to examine the influence of orthotic intervention on multisegment foot kinematics and plantar fascia strain during running. Fifteen male participants ran at 4.0 m·s−1 with and without orthotics. Multisegment foot kinematics and plantar fascia strain were obtained during the stance phase and contrasted using paired t tests. Relative coronal plane range of motion of the midfoot relative to the rearfoot was significantly reduced with orthotics (1.0°) compared to without (2.2°). Similarly, relative transverse plane range of motion was significantly lower with orthotics (1.1°) compared to without (1.8°). Plantar fascia strain did not differ significantly between orthotic (7.1) and nonorthotic (7.1) conditions. This study shows that although orthotics did not serve to reduce plantar fascia strain, they are able to mediate reductions in coronal and transverse plane rotations of the midfoot.
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19
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Banwell HA, Mackintosh S, Thewlis D, Landorf KB. Consensus-based recommendations of Australian podiatrists for the prescription of foot orthoses for symptomatic flexible pes planus in adults. J Foot Ankle Res 2014; 7:49. [PMID: 25558287 PMCID: PMC4282733 DOI: 10.1186/s13047-014-0049-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Foot orthoses are commonly used for symptomatic flexible pes planus in adults. However, there are no clinical guidelines for the prescription of customised foot orthoses that are specific to this population. The aim of this study was to investigate prescription habits of Australian podiatrists for customised foot orthoses for symptomatic flexible pes planus in adults and to develop consensus-based practice recommendations for the prescription of these foot orthoses. METHODS A four round Delphi survey was undertaken with 24 podiatric experts to establish current use and rationale for individual prescription variables of customised foot orthoses for symptomatic flexible pes planus in adults. Round one determined prescription use (consensus) and rounds two, three and four determined the rationale for use (agreement) of prescription variables across the rearfoot, midfoot, forefoot, as well as accommodation and materials used. For consensus and agreement to be accepted, 70% of the respondents were required to use or agree on the rationale for use of individual prescription variables. RESULTS Consensus was reached in round one for two variables, choice of shell material (polyolefin) and when to prescribe a forefoot post balanced to perpendicular. In rounds two, three and four, agreement was reached for 52 statements related to the rationale for use of individual prescription variables, including when to prescribe: an inverted cast pour [heel in an inverted position], an inverted rearfoot post, a medial heel (Kirby) skive, minimal/maximum arch fill, a medial flange, a forefoot post and common orthotic accommodations. CONCLUSION This study found consensus or agreement for the use of several prescription variables for customised foot orthoses for symptomatic flexible pes planus in adults. The findings were used to develop the Foot orthosis Prescription Recommendations for symptOmatic flexible Pes planus in adults (FootPROP) proforma, to guide clinicians and researchers in the prescription of customised foot orthoses for this population.
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Affiliation(s)
- Helen A Banwell
- />International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Shylie Mackintosh
- />International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
- />Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Dominic Thewlis
- />Biomechanics and Neuromotor Laboratory, School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
- />Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Karl B Landorf
- />Department of Podiatry and Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Victoria, 3083 Australia
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20
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Souza TR, Fonseca HL, Vaz ACA, Antero JS, Marinho CS, Fonseca ST. Between-day reliability of a cluster-based method for multisegment kinematic analysis of the foot-ankle complex. J Am Podiatr Med Assoc 2014; 104:601-9. [PMID: 25514272 DOI: 10.7547/8750-7315-104.6.601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Detailed description of foot pronation-supination requires multisegment evaluation of the kinematics of the foot-ankle complex. There are noninvasive methods with independent (single) tracking markers attached directly to the skin. However, these methods are inconsistent with the usual rigid segments assumption. In contrast, using clustered markers is compatible with this assumption and is necessary for analyses that need tracking markers to be distant from the foot (eg, shod walking). This study investigated the between-day reliability of a cluster-based method for multisegment analysis of foot-ankle angles related to pronation-supination. METHODS Ten healthy adults participated in the study. An anatomically based, three-dimensional model comprising the shank, calcaneus, and forefoot was created. Rigid clusters of tracking markers were used to determine the relative positions and motions of the segments. Mean positions were measured with the subtalar joint in neutral position during standing. Furthermore, mean angles, peaks, and timings of peaks were measured during the stance phase of walking. All of the variables were measured twice, with a 1-week interval. To evaluate reliability, intraclass correlation coefficients were calculated for discrete variables and coefficients of multiple correlation for entire gait curves. RESULTS Intraclass correlation coefficients varied from 0.8 to 0.93 for the angles obtained when the subtalar joint was in neutral and from 0.76 to 0.9 for walking variables. Coefficients of multiple correlation varied from 0.93 to 0.97 for walking curves. CONCLUSIONS The method described has good to high reliability and provides a systematic method for multisegment kinematic evaluation of foot-ankle pronation-supination.
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Affiliation(s)
- Thales R. Souza
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Haroldo L. Fonseca
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana Carolina A. Vaz
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juliana S. Antero
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cristiano S. Marinho
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sérgio T. Fonseca
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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21
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Monaghan GM, Hsu WH, Lewis CL, Saltzman E, Hamill J, Holt KG. Forefoot angle at initial contact determines the amplitude of forefoot and rearfoot eversion during running. Clin Biomech (Bristol, Avon) 2014; 29:936-42. [PMID: 25001326 DOI: 10.1016/j.clinbiomech.2014.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 06/18/2014] [Accepted: 06/19/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinically, foot structures are assessed intrinsically - relation of forefoot to rearfoot and rearfoot to leg. We have argued that, from a biomechanical perspective, the interaction of the foot with the ground may influence forces and torques that are propagated through the lower extremity. We proposed that a more appropriate measure is an extrinsic one that may predict the angle the foot makes with ground at contact. The purposes of this study were to determine if the proposed measure predicts contact angles of the forefoot and rearfoot and assess if the magnitude of those angles influences amplitude and duration of foot eversion during running. METHODS With the individual in prone, extrinsic clinical forefoot and rearfoot angles were measured relative to the caudal edge of the examination table. Participants ran over ground while frontal plane forefoot and rearfoot contact angles, forefoot and rearfoot eversion amplitude and duration were measured. Participants were grouped twice, once based on forefoot contact inversion angle (moderate<median and large>median) and once based on rearfoot contact inversion angle (moderate<median and large>median). FINDINGS The forefoot and rearfoot extrinsic clinical angles predicted, respectively, the forefoot and rearfoot angles at ground contact. Large forefoot contact angles were associated with greater amplitudes (but not durations) of forefoot and rearfoot eversion during stance. Rearfoot contact angles, however, were associated with neither amplitudes nor durations of forefoot and rearfoot eversion. INTERPRETATION Possible mechanisms for the increased risk of running injuries associated with large forefoot angles are discussed.
