A comparative study between isolated gastrocnemius tightness patients and controls by quantitative Gait analysis and baropodometry.

BACKGROUND: Isolated gastrocnemius tightness (IGT) has been suggested as an etiologic factor in mechanical disorders of the foot and ankle without a clear pathophysiological mechanism in the literature. We hypothesized that restricted ankle dorsiflexion inducing increased forefoot pressure in IGT patients could be this pathophysiological mechanism. METHODS: Case/control experimental observational investigation. Forty lower limbs in 20 asymptomatic IGT patients were included and compared to controls. Quantitative gait analyses coupled with dynamic baropodometry were used for comparison between groups. The primary outcome was maximum ankle dorsiflexion during stance phase. Secondary outcomes were knee flexion and forefoot pressure. RESULTS: Maximum ankle dorsiflexion and maximum forefoot pressure were similar between groups. Increased knee flexion was found in the asymptomatic IGT group. CONCLUSIONS: IGT induced compensatory knee flexion during stance phase, which probably prevents increased pressure on the forefoot by allowing ankle dorsiflexion. LEVEL OF EVIDENCE: Level IV, Case/control experimental observational investigation.

Effects of Insoles on Gait Kinematics and Low Back Pain in Patients with Leg Length Inequality: A Systematic Review.

The aim of this systematic review was to examine the effects of foot orthoses on gait kinematics and low back pain (LBP) in individuals with leg length inequality (LLI). This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and has been undertaken in the PubMed-NCBI, EBSCO Host, Cochrane Library, and ScienceDirect databases. Inclusion criteria were the analysis of kinematic parameters during walking or LBP before and after foot orthosis use in patients with LLI. Ultimately, five studies were retained. We extracted the following information: study identity, patients, type of foot orthosis, duration of orthopedic treatment, protocols, methods, and data to assess gait kinematics and LBP. The results showed that insoles seem to reduce pelvic drop and active compensations of the spine when LLI is moderate/severe. However, insoles do not always seem to be efficient in improving gait kinematics in patients with low LLI. All of the studies noted a significant reduction of LBP with use of insoles. Consequently, although these studies revealed no consensus on whether and how insoles affect gait kinematics, the orthoses seemed helpful in relieving LBP.

Effects of Orthotic Insoles on Gait Kinematics and Low-Back Pain in Patients with Mild Leg Length Discrepancy.

BACKGROUND: Mild leg length discrepancy increases biomechanical asymmetry during gait, which leads to low-back pain. Orthotic insoles with a directly integrated heel lift were used to reduce this asymmetry and thus the associated low-back pain. The aim of this study was to analyze the biomechanical adaptations of the locomotor apparatus during gait and the subjective pain ratings before and after the establishment of orthotic insole use. METHODS: Eight patients with mild leg length discrepancy (≤2.0 cm) underwent three-dimensional biomechanical analysis while walking before and after 3 weeks of orthotic insole use. Low-back pain was assessed separately before both measurement sessions using a visual analog scale. RESULTS: Analysis of the kinematic parameters highlighted individual adaptations. The symmetry index of Dingwell indicated that orthotic insoles had no significant effect on the kinematic gait parameters and an unpredictable effect across patients. Orthotic insole use significantly and systematically (in all of the patients) reduced low-back pain (P < .05), which was correlated with changes in ankle kinematics (P = .02, r = 0.80). CONCLUSIONS: The effects of orthotic insoles on gait symmetry are unpredictable and specific to each patient's individual manner of biomechanical compensation. The reduction in low-back pain seems to be associated with the improved ankle kinematics during gait.

Orthotic Insoles Improve Gait Symmetry and Reduce Immediate Pain in Subjects With Mild Leg Length Discrepancy.

Background: Mild leg length discrepancy can lead to musculoskeletal disorders; however, the magnitude starting from which leg length discrepancy alters the biomechanics of gait or benefits from treatment interventions is not clear. Research question: The aim of the current study was to examine the immediate effects of orthotic insoles on gait symmetry and pain on mild leg length discrepancy according to two groups of the leg length discrepancy (i.e., LLD ≤ 1 cm vs. LLD > 1 cm). Methods: Forty-six adults with mild leg length discrepancy were retrospectively included and classified into two groups (GLLD≤1cm or GLLD>1cm). All subjects underwent routine 3D gait analysis with and without orthotic insoles. The symmetry index was calculated to assess changes in gait symmetry between the right and left limbs. Pain was rated without (in standing) and with the orthotic insoles (after 30 min of use) on a visual analog scale. Results: There was a significant improvement in the symmetry index of the pelvis in the frontal plane (p = 0.001) and the ankle in the sagittal plane (p = 0.010) in the stance with the orthotic insoles independent from the group. Pain reduced significantly with the orthotic insoles independently from the group (p < 0.001). Significance: Orthotic insoles significantly improved gait symmetry in the pelvis in the frontal plane and the ankle in the sagittal plane, as well as pain in all subjects (both LLD ≤ 1 cm and LLD > 1 cm) suggesting that it may be appropriate to treat even mild leg length discrepancy.

The effects of shoe type on lower limb venous status during gait or exercise: A systematic review.

This systematic review evaluated the literature pertaining to the effect of shoes on lower limb venous status in asymptomatic populations during gait or exercise. The review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed-NCBI, EBSCO Host, Cochrane Library and Science Direct databases were searched (March 2019) for words around two concepts: shoes and venous parameters. The inclusion criteria were as follows: (1) the manuscript had to be published in an English-language peer-reviewed journal and the study had to be observational or experimental and (2) the study had to suggest the analysis of many types of shoes or orthotics on venous parameters before, during and/or after exercise. Out of 366 articles, 60 duplications were identified, 306 articles were analyzed, and 13 articles met the eligibility criteria after screening and were included. This review including approximately 211 participants. The methodological rigor of these studies was evaluated with the modified Downs and Black quality index. Nine studies investigated the effect of shoes on blood flow parameters, two on venous pressure and two on lower limb circumferences with exercise. Evidence was found that unstable shoes or shoes with similar technology, sandals, athletic or soft shoes, and customized foot orthotics elicited more improvement in venous variables than high-heeled shoes, firm shoes, ankle joint immobilization and barefoot condition. These venous changes are probably related to the efficiency of muscle pumps in the lower limbs, which in turn seem to be dependent on shoe features associated with changes in the kinetics, kinematics and muscle activity variables in lower limbs during gait and exercise.