Capitalizing on skin in orthotics design: the effects of texture on plantar intrinsic foot muscles during locomotion.

Foot orthoses (FO) are a commonly prescribed intervention to alter foot function during walking although their effects have been primarily studied in the extrinsic muscles of the foot. Furthermore, enhancing sensory feedback under the foot sole has been recently shown to alter extrinsic muscle activity during gait; however, the effects of FOs with enhanced sensory feedback on plantar intrinsic foot muscles (PIFMs) remain unknown. Thus, the purpose of this study was to investigate the effect of FOs with and without sensory facilitation on PIFM activity during locomotion. Forty healthy adults completed a series of gait trials in non-textured and textured FOs when walking over hard and soft flooring. Outcome measures included bilateral joint kinematics and electromyography (EMG) of four PIFMs. Results of this study highlight the distinct onset and cessations of each PIFM throughout the stance phase of gait. PIFMs remained active during mid-stance when wearing FOs and textured FOs facilitated muscle activity across the stance phase of gait. Increasing cutaneous input from foot sole skin, via the addition of texture under the foot sole, appears to alter motor-neuron pool excitation of PIFMs. Future academics are encouraged to increase our understanding on which pathologies, diseases, and/or medical conditions would best benefit from textured FOs.

The UK prosthetic and orthotic workforce: current status and implications for the future.

BACKGROUND: Prosthetists and orthotists (POs) are the smallest of the 14 allied health profession (AHP) workforces within NHS England. Obtaining data on the workforce has always been challenging due to this information being held across different organisations. An understanding of the prosthetic and orthotic (P&O) workforce is essential to ensure that it is adequately equipped to meet the evolving needs of users of P&O services. The study aims to estimate the size and composition, for the first time, of the UK P&O workforce and P&O service provision. METHODS: To gather the required information, two surveys (one for the UK P&O workforce and one for UK P&O private company) and two freedom of information (FOI) requests [one for all NHS Trusts and Health Boards (HB) in the UK and one for the higher education institutes in the UK offering programmes leading to registration as a PO were developed and distributed from September to December 2022. RESULTS: The P&O workforce survey received a 74% response rate (863 POs) and 25 private companies reported employing one or more P&O staffing groups. From the FOI requests, 181 of a potential 194 Trusts/Health Boards and all four higher education institutions responded. The study indicated a total of 1766 people in the UK P&O workforce, with orthotists and orthotic technicians representing the largest percentage of the workforce at 32% and 30%, respectively. A greater percentage of prosthetists (65%) and orthotists (57%) were employed by private companies compared to the NHS. Only 34% of POs stated that they "definitely" planned to remain in the workforce for the next 5 years. The current UK PO employment levels are 142 to 477 short of the World Health Organisation's (WHO) recommendation. CONCLUSIONS: The low job satisfaction amongst many POs and the projected increase in the number of people who will require prosthetic and/or orthotic care in the UK are challenges for future UK P&O services. Strategies are required to create a sustainable and resilient workforce that can meet the needs of a changing healthcare landscape.

The impact of foot orthoses on gait in children with Osteogenesis Imperfecta type I, III and IV - a cross-sectional study.