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Affiliation(s)
- Gail M Monaghan
- Department of Physical Therapy & Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA.
| | - Wen-Hao Hsu
- Department of Physical Therapy & Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Cara L Lewis
- Department of Physical Therapy & Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Elliot Saltzman
- Department of Physical Therapy & Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Joseph Hamill
- Department of Kinesiology, University of Massachusetts, Amherst, MA, USA
| | - Kenneth G Holt
- Department of Physical Therapy & Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
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22
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Rabin A, Kozol Z, Spitzer E, Finestone A. Ankle dorsiflexion among healthy men with different qualities of lower extremity movement. J Athl Train 2014; 49:617-23. [PMID: 25098656 DOI: 10.4085/1062-6050-49.3.14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Lower extremity movement patterns have been implicated as a risk factor for various knee disorders. Ankle-dorsiflexion (DF) range of motion (ROM) has previously been associated with a faulty movement pattern among healthy female participants. OBJECTIVE To determine the association between ankle DF ROM and the quality of lower extremity movement during the lateral step-down test among healthy male participants. DESIGN Cross-sectional study. SETTING Training facility of the Israel Defense Forces. PATIENTS OR OTHER PARTICIPANTS Fifty-five healthy male Israeli military recruits (age = 19.7 ± 1.1 years, height = 175.4 ± 6.4 cm, mass = 72.0 ± 7.6 kg). INTERVENTION(S) Dorsiflexion ROM was measured in weight-bearing and non-weight-bearing conditions using a fluid-filled inclinometer and a universal goniometer, respectively. Lower extremity movement pattern was assessed visually using the lateral step-down test and classified categorically as good or moderate. All measurements were performed bilaterally. MAIN OUTCOME MEASURE(S) Weight-bearing and non-weight-bearing DF ROM were more limited among participants with moderate quality of movement than in those with good quality of movement on the dominant side (P = .01 and P = .02 for weight-bearing and non-weight-bearing DF, respectively). Non-weight-bearing DF demonstrated a trend toward a decreased range among participants with moderate compared with participants with good quality of movement on the nondominant side (P = .03 [adjusted P = .025]). Weight-bearing DF was not different between participants with good and moderate movement patterns on the nondominant side (P = .10). Weight-bearing and non-weight-bearing ankle DF ROM correlated significantly with the quality of movement on both sides (P < .01 and P < .05 on the dominant and nondominant side, respectively). CONCLUSIONS Ankle DF ROM was associated with quality of movement among healthy male participants. The association seemed weaker in males than in females.
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23
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Orthoses posted in both the forefoot and rearfoot reduce moments and angular impulses on lower extremity joints during walking. J Biomech 2014; 47:2618-25. [DOI: 10.1016/j.jbiomech.2014.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/25/2014] [Accepted: 05/24/2014] [Indexed: 11/23/2022]
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Vincent HK, Herman DC, Lear-Barnes L, Barnes R, Chen C, Greenberg S, Vincent KR. Setting standards for medically-based running analysis. Curr Sports Med Rep 2014; 13:275-83. [PMID: 25014394 PMCID: PMC4469466 DOI: 10.1249/jsr.0000000000000071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Setting standards for medically based running analyses is necessary to ensure that runners receive a high-quality service from practitioners. Medical and training history, physical and functional tests, and motion analysis of running at self-selected and faster speeds are key features of a comprehensive analysis. Self-reported history and movement symmetry are critical factors that require follow-up therapy or long-term management. Pain or injury is typically the result of a functional deficit above or below the site along the kinematic chain.
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Affiliation(s)
- Heather K. Vincent
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL
- Sports Performance Center, University of Florida, Gainesville, FL
| | - Daniel C. Herman
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL
- Sports Performance Center, University of Florida, Gainesville, FL
| | | | - Robert Barnes
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL
| | - Cong Chen
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL
- Sports Performance Center, University of Florida, Gainesville, FL
| | - Scott Greenberg
- Sports Performance Center, University of Florida, Gainesville, FL
- Shands Physical Therapy, University of Florida, Gainesville, FL
| | - Kevin R. Vincent
- Department of Orthopaedics and Rehabilitation, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL
- Sports Performance Center, University of Florida, Gainesville, FL
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25
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Association of navicular drop and selected lower-limb biomechanical measures during the stance phase of running. J Appl Biomech 2013; 30:250-4. [PMID: 24145867 DOI: 10.1123/jab.2011-0162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is evidence to suggest that navicular drop measures are associated with specific lower-extremity gait biomechanical parameters. The aim of this study was to examine the relationship between navicular drop and a) rearfoot eversion excursion, b) tibial internal rotation excursion, c) peak ankle inversion moment, and d) peak knee adduction moment during the stance phase of running. Sixteen able-bodied men having an average age of 28.1 (SD=5.30) years, weight of 81.5 (SD=10.40) kg, height of 179.1 (SD=5.42) cm volunteered and ran barefoot at 170 steps/minute over a force plate. Navicular drop measures were negatively correlated with tibial internal rotation excursion (r=-0.53, P=.01) but not with rearfoot eversion excursion (r=-0.19; P=.23). Significant positive correlations were found between navicular drop and peak knee adduction moment (r=.62, P<.01) and peak ankle inversion moment (r=.60, P<.01). These findings suggest that a low navicular drop measure could be associated with increasing tibial rotation excursion while high navicular drop measure could be associated with increased peak ankle and knee joint moments. These findings indicate that measures of navicular drop explained between 28% and 38% of the variability for measures of tibial internal rotation excursion, peak knee adduction moment and peak ankle inversion moments.
