Adolescent perspectives on participating in a feasibility trial investigating shoe inserts for patellofemoral pain.

BACKGROUND: Patellofemoral pain (PFP) affects one-quarter of adolescents, yet there are few evidence-informed recommendations to treat PFP in this population. HAPPi Kneecaps! is a randomised, controlled, participant- and assessor-blind, parallel-group feasibility trial of shoe inserts for adolescents with PFP. The aim of this qualitative study was to explore adolescents' perspectives of participating in HAPPi Kneecaps!. METHODS: All 36 adolescents with PFP from the HAPPi Kneecaps! study were invited to participate in semi-structured interviews. We used a descriptive qualitative methodology underpinned by a relativist framework to investigate adolescents' perspectives on participating in the trial. Inductive thematic analysis was used to examine patterns regarding how each adolescent experienced the HAPPi Kneecaps! study within their social, cultural, and historical contexts. RESULTS: 14 out of 36 HAPPi Kneecaps! participants provided consent and participated in interviews (12 females; mean [SD] age 14.9 [2.4] years). Overall, most adolescents responded positively when discussing their experience, such as improvements in their knee pain and satisfaction with how the study was run. Major themes that were generated from the analysis and feedback were: (1) shoe inserts require little effort to use; (2) perceptions of the program were generally positive; (3) participation in the trial could be made easier; (4) warm weather matters; and (5) life happens. CONCLUSION: Adolescents with PFP who participated in the HAPPi Kneecaps! study found that shoe inserts were easy to wear. Most adolescents experienced an improvement in their symptoms and enhanced participation in sport and exercise. Adolescents with PFP prefer an option for warmer climates (e.g. flip flops or sandals), access to online logbooks, and clinicians who are easily accessible. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000957190 . Date registered: 8/07/2019.

How to help runners steer clear of injury.

Assess risk factors, then work to address modifiable ones, such as wearing the right running shoes and building up slowly. Don't let overweight or OA dampen enthusiasm.

Effects of shoe weight on landing impact and side-to-side asymmetry.

Shoes of different weights affect proprioception. Drop jump (DJ) tasks are often used to explore the risks and mechanisms of lower limb injuries. Leg dominance mainly refers to differences between the dominant and nondominant legs. Eight males and eight females participated in this study. The weights of the shoes in this investigation were 255 g, 335 g, and 415 g, and the heights of the DJ were 30 cm, 40 cm, and 50 cm. The side-to-side asymmetry of the time of contact initiation for the 30DJ was greater than that of the 40DJ and 50DJ, and the asymmetry for shoes weighing 415 g and 355 g was greater than that for shoes weighing 255 g. When the drop height increased, the side-to-side asymmetry of the peak ground reaction force (PGRF). also increased. The ground contact time increased as the drop height increased to 50DJ. Higher drop heights caused greater side-to-side asymmetry of the PGRF. Heavier shoes caused the peak ground reaction force time (PGRFT) in the nondominant leg to appear earlier, reduced the jump height and affected the performance. Heavier shoes caused greater side-to-side asymmetry at the initial ground contact and at the ground contact time, affecting training effectiveness.

Evaluation of the design and implementation of municipal ice cleat distribution programs for the prevention of ice-related fall injuries among older adults in Sweden.

INTRODUCTION: The risk for outdoor falls tends to increase during winter due to icy road conditions. Several Swedish municipalities have introduced programs that provide their senior citizens with a pair of ice cleats in an attempt to tackle this problem. In this paper, we perform a process evaluation to identify potential barriers to the success of these programs and analyze the logic of their design. METHODS: We sent a survey to all 290 Swedish municipalities to collect data on the characteristics of ice cleat distribution programs. We also performed focus-group interviews with older adults to gain insight into their thoughts about ice cleat programs. We synthesized our data with existing literature on ice cleats and behavior change theory to populate a logic model to identify and analyze hidden assumptions and potential flaws using program theory analysis. RESULTS: On average, about 40% of the eligible population living in the intervention municipalities collected a pair of ice cleats. While we identified some other, but mostly minor, barriers to implementation, the main barrier appears to be a lack of scale (i.e., insufficient procurement and distribution of ice cleats), as 90% of all purchased ice cleats were eventually distributed. While previous research suggests that ice cleats can decrease injury risks if worn, we find that there is limited evidence on the effects of distribution on ice cleat use. Our interviewees emphasized the potential utility of ice cleats for staying safe and active during winter but stressed that ice cleats need to be user-friendly and of high-quality to increase the likelihood that a distribution program encourages behavior change. CONCLUSION: Existing ice cleat distribution programs appear to have reached a meaningful share of the targeted population. Additional research is required to assess their effects on ice cleat use and injury rates.

