Telehealth competencies for allied health professionals: A scoping review.

INTRODUCTION: Telehealth has become one of the main methods of delivering allied health professional services world-wide, yet many professionals do not have sufficient training to deliver high-quality telehealth services. This review aims to identify what competencies allied health professionals require for effective telehealth service delivery. METHODS: This scoping review used the Population Concept Context framework and searched the following databases: MEDLINE, CINAHL, PsychInfo, Cochrane, EMBASE, Web of Science, PEDro, United Kingdom Health Forum, WHO, Health Education England, and all UK and Australian AHP professional bodies. RESULTS: A total of 37 articles were included out of 92,525 identified by the literature search. Competencies were related to two areas: (1) delivery of the telehealth consultation and (2) service management of telehealth consultations. The first area included the following competency themes: clinical reasoning, communication, effectively using technology, person-centred care, practice-based assessment and intervention knowledge/behaviour/skills, privacy, security, and patient safety, professionalism, and setting up the technical environment. The second area included the following competency themes: digital infrastructure, informing practice, and management. Although findings emphasised the importance of telehealth competencies, none have been implemented within education. One-third of the articles were from the discipline of psychology. CONCLUSION: This is the first scoping review to combine telehealth competencies reported across allied health disciplines. Although there were a vast range of competencies, they need implementation into teaching and learning to be practically useful. Most competencies were from psychology, but potentially applicable for other allied health professionals. A shared and adaptable standard for telehealth competencies would be useful to ensure high-quality practice across all allied health professionals.

Demographic, practice and clinical management characteristics of osteopaths referring to podiatrists: secondary analysis of a nationally representative sample of Australian osteopaths.

BACKGROUND: Interprofessional care is paramount in contemporary healthcare practice. How different professions interact, and the characteristics of those practitioners who practice in an interprofessional way are rarely described in the literature. The aim of the current work was to identify the demographic, practice and clinical management characteristics of Australian osteopaths who report referring to podiatrists. METHODS: The study was a secondary analysis of data from the Osteopathy Research and Innovation Network (ORION). Inferential statistics were generated to identify statistically significant demographic, practice and clinical management characteristics associated with referrals to podiatrists by Australian osteopaths. RESULTS: Nine-hundred and ninety-two Australian osteopaths responded to the questionnaire. Sending referrals to a podiatrist was reported by 651 participants (65.6%). Female Australian osteopaths were less likely to report referring to podiatrists compared to male osteopaths (OR 0.76, 95%CI 0.59-0.99). Australian osteopaths who reported referring to podiatrists were more likely to report receiving referrals from podiatrists (OR 9.75, 95%CI 6.98-13.61), use orthopaedic testing in patient assessment (OR 7.62, 95%CI 2.82-20.60), and often treat patients with postural disorders (OR 1.71, 95%CI 1.03-2.26), compared to osteopaths who do not refer to podiatrists. CONCLUSION: This study provides initial evidence for the referral relationship between Australian osteopaths and podiatrists. Further work could explore the nature of these referrals, including the complaints resulting in referral and outcomes of care. This information will be useful to those involved in health policy development and the professions advocating for their role in the wider healthcare system.

Establishing trace element concentrations for lichens and bryophytes in the ring of fire region of the Hudson Bay Lowlands, Ontario, Canada.

Peatlands dominate the landscape of the Hudson Bay Lowlands in Ontario, Canada. Recently, mineral deposits of chromium (Cr), nickel (Ni), and copper (Cu) were discovered in the region and anticipated future industrial mining operations have the potential to impact the environment. Lichens and bryophytes are considered excellent biomonitors and indicators of deposition, deriving their nutrients directly from the atmosphere. Trace element concentrations in lichens and bryophytes have not been reported in the Hudson Bay Lowlands. Here, we seek to determine the baseline trace element concentrations of six non-vascular species (Evernia mesomorpha, Bryoria spp., Cladonia stellaris, Cladonia stygia, Sphagnum fuscum, and Sphagnum capillifolium) common to the region, explore linear relationships of trace elements with iron (Fe) as a signature of particulates with geogenic origin, and calculate trace element enrichment factors. Thalli, foliage, and peat (0-30 cm) were collected from 55 locations between 2013 and 2018 and analyzed for trace elements. Thalli and foliar concentrations are among the lowest reported in the broader literature and differ substantially from peat. Fe concentrations were significantly correlated (Pearson's r ≥ 0.8) with aluminum (Al), titanium (Ti), and vanadium (V) in all six species. Enrichment factors show some anthropogenic deposition effects non-vascular organism chemistry. Most trace element concentrations in lichens and bryophytes are indicative of long-range atmospheric transport of dust, but some is attributed to industry, with only minimal inclusions from the local area. Epiphytic lichens are well suited for ongoing atmospheric biomonitoring as industrialization commences.