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Lucy Hatton A, Dixon J, Rome K, Martin D. Effect of foot orthoses on lower limb muscle activation: a critical review. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328808x252037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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27
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Griffiths IB, McEwan IM. Reliability of a new supination resistance measurement device and validation of the manual supination resistance test. J Am Podiatr Med Assoc 2013; 102:278-89. [PMID: 22826326 DOI: 10.7547/1020278] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Kinematic observations are inconsistent in predicting lower-extremity injury risk, and research suggests that kinetic variables may be more important in this regard. Before kinetics can be prospectively investigated, we need reliable ways of measuring them clinically. A measurement instrument was manufactured that closely mirrors a manual test used to clinically estimate supination resistance force. The reliability of the instrument and the validity of the clinical test were investigated. METHODS The left feet of 26 healthy individuals (17 men and 9 women; mean ± SD age, 25.9 ± 9.2 years; mean ± SD weight, 77.7 ± 13.3 kg) were assessed. Foot Posture Index (FPI-6), manual supination resistance, and machine supination resistance were measured. Intrarater and interrater reliability of all of the measurements were calculated. Correlations of the supination resistance measured by the device with FPI-6, the manual supination resistance test, and body weight were investigated. RESULTS Interrater reliability of all of the measurements was generally poor. The supination resistance machine correlated highly with the manual supination test for the rater experienced with its use. Supination resistance measurements correlated poorly with the FPI-6 and weakly with body weight. CONCLUSIONS The supination resistance machine was shown to have sufficient limits of agreement for the study, but improvements need to be made for more meaningful research going forward. In this study, the force required to supinate a foot was independent of its posture, and approximately 12% of it was explained by body weight. Further work is required with a much larger sample size to build regression models that sufficiently predict supination resistance force and that will be of clinical use. The manual supination test is a valid clinical test for clinicians experienced in its use.
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Affiliation(s)
- Ian B Griffiths
- Sports Podiatry Info Ltd, Brentwood Medical Centre, Brentwood, Essex, England, UK.
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28
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Dose-response effects of customised foot orthoses on lower limb kinematics and kinetics in pronated foot type. J Biomech 2013; 46:1489-95. [PMID: 23631857 DOI: 10.1016/j.jbiomech.2013.03.036] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 01/30/2013] [Accepted: 03/30/2013] [Indexed: 11/21/2022]
Abstract
Despite the widespread use of customised foot orthoses (FOs) for the pronated foot type there is a lack of reliable information on the dose-response effect on lower limb mechanics. This study investigated these effects in subjects with normal and pronated foot types. Customised FOs were administered to 12 participants with symptomatic pronated foot type and 12 age and gender matched controls. A computer-aided design (CAD) software was used to design nine FOs per participant with dose incrementally changed by varying only the rearfoot post angle. This was done in 2° increments from 6° lateral to 10° medial posting. A 3D printing method was used to manufacture the FOs. Quantification of the dose-response effect was performed using three-dimensional gait analyses for selected rearfoot and knee kinematics and kinetics. Under these experimental conditions, significant and linear effects of posting were seen for the peak (p<0.001) and mean (p<0.001) rearfoot eversions, peak (p=0.003) and mean (p<0.001) ankle eversion moments and peak (p=0.017) and mean (p=0.005) knee adduction moment variables. Group effects were observed for the peak (p=0.007) and mean (p=0.007) forefoot abduction and for the peak (p=0.007) knee adduction moment. A significant interaction between posting and group was seen for internal tibial rotation (p=0.004). These data indicate that a dose-response effect, with a linear trend for both the rearfoot and knee, exists for customised FOs used to treat pronated foot type.
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Rodrigues P, Chang R, TenBroek T, Hamill J. Medially posted insoles consistently influence foot pronation in runners with and without anterior knee pain. Gait Posture 2013; 37:526-31. [PMID: 23137595 DOI: 10.1016/j.gaitpost.2012.09.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 09/04/2012] [Accepted: 09/13/2012] [Indexed: 02/02/2023]
Abstract
Anterior knee pain (AKP) is a common injury among runners and effectively treated with posted insoles and foot orthotics. While clinically effective, the underlying biomechanical mechanisms that bring about these improvements remain debatable. Several methodological factors contribute to the inconsistent biomechanical findings, including errors associated with removing and reattaching markers, inferring foot motion from markers placed externally on a shoe, and redefining segmental coordinate systems between conditions. Therefore, the purpose of this study was to evaluate the influence of medially posted insoles on lower extremity kinematics in runners with and without AKP while trying to limit the influence of these methodological factors. Kinematics of 16 asymptomatic and 17 runners with AKP were collected while running with and without insoles. Reflective markers were attached to the surface of the calcaneus and kept in place (as opposed to detached) between conditions, eliminating the error associated with reattaching markers and redefining segmental coordinate systems. Using these methods, no significant interactions between insole and injury and the main effect of injury were detected (p>0.05); therefore, means were pooled across injury. Insoles, on average, reduced peak eversion by 3.6° (95% confidence interval -2.9° to -4.3°), peak eversion velocity by 53.2°/s (95% confidence interval -32.9 to -73.4) and eversion range of motion by 1.33 (95% confidence interval -0.8 to -1.9). However, while insoles systematically reduced eversion variables, they had small influences on the transverse plane kinematics of the tibia or knee, indicating that they may bring about their clinical effect by influencing other variables.
