Clinical and biomechanical characteristics of responders and non-responders to insoles in individuals with excessive foot pronation during walking.

This study aimed to identify the clinical and biomechanical factors of subjects with excessive foot pronation who are not responsive (i.e., "non-responders") to medially wedged insoles to increase knee adduction external moment. Ankle dorsiflexion range of motion, forefoot-shank alignment, passive hip stiffness, and midfoot passive resistance of 25 adults with excessive bilateral pronation were measured. Also, lower-limb angles and external moments were computed during walking with the participants using control (flat surface) and intervention insoles (arch support and 6° medial heel wedge). A comparison between "responders" (n = 34) and "non-responders" (n = 11) was conducted using discrete and continuous analyses. Compared with the responders, the non-responders had smaller forefoot varus (p = 0.014), larger midfoot passive internal torque peak (p = 0.005), and stiffness measured by the torsimeter (p = 0.022). During walking, non-responders had lower angle peaks for forefoot eversion (p = 0.001), external forefoot rotation (p = 0.037), rearfoot eversion (p = 0.022), knee adduction (p = 0.045), and external hip rotation (p = 0.022) and higher hip internal rotation angle peak (p = 0.026). Participants with small forefoot varus alignment, large midfoot passive internal torque, stiffness, small knee valgus, hip rotated internally, and foot-toed-in during walking did not modify the external knee adduction moment ("non-responders"). Clinicians are advised to interpret these findings with caution when considering the prescription of insoles. Further investigation is warranted to fully comprehend the response to insole interventions among individuals with specific pathologies, such as patellofemoral pain and knee osteoarthritis (OA).

Efficacy of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis: a systematic review and meta-analysis.

OBJECTIVE: To investigate the effects of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis. DESIGN: Systematic review of randomised controlled trials (RCTs). DATA SOURCES: AMED, MEDLINE, PEDro, Cochrane, SPORTDiscus, CINAHL, EMBASE and PsycINFO without language or date restrictions up to 3 February 2023. ELIGIBILITY CRITERIA: RCTs that evaluated the efficacy of any pharmacological and non-pharmacological therapies compared with control (placebo, sham, waiting list or no intervention) on pain intensity and disability in people with plantar fasciitis. Two reviewers independently screened eligible trials, extracted data, assessed the methodological quality of included trials and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. Mean differences (MDs) with 95% CIs were reported. RESULTS: Seventeen different therapies investigated in 28 trials were included in the quantitative analysis. For non-pharmacological therapies, moderate certainty evidence showed short-term effects of customised orthoses on pain intensity when compared with control (MD of -12.0 points (95% CI -17.1 to -7.0) on a 0-100 scale). Low certainty evidence showed short-term effects of taping on pain intensity (-21.3 (95% CI -38.6 to -4.0)). Long-term effects and effects on disability are still uncertain. For pharmacological therapies, low to very low quality evidence from few trials with small samples was inconclusive and supports that high-quality trials are needed. CONCLUSIONS: Moderate-quality and low-quality evidence demonstrates customised orthoses and taping, respectively, reduce pain intensity in the short term in patients with plantar fasciitis. PROSPERO REGISTRATION NUMBER: CRD42021224416.

A new marker cluster anchored to the iliotibial band improves tracking of hip and thigh axial rotations.

Tracking hip and thigh axial rotation has limited accuracy due to the large soft tissue artifact. We proposed a tracking-markers cluster anchored to the prominent distal part of the iliotibial band (ITB) to improve thigh tracking. We investigated if the ITB cluster improves accuracy compared with a traditionally used thigh cluster. We also compared the hip kinematics obtained with these clusters during walking and step-down. Hip and thigh kinematics were assessed during a task of active internal-external rotation with the knee extended, in which the shank rotation is a reference due to smaller soft-tissue artifact. Errors of the hip and thigh axial rotations obtained with the thigh clusters compared to the shank cluster were computed as root-mean-square errors, which were compared by paired t-tests. The angular waveforms of this task were compared using the statistical parametric mapping (SPM). Additionally, the hip waveforms in all planes obtained with the thigh clusters were compared during walking and step-down, using Coefficients of Multiple Correlation (CMC) and SPM (α = 0.05 for all analyses). The ITB cluster errors were approximately 25 % smaller than the traditional cluster error (p < 0.001). ITB cluster errors were smaller at external rotation angles while the traditional cluster error was smaller at internal rotation angles (p < 0.001), although the clusters' waveforms were not significantly different (p ≥ 0.005). During walking and step-down, both clusters provided similar hip kinematics (CMC ≥ 0.75), but differences were observed in parts of the cycles (p ≤ 0.04). The findings suggest that the ITB cluster may be used in studies focused on hip axial rotation.

