Effectiveness of foot orthoses for the prevention of lower limb overuse injuries in naval recruits: a randomised controlled trial.

OBJECTIVES: To evaluate the effectiveness of prefabricated foot orthoses for the prevention of lower limb overuse injuries in naval recruits. METHODS: This study was a participant-blinded and assessor-blinded, parallel-group randomised controlled trial. Three-hundred and six participants aged 17-50 years who undertook 11 weeks of initial defence training at the Royal Australian Navy Recruit School (Cerberus, Australia) were randomised to a control group (flat insoles, n=153) or an intervention group (contoured, prefabricated foot orthoses, n=153). The combined incidence of medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy and plantar fasciitis/plantar heel pain during the 11-week training period were compared using incidence rate ratios (IRR). Data were analysed using the intention-to-treat principle. RESULTS: Sixty-seven injuries (21.9%) were recorded. The control and intervention group sustained 40 (26.1%) and 27 (17.6%) injuries, respectively (IRR 0.66, 95% CI 0.39 to 1.11, p=0.098). This corresponds to a 34% reduction in risk of developing medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy or plantar fasciitis/plantar heel for the intervention group compared with the control group. Participants in the prefabricated orthoses group were more likely to report at least one adverse event (20.3% vs 12.4%; relative risk (RR) 1.63, 95% CI 0.96 to 2.76; p=0.068; number needed to harm 13, 95% CI 6 to 253). The most common adverse events were foot blisters (n=20, 6.6%), arch pain (n=10, 3.3%) and shin pain (n=8, 2.6%). CONCLUSION: Prefabricated foot orthoses may be beneficial for reducing the incidence of lower limb injury in naval recruits undertaking defence training. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry: ACTRN12615000024549.

Eficácia das palmilhas de total contato em comparação com o tratamento Fisioterapêutico / Efficacy of full contact insoles compared to Physical Therapy

Objetivo: Analisar um programa de tratamento para fascite plantar com fisioterapiaem comparação com a utilização diária de uma palmilha de EVA.Métodos: Foram avaliados 10 indivíduos com diagnóstico de FP, divididosaleatoriamente entre grupo tratamento Gt = 5, que recebeu tratamentofisioterapêutico e grupo palmilha Gp= 5, que utilizou palmilha de EVA, ambos comduração de 5 semanas. Então os participantes de cada grupo foram reavaliadosquanto a intensidade da dor, o desempenho em atividades funcionais e a descargade peso estática. Os dados foram analisados comparando o resultado de cadapaciente dentro do grupo. Realizamos uma média da pontuação dos participantesdo grupo equivalente ao resultado do mesmo e então comparamos os dois grupos.Resultados: Não houve relação entre a diminuição da descarga de peso estática,melhora do desempenho funcional e alívio da dor. No entanto, avaliando somente amelhora do desempenho e o alívio da dor o grupo palmilha obteve melhoresresultados...

Biomechanical analysis of suture locations of the distal plantar fascia in partial foot.

PURPOSE: The aim of this study was to evaluate the rationality of the suture locations of distal plantar fascia (DPF) after foot amputation to avoid the risk factors of re-amputation or plantar fasciitis. METHODS: The tensile strain of plantar fascia (PF) in the different regions was measured by uni-axial tensile experiment. A three-dimensional (3D) finite element model was also developed to simulate tensile behaviour of PF in weight bearing conditions. The model includes 12 bones, ligaments, PF, cartilage and soft tissues. Four suture location models for the DPF were considered: the fourth and fifth DPF were sutured on the third metatarsal, the cuboid, and both the third metatarsal and the cuboid, and one un-sutured model. RESULTS: The peak tensile strain of the first, second and third PF was 0.134, 0.128 and 0.138 based on the mechanical test, respectively. The fourth and fifth DPF sutured at the cuboid and the third metatarsal could offer more favourable outcomes. The peak strain of 4.859 × 10(-2), 2.347 × 10(-2) and 1.364 × 10(-2) in the first, second and third PF showed the least outcomes in stance phase. Also, peak strain and stress of the residual PF reduced to 4.859 × 10(-2) and 1.834 MPa, respectively. The stress region was redistributed on the mid-shaft of the first and third PF and the peak stress of medial cuneiform bone evidently decreased. CONCLUSIONS: The fourth and fifth DPF suture at the third metatarsal and cuboid was appropriate for the partial foot. The findings are expected to suggest optimal surgical plan of the DPF suture and guide further therapeutic planning of partial foot patients.