BACKGROUND: For children with Osteogenesis Imperfecta (OI), a rare genetic bone disease, walking can be difficult to carry out due to a combination of bone fragility and deformity, muscle weakness, joint hypermobility, and pain. Bisphosphonate treatment has facilitated more children being able to walk, but for many, foot and ankle hypermobility is a limiting factor. Current evidence on foot orthoses in children with OI is sparse. This study aimed to evaluate gait characteristics in children with OI walking barefoot as compared to walking with foot orthoses. METHODS: Twenty-three children with OI and hypermobility (mean age 8.3 ± 3.0 years) were included in this cross-sectional study. Children conducted three-dimensional gait analysis barefoot, and with foot orthoses and appropriate foot wear (stable yet light-weight), respectively. Walking speed, step length, lower limb kinematics and kinetics were collected. Differences in gait characteristics between test conditions were evaluated using paired sample t-tests. RESULTS: When walking with foot orthoses, the external foot progression angle was reduced, peak ankle dorsiflexion angle increased, and peak plantarflexion moment increased as compared to barefoot. No difference was found in walking speed between test conditions, however, children with OI walked with longer steps with foot orthoses as compared to barefoot. CONCLUSION: The observed gait alterations suggest that foot orthoses, aiming to support the foot and ankle joint, contributed to reduced overall foot rotation as measured by external foot progression, increased peak plantarflexion moment, and increased step length. In a wider perspective, the ability to walk provides the opportunity to be physically active, and thereby increase skeletal loading and prevent fractures, thus, foot orthoses may be an important treatment option to consider in children with OI. LEVEL OF EVIDENCE: III.

Knee braces and foot orthoses multimodal 3-month treatment of medial knee osteoarthritis in a randomised crossover trial.

PURPOSE: Immediate biomechanical and functional benefits of knee braces and lateral wedge foot orthoses (FO) are often reported on patients with medial knee osteoarthritis. However, the effectiveness of their combined use in a longer-term orthotic treatment remains unclear. The aim was to evaluate pain, function, comfort and knee adduction moment (KAM) during the stance phase of gait with three modalities of orthotic treatment. METHODS: Twenty-two patients with knee osteoarthritis were analysed in a randomised crossover trial including a knee brace with valgus and external rotation functions (VER), FO and their combined use (VER + FO). Western Ontario and McMaster Universities scale (WOMAC) and Knee injury and Osteoarthritis Outcome Scores and KAM during gait were obtained before and after each orthotic treatment of 3 months. Repeated measures analyses of variance contrasted the factors orthosis (VER, FO, VER + FO), treatment (pre and post) and wear (without and with) on pain, function, comfort and KAM. RESULTS: An interaction between orthosis and treatment on the WOMAC pain (effect size [ES] = 0.17) and a main effect on the pain visual analogue score (ES = 0.24) indicated that VER and VER + FO were more alleviating than FO. The three modalities of orthotic treatment significantly improved functional scores (ES > 0.2) and reduced discomfort (ES = 0.25). A significant multivariate interaction between orthosis and wear (ES = 0.73) showed that the KAM reduction while wearing the orthoses was more pronounced with the VER and VER + FO than the FO. CONCLUSION: The VER-brace obtained more effectiveness than FO on pain and KAM after 3 months for medial knee osteoarthritis and the combined treatment did not substantially improve biomechanical and functional outcomes. LEVEL OF EVIDENCE: Therapeutic study level I randomised crossover trial.

Osteoarthritic Tibiofemoral Joint Contact Characteristics During Weightbearing With Arch-Supported and Standalone Lateral Wedge Insoles.

Imbalanced joint load distribution across the tibiofemoral surface is a risk factor for osteoarthritic changes to this joint. Lateral wedge insoles, with and without arch support, are a form of biomechanical intervention that can redistribute tibiofemoral joint load, as estimated by external measures of knee load. The objective of this study was to examine the effect of these insoles on the internal joint contact characteristics of osteoarthritic knees during weightbearing. Fifteen adults with tibiofemoral osteoarthritis underwent magnetic resonance imaging of the affected knee, while standing under 3 insole conditions: flat control, lateral wedge alone, and lateral wedge with arch support. Images were processed, and the surface area and centroid location of joint contact were quantified separately for the medial and lateral tibiofemoral compartments. Medial contact surface area was increased with the 2 lateral wedge conditions compared with the control (P ≤ .012). A more anterior contact centroid was observed in the medial compartment in the lateral wedge with arch support compared with the lateral wedge alone (P = .009). Significant changes in lateral compartment joint contact outcomes were not observed. These findings represent early insights into how loading at the tibiofemoral interface may be altered by lateral wedge insoles as a potential intervention for knee osteoarthritis.