Fate and budget of poly- and perfluoroalkyl substances in three common garden plants after experimental additions with contaminated river water.

Poly- and perfluoroalkyl substances (PFAS) have become ubiquitous contaminants in the environment. Contamination of the terrestrial ecosystem can occur from the release of aqueous film forming foams (AFFF) used in firefighting operations. Following soil contamination with AFFF, studies report root uptake and translocation of PFAS to other plant organs, typically favouring the short chain moiety. This body of experimental work often focuses on edible organs and generally lacks entire PFAS budgets. Here, we calculate short chain (≤6 carbons) and long chain (≥6 or ≥ 7 carbons) PFAS concentrations and respective budgets for terrestrial multimedia mesocosms (plants, soil and lysimeter) of three common agricultural plants (tomato, lettuce and beet) following irrigation with low level PFAS (<1 µg L-1) contaminated river water (short chain: 167 ng L-1; long chain 526 ng L-1). Total net recoveries were strong, ranging between 91% and 118% of added PFAS across all media. While soil was the largest receptor of PFAS in general (∼70% and 115%), there was considerable mobility to various media, including vegetation (∼3% and 20%) and leachate (∼1%). Translocation of short chain PFAS to tomato flowers resulted with biomagnified concentrations (maximus >4000 ng g-1) and accounted for 1.4% of PFAS additions. While smaller tomato fruits had higher concentrations of short chain PFAS, larger fruit had more total PFAS mass. This work provides a detailed description of the fate of short and long chain PFAS when added to relatively uncontaminated terrestrial agricultural systems. We show low-level PFAS concentrations from real-world irrigation sources can affect various receptors across the multimedia landscape. This is most evident in tomato flowers and fruit where biomagnification and high total masses of short chain PFAS occurred which could have implications for pollinators and consumption, respectively.

Evaluating the outcomes of a podiatry-led assessment service in a public hospital orthopaedic unit.

BACKGROUND: In Australia, the demand for foot and ankle orthopaedic services in public health settings currently outweighs capacity. Introducing experienced allied health professionals into orthopaedic units to initiate the triage, assessment and management of patients has been proposed to help meet demand. The aim of this study was to evaluate the effect of introducing a podiatry-led assessment service in a public hospital orthopaedic unit. The outcomes of interest were determining: the proportion of patients discharged without requiring an orthopaedic appointment, agreement in diagnosis between the patient referral and the assessing podiatrist, the proportion of foot and ankle conditions presenting to the service, and the proportion of each condition to require an orthopaedic appointment. METHODS: This study audited the first 100 patients to receive an appointment at a new podiatry-led assessment service. The podiatrist triaged 'Category 3' referrals consisting of musculoskeletal foot and ankle conditions and appointments were provided for those considered likely to benefit from non-surgical management. Following assessment, patients were referred to an appropriate healthcare professional or were discharged. At the initial appointment or following a period of care, patients were discharged if non-surgical management was successful, surgery was not indicated, patients did not want surgery, and if patient's failed to attend their appointments. All other patients were referred for an orthopaedic consultation as indicated. RESULTS: Ninety-five of the 100 patients (69 females and 31 males; mean age 51.9, SD 16.4 years) attended their appointment at the podiatry-led assessment service. The 95 referrals contained a total of 107 diagnoses, of which the podiatrist agreed with the diagnosis stated on the referral in 56 cases (Kappa =0.49, SE = 0.05). Overall, 34 of the 100 patients were referred to an orthopaedic surgeon and the remaining 66 patients were discharged from the orthopaedic waiting list without requiring an orthopaedic consultation. CONCLUSIONS: Two-thirds of patients who had an appointment at the podiatry-led assessment service were discharged without requiring a surgical consultation. The introduction of a podiatry-led service assists with timely provision of patient care and ensures those with the greatest need for orthopaedic surgery have improved access to specialist care.

Foot posture, leg length discrepancy and low back pain--their relationship and clinical management using foot orthoses--an overview.