Finite element analysis of plantar fascia during walking: a quasi-static simulation.

BACKGROUND: The plantar fascia is a primary arch supporting structure of the foot and is often stressed with high tension during ambulation. When the loading on the plantar fascia exceeds its capacity, the inflammatory reaction known as plantar fasciitis may occur. Mechanical overload has been identified as the primary causative factor of plantar fasciitis. However, a knowledge gap exists between how the internal mechanical responses of the plantar fascia react to simple daily activities. Therefore, this study investigated the biomechanical responses of the plantar fascia during loaded stance phase by use of the finite element (FE) modeling. METHODS: A 3-dimensional (3-D) FE foot model comprising bones, cartilage, ligaments, and a complex-shaped plantar fascia was constructed. During the stance phase, the kinematics of the foot movement was reproduced and Achilles tendon force was applied to the insertion site on the calcaneus. All the calculations were made on a single healthy subject. RESULTS: The results indicated that the plantar fascia underwent peak tension at preswing (83.3% of the stance phase) at approximately 493 N (0.7 body weight). Stress concentrated near the medial calcaneal tubercle. The peak von Mises stress of the fascia increased 2.3 times between the midstance and preswing. The fascia tension increased 66% because of the windlass mechanism. CONCLUSION: Because of the membrane element used in the ligament tissue, this FE model was able to simulate the mechanical structure of the foot. After prescribing kinematics of the distal tibia, the proposed model indicated the internal fascia was stressed in response to the loaded stance phase. CLINICAL RELEVANCE: Based on the findings of this study, adjustment of gait pattern to reduce heel rise and Achilles tendon force may lower the fascia loading and may further reduce pain in patients with plantar fasciitis.

Changes in windlass effect in response to different shoe and insole designs during walking.

Windlass effect occurs during the pre-swing phase of gait cycle in which the peak tensile strain and force of the plantar aponeurosis (PA) is reached. The increased dorsiflexion angle of the 1st metatarsophalangeal (MTP) joint is the main causing factor. The aim of this study was to investigate thoroughly in finding the appropriate shoe and insole combination that can effectively decrease the windlass effect. Foot kinematic analyses of 10 normal volunteers (aged 25.2±2.1 years, height of 167.4±9.1 cm, and weight of 66.2±18.1 kg) were performed during gait under the conditions of barefoot, standard shoe (SS) with flat insole (FI) or carbon fiber insole (CFI), and rocker sole shoe (RSS) with FI or CFI. The shoe cover consisting of transparent polymer was used for accurate measurement of kinematic data as specific areas on the cover can be cut away for direct placement of reflective markers onto the skin. Under barefoot condition, the mean of maximum dorsiflexion angle of the 1st MTP joint was measured to be 48.0±7.3°, and decreased significantly to 28.2±5.7° when wearing SS with FI, and 24.1±5.7° when wearing SS with CFI. This angle was further decreased to around 13° when wearing RSS with FI or CFI. Subjects wearing footwear alone can increase the minimum medial longitudinal angle and decrease the maximum plantarflexion angle of metatarsus related to the calcaneus as compared with barefoot condition, resulting in flatter medial foot arch. Results suggested that RSS is the effective footwear in reducing the windlass effect regardless the type of insole inserted. The findings in this study provided us with the evidences in finding the appropriate footwear for treating foot disorders such as plantar fasciitis by effectively reducing the windlass effect.

In the clinic. Plantar fasciitis.

This issue provides a clinical overview of plantar fasciitis focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

Risk factors for plantar fasciitis among assembly plant workers.

