"I'm More Comfortable with a Wide-Fit Shoe" The Footwear Needs and Preferences of Older Adults in Racket Sports.

BACKGROUND: Physical activity is important throughout the lifespan. Racket sports are popular with older adults and offer important social benefits. It is unknown how the physiologic changes attributable to aging affect lower limb loading during multidirectional sports and how this may influence footwear requirements. The purpose of this work was to explore the footwear needs and preferences of older adults in racket sports to inform footwear design and development. METHODS: Semistructured interviews were conducted online with 16 participants (56-92 years of age) who typically play racket sports at least once per week. Thematic analysis was used to group basic themes into organizing themes. RESULTS: The organizing themes were comfort (general comfort, pain-free, and cushioning), functionality (relating to the structure of the shoe and performance), and choice (mostly around the appearance of the shoe). Comfort was a key priority for the majority of participants, although it was often stressed that the footwear must also be supportive. Support was frequently defined in relation to preventing ankle sprains; however, when asked directly about managing injury risk, avoiding certain shots and appropriate grip were mentioned over support. More than half of participants reported needing a wide-fitting sport shoe, which limited the footwear selection available to them. CONCLUSIONS: This study provides novel insight into the footwear requirements of active older adults, which can inform the development of footwear to facilitate safe and pain-free participation in sport for all.

Location-specific cutaneous electrical stimulation of the footsole modulates corticospinal excitability to the plantarflexors and dorsiflexors during standing.

Non-noxious electrical stimulation to distinct locations of the foot sole evokes location-specific cutaneous reflex responses in lower limb muscles. These reflexes occur at latencies that may enable them to be mediated via a transcortical pathway. Corticospinal excitability to the plantarflexors and dorsiflexors was measured in 16 participants using motor evoked potentials (MEPs). Spinal excitability was measured in eight of the original participants using cervicomedullary motor evoked potentials (CMEPs). Measurements were collected with and without preceding cutaneous stimulus to either the heel (HEEL) or metatarsal (MET) locations of the foot sole, and evoked potentials were elicited to coincide with the arrival of the cutaneous volley at either the motor cortex or spinal cord. Plantarflexor MEPs and CMEPs were facilitated with cutaneous stimulation to the HEEL for MEPs (soleus p = 0.04, medial gastrocnemius (MG) p = 0.017) and CMEPs (soleus p = 0.047 and MG p = 0.015), but they were unchanged following MET stimulation for MEPs or CMEPs. Dorsiflexor MEPs were unchanged with cutaneous stimulation at either location, but dorsiflexor CMEPs increased with cutaneous stimulation (p = 0.05). In general, the increase in CMEP amplitudes was larger than the increase in MEP amplitudes, indicating that an increase in spinal excitability likely explains most of the increase in corticospinal excitability. The larger change observed in the CMEP also indicates that excitability from supraspinal sources likely decreased, which could be due to a net change in the excitability of intracortical circuits. This study provides evidence that cutaneous reflexes from foot sole skin are likely influenced by a transcortical pathway.

The immediate effects of foot orthosis geometry on lower limb muscle activity and foot biomechanics.

Foot orthoses (FOs) are used to treat clinical conditions by altering the external forces applied to the foot and thereafter the forces of muscles and tendons. However, whether specific geometric design features of FOs affect muscle activation is unknown. The aim of this study was to investigate if medial heel wedging and increased medial arch height have different effects on the electromyography (EMG) amplitude of tibialis posterior, other muscles of the lower limb and the kinematics and kinetics at the rearfoot and ankle. Healthy participants (n = 19) walked in standardised shoes with i) a flat inlay; ii) a standard shape FOs, iii) standard FOs adjusted to incorporate a 6 mm increase in arch height, iv) and standard FOs adjusted to incorporate an 8° medial heel wedging and v) both the 6 mm increase in arch height and 8° increase in medial wedging. EMG was recorded from medial gastrocnemius, peroneus longus, tibialis anterior and in-dwelling tibialis posterior muscles. Motion and ground reaction force data were collected concurrently. Tibialis posterior EMG amplitude reduced in early stance with all FOs (ηp2 = 0.23-1.16). Tibialis posterior EMG amplitude and external ankle eversion moment significantly reduced with FOs incorporating medial wedging. The concurrent reduction in external eversion moment and peak TP EMG amplitude in early stance with medial heel wedging demonstrates the potential for this specific FOs geometric feature to alter TP activation. Medial wedged FOs could facilitate tendon healing in tibialis posterior tendon dysfunction by reducing force going through the TP muscle tendon unit.