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Affiliation(s)
- Pedro Rodrigues
- New Balance Sports Research Laboratory, Lawrence, MA, United States; Biomechanics Laboratory, University of Massachusetts, Amherst, MA, United States.
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The Effects of Rearfoot Position on Lower Limb Kinematics during Bilateral Squatting in Asymptomatic Individuals with a Pronated Foot Type. J Hum Kinet 2013; 31:5-15. [PMID: 23486735 PMCID: PMC3588658 DOI: 10.2478/v10078-012-0001-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinicians frequently assess movement performance during a bilateral squat to observe the biomechanical effects of foot orthotic prescription. However, the effects of rearfoot position on bilateral squat kinematics have not been established objectively to date. This study aims to investigate these effects in a population of healthy adults with a pronated foot type. Ten healthy participants with a pronated foot type bilaterally (defined as a navicular drop >9mm) performed three squats in each of three conditions: barefoot, standing on 10mm shoe pitch platforms and standing on the platforms with foam wedges supporting the rearfoot in subtalar neutral. Kinematic data was recorded using a 3D motion analysis system. Between-conditions changes in peak joint angles attained were analysed. Peak ankle dorsiflexion (p=0.0005) and hip abduction (p=0.024) were significantly reduced, while peak knee varus (p=0.028) and flexion (p=0.0005) were significantly increased during squatting in the subtalar neutral position compared to barefoot. Peak subtalar pronation decreased by 5.33° (SD 4.52°) when squatting on the platforms compared to barefoot (p=0.006), but no additional significant effects were noted in subtalar neutral. Significant changes in lower limb kinematics may be observed during bilateral squatting when rearfoot alignment is altered. Shoe pitch alone may significantly reduce peak pronation during squatting in this population, but additional reductions were not observed in the subtalar neutral position. Further research investigating the effects of footwear and the subtalar neutral position in populations with lower limb pathology is required.
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Hinman RS, Bardin L, Simic M, Bennell KL. Medial arch supports do not significantly alter the knee adduction moment in people with knee osteoarthritis. Osteoarthritis Cartilage 2013; 21:28-34. [PMID: 23103749 DOI: 10.1016/j.joca.2012.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 10/07/2012] [Accepted: 10/14/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to evaluate the immediate effects of medial arch supports on indices of medial knee joint load (the peak external knee adduction moment (KAM) and knee adduction angular (KAA) impulse) and knee pain during walking in people with medial knee osteoarthritis (OA). DESIGN Twenty-one people with medial compartment OA underwent gait analysis in standardised athletic shoes wearing (1) no medial arch supports and (2) prefabricated medial arch supports, in random order. Outcomes were the first and second peaks in the external KAM, the KAA impulse and severity of knee pain during testing. Outcomes were compared across conditions using paired t tests (gait data) and Wilcoxon Signed Ranks test (pain data). RESULTS There were no significant changes in either first or second peak KAM, or in the KAA impulse, with the addition of medial arch supports (all P > 0.05). Considerable individual variation in response to the arch supports was observed across participants. There was no immediate change in knee pain during walking when medial arch supports were worn (P = 0.56). CONCLUSIONS This study showed no mean change in any of the measured indices of medial knee load with medial arch supports. No immediate changes in knee pain were evident.
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Affiliation(s)
- R S Hinman
- Centre for Health, Exercise and Sports Medicine, Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
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Barwick A, Smith J, Chuter V. The relationship between foot motion and lumbopelvic-hip function: a review of the literature. Foot (Edinb) 2012; 22:224-31. [PMID: 22503311 DOI: 10.1016/j.foot.2012.03.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 03/14/2012] [Accepted: 03/15/2012] [Indexed: 02/04/2023]
Abstract
Excessive pronation has been implicated in the development of numerous overuse injuries of the lower limb and is suggested to cause more proximal biomechanical dysfunction. Functional foot orthoses (FFO) are frequently prescribed for lower limb injury associated with excessive foot pronation and have been demonstrated to have efficacy with specific conditions. However, the mechanism of action of FFO is largely unknown. Research investigating the kinematic and kinetic changes associated with FFO use is inconclusive. Furthermore there is a growing body of evidence suggesting that changes to muscle activity patterns in response to FFO may be responsible for their therapeutic effect. Additionally, current research suggests dysfunction of musculature of the lumbopelvic-hip complex is involved in lower extremity functional changes and is related to the development some pathologies traditionally attributed to excessive foot pronation. Evidence of temporal coupling between the hip and the foot and changes in hip muscle activity associated with FFO use further suggest a relationship between proximal and distal lower limb function. The aim of this review is to discuss the association between foot and lumbopelvic-hip complex dysfunction and injury, assess the evidence for functional changes to lower limb and lumbopelvic-hip function with FFO use and finally to discuss the potential for changes to hip musculature activation with FFO use to influence distal mechanics and produce a therapeutic benefit.
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Affiliation(s)
- Alex Barwick
- School of Health Science, University of Newcastle, Australia
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Effects of medially wedged foot orthoses on knee and hip joint running mechanics in females with and without patellofemoral pain syndrome. J Appl Biomech 2012; 29:68-77. [PMID: 22815282 DOI: 10.1123/jab.29.1.68] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.