An exploration of the effects of prefabricated and customized insoles on lower limb kinetics and kinematics during walking, stepping up and down tasks: A time series analysis.

BACKGROUND: Prefabricated and customized insoles are used in clinical practice to reduce foot pronation. Although data exist on the effects at key points within the stance phase, exploring the impact of different insoles using time series analysis may reveal more detail about their efficacy. RESEARCH QUESTION: What are the effects revealed by a time series analysis of arch-supported prefabricated insoles (PREFABRICATED) versus arch-supported prefabricated insoles customized with a 6º medial wedge (CUSTOMIZED) on the lower limb biomechanics during walking, stepping up and down tasks in individuals with pronated feet? METHODS: Nineteen individuals with excessive foot pronation performed walking, stepping up and down tasks using three insoles: CONTROL (flat insole), CUSTOMIZED, and PREFABRICATED. Angles and moments of ankle and knee coronal and hip transverse planes were compared between conditions using statistical parametric mapping (SPM). RESULTS: For walking, CUSTOMIZED reduced ankle eversion moment compared to CONTROL during midstance and PREFABRICATED during propulsion. CUSTOMIZED decreased KAM during midstance and propulsion compared to PREFABRICATED. Compared to CONTROL, CUSTOMIZED and PREFABRICATED reduced hip internal rotation during propulsion and loading response, respectively. CUSTOMIZED decreased eversion movement during midstance and propulsion for the stepping up task. PREFABRICATED reduced eversion movement during midstance in comparison to CONTROL. For the stepping down task, CUSTOMIZED increased eversion movement during propulsion compared to PREFABRICATED. CUSTOMIZED reduced hip internal rotation angle for stepping up task during propulsion, decreased medial rotation movement during midstance compared to CONTROL, and reduced medial rotation during midstance compared to PREFABRICATED. CUSTOMIZED increased KAM for stepping up and down tasks during propulsion. SIGNIFICANCE: These findings suggest that both CUSTOMIZED and PREFABRICATED reduce foot pronation. However, non-local effects, such as changes in KAM and hip internal rotation, were seen only in the CUSTOMIZED. Therefore, CUSTOMIZED may be preferable if the objective is to modify the knee and hip mechanics.

Is there a dose-response of medial wedge insoles on lower limb biomechanics in people with pronated feet during walking and running?

BACKGROUND: Although the effects of medial wedge insoles on lower limb biomechanics have been investigated, information about the effects of different magnitudes of medial posting is still lacking. RESEARCH QUESTION: What are the dose-response effects of medial wedge insoles with postings varying between 0 °, 3 °, 6 °, and 9 ° of inclination on the lower limb biomechanics during walking and running in individuals with pronated feet? METHODS: Sixteen participants with an FPI ≥ 6 were recruited. Four arch-supported insole conditions with varying degrees of medial heel wedge were tested (0°, 3°, 6°, and 9°). A 3D motion analysis system with force plates was used to obtain the kinetics and kinematics of walking and running at self-selected speeds. To compare the ankle, knee, and hip angles and moments among conditions, a time series analysis was performed using Statistical Parametric Mapping (SPM). RESULTS: A reduction in ankle eversion angle was observed during walking for all insoles. For running, the 6° and 9° insoles decreased the ankle eversion angle during early stance and increased this angle during the propulsive phase. A decrease in ankle eversion moment was observed in walking and running for 6° and 9° insoles. An increase in knee adduction moment occurred in walking and running for all insoles. For hip, the 6° and 9° insoles showed, during walking, a decrease in hip adduction angle and an increase in hip adduction and external rotation moments. For most variables, statistical differences were found for a greater period across the stance phase as the medial wedge increased, except for ankle eversion moment and hip external rotation moment during walking. SIGNIFICANCE: The biomechanical effects over the time series for many of the parameters increased with the addition of insole inclination, showing a dose-response effect of medial wedge insoles on the lower limb biomechanics during walking and running in adults with excessive foot pronation.

An online survey of clinical practice of Brazilian physical therapists on rehabilitation following rotator cuff repair.

