Postural control during quiet standing and voluntary stepping response tasks in individuals post-stroke: a case-control study.

BACKGROUND: Postural control impairments following a stroke have an impact on mobility, reduce independence, and increase the risk of falls. Assessing these impairments during tasks representative of real-life situations, such as quiet standing (QS) and voluntary stepping response (VSR), will enhance our understanding of how the postural control system is impaired in individuals post-stroke (IPS). It will also inform the development of a more targeted and effective rehabilitation to prevent falls in IPS. OBJECTIVES: Identify the postural control impairments encountered by IPS during QS and VSR. METHODS: Twenty IPS and 16 healthy controls were recruited to perform QS and VSR tasks, while ground reaction forces and whole-body motion were measured. Displacement and speed variation of the COM, center of pressure (COP) displacement and spatiotemporal data were calculated and compared between groups. RESULTS: During QS, IPS exhibited greater maximal COP displacement in mediolateral direction, COM displacement in vertical direction and COM speed excursions compared to controls. During VSR, IPS exhibited smaller step length, braking force, posterior foot placement in relation to the pelvis and COM anteroposterior excursion compared to controls. IPS presented less static and dynamic postural stability compared to controls. CONCLUSIONS: Greater postural sway during QS, smaller anteroposterior COM displacement before losing balance and altered voluntary recovering steps during VSR could place IPS at more risk of falling when they face a postural challenge in the community. These novel results will improve the current knowledge base and should be considered in IPS rehabilitation.

A qualitative study exploring the experiences and perceptions of patients with rheumatoid arthritis before and after wearing foot orthoses for 6 months.

Foot pathology in people with rheumatoid arthritis (RA) can have a psychosocial impact, but interventions such as foot orthoses can reduce foot pain, improving physical activity and quality of life. A previous meta-analysis concluded that foot orthoses can relieve pain and disability and enhance patient's well-being. The aim of this study was to explore the experiences of people with RA, before and after wearing foot orthoses for 6 months. Data were collected through digital recordings of semi-structured interviews carried out before and after wearing foot orthoses for 6 months. A thematic analysis of the transcripts was used to identify themes. Six female participants with RA wore foot orthoses for 6 months in Spain. The mean disease duration was more than 10 years. The findings showed three key themes emerged from the data: (1) improvement in physical activity; (2) footwear… a tricky situation and (3) social implications of RA feet. It is concluded that patients reported that wearing foot orthoses can have a positive impact on physical activity and improve general wellness and quality of life. However, to achieve the potential positive benefits, people with RA also needed to wear suitable footwear (defined as footwear which accommodates both the foot and the insole while maintaining the fit and function of the shoe). Despite the positive impact of wearing orthoses, participants stated that complexities of finding suitable footwear acted as a blocker.

A Systematic Review to Identify the Effects of Biologics in the Feet of Patients with Rheumatoid Arthritis.

Background and objective: Ninety percent of patients with rheumatoid arthritis (RA) feel foot pain during the disease process. Pharmacological treatment of RA has a systematic effect on the body and includes: Nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs (DMARDs) and biologics. The objective of our review was to examine the impact of biologics on patients with RA 'foot. Methods and material: A systematic review of randomized control trials and observational studies that evaluated the efficacy of biologics against other pharmacological treatment, and included a foot outcome measure. The search covered MEDLINE Ovid, Pubmed, CINAHL, Cochrane Library, Evidence Search, and Web of Science. Risk of bias was evaluated using Cochrane guidance and the Newcastle Ottawa Scale adapted version. Results: A total of eight studies fully met the inclusion criteria: Three randomized control trials, and five observational studies were the basis of our review. A total sample of 1856 RA patients with RA treatment participated. The use of biologics was not associated as a risk factor for post-operative surgical site infection or delayed wound healing. The benefits of biologics, in terms of the disease evolution, were assessed using X-ray. Conclusion: Evidence suggests that the use of biologics is not a risk factor for post-operative surgical site infection or delayed wound healing. The use of biologics presents benefits in terms of the disease evolution assessed through X-ray.

'Trial and error ', ' happy patients' and ' an old toy in the cupboard': a qualitative investigation of factors that influence practitioners in their prescription of foot orthoses.