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Neville C, Lemley FR. Effect of ankle-foot orthotic devices on foot kinematics in Stage II posterior tibial tendon dysfunction. Foot Ankle Int 2012; 33:406-14. [PMID: 22735283 PMCID: PMC5771477 DOI: 10.3113/fai.2012.0406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Data are limited on the various orthotic devices available for patients with Stage II posterior tibial tendon dysfunction (PTTD). Foot kinematics observed while walking with an orthotic device are hypothesized to be associated with clinical outcomes and could be used to refine future device designs. METHODS Fifteen subjects (age, 63.6 ± 6.8 years) with Stage II PTTD walked in the lab under four conditions: (1) shoe only (control condition), (2) shoe with a custom solid AFO (Arizona Co, Mesa, AZ), (3) shoe with a custom articulated AFO (Arizona Co, Mesa, AZ), and (4) shoe with an off-the-shelf AFO (AirLift, DJ Orthopedics). Kinematic data were collected to determine the degree of hindfoot inversion, forefoot plantarflexion (reflective of raising the MLA), and forefoot adduction associated with each condition. RESULTS The custom articulated device was associated with greater hindfoot inversion compared to the shoe only condition at loading response (p = 0.002), mid-stance (p < 0.001), and terminal stance (p = 0.02). The custom articulated device, custom solid device, and off-the-shelf device were associated with greater forefoot plantarflexion compared to the shoe only condition across all four phases of stance. There were no differences between any of the devices and the shoe condition associated with forefoot adduction. CONCLUSION The custom devices were associated with greater hindfoot inversion and forefoot plantarflexion compared to walking with only a shoe, while the off-the-shelf device was associated with forefoot plantarflexion but no change in hindfoot motion. None of the devices corrected forefoot abduction compared to the shoe only condition. CLINICAL RELEVANCE The current biomechanical data may aid in understanding the clinical outcomes seen using these devices as well as provide data to support new designs.
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Abstract
Orthoses have been broadly used by clinicians to treat mechanical misalignments, such as abnormal foot pronation. As such, the influences of orthoses on lower-limb kinematics have been studied numerous times, with many articles reporting nonsystematic results; the aim of this review, therefore, was to examine the recognized effects of foot orthoses on lower-limb kinematics. The findings from this review suggest that foot orthoses seem to have certain generic and common effects on the lower limb when designed to control rearfoot pronation. We also discuss the possible reasons behind the lack of consistent results between studies. Based on the findings, a list of recommendations is presented for future research on foot orthoses to facilitate comparisons between studies and enable the scientific and clinical communities to better comprehend the effects that these variables might have on the kinematics and, possibly, the treatment outcomes.
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Ferber R, Benson B. Changes in multi-segment foot biomechanics with a heat-mouldable semi-custom foot orthotic device. J Foot Ankle Res 2011; 4:18. [PMID: 21693032 PMCID: PMC3128848 DOI: 10.1186/1757-1146-4-18] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 06/21/2011] [Indexed: 11/10/2022] Open
Abstract
Background Semi-custom foot orthoses (SCO) are thought to be a cost-effective alternative to custom-made devices. However, previous biomechanical research involving either custom or SCO has only focused on rearfoot biomechanics. The purpose of this study was therefore to determine changes in multi-segment foot biomechanics during shod walking with and without an SCO. We chose to investigate an SCO device that incorporates a heat-moulding process, to further understand if the moulding process would significantly alter rearfoot, midfoot, or shank kinematics as compared to a no-orthotic condition. We hypothesized the SCO, whether moulded or non-moulded, would reduce peak rearfoot eversion, tibial internal rotation, arch deformation, and plantar fascia strain as compared to the no-orthoses condition. Methods Twenty participants had retroreflective markers placed on the right limb to represent forefoot, midfoot, rearfoot and shank segments. 3D kinematics were recorded using an 8-camera motion capture system while participants walked on a treadmill. Results Plantar fascia strain was reduced by 34% when participants walked in either the moulded or non-moulded SCO condition compared to no-orthoses. However, there were no significant differences in peak rearfoot eversion, tibial internal rotation, or medial longitudinal arch angles between any conditions. Conclusions A semi-custom moulded orthotic does not control rearfoot, shank, or arch deformation but does, however, reduce plantar fascia strain compared to walking without an orthoses. Heat-moulding the orthotic device does not have a measurable effect on any biomechanical variables compared to the non-moulded condition. These data may, in part, help explain the clinical efficacy of orthotic devices.
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Affiliation(s)
- Reed Ferber
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Brittany Benson
- Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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Gender and Foot Orthotic Device Effect on Frontal Plane Hip Motion During Landing From a Vertical Jump. J Appl Biomech 2011; 27:130-6. [DOI: 10.1123/jab.27.2.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Excessive hip motion has been linked to lower extremity pathology. Foot orthoses are commonly used to control motion within lower extremity joints when lower extremity pathology and dysfunction are present. Few studies have investigated the effect of foot orthoses on hip angular kinematics during functional activities. Eighteen females and 18 males performed a vertical jump with and without a prefabricated foot orthoses to determine the biomechanical effect of foot orthoses on hip kinematics when landing from a jump. Data collection included three-dimensional motion analysis of the lower extremity. Pairedttests were performed to determine if differences existed within genders with and without foot orthoses. At the hip joint, there was significantly less hip adduction motion in the foot orthoses condition as compared with the no foot orthoses condition in females (p< .05). There were no differences between foot orthoses conditions in males. Females appear to have a different proximal response to foot orthoses when landing from a forward jump than males.