The influence of contraction type, prior performance of a maximal voluntary contraction and measurement duration on fine-wire EMG amplitude.

We aimed to investigate the impact of time on fine-wire (fw) electromyography (EMG) signal amplitude, and to determine whether any attenuation is confounded by task type. Twenty healthy participants were instrumented with fw and surface (s) EMG electrodes at the biceps brachii bilaterally. Participants held a weight statically with one arm and with the other arm either repeated the same task following a maximum voluntary contraction (MVC) or repeated dynamic elbow flexion/extension contractions. Each task was repeated for 30 s every five minutes over two hours. EMG amplitude was smoothed and normalized to time = 0. Stable median power frequency of the s-EMG ruled out the confounding influence of fatigue. Repeated-measures ANCOVAs determined the effect of electrode type and time (covariate) on EMG amplitude and the confounding impact of task type. During the isometric protocol, fw-EMG amplitude reduced over time (p = 0.002), while s-EMG amplitude (p = 0.895) and MPF (p > 0.05) did not change. Fw-EMG amplitude attenuated faster during the dynamic than the isometric protocol (p = 0.008) and there was evidence that the MVC preceding the isometric protocol impacted the rate of decline (p = 0.001). We conclude that systematic signal attenuation of fw-EMG occurs over time and is more pronounced during dynamic tasks.

The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. METHODS: For the data sources, a structured search of the peer-reviewed literature (English language; 1960-April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed manuscripts that reported on anatomical, physiological or functional differences between females with signs and/or symptoms consistent with SUI and a concurrently recruited control group of continent females without any substantive urogynecological symptoms. Of 4629 publications screened, 84 met the inclusion criteria and were retained, among which 24 were included in meta-analyses. RESULTS: Selection bias was moderate to high; < 25% of studies controlled for major confounding variables for SUI (e.g., age, BMI and parity). There was a lack of standardization of methods among studies, and several measurement issues were identified. Results were synthesized qualitatively, and, where possible, random-effects meta-analyses were conducted. Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. Meta-analyses showed that observed bladder neck dilation and lower functional urethral length, bladder neck support and maximum urethral closure pressures are strong characteristic signs of SUI. CONCLUSION: The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. While there is also evidence of impaired urethral support and levator ani function, standardized approaches to measurement are needed to generate higher levels of evidence.

EMG gait data from indwelling electrodes is attenuated over time and changes independent of any experimental effect.

The effect of time on the validity of electromyography (EMG) signals from indwelling fine-wire electrodes has not been explored. This is important because experiments using intramuscular electrodes are often long and biochemical and mechanical factors, may impair measurement accuracy over time. Measures over extended periods might therefore be erroneous. Twelve healthy participants (age = 33 ± 8 years) walked for 50 min at a controlled speed. Fine-wire electrodes were inserted into tibialis anterior and a surface EMG sensor attached near the fine-wire insertion site. EMG signals progressively and significantly decreased with time with the fine-wire electrode, but not the surface electrode. For the fine-wire electrode, after 25 min mean amplitude had reduced by 11% (p < 0.001) and after 50 min by 16% (p < 0.001), and peak amplitude reduced 22% at 20 min (p = 0.006) and 37% at 50 min (p < 0.001). Reduced amplitude with indwelling EMG without concurrent changes in surface EMG signal suggests an important inconsistency in data from fine-wire EMG electrodes. Changes in EMG signal will occur over time independent of the experimental condition and this questions their use in experiments of more than 30 min. These results should impact on experimental study design. They also invite reinterpretation of prior literature and sensor innovation to improve measurement performance.

A systematic review of the effect of footwear, foot orthoses and taping on lower limb muscle activity during walking and running.