Role of insole material in treatment of plantar fasciitis: A randomized clinical trial.

BACKGROUND: In this randomized clinical trial, we compared the early effects of polyethylene (PE), polyurethane (PU), and Carbon Fiber insoles in the treatment of PF using a set of patient-reported outcomes. METHODS: Patients were randomly allocated one of the three prefabricated insoles - Carbon Fiber (n = 14), PU (n = 14), or PE (n = 17) for regular use. Their response was recorded using PROMIS 3a (for pain intensity), PROMIS 4a (for pain interference), FAOS (Foot and Ankle Outcome Score), and VAS for pain at baseline, two, six, and twelve weeks. RESULTS: The PROMIS pain intensity scores improved in both the Carbon Fiber and the PE groups starting at the 6th week (p = 0.04) and 2nd week (p = 0.002), respectively. PROMIS pain interference scores also showed positive trends in these two groups (p = 0.02, p = 0.004, respectively). CONCLUSION: Prefabricated Carbon Fiber and PE insoles showed significant pain-reducing effects in patients with PF. LEVELS OF EVIDENCE: Level I, Randomized controlled trial.

Offloading of diabetes-related neuropathic foot ulcers at Swedish prosthetic and orthotic clinics.

AIMS: This study aimed to assess (1) the use of different offloading interventions in Sweden for the healing of diabetes-related plantar neuropathic forefoot ulcers, (2) factors influencing the offloading intervention choice, and (3) the awareness of current gold standard offloading devices. METHODS: An online questionnaire was distributed via SurveyMonkey to 51 prosthetic and orthotic clinics in Sweden. RESULTS: Thirty-five (69%) practitioners responded to the questionnaire. Eighty-six percent of the practitioners provided modified off-the-shelf footwear combined with insoles to treat diabetes-related plantar neuropathic forefoot ulcers. A total contact cast (TCC) was provided by 20% of the practitioners, and a nonremovable knee-high walker was provided by 0%. Multiple practitioner-, patient-, intervention-, and wound-related factors were considered when practitioners provided offloading interventions to patients with this type of ulcer. The majority of the practitioners did not or were unsure whether they considered TCC or a nonremovable knee-high walker to be the gold standard treatment. CONCLUSIONS: Practitioners mainly provided the offloading intervention that the International Working Group on the Diabetic Foot strongly recommends not be provided, namely, modified off-the-shelf footwear with insoles. In contrast, TCC and nonremovable knee-high walkers, as the gold standards, were vastly underutilised. Therefore, the pattern of providing offloading interventions was almost exactly opposite to the recommendations of evidence-based guidelines. Different factors were considered when providing offloading interventions to patients with diabetes-related plantar neuropathic forefoot ulcers. The practitioners' lack of awareness regarding gold standard devices may have contributed to the underutilisation of TCC and nonremovable knee-high walkers.

Online education for prosthetics and orthotics students in the era of COVID-19 pandemic in Iran: challenges, opportunities, and recommendations.

INTRODUCTION: With the advent of the COVID-19 pandemic, many higher education programs in Iran, including prosthetics and orthotics (P&O), had to shift to the online environment all at once. This unanticipated transition was challenging for the educational system. However, online education is superior in some aspects to conventional methods, and this situation may offer opportunities. This study was carried out from September 2021 to March 2022 to investigate the challenges and opportunities of online education in the P&O sector in Iran based on the opinions of students and faculty members. Relevant recommendations will also be discussed. METHODS: In this qualitative study, semi-structured interviews were conducted in both oral and written formats. Purposive and snowball sampling techniques were used to recruit undergraduate and postgraduate P&O students, as well as P&O faculty members, for this qualitative study. The data gathered from interviews with study participants were analyzed by thematic analysis. RESULTS: Based on the data analysis, many sub-themes of the three main themes were recognized: (1) challenges: technical, socioeconomic, environmental distractors, supervision and evaluation, workload, digital competence, interactions, motivation, sessions-related issues, class time, hands-on and clinical training; (2) opportunities: technological innovations, infrastructure development, flexible learning environment, student-centered learning, availability of contents, time and cost saving, high concentration, more self-confidence; (3) recommendations: technical infrastructure, team dynamics, hybrid courses, time management, awareness. CONCLUSION: Online education of P&O during the era of the COVID-19 pandemic was accompanied by a series of challenges. Technical issues and the gravity of hands-on training in this field were significant challenges. This era, however, provided the opportunity to facilitate the establishment of needed infrastructure and support technological innovations for online education. Considering hybrid (mixed online and on-site) courses was recommended to improve the quality of learning.