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Measures of range of motion and strength among healthy women with differing quality of lower extremity movement during the lateral step-down test. J Orthop Sports Phys Ther 2010; 40:792-800. [PMID: 20972344 DOI: 10.2519/jospt.2010.3424] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVE To determine the association between hip and ankle range-of-motion measures, as well as measures of hip muscle strength, with measures of quality of lower extremity movement, as assessed visually during the lateral step-down test in healthy women. BACKGROUND Altered lower extremity movement pattern consisting of excessive femoral adduction and internal rotation, leading to excessive knee valgus alignment, is associated with increased risk of knee ligament injury, as well as patellofemoral pain syndrome. Previous investigations of lower extremity kinematics, using 3-dimensional motion analysis systems, document an inconsistent association between hip muscle strength and lower extremity movement pattern. Currently, it is unknown whether differences in hip muscle strength or other physical measures exist among women with differing quality of lower extremity movement as assessed by visual observation. METHODS Two physical therapists assessed the quality of movement during the lateral step-down among 29 healthy women (mean ± SD age, 24.3 ± 3.2 years). Subjects were instructed on the optimal movement pattern prior to performing the test. The quality of movement was categorized as "good" or "moderate," based on a previously established 6-point scale. Several measures of hip strength (handheld dynamometer) and hip and ankle range of motion (fluid-filled inclinometer and universal goniometer) were also assessed. Differences in strength and range-of-motion measures between women with good and women with moderate quality of movement were assessed with a Mann-Whitney U test. RESULTS Both examiners found decreased ankle dorsiflexion range of motion, as measured with the knee bent (P<.05 and P<.01 for examiner 1 and 2, respectively) and in weight bearing (P<.001 and P<.01 for examiner 1 and 2, respectively) among women with a moderate quality of movement compared to women with a good quality of movement on the lateral step-down test. CONCLUSION Following receipt of instructions on optimal lower extremity movement pattern, women who demonstrate a moderate quality of movement, as assessed visually during the lateral step-down test, exhibit decreased ankle dorsiflexion range of motion compared to women with a good quality of movement. Clinicians should consider evaluating ankle dorsiflexion range of motion when observing an altered lower extremity movement pattern during the lateral step-down test.
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Comparative biomechanical effectiveness of over-the-counter devices for individuals with a flexible flatfoot secondary to forefoot varus. Clin J Sport Med 2010; 20:428-35. [PMID: 21079438 DOI: 10.1097/jsm.0b013e3181fb539f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Evaluate effects of a new off-the-shelf insert on frontal plane foot biomechanics and compare effectiveness of the new and an existing off-the-shelf insert and a motion-control shoe in neutralizing frontal plane foot biomechanics. DESIGN Descriptive. SETTING Biomechanics laboratory. PARTICIPANTS Fifteen uninjured subjects with a flexible flatfoot secondary to forefoot varus. ASSESSMENT OF RISK FACTORS Three-dimensional kinematic and kinetic data were collected as subjects walked and jogged at their self-selected speed while wearing a motion-control running shoe, the shoe with a new off-the-shelf insert, and the shoe with an existing off-the-shelf insert. MAIN OUTCOME MEASURES Frontal plane kinematics and rearfoot kinetics were evaluated during stance. Statistical analysis was performed using a repeated measures analysis of variance and Student-Newman-Keuls post hoc tests (α ≤ 0.05). RESULTS The new insert and motion-control shoe placed the forefoot in a less-everted position than the existing off-the-shelf insert during walking. There were no differences in forefoot kinematics during jogging, nor were there differences in rearfoot motion during walking or jogging. The rearfoot eversion moment was significantly lower with the new off-the-shelf insert compared with the motion-control shoe and the existing insert during walking and jogging. CONCLUSIONS A new off-the-shelf device is available that promotes more neutral frontal plane biomechanics, thus providing a theoretical rationale for using this device for injury prevention and treatment. The comparative biomechanical effectiveness of a motion-control shoe and the orthotic inserts may assist health care professionals in selecting a device to correct the flatfoot structure.
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Van Gheluwe B, Kirby K. Research and clinical synergy in foot and lower extremity biomechanics. FOOTWEAR SCIENCE 2010. [DOI: 10.1080/19424280.2010.497169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chuter VH. Relationships between foot type and dynamic rearfoot frontal plane motion. J Foot Ankle Res 2010; 3:9. [PMID: 20550714 PMCID: PMC2894016 DOI: 10.1186/1757-1146-3-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 06/16/2010] [Indexed: 11/20/2022] Open
Abstract
Background The Foot Posture Index (FPI) provides an easily applicable, validated method for quantifying static foot posture. However there is limited evidence relating to the ability of the FPI to predict dynamic foot function. This study aimed to assess the relationship between dynamic rearfoot motion and FPI scores in pronated and normal foot types. Methods 40 participants were recruited with equal numbers of pronated and normal foot types as classified by their FPI score. Three dimensional rearfoot motion was collected for each of the participants. Dynamic maximum rearfoot eversion was correlated with the total FPI score across all participants and within the normal and pronated foot types. Linear correlations were performed between components of the total FPI scores measuring frontal plane rearfoot position and maximum rearfoot eversion. The capacity of the total FPI score to predict maximum frontal plane motion of the rearfoot was investigated using linear regression analysis. Results The correlation between the total FPI score and maximum rearfoot eversion was strongly positive (r = 0.92, p < 0.05). Correlation performed on data subsets demonstrated the pronated foot type (FPI = +6 to +9) and maximum rearfoot eversion angle were more strongly positively correlated (r = 0.81, p < 0.05) than the normal foot type (FPI = 0 to +5) and maximum rearfoot eversion (r = 0.76, p < 0.05). Correlations between frontal plane rearfoot FPI score and frontal plane motion during gait were strongly positive, (r = 0.79 p < 0.05 pronated group, r = 0.71 p < 0.05 normal group), however were less strong than the total FPI score and rearfoot motion. Linear regression analysis demonstrated a significant and strong relationship between the total FPI score and maximum rearfoot eversion (r2 = 0.85, p < 0.001). Conclusions The results of this study suggest the FPI has strong predictive ability for dynamic rearfoot function. This will assist in clinical screening and research by allowing easy classification by functional foot type. Positive correlations between frontal plane rearfoot measurements and maximum rearfoot eversion suggest the FPI may identify dominant planar components of dynamic rearfoot motion and warrants further investigation.