BACKGROUND: Foot orthoses are used to manage of a plethora of lower limb conditions. However, whilst the theoretical foundations might be relatively consistent, actual practices and therefore the experience of patients is likely to be less so. The factors that affect the prescription decisions that practitioners make about individual patients is unknown and hence the way in which clinical experience interacts with knowledge from training is not understood. Further, other influences on orthotic practice may include the adoption (or not) of technology. Hence the aim of this study was to explore, for the first time, the influences on orthotic practice. METHODS: A qualitative approach was adopted utilising two focus groups (16 consenting participants in total; 15 podiatrists and 1 orthotist) in order to collect the data. An opening question "What factors influence your orthotic practice?" was followed with trigger questions, which were used to maintain focus. The dialogue was recorded digitally, transcribed verbatim and a thematic framework was used to analyse the data. RESULTS: There were five themes: (i) influences on current practice, (ii) components of current practice, (iii) barriers to technology being used in clinical practice, (iv) how technology could enhance foot orthoses prescription and measurement of outcomes, and (v) how technology could provide information for practitioners and patients. A final global theme was agreed by the researchers and the participants: 'Current orthotic practice is variable and does not embrace technology as it is perceived as being not fit for purpose in the clinical environment. However, practitioners do have a desire for technology that is usable and enhances patient focussed assessment, the interventions, the clinical outcomes and the patient's engagement throughout these processes'. CONCLUSIONS: In relation to prescribing foot orthoses, practice varies considerably due to multiple influences. Measurement of outcomes from orthotic practice is a priority but there are no current norms for achieving this. There have been attempts by practitioners to integrate technology into their practice, but with largely negative experiences. The process of technology development needs to improve and have a more practice, rather than technology focus.

Pilot study demonstrating that sole mechanosensitivity can be affected by insole use.

Insoles are known to alter plantar loads and thus plantar sensory input. We therefore hypothesised that plantar somatosensory sensation could be modified over time by use of hard metatarsal pads. A sample of 12 healthy female participants was randomly allocated to either soft metatarsal pads (n=6, latex foam, Shore A11) or hard metatarsal pads groups (n = 6, thermoplastic, ShoreA65). All wore the same shoe type and pedometers measured daily activities. Using a bespoke actuated device, multiple mechanical stimuli were applied to the forefoot and rearfoot before and after 8 and 30 days of wearing the pads. A control test comprised estimation of multiple auditory sensations at day 0, 8 and 30. Changes in detection of the mechanical and sound stimuli were estimated using the Stevens power function, Ψ = k × Φ(n) (estimate = Ψ; stimulus = Φ). The k coefficient measured the sensitivity, i.e. the lowest detectable load/sound, and the n coefficient the gain in perception over time. After 30 days, hard metatarsal pads group had increased plantar sensitivity in the forefoot but not the rearfoot. The soft metatarsal pads group showed no changes in plantar sensitivity and the detection of auditory sensation remained stable over the 30 days.Metatarsal pads with relatively high hardness increased the perception of the lowest mechanical stimulus in the forefoot compared to soft metatarsal pads. This provides initial evidence of the potential for changes in plantar somatosensory sensation due to choice of orthotic designs in patients with foot-related problems.

Effect of an antipronation foot orthosis on ankle and subtalar kinematics.

INTRODUCTION/PURPOSE: The aim of this study was to describe the effect of an antipronation foot orthosis on motion of the heel relative to the leg and explore the individual contributions of the ankle and subtalar joints to this effect. METHODS: Five subjects were investigated using invasive intracortical pins to track the movement of the tibia, talus, and calcaneus during walking with and without a foot orthosis. RESULTS: The antipronation foot orthosis produced small and unsystematic reductions in eversion and abduction of the heel relative to the leg at various times during stance. Changes in calcaneus-tibia motion were comparable with those described in the literature (1°-3°). Changes at both the ankle and subtalar joints contributed to this orthotic effect. However, the nature and scale of changes were highly variable between subjects. Peak angular position, range of motion, and angular velocity in frontal and transverse planes were affected to different degrees in different subjects. In some cases, changes occurred mainly at the ankle; in other cases, changes occurred mainly at the subtalar joint. CONCLUSION: The changes in ankle and subtalar kinematics in response to the foot orthosis contradict existing orthotic paradigms that assume that changes occur only at the subtalar joint. The kinematic changes due to the orthosis are indicative of a strong interaction between the often common function of the ankle and subtalar joints.