Impact of Bracing and Therapy Services on Perioperative Costs for Patients Undergoing Distal Biceps Tendon Repair.

PURPOSE: This study aimed to quantify and assess perioperative costs in an integrated healthcare system for patients undergoing distal biceps tendon (DBT) repair with and without the use of postoperative bracing and formal physical (PT) or occupational (OT) therapy services. In addition, we aimed to define clinical outcomes after DBT repair using a brace-free, therapy-free protocol. METHODS: We retrospectively reviewed all cases of DBT repairs within our integrated system from 2015 to 2021. We performed a retrospective review of a series of DBT repairs utilizing the brace-free, therapy-free protocol. For patients with our integrated insurance plan, a cost analysis was conducted. Claims were subdivided to assess total charges, costs to the insurer, and patient costs. Three groups were created for comparisons of total costs: (1) patients who had both postoperative bracing and PT/OT, (2) patients who had either postoperative bracing or PT/OT, and (3) patients who had neither postoperative bracing nor PT/OT. RESULTS: A total of 36 patients had our institutional insurance plan and were included in the cost analysis. For patients using both bracing and PT/OT, these services contributed 12% and 8% of the total perioperative costs, respectively. Implant costs accounted for 28% of the overall cost. Forty-four patients were included in the retrospective review with a mean follow-up of 17 months. The overall QuickDASH was 12; two cases resulted in unresolved neuropraxia, and there were no cases of re-rupture, infection, or reoperation. CONCLUSIONS: Within an integrated healthcare system, postoperative bracing and PT/OT services increase the cost of care for DBT repair and account for 20% of the total perioperative charges in cases where bracing and therapy are used. Considering the results of prior investigations indicating that formal PT/OT and bracing offer no clinical advantages over immediate range of motion (ROM) and self-directed rehabilitation, upper-extremity surgeons should forego routine brace and PT/OT utilization after DBT repair. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

The effect of texture under distinct regions of the foot sole on human locomotion.

Sensory feedback from the foot sole plays an important role in shaping human locomotion. While net muscle activity and kinematic changes have been correlated with electrical stimulation to five topographical regions of the foot, it remains unknown if these responses are similar with tactile stimulation. The purpose of this study was to use texture in foot orthosis design, applied to five distinct regions under the foot sole, and measure joint kinematics, location of center of pressure, and muscle activity of eight lower leg muscles during level and incline walking. Fifty-five healthy adults completed 48 walking trials in textured and non-textured foot orthoses. Study results confirm that tactile stimulation is stimulation-site and gait-phase specific in modulating lower leg muscle activity during walking. For example, texture under the lateral forefoot consistently generated a suppression of EMG and texture under the lateral midfoot always generated a facilitation. In early stance, adding texture under the medial midfoot or calcaneus facilitated extensor muscle activity and suppressed flexor muscle activity. Texture under the lateral midfoot or medial forefoot facilitated tibialis posterior activation. These results support the topographical organization of cutaneous mechanoreceptors in foot sole skin while considering how texture can be used in foot orthosis design to target lower leg muscular changes during locomotion.

Charcot-Marie-Tooth neuropathy score and ambulation index are both predictors of orthotic need for patients with CMT.