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Affiliation(s)
- Vivienne H Chuter
- Discipline of Podiatry, Faculty of Health, University of Newcastle, Ourimbah, New South Wales, Australia.
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Foot orthotic devices decrease transverse plane motion during landing from a forward vertical jump in healthy females. J Appl Biomech 2010; 25:387-95. [PMID: 20095460 DOI: 10.1123/jab.25.4.387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The use of foot orthoses has been evaluated during a variety of functional activities. Twelve college-aged active females wore two types of foot orthoses and performed a vertical jump to determine the biomechanical effect of the orthoses on lower extremity transverse plane movement during landing. Data collection included three-dimensional analysis of the tibia, knee, and hip. A repeated-measures ANOVA was performed to determine the differences between no orthoses, over-the-counter, and custom-made orthoses with transverse plane motion. At the hip joint, there was significantly less internal rotation (p < .05) in the over-the-counter condition as compared with the no orthoses condition. There was significantly less tibial internal rotation (p < .05) in the custom-made condition as compared with no orthoses. Over-the-counter devices decreased transverse plane motion at the hip, whereas custom-made devices decreased transverse plane motion of the tibia.
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Changes in running kinematics and kinetics in response to a rockered shoe intervention. Clin Biomech (Bristol, Avon) 2009; 24:872-6. [PMID: 19744753 DOI: 10.1016/j.clinbiomech.2009.08.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 08/06/2009] [Accepted: 08/10/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND A suggested link between ambulatory mechanics and injury development has resulted in significant interest the development of footwear to change locomotion patterns. The purpose of this study was to test the hypothesis that there will be significant changes in the kinematics and kinetics at the ankle and minimal changes at the knee and hip in the mechanics of running in a shoe with a sagittal plane curvature relative to a flat soled shoe. METHODS During running 3-D lower extremity kinematics and kinetics for 19 healthy volunteers were quantified using an optoelectronics system and a force plate. Data were collected for a flat sole conventional shoe (New Balance 658 (Control)) and a shoe with a rounded sole in the sagittal plane (Masai Barefoot Technologies (MBT)). Data were compared for the two shoe conditions using paired Student t-tests (alpha=0.05). FINDINGS The ankle dorsi-flexion angles at heel-strike and mid-stance were greater, while the ankle plantar and dorsi-flexion moments and peak ankle joint power were significantly lower with the MBT relative to the control (P<0.05). Decreases in the first medial GRF peak and the peak anterior GRF peak were also found for running in the MBT shoe. INTERPRETATION Despite a major difference in sole geometry, accommodations to the rockered sole were found only at the ankle. These results suggest changes in ankle kinematics and kinetics may be used to minimize the effect of changes in sole rocker on limb dynamics. Thus, changes in shoe rocker may offer potential therapeutic opportunities for running related conditions at the ankle without substantial risk to the knee or hip.
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Choosing among 3 ankle-foot orthoses for a patient with stage II posterior tibial tendon dysfunction. J Orthop Sports Phys Ther 2009; 39:816-24. [PMID: 19881002 PMCID: PMC2872085 DOI: 10.2519/jospt.2009.3107] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND No head-to-head comparisons of different orthoses for patients with stage II posterior tibial tendon dysfunction (PTTD) have been performed to date. Additionally, the cost of orthoses varies considerably, thus choosing an effective orthosis that is affordable to the patient is largely a trial-and-error process. CASE DESCRIPTION A 77-year-old woman was seen with complaints of abnormal foot posture ('my foot is out'), minimal medial foot and ankle pain, and a 3-year history of conservatively managed stage II PTTD. The patient was not able to complete 1 single-limb heel rise on the involved side, while she could complete 3 on the uninvolved side. Ankle strength testing revealed a mild to moderate loss of plantar flexor strength (20%-31% deficit on the involved side), combined with a 22% deficit in isometric ankle inversion and forefoot adduction strength. To assist this patient in managing her flatfoot posture and PTTD, 3 orthoses were considered: an off-the-shelf ankle-foot orthosis (AFO), a custom solid AFO, and a custom articulated AFO. The patient's chief complaint was partly cosmetic (ìmy foot is outî). As decreasing flatfoot kinematics may unload the tibialis posterior muscle, thus prevent the progression of foot deformity, the primary goal of orthotic intervention was to improve flatfoot kinematics. Given the difficulties in clinical approaches to evaluating flatfoot kinematics, a quantitative gait analysis, using a multisegment foot model, was used. OUTCOMES In the frontal plane, all 3 orthoses were associated with small changes toward hindfoot inversion. In the sagittal plane, between 2.7 degrees and 6.1 degrees , greater forefoot plantar flexion (raising the medial longitudinal arch) occurred. There were no differences among the orthoses on hindfoot inversion and forefoot plantar flexion. In the transverse plane, the off-the-shelf design was associated with forefoot abduction, the custom solid orthosis was associated with no change, and the custom articulated orthosis was associated with forefoot adduction. DISCUSSION Based on gait analysis, the higher-cost custom articulated orthosis was chosen as optimal for the patient. This custom articulated orthosis was associated with the greatest change in flatfoot deformity, assessed using gait analysis. The patient felt it produced the greatest correction in foot deformity. Reducing flatfoot deformity while allowing ankle movement may limit progression of stage II PTTD. LEVEL OF EVIDENCE Therapy, level 4.