Mechanical low back pain (LBP) is a very common, expensive, and significant health issue in the western world. Functional musculoskeletal conditions are widely thought to cause mechanical low back pain. The role of foot posture and leg length discrepancy in contributing to abnormal biomechanics of the lumbopelvic region and low back pain is not sufficiently investigated. This critical review examines the evidence for the association between foot function, particularly pronation, and mechanical LBP. It also explores the evidence for a role for foot orthoses in the treatment of this condition. There is a body of evidence to support the notion that foot posture, particularly hyperpronation, is associated with mechanical low back pain. Mechanisms that have been put forward to account for this finding are based on either mechanical postural changes or alterations in muscular activity in the lumbar and pelvic muscles. More research is needed to explore and quantify the effects of foot orthoses on chronic low back pain, especially their effects on lumbopelvic muscle function and posture. The clinical implications of this work are significant since foot orthoses represent a simple and potentially effective therapeutic measure for a clinical condition of high personal and social burden.

The effect of different depths of medial heel skive on plantar pressures.

BACKGROUND: Foot orthoses are often used to treat lower limb injuries associated with excessive pronation. There are many orthotic modifications available for this purpose, with one being the medial heel skive. However, empirical evidence for the mechanical effects of the medial heel skive modification is limited. This study aimed to evaluate the effect that different depths of medial heel skive have on plantar pressures. METHODS: Thirty healthy adults (mean age 24 years, range 18-46) with a flat-arched or pronated foot posture and no current foot pain or deformity participated in this study. Using the in-shoe pedar-X® system, plantar pressure data were collected for the rearfoot, midfoot and forefoot while participants walked along an 8 metre walkway wearing a standardised shoe. Experimental conditions included a customised foot orthosis with the following 4 orthotic modifications: (i) no medial heel skive, (ii) a 2 mm medial heel skive, (iii) a 4 mm medial heel skive and (iv) a 6 mm medial heel skive. RESULTS: Compared to the foot orthosis with no medial heel skive, statistically significant increases in peak pressure were observed at the medial rearfoot - there was a 15% increase (p = 0.001) with the 4 mm skive and a 29% increase (p < 0.001) with the 6 mm skive. No significant change was observed with the 2 mm medial heel skive. With respect to the midfoot and forefoot, there were no significant differences between the orthoses. CONCLUSIONS: This study found that a medial heel skive of 4 mm or 6 mm increases peak pressure under the medial rearfoot in asymptomatic adults with a flat-arched or pronated foot posture. Plantar pressures at the midfoot and forefoot were not altered by a medial heel skive of 2, 4 or 6 mm. These findings provide some evidence for the effects of the medial heel skive orthotic modification.

Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial.

OBJECTIVE: To investigate the effectiveness of ultrasound guided corticosteroid injection in the treatment of plantar fasciitis. DESIGN: Randomised, investigator and participant blinded, placebo controlled trial. SETTING: University clinic in Melbourne, Australia. PARTICIPANTS: 82 people with a clinical and ultrasound diagnosis of plantar fasciitis unrelated to systemic inflammatory disease. INTERVENTIONS: Participants were randomly allocated to ultrasound guided injection of the plantar fascia with either 1 mL of 4 mg/mL dexamethasone sodium phosphate (experimental group) or 1 mL normal saline (placebo). Before injection the participants were given an ultrasound guided posterior tibial nerve block with 2% lidocaine (lignocaine). MAIN OUTCOME MEASURES: Primary outcomes were pain, as measured by the foot health status questionnaire (0-100 point scale), and plantar fascia thickness, measured by ultrasound at 4, 8, and 12 weeks. RESULTS: Reduction in pain at four weeks favoured the dexamethasone group by 10.9 points (95% confidence interval 1.4 to 20.4, P=0.03). Between group differences for pain scores at eight and 12 weeks were not statistically significant. Plantar fascia thickness measured at four weeks favoured the dexamethasone group by -0.35 mm (95% confidence interval -0.67 to -0.03, P=0.03). At eight and 12 weeks, between group differences for plantar fascia thickness also favoured dexamethasone, at -0.39 mm (-0.73 to -0.05, P=0.02) and -0.43 mm (-0.85 to -0.01, P=0.04), respectively. The number needed to treat with dexamethasone for one successful outcome for pain at four weeks was 2.93 (95% confidence interval 2.76 to 3.12). There were no reported adverse events associated with the intervention. CONCLUSION: A single ultrasound guided dexamethasone injection is a safe and effective short term treatment for plantar fasciitis. It provides greater pain relief than placebo at four weeks and reduces abnormal swelling of the plantar fascia for up to three months. However, clinicians offering this treatment should also note that significant pain relief did not continue beyond four weeks. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12610000239066.