Charcot-Marie-Tooth (CMT) disease is the most common hereditary neuropathy with an estimated prevalence of 1 person affected on 2500. Frequent symptoms include distal weakness and muscle wasting, sensory loss, reduced deep tendon reflexes, and skeletal deformities, such as hammer toes and pes cavus. CMT is a progressive disease and patients' needs change over their lifetime. In particular, ambulation aids are increasingly needed to maintain ambulation and reduce the risk of falls. We performed a retrospective analysis of medical records from 149 patients with confirmed CMT to evaluate patients ambulation needs related to the severity of their CMT as measured by the CMT Neuropathy Score (CMTNS) and Ambulation Index (AI). Most patients required some form of orthotics (86.6%). The CMTNS and AI scores both differed significantly between patients with no orthotics compared to those who wore insoles/inserts. The CMTNS and AI also differed significantly between patients wearing insoles and those with ankle foot orthotics (AFOs). CMTNS and the AI were valid predictors of the type and choice of the orthotics. Both the CMTNS and AI can be effective tools to aid in the correct choice of orthotics in patients affected by CMT.

Acute intense fatigue does not modify the effect of EVA and TPU custom foot orthoses on running mechanics, running economy and perceived comfort.

We determined whether fatigue modifies the effect of custom foot orthoses manufactured from ethyl-vinyl acetate (EVA) and expanded thermoplastic polyurethane (TPU) materials, both compared to standardized footwear (CON), on running mechanics, running economy, and perceived comfort. Eighteen well-trained, males ran on an instrumented treadmill for 6 min at the speed corresponding to their first ventilatory threshold (13.8 ± 1.1 km/h) in three footwear conditions (CON, EVA, and TPU). Immediately after completion of a repeated-sprints exercise (8 × 5 s treadmill sprints, rest = 25 s), these run tests were replicated. Running mechanics, running economy and perceived comfort were determined. Two-way repeated measures ANOVA [condition (CON, EVA, and TPU) × fatigue (fresh and fatigued)] were conducted. Flight time shortened (P = 0.026), peak braking (P = 0.016) and push-off (P = 0.032) forces decreased and vertical stiffness increased (P = 0.014) from before to after the repeated-sprint exercise, independent of footwear condition. There was a global fatigue-induced deterioration in running economy (- 1.6 ± 0.4%; P < 0.001). There was no significant condition × fatigue [except mean loading rate (P = 0.046)] for the large majority of biomechanical, cardio-respiratory [except minute ventilation (P = 0.020) and breathing frequency (P = 0.019)] and perceived comfort variables. Acute intense fatigue does not modify the effect of custom foot orthoses with different resilience characteristics on running mechanics, running economy and perceived comfort.

Comparison of Existing Methods for Characterizing Bi-Linear Natural Ankle Quasi-Stiffness.

Natural ankle quasi-stiffness (NAS) is a mechanical property of the ankle joint during dynamic motion. NAS has been historically calculated as the average slope (linear regression) of the net ankle moment versus ankle angle during discrete phases of stance. However, recent work has shown that NAS is nonlinear during the stance phase. Specifically, during the loading phase of stance (∼10 to 60% of total stance), plantarflexion moment increases at an accelerating rate compared to dorsiflexion angle. Updated models have been developed to better capture this inherent nonlinearity. One type of model called bi-linear NAS (BL-NAS) divides the loading phase of stance into two subphases, called early loading (EL) and late loading (LL) NAS. Two papers, written by Crenna and Frigo (2011, "Dynamics of the Ankle Joint Analyzed Through Moment-Angle Loops During Human Walking: Gender and Age Effects," Hum. Mov. Sci., 30(6), pp. 1185-1198) and Shamaei et al. (2013, "Estimation of Quasi-Stiffness and Propulsive Work of the Human Ankle in the Stance Phase of Walking," PLoS One, 8(3), p. e59935), outline different BL-NAS models. Both models fit measured data better (lower root-mean-squared error (RMSE)) than standard single linear NAS (SL-NAS) models but have not been widely adopted, possibly because of methodological discrepancies and lack of applicability to physical devices at the time. This paper compares and contrasts these existing BL-NAS models and translates those findings to possible orthotic device designs. Results showed that both BL-NAS models had lower RMSE than SL-NAS, EL-NAS was not significantly different across walking speeds, and LL-NAS increased significantly at faster walking speeds. These improved models of NAS much better approximate natural human movement than commonly used SL-NAS models, and thus provide a basis to design ankle-foot devices with multiple stiffness properties to emulate and facilitate natural human motion.