BACKGROUND: Physical therapy is essential to help patients to recover their movements and function following a rotator cuff repair. However, there are uncertainties regarding how long a sling should be used for and when exercises should be started. OBJECTIVE: To investigate the current clinical practice of Brazilian physical therapists treating patients who had a rotator cuff repair. We also explored differences between shoulder specialists and non-specialists. METHODS: An online survey with 38 questions, including a clinical case, regarding the physical therapy clinical practice for patients having a rotator cuff repair. RESULTS: We analyzed 194 responses. Majority of participants were from the Southeast of Brazil (57.5%), had up to 10 years of clinical experience (61.4%) and were not shoulder-specialists (69.8%). Majority of the respondents stated that patients have their first post-operative physical therapy session within the first three weeks (51%). Patients usually use a sling for four to six weeks (60.6%). Passive mobilization is often started in the first-week post-surgery. Fifteen percent of shoulder specialists compared to only six percent of non-shoulder specialists would allow strengthening exercises to start between the first and third weeks post-surgery. CONCLUSION: Physical therapists in Brazil seems to follow similar postoperative programs to other countries. Shoulder specialists allow a faster return to activities and start of strengthening exercises.

Midfoot passive stiffness affects foot and ankle kinematics and kinetics during the propulsive phase of walking.

The midfoot joint complex (MFJC) is related to the mechanics and efficiency of the walking propulsive phase and low midfoot passive stiffness may require compensatory foot and ankle joint moments to avoid excessive pronation and inefficient propulsion. This study aimed to investigate the kinematics and kinetics of the MFJC and ankle during the propulsive phase of walking in subjects with larger and smaller midfoot passive stiffness. MFJC passive stiffness of 20 healthy adult participants, and the kinematics and kinetics of the MFJC (forefoot-rearfoot) and ankle (rearfoot-shank) during the stance phase of walking were measured. The participants were divided equally into two groups according to the MFJC passive stiffness. Ranges of motion (ROM) and mean joint moments were computed for the late stance. Independent t-tests (α = 0.05) revealed that subjects with lower midfoot passive stiffness showed an increased MFJC sagittal ROM (flattened longitudinal arch) (p = 0.002), increased ankle frontal ROM (more everted positions) (p = 0.002), increased MFJC frontal ROM (more inverted positions) (p = 0.019), as well as a tendency for larger ankle sagittal ROM (p = 0.056). They also showed increased MFJC (p = 0.021) and ankle (p = 0.018) moments in the sagittal plane, increased MFJC moment in the frontal plane (p = 0.047) and a tendency for a predominant ankle moment in the frontal (p = 0.058). Foot and ankle joint moments are possible strategies to reduce pronation and improve propulsion, but not sufficient to prevent the altered kinematics related to low midfoot stiffness. Therefore, midfoot passive stiffness is critical for foot and ankle kinematics and kinetics during walking propulsive phase and is a potential target of interventions.

Influence and benefits of foot orthoses on kinematics, kinetics and muscle activation during step descent task.

BACKGROUND: Medial wedged foot orthoses are frequently prescribed to reduce retropatellar stress in patients with patellofemoral pain (PFP) by controlling calcaneal eversion and internal rotation of the tibia. During activities of daily living, the highest patella loads occur during stair descent, but the effect of foot orthoses during stair descent remains unclear. RESEARCH QUESTION: The purpose of this study was to compare the kinematics, kinetics and muscle activation during a step descent task in healthy volunteers using three designs of foot orthoses (insoles). METHODS: Sixteen healthy subjects with a mean age of 25.7 years, BMI of 23.3, and +5 Foot Posture Index were recruited. Subjects performed a step down task from 20 cm using a 5o rearfoot medial wedge (R), a 5o rearfoot and forefoot medial wedge (R/F), and a control flat insole (C). RESULTS: Significant improvements in control were seen in the R and R/F insoles over the C insole in the foot and at the ankle and hip kinematics. The R and R/F insoles increased the knee adduction moments, but reduced knee internal rotation moment compared to the C insole. Abductor hallucis (AH) activity was reduced with both insoles, whereas tibialis anterior (TA) activity was reduced with the R insole only. SIGNIFICANCE: Foot orthoses can change joint mechanics in the foot and lower limbs providing greater stability and less work done by AH and TA muscles. This data supports the use of foot orthoses to provide functional benefits during step descent, which may benefit patients with PFP.