A comparison of augmented low-Dye taping and ankle bracing on lower limb muscle activity during walking in adults with flat-arched foot posture.

OBJECTIVE: To compare the effect of taping and bracing on lower limb muscle activity during gait. DESIGN: Cross-sectional laboratory study. METHODS: Twenty-seven asymptomatic adults with flat-arched foot posture were recruited to this study. They walked over-ground under three randomly allocated conditions: (i) barefoot; (ii) augmented low-Dye taping; (iii) replaceable ankle brace. Electromyographic (EMG) activity from tibialis posterior, tibialis anterior, peroneus longus and medial gastrocnemius was measured for each condition. Peak EMG amplitude and time of peak EMG amplitude were assessed from stance phase data. A series of one-way repeated measure analysis of variance followed by Bonferroni post hoc tests were undertaken (α=0.05). RESULTS: Tibialis posterior peak EMG amplitude decreased by 22% and 33% with bracing and taping (respectively), compared to barefoot. Peak amplitude was also decreased for peroneus longus by 34% and 30% and for tibialis anterior by 19% and 13% with bracing and taping (respectively), compared to barefoot. Small significant changes in time of peak EMG amplitude were found for tibialis posterior and tibialis anterior with taping and bracing compared to barefoot. The effect of taping and bracing was only different for tibialis posterior peak EMG amplitude, with tape producing a 15% reduction compared to bracing. CONCLUSION: The augmented low-Dye tape and replaceable ankle brace used in this study could be useful in managing overuse and dysfunction of selected leg muscles, particularly tibialis posterior, by reducing their level of activation during walking.

Ultrasound guided injection of dexamethasone versus placebo for treatment of plantar fasciitis: protocol for a randomised controlled trial.

BACKGROUND: Plantar fasciitis is the most commonly reported cause of chronic pain beneath the heel. Management of this condition commonly involves the use of corticosteroid injection in cases where less invasive treatments have failed. However, despite widespread use, only two randomised trials have tested the effect of this treatment in comparison to placebo. These trials currently offer the best available evidence by which to guide clinical practice, though both were limited by methodological issues such as insufficient statistical power. Therefore, the aim of this randomised trial is to compare the effect of ultrasound-guided corticosteroid injection versus placebo for treatment of plantar fasciitis. METHODS: The trial will be conducted at the La Trobe University Podiatry Clinic and will recruit 80 community-dwelling participants. Diagnostic ultrasound will be used to diagnose plantar fasciitis and participants will be required to meet a range of selection criteria. Participants will be randomly allocated to one of two treatment arms: (i) ultrasound-guided injection of the plantar fascia with 1 mL of 4 mg/mL dexamethasone sodium phosphate (experimental group), or (ii) ultrasound-guided injection of the plantar fascia with 1 mL normal saline (control group). Blinding will be applied to participants and the investigator performing procedures, measuring outcomes and analysing data. Primary outcomes will be pain measured by the Foot Health Status Questionnaire and plantar fascia thickness measured by ultrasound at 4, 8 and 12 weeks. All data analyses will be conducted on an intention-to-treat basis. CONCLUSION: This will be a randomised trial investigating the effect of dexamethasone injection on pre-specified treatment outcomes in people with plantar fasciitis. Within the parameters of this protocol, the trial findings will be used to make evidence-based recommendations regarding the use of corticosteroid injection for treatment of this condition. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry. ACTRN12610000239066.

Reliability of lower limb electromyography during overground walking: a comparison of maximal- and sub-maximal normalisation techniques.