Evaluating the Reliability of a Shape Capturing Process for Transradial Residual Limb Using a Non-Contact Scanner.

Advancements in digital imaging technologies hold the potential to transform prosthetic and orthotic practices. Non-contact optical scanners can capture the shape of the residual limb quickly, accurately, and reliably. However, their suitability in clinical practice, particularly for the transradial (below-elbow) residual limb, is unknown. This project aimed to evaluate the reliability of an optical scanner-based shape capture process for transradial residual limbs related to volumetric measurements and shape assessment in a clinical setting. A dedicated setup for digitally shape capturing transradial residual limbs was developed, addressing challenges with scanning of small residual limb size and aspects such as positioning and patient movement. Two observers performed three measurements each on 15 participants with transradial-level limb absence. Overall, the developed shape capture process was found to be highly repeatable, with excellent intra- and inter-rater reliability that was comparable to the scanning of residual limb cast models. Future work in this area should compare the differences between residual limb shapes captured through digital and manual methods.

The 2019 practice analysis of hand therapy and the use of orthoses by certified hand therapists.

BACKGROUND: In 2019, the Hand Therapy Certification Commission (HTCC), in consultation with Scantron Corporation, performed a practice analysis study of hand therapy, the sixth in a series of similar studies performed byHTCC over a 35-year period. PURPOSE: The primary goal of this study was to update and validate the definition and delineation of hand therapy and to ensure that the test content outline for the Hand Therapy Certification Examination (HTCE) reflects the critical tasks, knowledge, and skills required in the practice of hand therapy. Additionally, HTCC explored specific trends in hand therapy practice, compared findings with previous studies, and gathered data about the frequency, criticality, and performance expectations for the use and fabrication of orthoses by hand therapists. STUDY DESIGN: Quantitative Descriptive. METHODS: More than 40 subject matter experts from the United States and Canada, representing a broad range of experiences and perspectives, developed an updated delineation of the domains, tasks, knowledge, and techniques and tools used in hand therapy practice. A large-scale online survey of all certified hand therapists from the United States, Canada, and other countries was completed to test the profile within the practice of hand therapy. RESULTS: This large-scale online survey overwhelmingly validated the profile of hand therapy. The results affirmed the test specifications for the Hand Therapy Certification Examination; affirmed the definition of hand therapy; and refined the scope of hand therapy practice. New data was gathered regarding the use of orthotics in hand therapy. CONCLUSIONS: This study establishes content validity for the HTCE. It highlights that the specialty of hand therapy is a mature and stable specialty field of occupational therapy and physical therapy. Certified Hand Therapists frequently issue pre-fabricated and fabricate custom orthoses in the course of rehabilitation for clients with hand and arm injuries, and overall consider this a highly critical task in hand therapy practice. LEVEL OF EVIDENCE: N/A.

[Topical issues of rehabilitation of patients with osteoporotic vertebral fractures]. / Aktual'nye voprosy reabilitatsii patsientov s perelomami pozvonkov na fone osteoporoza.

