Determination of optimal shoe fitting for children tennis players: Effects of inner-shoe volume and upper stiffness.

The purpose of this study was to determine the optimal inner-shoe volume for children tennis players. Sixteen participants, aged from 8 to 12 years old assessed comfort of 6 shoes, which were a combination of 3 lasts (thin, medium and wide) and 2 upper constructions (flexible and stiff), while a sock equipped with textile sensors was measuring the pressure applied on their foot. The thin last was based on the proportion of an adult last. The widest shoes produced the lowest pressure on the 1st and 5th metatarsal heads, the medial midfoot and the medial and lateral heel (p < 0.05), whilst they were perceived the most comfortable for the 3rd and 5th metatarsal heads, the 5th metatarsal base and the medial and lateral heel (p < 0.05). These outcomes indicated that footwear manufacturers should design wider shoes for children than for adults.

Cancer Patients Dying in the Intensive Care Units and Access to Palliative Care.

BACKGROUND: In France, cancer has become the leading cause of death. Intensive care units (ICU) focus on survival, which may not be an appropriate setting to provide palliative care (PC) as needed by cancer patients and families. OBJECTIVE: To describe the cancer patients who died in the ICU in 2010 in a French academic medical center. DESIGN: Retrospective study Measurements: We reviewed medical records of all cancer patients who died in the ICU in 2010. The information collected from electronic medical records included patient sociodemographics and clinical characteristics, PC service referral, and the date of first contact with PC. RESULTS: Among the 536 cancer patients who died in 2010, 42 (8%) died in the ICU. The cancers were hematological (21%), gastrointestinal (21%) and head and neck (21%). One patient had a PC referral versus 45% in the total population (p < 0.001) and the referral was the same day as the death. Eight (19%) patients had chemotherapy during their last month of life and 2 during the ICU hospitalization. Seventy-four per cent of patient admissions to the ICU related directly to malignancy. The mean time between diagnosis of cancer and death was 2.3 years (standard deviation, 4.4). CONCLUSIONS: Our work highlights the need for early PC in the illness trajectory of cancer patients to prevent the transfer of dying patients to the ICU. More studies are needed to understand the decision making leading to such transfers.

Shoe drop reduction influences the lower limb biomechanics of children tennis players during an open stance forehand: A longitudinal study.

Compared to traditional tennis shoes, using 0-drop shoes was shown to induce an immediate switch from rear- to forefoot strike pattern to perform an open stance tennis forehand for 30% of children tennis players. The purpose of the study was to examine the long-term effects of a gradual reduction in the shoe drop on the biomechanics of children tennis players performing open stance forehands. Thirty children tennis players participated in 2 laboratory biomechanical test sessions (intermediate: +4 months and final: +8 months) after an inclusion visit where they were randomly assigned to control (CON) or experimental (EXP) group. CON received 12-mm-drop shoes twice, whereas EXP received 8 mm then 4-mm-drop shoes. Strike index indicated that all CON were rearfoot strikers in intermediate and final test sessions. All EXP were rearfoot strikers in intermediate test session, but half the group switched towards a forefoot strike pattern in final test session. This switch resulted in a decreased loading rate of the ground reaction force (-73%, p = .005) but increased peak ankle plantarflexors moment (+47%, p = .050) and peak ankle power absorption (+107%, p = .005) for these participants compared with CON. Biomechanical changes associated with the long-term use of partial minimalist shoes suggest a reduction in heel compressive forces but an increase in Achilles tendon tensile forces.

The influence of shoe aging on children running biomechanics.

Athletic children are prone to overuse injuries, especially at the heel and knee. Since footwear is an extrinsic factor of lower limb injury risk, the aim of this study was to assess the influence of shoe aging on children running biomechanics. Fourteen children active in sports participated in a laboratory biomechanical evaluation. A new pair of shoes was provided to each participant at an inclusion visit. Four months later, the participants performed a running task and their kinematics and kinetics were assessed both with their used shoes and with a new pair of shoes identical to the first. Furthermore, mechanical cushioning properties of shoes were evaluated before and after in-vivo aging. After 4months of use, the sole stiffness increased by 16% and the energy loss capacity decreased by 18% (p<0.001). No ankle or knee kinematic adjustment was found at foot strike in used shoes but changes were observed later during stance. Running with used shoes produced a higher loading rate of the vertical ground reaction force (+23%, p=0.016), suggesting higher compressive forces under the heel and placing children at risk to experience impact-related injuries. Nevertheless, the decreased peak ankle and knee power absorption in used shoes (-11%, p=0.010 and -12%, p=0.029, respectively) suggests a lower ankle and knee joints loading during the absorption phase that may be beneficial regarding stretch-related injuries.

The influence of shoe drop on the kinematics and kinetics of children tennis players.

This study investigated the immediate effects of reducing the shoe drop (i.e. the difference between the heel and the forefoot height) on the kinematics and kinetics of the lower extremities of children tennis players performing a tennis-specific movement. Thirteen children tennis players performed a series of simulated open stance forehands wearing 3 pairs of shoes differing only in the drop: 0 (D0), 6 (D6) and the control condition of 12 mm (D12). Two embedded forceplates and a motion capture system were used to analyse the ground reaction forces and ankle and knee joint angles and moments of the leading lower limb. In D6 compared with D12, the peak impact force was reduced by 24% (p = .004) and the ankle was less dorsiflexed at foot strike (p = .037). In D0 compared with D12, the peak impact force was reduced by 17% (p = .049), the ankle was less dorsiflexed at foot strike (p = .045) and the knee was more flexed at foot strike (p = .007). In addition, 4 out of 13 participants (31%) presented a forefoot strike pattern for some of the trials in D0. No difference was observed across shoe conditions for the peak knee extensor moment (p = .658) or the peak ankle plantarflexor moment (p = .071). The results provide preliminary data supporting the hypothesis that for children tennis players, using a 6-mm lower shoe drop might reduce heel impact forces and thus limit potentially impact-related injuries.