The Effect of Toe Flexion Exercises on Grip

Effects of Insole with Toe-Grip Bar on Barefoot Balance and Walking Function in Patients with Parkinson's Disease: A Randomized Controlled Trial

The maintenance and improvement of balance and walking function in patients with Parkinson’s disease (PD) is essential. Toe dysfunction in patients with PD is related to balance and walking. Recently, insoles have been developed to improve toe function, but their effects on the physical functions of patients with PD remain unclear. In this randomized controlled study, we investigated the effects of insoles with a toe-grip bar on balance and walking function in such patients. Twenty-nine patients with PD in Hoehn and Yahr stages II−IV were randomly assigned to an intervention or control group. Patients in the intervention and control groups wore shoes having insoles with and without a toe-grip bar for 4 weeks, respectively. The center of gravity sway of standing posture (total trajectory length, envelope area, and maximum anterior−posterior center of pressure [AP-COP] distance) and walking parameters at normal and fast speeds were measured pre- and post-intervention in the rehabilitation room. All measurements were performed with the participants being barefoot. The maximum AP-COP distance and step length of the fast-walking condition were significantly improved in the intervention compared to the control group (p < 0.05). Thus, insoles with a toe-grip bar may improve balance and walking function in patients with PD.

Surface electromyography of the foot: A protocol for sensor placement

BACKGROUND

The use of surface EMG (sEMG) to record muscle activity is common place yet due to restrictions in technology studies on the intrinsic foot muscles have been limited or only fine wire instruments have been used.

AIM

This paper looks at the potential reliability of a sEMG protocol for assessing the intrinsic foot muscles.

METHODS

Six intrinsic muscles were defined using ultrasound and muscle function testing. A protocol for sensor placement was created with repeatability and reliability testing of the protocol conducted by three separate testers on three subjects over two different time frames. Inter tester and Inter session repeatability and reliability was measured with ICC and percentage standard error of measurement.

RESULTS

Although there was good correlation between Extensor Digitorum Brevis, Dorsal Interossei, Abductor Digiti Minimi and Flexor Digitorum Brevis there was increased variability and poor correlation for Flexor hallucis Brevis and Abductor Hallucis. The percentage standard error of measurement did not support the high ICC values indicating a lower precision of measurement.

SIGNIFICANCE

Variability between testers and sessions shows an inconsistent reliability of sEMG and further work is required with protocols focussing on grouping muscles to improve the understanding of the intrinsic foot muscles.

Conservative treatment of Freiberg's infraction using foot orthoses: A tale of two prescriptions presented as a case study to open debate

'Freiberg's infraction or disease' is an osteonecrotic process primarily affecting the 2^nd & 3^rd metatarsal heads. Early diagnosis is difficult, and the underlying pathogenesis remains unclear. Surgical options for late disease have been widely reported in the literature, yet details on conservative management for the early stages of Freiberg's are largely absent. Pathology should be treated where possible using an evidence-based approach, yet evidence for conservative management in acute stages of Freiberg's is lacking. A case study is presented that outlines two different prescription interventions using foot orthoses; one that attempted to 'offload' the metatarsal head by creating space beneath it; and one that attempted to 'offloaded' by increasing controlled loading of the metatarsals proximal to the head. These resulted in very different outcomes for the patient. The authors will attempt to give a 'pathomechanical rationale' for the treatment outcomes based on mechanical stress principles, and a consequential explanation as to why one type of insole prescription seemed more successful in reducing symptoms and raising activity levels, while another was not.