The literature review analyzed 20 Russian and 69 foreign publications on the rehabilitation of elderly patients with osteoporotic vertebral fractures. The article deals in detail with the prevalence, medical and social significance of pathological osteoporotic fractures, including vertebral deformities. The data confirming the importance of osteoporosis for physical and rehabilitation medicine specialists are presented. Changes in the quality of life, functional and gate disorders associated with osteoporotic vertebral fractures are described. Based on the available literature data, the principles of rehabilitation of patients with osteoporotic vertebral compression fractures are formulated, including the effectiveness of various methods of physical therapy, mechanotherapy and apparatus physiotherapy. From the standpoint of evidence-based medicine, the role of orthotics in the complex rehabilitation of such patients is described. Based on the analysis of literature data, it was concluded that the problem of osteoporosis is relevant for physicians working in the field of rehabilitation medicine; osteoporotic vertebral fractures are characterized by a high prevalence over the age of 50 years and are associated with a decrease in the quality of life, motor and functional limitations, and an increased risk of death, and well-planned medical rehabilitation programs including physical exercises, physiotherapy and orthotics can significantly improve patient functionality.

Bracing adults with chronic low back pain secondary to severe scoliosis: six months results of a prospective pilot study.

PURPOSE: Adult scoliosis is sometimes associated with back pain and severe curves can progress over time. Despite scoliosis has been estimated to affect up to 68% of the population over 60, there is scant literature about conservative treatment for adult scoliosis. Recently, we tested a new brace designed to alleviate pain for adult patients with chronic pain secondary to scoliosis. The study aims to test the efficacy of a prefabricated brace in reducing pain in adult scoliosis patients. METHODS: Twenty adults (age 67.8 ± 10.5, curve 61.9 ± 12.6° Cobb) with chronic low back pain (cLBP) secondary to Idiopathic Scoliosis (IS) were included. Patients were evaluated at baseline immediately before starting with the brace and after 6 months. Outcome measures were GRS, Oswestry Disability Index (ODI), Roland Morris Questionnaire (RM), COMI. The paired t test, ANOVA and Wilcoxon tests were used for statistical analysis RESULTS: At six months, worst pain, leg pain and back pain were significantly improved: from 7.15 to 5.60, from 5.65 to 4.35 and from 6.55 to 5.25 (p < 0.05). Sixty-five percent of patients achieved the minimal clinically important difference of 2 points for worst pain and leg pain, 55% for back pain. RM and COMI improved (p < 0.05), no differences for ODI. CONCLUSION: The prefabricated brace showed a significant improvement at 6 months of worst, leg and back pain in most patients in a group of adult women with IS and cLBP. The quality of life didn't change in a clinically significant way even if the patients reported satisfaction with the treatment. Trial registration number and date of registration: ClinicalTrials.gov Identifier: NCT02643290, December 31, 2015.

Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial.

OBJECTIVES: To compare the efficacy of in-shoe heel lifts to calf muscle eccentric exercise in reducing pain and improving function in mid-portion Achilles tendinopathy. METHODS: This was a parallel-group randomised superiority trial at a single centre (La Trobe University Health Sciences Clinic, Discipline of Podiatry, Melbourne, Victoria, Australia). One hundred participants (52 women and 48 men, mean age 45.9, SD 9.4 years) with clinically diagnosed and ultrasonographically confirmed mid-portion Achilles tendinopathy were randomly allocated to either a (1) heel lifts (n=50) or (2) eccentric exercise (n=50) group. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 12 weeks. Differences between groups were analysed using intention to treat with analysis of covariance. RESULTS: There was 80% follow-up of participants (n=40 per group) at 12 weeks. The mean VISA-A score improved by 26.0 points (95% CI 19.6 to 32.4) in the heel lifts group and by 17.4 points (95% CI 9.5 to 25.3) in the eccentric exercise group. On average, there was a between-group difference in favour of the heel lifts for the VISA-A (adjusted mean difference 9.6, 95% CI 1.8 to 17.4, p=0.016), which approximated, but did not meet our predetermined minimum important difference of 10 points. CONCLUSION: In adults with mid-portion Achilles tendinopathy, heel lifts were more effective than calf muscle eccentric exercise in reducing pain and improving function at 12 weeks. However, there is uncertainty in the estimate of effect for this outcome and patients may not experience a clinically worthwhile difference between interventions. TRIAL REGISTRATION NUMBER: ACTRN12617001225303.