Characteristics of clinical measurements between biomechanical responders and non-responders to a shoe designed for knee osteoarthritis.

PURPOSE: The purpose of this study was to investigate the characteristics of biomechanical and clinical measurements in relation to the knee adduction moment when wearing a standard shoe and a shoe design for individuals with knee osteoarthritis (Flex-OA). METHODS: Kinematic and kinetic data were collected from thirty-two healthy individuals (64 knees) using a ten camera motion analysis system and four force plates. Subjects performed 5 walking trials under the two conditions and the magnitude of individuals' biomechanical responses where explored in relation to the clinical assessment of the Foot Posture Index, hip rotation range, strength of hip rotators, and active ankle-foot motion, all of which have been described as possible compensation mechanisms in knee osteoarthritis. RESULTS: Significant reductions in the first peak of the knee adduction moment (KAM) during stance phase (9.3%) were recorded (p<0.0001). However, despite this difference, 22 of 64 knees showed either no change or an increased KAM, indicating a non-response or negative-response to the Flex-OA shoe. Significant differences were observed between the responder and non-responder subgroups in the hip rotation range ratio (p=0.044) and the hip rotators strength ratio (p=0.028). CONCLUSION: Significant differences were seen in clinical assessments of hip rotation range and hip rotator strength between responders and non-responders using a cut-off of 0.02Nm/kg change in the KAM.

Decreased gastrocnemius temporal muscle activation during gait in elderly women with history of recurrent falls.

Gait dysfunction is a strong issue in elderly women with a history of falls. The purpose of this study was to compare the temporal activity of the ankle muscles during gait in elderly women with and without a history of recurrent falls. Eighty-nine (89) elderly women - one group with a history of falls (45) and another group without (44) - participated in the study. The mean range of temporal activation of the gastrocnemius, tibialis anterior and soleus muscles during gait was obtained using electromyography. The muscles were considered active when the signal magnitude surpassed two standard deviations of the minimal magnitude of the average signal per individual. The results showed that the mean range of gastrocnemius muscle activation of the group of recurrent fallers was significantly shorter, 2.9% (16.9±5.7%) compared to the group without recurrent falls (19.8±6.6%) (p=0.004). The shorter duration in the gastrocnemius muscle activation during stance could possibly affect stability in the support phase, since the gastrocnemius is the main decelerator of the trunk. Clinically, this finding shows the importance of rehabilitation programs for elderly women that focus on strengthening the plantar flexor musculature aiming to reestablish the function and stability of gait and possibly avoiding falls.

Pronação excessiva e varismos de pé e perna: relação com o desenvolvimento de patologias músculo-esqueléticas: revisão de literatura / Excessive pronation and varus alignment of foot and shank: relationship with development of musculoskeletal pathologies: literature review

A literatura propõe mecanismos biomecânicos que relacionam a pronação subtalar excessiva ao desenvolvimento de diversas patologias músculo-esqueléticas. A presença dos desalinhamentos anatômicos antepé varo, retropé varo e tíbia vara pode levar à ocorrência da pronação subtalar excessiva. Entretanto, não existe um consenso sobre a contribuição do padrão de movimento e da presença desses desalinhamentos para o desenvolvimento de patologias. O objetivo deste estudo foi realizar uma revisão da literatura para investigar a influência de varismos aumentados de antepé, retropé e tíbia e da pronação subtalar excessiva no surgimento de patologias músculo-esqueléticas. Foi realizada uma pesquisa bibliográfica sistematizada nas bases Medline, ISI – Web of Science, Lilacs e SciELO, tendo sido selecionados 13 estudos analíticos. Do total de 13 estudos, 10 encontraram associação de patologias no membro inferior com um ou mais dos desalinhamentos anatômicos analisados ou com um ou mais parâmetros cinemáticos relacionadas à pronação subtalar excessiva. A análise dos estudos sugere que a pronação subtalar excessiva e/ou a presença de desalinhamentos que podem levar a esse padrão de movimento são possíveis fatores de risco para o desenvolvimento de patologias músculo-esqueléticas no membro inferior.