The purpose of this study was to determine the reliability of investigating electromyography (EMG) of selected leg muscles during walking. Tibialis posterior and peroneus longus EMG activity were recorded via intramuscular electrodes. Tibialis anterior and medial gastrocnemius EMG activity were recorded with surface electrodes. Twenty-eight young adults attended two test-sessions approximately 15 days apart. Relative and absolute measures of reliability were calculated for EMG timing and amplitude parameters during specific phases of the gait cycle. Maximum contractions and sub-maximal contractions were obtained via maximum isometric voluntary contractions and a very fast walking speed, respectively. Time of peak EMG amplitude for all muscles displayed relatively narrow limits of random error. However, reliability of peak and root mean square amplitude parameters for tibialis posterior and peroneus longus displayed unacceptably wide limits of random error, regardless of the normalisation reference technique. Whilst some amplitude parameters for tibialis anterior and medial gastrocnemius displayed good to excellent relative reliability, the corresponding values for absolute error were generally large. Timing and amplitude EMG parameters for all muscles displayed low to moderate coefficient of variation within each test session (range: 7-25%). Overall, between-participant variability was minimised with sub-maximal normalisation values. These results demonstrate that re-application of electrodes results in large random error between sessions, particularly with tibialis posterior and peroneus longus. Researchers planning studies of these muscles with a repeated-test design (e.g. to evaluate the effect of an intervention) must consider whether this level of error is acceptable.

Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis.

BACKGROUND: Chronic plantar heel pain (CPHP) is a generalised term used to describe a range of undifferentiated conditions affecting the plantar heel. Plantar fasciitis is reported as the most common cause and the terms are frequently used interchangeably in the literature. Diagnostic imaging has been used by many researchers and practitioners to investigate the involvement of specific anatomical structures in CPHP. These observations help to explain the underlying pathology of the disorder, and are of benefit in forming an accurate diagnosis and targeted treatment plan. The purpose of this systematic review was to investigate the diagnostic imaging features associated with CPHP, and evaluate study findings by meta-analysis where appropriate. METHODS: Bibliographic databases including Medline, Embase, CINAHL, SportDiscus and The Cochrane Library were searched electronically on March 25, 2009. Eligible articles were required to report imaging findings in participants with CPHP unrelated to inflammatory arthritis, and to compare these findings with a control group. Methodological quality was evaluated by use of the Quality Index as described by Downs and Black. Meta-analysis of study data was conducted where appropriate. RESULTS: Plantar fascia thickness as measured by ultrasonography was the most widely reported imaging feature. Meta-analysis revealed that the plantar fascia of CPHP participants was 2.16 mm thicker than control participants (95% CI = 1.60 to 2.71 mm, P < 0.001) and that CPHP participants were more likely to have plantar fascia thickness values greater than 4.0 mm (OR = 105.11, 95% CI = 3.09 to 3577.28, P = 0.01). CPHP participants were also more likely to show radiographic evidence of subcalcaneal spur than control participants (OR = 8.52, 95% CI = 4.08 to 17.77, P < 0.001). CONCLUSION: This systematic review has identified 23 studies investigating the diagnostic imaging appearance of the plantar fascia and inferior calcaneum in people with CPHP. Analysis of these studies found that people with CPHP are likely to have a thickened plantar fascia with associated fluid collection, and that thickness values >4.0 mm are diagnostic of plantar fasciitis. Additionally, subcalcaneal spur formation is strongly associated with pain beneath the heel.

Effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running: a systematic review.

The aim of this systematic review was to evaluate the literature pertaining to the effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running. A database search of Medline, CINAHL, Embase and SPORTDiscus without language restrictions revealed 504 citations for title and abstract review. Three articles were translated to English and a final 46 articles underwent a two-tiered quality assessment. First, all articles were scored for their reporting of electromyographic methodology using a set of standards adopted by the International Society of Electrophysiology and Kinesiology. Thirty-eight articles displayed adequate reporting of electromyographic methodology and qualified for detailed review including a second quality assessment using a modified version of the Quality Index. These included six studies investigating the effect of foot posture, 12 the effect of foot orthoses and 20 the effect of footwear on lower limb muscle activity during walking or running. Meta-analysis was not conducted due to heterogeneity between studies. Some evidence exists that: (i) pronated feet demonstrate greater electromyographic activation of invertor musculature and decreased activation of evertor musculature; (ii) foot orthoses increase activation of tibialis anterior and peroneus longus, and may alter low back muscle activity; and (iii) shoes with elevated heels alter lower limb and back muscle activation. Most studies reported statistically significant changes in electromyographic activation, although these findings were often not well supported when confidence intervals were calculated. Most important, however, is that there is a need for further research of more rigorous methodological quality, including greater consensus regarding standards for reporting of electromyographic parameters.

A weightbearing technique for the measurement of ankle joint dorsiflexion with the knee extended is reliable.