Assessment of the Shank-to-Vertical Angle While Changing Heel Heights Using a Single Inertial Measurement Unit in Individuals with Incomplete Spinal Cord Injury Wearing an Ankle-Foot-Orthosis.

Previous research showed that an Inertial Measurement Unit (IMU) on the anterior side of the shank can accurately measure the Shank-to-Vertical Angle (SVA), which is a clinically-used parameter to guide tuning of ankle-foot orthoses (AFOs). However, in this context it is specifically important that differences in the SVA are detected during the tuning process, i.e., when adjusting heel height. This study investigated the validity of the SVA as measured by an IMU and its responsiveness to changes in AFO-footwear combination (AFO-FC) heel height in persons with incomplete spinal cord injury (iSCI). Additionally, the effect of heel height on knee flexion-extension angle and internal moment was evaluated. Twelve persons with an iSCI walked with their own AFO-FC in three different conditions: (1) without a heel wedge (refHH), (2) with 5 mm heel wedge (lowHH) and (3) with 10 mm heel wedge (highHH). Walking was recorded by a single IMU on the anterior side of the shank and a 3D gait analysis (3DGA) simultaneously. To estimate validity, a paired t-test and intraclass correlation coefficient (ICC) between the SVAIMU and SVA3DGA were calculated for the refHH. A repeated measures ANOVA was performed to evaluate the differences between the heel heights. A good validity with a mean difference smaller than 1 and an ICC above 0.9 was found for the SVA during midstance phase and at midstance. Significant differences between the heel heights were found for changes in SVAIMU (p = 0.036) and knee moment (p = 0.020) during the midstance phase and in SVAIMU (p = 0.042) and SVA3DGA (p = 0.006) at midstance. Post-hoc analysis revealed a significant difference between the ref and high heel height condition for the SVAIMU (p = 0.005) and knee moment (p = 0.006) during the midstance phase and for the SVAIMU (p = 0.010) and SVA3DGA (p = 0.006) at the instant of midstance. The SVA measured with an IMU is valid and responsive to changing heel heights and equivalent to the gold standard 3DGA. The knee joint angle and knee joint moment showed concomitant changes compared to SVA as a result of changing heel height.

Effectiveness and Reliability of Foot Orthoses on Impact Loading and Lower Limb Kinematics When Running at Preferred and Nonpreferred Speeds.

This study examined the effect of foot orthoses used on ground reaction forces, ankle, and knee kinematics when running at preferred and nonpreferred speeds. Sixteen runners ran on instrumented treadmills at various speeds (90%, 100%, and 110% of preferred speed) when wearing arch-support and flat-control orthoses. Two-way repeated analysis of variance (ANOVA) was performed on the mean and coefficient of variation of all variables. Results indicated that arch-support orthoses experienced larger maximum loading rates than flat-control orthoses (P = .017, 95% CI, 2.22 to 19.53). Slower speed was related to smaller loading rates (preferred: P = .002, 95% CI, -17.02 to -4.20; faster: P = .003, 95% CI, -29.78 to -6.17), shorter stride length (preferred: P < .001, 95% CI, -0.204 to -0.090; faster: P < .001, 95% CI, -0.382 to -0.237), and longer contact time (preferred: P < .001, 95% CI, 0.006-0.021; faster: 95% CI, 0.012-0.042). In arch-support condition, preferred speed induced higher stride length coefficient of variation (P = .046, 95% CI, 0.035-1.117) than faster speed, while displaying no differences in flat-control condition. These findings suggest that the use of arch-support orthoses would influence impact loading, but not spatial-temporal and joint kinematics in recreational runners.