The literature proposes biomechanical mechanisms that link excessive subtalar joint pronation to the development of several musculoskeletal pathologies. The presence of forefoot varus, rearfoot varus and tibiofibular varum can lead to the occurrence of excessive subtalar pronation. However, there is no consensus about the contribution of the movement pattern and/or the presence of these anatomical misalignments to the development of pathologies. The aim of the present study was to conduct a literature review in order to investigate the influence of increased varus alignment of forefoot, rearfoot and shank and of excessive subtalar pronation on the development of musculoskeletal pathologies. A systematic literature search was performed in the databases Medline, ISI – Web of Science, Lilacs and SciELO, and 13 analytic studies were selected. Ten studies found significant associations of lower-limb musculoskeletal pathologies with one or more of the anatomical misalignments analyzed or with one or more kinematic parameters related to excessive subtalar pronation. The analysis of the studies suggests that excessive pronation and/or the presence of these anatomical misalagniments should be regarded as possible risk factors for the development of musculoskeletal pathologies in the lower limb.

Temporal couplings between rearfoot-shank complex and hip joint during walking.

BACKGROUND: Rearfoot pronation-supination and hip internal-external rotation are commonly assumed to be temporally coupled. Many mechanisms of musculoskeletal injury are proposed based on this assumption. Previous studies suggested that this theoretical coupling does not exist. However, recent experimental studies observed relationships consistent with foot-hip mechanical interdependence. METHODS: Three-dimensional kinematics of the lower extremity of 18 healthy subjects, wearing flat trekking sandals, was measured during the stance phase of normal walking. Rearfoot-shank complex motion in the transverse plane (shank internal-external rotation) and frontal plane (rearfoot eversion-inversion) and hip motion in the transverse plane were analyzed. Cross-correlation coefficients were calculated to investigate temporal similarities between curves of rearfoot-shank and hip motions. Pearson correlations were used to investigate relationships between the timings of the peaks of these motions. FINDINGS: Cross-correlations revealed a strong mean temporal coupling (mean r=0.77, range 0.56 to 0.92) between shank internal-external rotation and hip internal-external rotation and a moderate mean temporal coupling (mean r=0.56, range 0.37 to 0.78) between rearfoot eversion-inversion and hip internal-external rotation. Pearson correlations revealed significant (P

Late rearfoot eversion and lower-limb internal rotation caused by changes in the interaction between forefoot and support surface.

BACKGROUND: The influence of distal mechanical factors that change the interaction between the forefoot and the support surface on lower-limb kinematics is not well established. This study investigated the effects of the use of lateral wedges under the forefoot on the kinematics of the lower extremity during the stance phase of walking. METHODS: Sixteen healthy young adults participated in this repeated-measures study. They walked wearing flat sandals and laterally wedged sandals, which were medially inclined only in the forefoot. One wedged sandal had a forefoot lateral wedge of 5 degrees and the other wedged sandal had a forefoot lateral wedge of 10 degrees. Kinematic variables of the lower extremity, theoretically considered clinically relevant for injury development, were measured with a three-dimensional motion analysis system. The variables were evaluated for three subphases of stance: loading response, midstance, and late stance. RESULTS: The 5 degrees laterally wedged sandal increased rearfoot eversion during midstance and the 10 degrees laterally wedged sandal increased rearfoot eversion during mid- and late stances, in comparison to the use of flat sandals. The 10 degrees laterally wedged sandal produced greater internal rotation of the shank relative to the pelvis and of the hip joint, during the midstance, also compared to the use of flat sandals. CONCLUSIONS: Lateral wedges under the forefoot increase rearfoot eversion during mid-and late stances and may cause proximal kinematic changes throughout the lower-extremity kinetic chain. Distal mechanical factors should be clinically addressed when a patient presents late excessive rearfoot eversion during walking.

Bilateral and unilateral increases in calcaneal eversion affect pelvic alignment in standing position.

Excessive foot pronation has been associated with the occurrence of low back pain, possibly for generating changes in the lumbopelvic alignment. However, the influence of foot pronation (measured as calcaneal eversion) on pelvic alignment during standing has not been well established. Fourteen young healthy subjects participated in the study. A Motion Analysis System was used to obtain pelvic positions in sagittal and frontal planes and calcaneal position in the frontal plane. Volunteers were filmed in relaxed standing position during three trials, in three conditions: control; unilateral experimental with increased right calcaneal eversion and bilateral experimental with increased bilateral calcaneal eversion. Increased calcaneal eversion was obtained using wedges tilted 10 degrees medially, unilaterally and bilaterally. Repeated measures ANOVAs with Bonferroni corrections were used for statistical analysis. Unilateral and bilateral use of medially tilted wedges produced a significant increase of calcaneal eversion (P