BACKGROUND: External devices are used to manage musculoskeletal pathologies by altering loading of the foot, which could result in altered muscle activity that could have therapeutic benefits. OBJECTIVES: To establish if evidence exists that footwear, foot orthoses and taping alter lower limb muscle activity during walking and running. STUDY DESIGN: Systematic literature review. METHODS: CINAHL, MEDLINE, ScienceDirect, SPORTDiscus and Web of Science databases were searched. Quality assessment was performed using guidelines for assessing healthcare interventions and electromyography methodology. RESULTS: Thirty-one studies were included: 22 related to footwear, eight foot orthoses and one taping. In walking, (1) rocker footwear apparently decreases tibialis anterior activity and increases triceps surae activity, (2) orthoses could decrease activity of tibialis posterior and increase activity of peroneus longus and (3) other footwear and taping effects are unclear. CONCLUSION: Modifications in shoe or orthosis design in the sagittal or frontal plane can alter activation in walking of muscles acting primarily in these planes. Adequately powered research with kinematic and kinetic data is needed to explain the presence/absence of changes in muscle activation with external devices. CLINICAL RELEVANCE: This review provides some evidence that foot orthoses can reduce tibialis posterior activity, potentially benefitting specific musculoskeletal pathologies.

Can texture change joint position sense at the knee joint in those with poor joint position accuracy?

Purpose: Skin contributes to joint position sense (JPS) at multiple joints. Altered cutaneous input at the foot can modulate gait and balance and kinesiology tape can enhance proprioception at the knee, but its effect may be dependent on existing capacity. The effect of texture at the knee, particularly in those with poor proprioception, is unknown. The aim of this study was to determine the effect of textured panels on JPS about the knee. Materials and methods: Eighteen healthy females were seated in an adjustable chair. Their left leg (target limb) moved passively from 65° to a target of flexion (115° or 90°) or extension (40°). Their right leg (matching limb) was passively moved towards this target angle and participants indicated when their limbs felt aligned. We tested three textured panels over the knee of the matching limb and two control conditions. The target limb maintained a control panel. Directional error, absolute error and variable error in matching between limbs were calculated. Results: On average textured panels over the knee increased JPS error compared to control pants for participants with poor JPS. These participants undershot the target at 90° of flexion significantly more with textured panels (-11° ± 3°) versus control (-7° ± 3°, p = 0.04). Conclusions: For participants with poor JPS accuracy, increased JPS error at 90° with a textured panel suggests these individuals utilised altered cutaneous information to adjust joint position. We propose increased error results from enhanced skin input at the knee leading to the perception of increased flexion.

The between-day reliability of peroneus longus EMG during walking.

The peroneus longus (PL) is a rearfoot evertor, important in frontal plane foot motion. Studying PL function has been limited by previous electromyography (EMG) studies reporting poor between-day reliability. Due to its close proximity to adjacent muscles, EMG measures of PL may be susceptible to crosstalk, thus correct electrode placement is vital. The aim of this study was to use ultrasound to aid placement of small surface EMG electrodes and determine the between-day reliability of PL EMG in healthy participants' walking. Ten participants walked barefoot and shod at a controlled, self-selected speed. Six trials per condition, per session, were recorded over two days (mean (SD): 5 (3) days apart). The muscle belly was located using ultrasound. EMG was recorded with surface electrodes (Trigno™ Mini, Delsys, Inc.) at 2000 Hz. Amplitude was normalized to the peak per gait cycle and time normalized to the gait cycle. Reliability of discrete variables were primarily assessed with the standard error of measurement (SEM), plus the coefficient of multiple correlation (CMC), the coefficient of variation (CV) and the intra-class correlation coefficient (ICC). The pattern of the EMG profile was consistent. The SEM of peak amplitude was 4% (3-8%) and 3% (2-5%) for barefoot and shod respectively. For timing of the peak the SEM was 2% (1-3%) and 1% (1-2%) for barefoot and shod respectively. Low SEM of discrete variables suggests good reliability of PL EMG during walking supporting the future use of this protocol. Therefore activation of PL can be confidently studied in repeated-measures study designs.