Dose–response effects of customised foot orthoses on lower limb kinematics and kinetics in pronated foot type

S Telfer, M Abbott, MM Steultjens, J Woodburn - Journal of Biomechanics, 2013

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.

http://www.jbiomech.com/article/S0021-9290(13)00166-8/abstract

The effectiveness of footwear as an intervention to prevent or to reduce biomechanical risk factors associated with diabetic foot ulceration: A systematic review

A Healy, R Naemi, N Chockalingam - Journal of Diabetes and its Complications

Abstract 

Aim

Footwear interventions are used within clinical practice in an effort to reduce ulcerations however the effectiveness of these interventions is unclear. The aim of this paper was to conduct a systematic review which examined the effectiveness of footwear as an intervention for prevention of diabetic foot ulcers or the reduction of biomechanical risk factors for ulceration and to discuss the quality and interpret the findings of research to date.

Methods

The CINAHL, Medline and Cochrane Register of Controlled Trials databases were searched with 12 articles identified for review.

Results

The majority of these studies were cross sectional and examined the effect of different footwear conditions on plantar pressure measurements. Factors which influenced study findings such as participant selection, measurement and analysis techniques, footwear design and compliance are discussed and recommendations for future studies are provided.

Conclusions

No research to date has examined the effectiveness of footwear in preventing ulceration. Conflicting findings are reported on the effective of footwear interventions to prevent reulceration. While the use of rocker sole footwear and custom orthoses in plantar pressure reduction are supported in cross sectional studies, longitudinal studies are required to confirm their benefit.

http://www.jdcjournal.com/article/S1056-8727(13)00056-1/abstract

Scoliosis—treatment indications according to current evidence

HR Weiss, M Moramarco

Abstract

Introduction

Long-term follow-ups of untreated patients with adolescent idiopathic 

scoliosis (AIS) indicate that the consequences of AIS over a lifetime are 

minimal, sometimes moderate in more severe cases, however, never 

life-threatening. In light of these findings, the historical indications 

for treatment should be investigated according to current evidence.

Recent reviews have been investigated for their contribution to 

evidence in the field of scoliosis treatment—especially the impact of 

the results obtained on the historical modes of treatment. 

From these findings, we may conclude that there is promising 

evidence for the application of physiotherapy in the treatment of scoliosis in children or adolescents and for adults with curvatures exceeding 35° 

Cobb. There is a stronger evidence for the application of (hard) braces 

during growth. There is no evidence for spinal fusion surgery for AIS. The 

use of surgery should be limited in patients with scoliosis of other origin. This critical review discusses the treatment methods for scoliosis.

Conclusion

There is some evidence for the use of physiotherapy as a treatment for 

scoliosis. There is strong evidence for the use of hard braces during growth. 

http://www.oapublishinglondon.com/images/article/pdf/1368523536.pdf

Foot Drop Stimulation Versus Ankle Foot Orthosis After Stroke - 30-Week Outcomes

Patricia M. Kluding, PhD, 

Kari Dunning, PhD, 

Michael W. O'Dell, MD,

Samuel S. Wu, PhD, 

Jivan Ginosian, MS, 

Jody Feld, DPT and

Keith McBride, DPT

Abstract

Background and Purpose—Drop foot after stroke may be addressed using an ankle foot orthosis (AFO) or a foot drop stimulator (FDS). The Functional Ambulation: Standard Treatment versus Electric Stimulation Therapy (FASTEST) trial was a multicenter, randomized, single-blinded trial comparing FDS and AFO for drop foot among people ≥3 months after stroke with gait speed ≤0.8 m/s.

Methods—Participants (n=197; 79 females and 118 males; 61.14±11.61 years of age; time after stroke 4.55±4.72 years) were randomized to 30 weeks of either FDS or a standard AFO. Eight dose-matched physical therapy sessions were provided to both groups during the first 6 weeks of the trial.

Results—There was significant improvement within both groups from baseline to 30 weeks in comfortable gait speed (95% confidence interval for mean change, 0.11–0.17 m/s for FDS and 0.12–0.18 m/s for AFO) and fast gait speed. However, no significant differences in gait speed were found in the between-group comparisons. Secondary outcomes (standard measures of body structure and function, activity, and participation) improved significantly in both groups, whereas user satisfaction was significantly higher in the FDS group than in the control group.

Conclusions—Using either an FDS or an AFO for 30 weeks yielded clinically and statistically significant improvements in gait speed and other functional outcomes. User satisfaction was higher in the FDS group. Although both groups did receive intervention, this large clinical trial provides evidence that FDS or AFO with initial physical therapy sessions can provide a significant and clinically meaningful benefit even years after stroke.

http://stroke.ahajournals.org/content/early/2013/05/02/STROKEAHA.111.000334.abstract