Measurement of ankle joint dorsiflexion is routinely undertaken by clinicians who manage lower limb musculoskeletal pathology. This study aimed to determine the reliability of a technique to measure ankle joint dorsiflexion in a weightbearing position with the knee extended. Four raters with varying clinical experience measured ankle joint dorsiflexion in a weightbearing position with the knee extended on 30 asymptomatic participants. Measurements occurred on two occasions, 1 week apart using (i) a digital inclinometer and (ii) a clear acrylic plate apparatus. Intraclass correlation coefficients (ICCs) and 95% limits of agreement (LOAs) were calculated. Intra-rater reliability of the experienced raters was high for both the digital inclinometer (average ICC=0.88, average 95% LOA=-6.6 degrees to 4.8 degrees ) and the clear acrylic plate apparatus (average ICC=0.89, average 95% LOA=-7.2 degrees to 4.3 degrees ). Intra-rater reliability of the inexperienced rater was good to high for both the digital inclinometer (ICC=0.77, 95% LOA=-9.1 degrees to 8.3 degrees ) and the clear acrylic plate apparatus (ICC=0.89, 95% LOA=-8.1 degrees to 4.6 degrees ). Inter-rater reliability was high for both the digital inclinometer (ICC=0.95, 95% LOA=-5.7 degrees to 5.7 degrees ) and the clear acrylic plate apparatus (ICC=0.97, 95% LOA=-4.7 degrees to 4.7 degrees ). Measurements of ankle dorsiflexion in a weightbearing position with the knee extended can be performed reliably by experienced and inexperienced raters. However, the reliability of this measurement technique needs to be interpreted in the context of the purpose for which the measurement is intended.

The effect of three levels of foot orthotic wedging on the surface electromyographic activity of selected lower limb muscles during gait.

BACKGROUND: Some types of foot orthoses have been researched for their effect on lower limb electromyographic muscle activity during walking. However, foot orthoses with high levels of medial rearfoot wedging ('inverted' foot orthoses) have not been investigated. METHODS: In a cross-sectional study, asymptomatic participants with a pronated foot type (n=15) were each issued with a pair of 0 degrees, 15 degrees and 30 degrees inverted custom-made foot orthoses. After four weeks of habituation to the orthoses, surface electromyography was used to measure the onset and maximum EMG amplitude of tibialis anterior, peroneus longus, medial gastrocnemius and soleus muscles using five conditions [barefoot, shoe-only, 0 degrees, 15 degrees and 30 degrees inverted foot orthoses conditions]. FINDINGS: A statistically significant increase in tibialis anterior maximum EMG amplitude occurred using the shoe only (30% increase), 0 degrees (33% increase), 15 degrees (38% increase) and 30 degrees (30% increase) inverted orthoses conditions compared to walking barefoot (P<0.01). Peroneus longus maximum EMG amplitude increased significantly using the 15 degrees inverted orthosis condition compared to walking barefoot (21% increase, P=0.04). INTERPRETATION: Footwear and orthoses can significantly alter the maximum EMG amplitude of leg muscles during walking. Foot orthoses appear to increase peroneus longus EMG amplitude compared to footwear alone. However, the level of medial rearfoot posting within an orthosis does not appear to significantly alter maximum EMG amplitude. The individual responses to foot orthoses are highly variable. The changes in EMG amplitude with the use of foot orthoses and shoes may have clinical implications.

The effect of foot wedging on electromyographic activity in the erector spinae and gluteus medius muscles during walking.

The use of foot orthoses for treatment of low back pain (LBP) has received some attention in the literature, mainly from a clinical or theoretical perspective. It has been proposed that this treatment alleviates pain by altering muscle activity in the area of the low back but there is no direct evidence of such an effect. The objective of this study was to determine the effects of different types of foot wedging on the bilateral surface electromyographic activity of erector spinae (ErSp) (L3 level) and gluteus medius (GlMed) of 13 participants without LBP. Activity in ErSp had a significantly earlier onset during the gait cycle with bilateral heel lifts and bilateral lateral forefoot wedging. GlMed activity had a significantly later onset with bilateral heel lifts, and with an unilateral heel lift on the ipsilateral side (P<0.0125). No significant amplitude changes were demonstrated in either muscle for any of the forms of wedging tested. These results show that foot wedging can produce measurable changes in timing of muscle activity within the low back and pelvis during the gait cycle. Further investigation is required to determine whether this effect contributes to the alleviation of LBP.