OBJECTIVE: The objective of this study was to determine the relative contributions of work activity (time spent standing, walking, or sitting), floor surface characteristics, weight, body mass index, age, foot biomechanics, and other demographic and medical history factors to the prevalence of plantar fasciitis. DESIGN: A cross-sectional observational study design was used. SETTING: The study site was an automobile engine assembly plant. PARTICIPANTS: Full-time employees of the assembly plant who had been working at least 6 months. ASSESSMENT OF RISK FACTORS: The independent variables included baseline demographics, medical history, ergonomic exposures, psychosocial factors, discomfort ratings, shoe characteristics, and foot biomechanics. MAIN OUTCOME MEASUREMENTS: The dependent variable was the finding of plantar fasciitis on physical examination. RESULTS: The study demonstrated that forefoot pronation on physical examination, high metatarsal pressure on the gait assessment, increasing time spent standing on hard surfaces, increased time spent walking, medium tenure at the plant, and an increased number of times getting in and out of the vehicle (for the truck/forklift drivers) increased the risk of presenting with plantar fasciitis. Rotation of shoes during the work week was found to reduce the risk of presenting with plantar fasciitis. Increased supervisor support showed a trend toward reducing the prevalence of plantar fasciitis. CONCLUSIONS: Plantar fasciitis is relatively common in the manufacturing setting. These findings suggest several options for primary and secondary prevention strategies. Shoe rotation may be an effective strategy that may be used as either a primary or secondary strategy. The use of shoe orthoses with a medial longitudinal arch and metatarsal pad may be used as a preventive or treatment strategy. Work stations that decrease the percentage of time walking or standing on hard surfaces (eg, allowing workers to alternate between sitting and standing postures or providing cushioning mats for concrete surfaces) may lower the risk for plantar fasciitis.

Examining the degree of pain reduction using a multielement exercise model with a conventional training shoe versus an ultraflexible training shoe for treating plantar fasciitis.

Plantar fasciitis is a common injury to the plantar aponeurosis, manifesting as pain surrounding its proximal insertion at the medial calcaneal tubercle. Pain is typically worse in the morning when getting out of bed, and may subside after the tissue is sufficiently warmed up. For running-based athletes and individuals who spend prolonged periods of time on their feet at work, plantar fasciitis may become recalcitrant to conservative treatments such as ice, rest, and anti-inflammatory medication. Exercise-based therapies have received only limited attention in the literature for this common problem, yet they are becoming increasingly validated for pain relief and positive tissue remodeling at other sites of similar soft-tissue overuse injury. This study reports on pain outcomes in individuals experiencing chronic plantar fasciitis while wearing a shoe with an ultraflexible midsole (Nike Free 5.0) (FREE) versus a conventional training (CON) shoe in a 12-week multielement exercise regimen, and after a 6-month follow-up. Adults with >or= 6-month history of painful heel pain were recruited and randomly assigned to wear 1 of the 2 shoes. All subjects completed the same exercise protocol. A visual analogue scale item tracked peak pain in the preceding 24 hours taken at baseline, 6- and 12-week points, and at the 6-month follow-up. Twenty-one subjects completed the program (9 FREE; 12 CON). Both groups reported significant improvements in pain by the 6-month follow-up, and the FREE group reported an overall reduced level of pain throughout the study as a result of lower mean pain scores at the midpoint and post-test compared with the CON group. The exercise regimen employed in this study appears to reduce pain associated with chronic plantar fasciitis, and in doing so, the Nike 5.0 shoe may result in reductions in pain earlier than conventional running shoes.

A study of the discomfort associated with tennis shoes.

Subjective tests based on information gathered using 'discomfort questionnaires' have been used widely in ergonomics. In this study, we used a similar method to examine the discomfort associated with the footwear worn in tennis matches. A sample of 146 tennis players from a population of approximately 4000 completed the questionnaire. We performed a descriptive analysis of the study variables. The associations between discomfort and pain and between discomfort and design errors were evaluated using cross-tabulation and chi-squared tests. We found that 9% of players considered their footwear to be uncomfortable, 23% considered it to be acceptable and 68% regarded it as comfortable. Six design errors were identified and five body areas were reported as experiencing discomfort due to the footwear. Factor analysis identified four factors related to discomfort and six design errors. Subsequent correlation analysis identified several relationships among these factors. There was a strong correlation (r = 0.187, P = 0.022) between plantar discomfort and incorrect arch support.