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Influence of running shoe midsole composition and custom foot orthotic intervention on lower extremity dynamics during running. J Appl Biomech 2009; 25:54-63. [PMID: 19299830 DOI: 10.1123/jab.25.1.54] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to analyze the influence of varying running shoe midsole composition on lower extremity dynamics with and without a custom foot orthotic intervention. Three-dimensional dynamics were collected on 12 female runners who had completed 6 weeks of custom foot orthotic therapy. Participants completed running trials in 3 running shoe midsole conditions-with and without a custom foot orthotic intervention. Results from the current study revealed that only maximum rearfoot eversion velocity was influenced by the midsole durometer of the shoe. Maximum rearfoot eversion velocity was significantly decreased for the hard shoe compared with the soft shoe. However, the orthotic intervention in the footwear led to significant decreases in several dynamic variables. The results suggest that the major component influencing the rearfoot dynamics was the orthotic device and not the shoe composition. In addition, data suggest that the foot orthoses appear to compensate for the lesser shoe stability enabling it to function in a way similar to that of a shoe of greater stability.
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Effects of the AirLift PTTD brace on foot kinematics in subjects with stage II posterior tibial tendon dysfunction. J Orthop Sports Phys Ther 2009; 39:201-9. [PMID: 19252264 DOI: 10.2519/jospt.2009.2908] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Experimental laboratory study. OBJECTIVES To investigate the effect of inflation of the air bladder component of the AirLift PTTD brace on relative foot kinematics in subjects with stage II posterior tibial tendon dysfunction (PTTD). BACKGROUND Orthotic devices are commonly recommended in the conservative management of stage II PTTD to improve foot kinematics. METHODS AND MEASURES Ten female subjects with stage II PTTD walked in the laboratory wearing the AirLift PTTD brace during 3 testing conditions (air bladder inflation to 0, 4, and 7 PSI [SI equivalent: 0, 27,579, and 48,263 Pa]). Kinematics were recorded from the tibia, calcaneus (hindfoot), and first metatarsal (forefoot), using an Optotrak motion analysis system. Comparisons were made between air bladder inflation and the 0-PSI condition for each of the dependent kinematic variables (hindfoot eversion, forefoot abduction, and forefoot dorsiflexion). RESULTS Greater hindfoot inversion was observed with air bladder inflation during the second rocker (mean, 1.7 degrees; range, -0.7 degrees to 6.1 degrees). Less consistent changes in forefoot plantar flexion and forefoot adduction occurred with air bladder inflation. The greatest change toward forefoot plantar flexion was observed during the third rocker (mean, 1.4 degrees; range, -3.8 degrees to 3.9 degrees). The greatest change towards adduction was observed during the third rocker (mean, 2.3 degrees; range, -3.4 degrees to 6.5 degrees). CONCLUSIONS On average, the air bladder component of the AirLift PTTD brace was successful in reducing the amount of hindfoot eversion observed in subjects with stage II PTTD; however, the effect on forefoot motion was more variable. Some subjects tested had marked improvement in foot kinematics, while 2 subjects demonstrated negative results. Specific foot characteristics are hypothesized to explain these varied results.
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Davis IS, Zifchock RA, Deleo AT. A comparison of rearfoot motion control and comfort between custom and semicustom foot orthotic devices. J Am Podiatr Med Assoc 2009; 98:394-403. [PMID: 18820043 DOI: 10.7547/0980394] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Motion control and comfort are primary objectives in orthotic intervention. Semicustom orthotic devices have been presented as a more cost-effective solution than custom orthotic devices. However, no studies have compared their function or comfort to that of custom orthotic devices. METHODS Nineteen uninjured runners were fitted for custom and semicustom orthotic devices. Subjects underwent an instrumented gait analysis of running and walking in no-orthotic, custom orthotic, and semicustom orthotic conditions. Subjects completed visual analog scales for the custom and semicustom orthotic conditions. One-way repeated measures analyses of variance were performed on the rearfoot variables of peak eversion, eversion excursion, eversion duration, and eversion velocity. Two-tailed, dependent t tests were used to compare comfort. RESULTS Eversion excursion showed significant differences between the conditions: during running, it was reduced in the custom orthotic as compared to the no-orthotic condition; during walking, it was reduced in the semicustom orthotic as compared to both the custom and no-orthotic conditions. The custom orthotic devices were significantly more comfortable (P < .05) than the semicustom devices in the area of the edges only. CONCLUSION The results suggest that, in uninjured individuals, there are few differences in rearfoot motion control and comfort between the custom and semicustom orthotic devices used in this study.
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Affiliation(s)
- Irene S Davis
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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McMillan A, Payne C. Effect of foot orthoses on lower extremity kinetics during running: a systematic literature review. J Foot Ankle Res 2008; 1:13. [PMID: 19014705 PMCID: PMC2611967 DOI: 10.1186/1757-1146-1-13] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 11/17/2008] [Indexed: 11/18/2022] Open
Abstract
Background Throughout the period of one year, approximately 50% of recreational runners will sustain an injury that disrupts their training regimen. Foot orthoses have been shown to be clinically effective in the prevention and treatment of several running-related conditions, yet the physical effect of this intervention during running remains poorly understood. The aim of this literature review was therefore to evaluate the effect of foot orthoses on lower extremity forces and pressure (kinetics) during running. Methods A systematic search of electronic databases including Medline (1966-present), CINAHL, SportDiscus, and The Cochrane Library occurred on 7 May 2008. Eligible articles were selected according to pre-determined criteria. Methodological quality was evaluated by use of the Quality Index as described by Downs & Black, followed by critical analysis according to outcome variables. Results The most widely reported kinetic outcomes were loading rate and impact force, however the effect of foot orthoses on these variables remains unclear. In contrast, current evidence suggests that a reduction in the rearfoot inversion moment is the most consistent kinetic effect of foot orthoses during running. Conclusion The findings of this review demonstrate systematic effects that may inform the direction of future research, as further evidence is required to define the mechanism of action of foot orthoses during running. Continuation of research in this field will enable targeting of design parameters towards biomechanical variables that are supported by evidence, and may lead to advancements in clinical efficacy.
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Affiliation(s)
- Andrew McMillan
- Department of Podiatry, La Trobe University, Bundoora, Vic, 3086, Australia.
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