Analysis of hip joint loading during walking with different shoe types using instrumented total hip prostheses.

Hip joint loads need careful consideration during postoperative physiotherapy after joint replacement. One factor influencing joint loads is the choice of footwear, but it remains unclear which footwear is favorable. The objective of the present study was to investigate the influence of footwear on hip joint loads in vivo. Instrumented hip endoprostheses were used for in vivo load measurements. The parameters resultant contact force (Fres), bending moment (Mbend) and torsional moment (Mtors) were evaluated during treadmill walking at 4 km/h with different shoe types. In general, footwear tended to increase hip joint loading, with the barefoot shoe having the least influence. Fres and Mbend were significantly increased during heel strike for all shoe types in comparison to barefoot walking, with everyday shoe (34.6%; p = 0.028 and 47%; p = 0.028, respectively) and men's shoe (33.2%; p = 0.043 and 41.1%; p = 0.043, respectively) resulting in the highest changes. Mtors at AbsMax was increased by all shoes except for the barefoot shoe, with the highest changes for men's shoe (+ 17.6%, p = 0.043) and the shoe with stiffened sole (+ 17.5%, p = 0.08). Shoes, especially those with stiff soles or elaborate cuishing and guiding elements, increase hip joint loads during walking. The influence on peak loads is higher for Mtors than for Fres and Mbend. For patients in which a reduction of hip joints loads is desired, e.g. during physiotherapy after recent surgery or to alleviate symptoms of osteoarthritis, low profile shoes with a flexible sole may be preferred over shoes with a stiff sole or elaborate cushioning elements.

Effects of orthopedic insoles on patients with knee osteoarthritis: A meta-analysis and systematic review.

OBJECTIVE: Recent clinical evidence supports that orthopaedic insoles, especially lateral-wedge insoles, can significantly benefit patients with knee osteoarthritis. The aim of this study is to explore the effects of orthopaedic insoles in patients with knee osteoarthritis. METHODS: Randomized controlled trials evaluating the effects of orthopaedic insoles on patients with knee osteoarthritis, published up to 16 February 2021, were reviewed and outcomes quantitatively summarized. RESULTS: A total of 15 studies from 13 randomized controlled trials that involved 1,086 participants were included in this study. All the included studies exhibited a moderate bias risk and were of acceptable quality. The pooled mean difference of pain determined by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was -1.21 (p < 0.001, 95% confidence interval (95% CI) -2.61-0.18) with a high heterogeneity (I2 = 75%). In the sensitivity analysis, the overall incidence was -0.20 (p= 0.62, 95% CI= -0.87-0.46) with an accepted heterogeneity (I2 = 0%). No difference was observed between the Asian and Caucasian groups (p= 0.28). No significant difference was found in the pain score, Lequesne index or functional improvements. CONCLUSION: Meta-analysis revealed that orthopaedic insoles do not provide relief of pain or improve functionality in patients with knee osteoarthritis.

Effect of a carbon reinforcement for maximizing shoe outsole bending stiffness on plantar pressure and walking comfort in people with diabetes at high risk of foot ulceration.

BACKGROUND: Different shoe design features can reduce peak plantar pressure to help prevent foot ulcers in people with diabetes. A carbon reinforcement of the shoe outsole to maximize bending stiffness is commonly applied in footwear practice, but its effect has not been studied to date. RESEARCH QUESTION: What is the effect of a carbon shoe-outsole reinforcement on peak plantar pressure and walking comfort in people with diabetes at high risk of foot ulceration? METHODS: In 24 high-risk people with diabetes, in-shoe regional peak pressures were measured during walking at a comfortable speed in two different shoe conditions: an extra-depth diabetes-specific shoe with a non-reinforced outsole and the same type of shoe with a 3-mm-thick full-length carbon reinforcement of the outsole. The same custom-made insole was worn in both shoe conditions. Walking comfort was assessed using a Visual Analogue Scale (0-10, 10 being highest possible comfort). RESULTS: Significantly lower metatarsal head peak pressures (by a median 10-22 kPa) were found with the reinforced shoe compared to the non-reinforced shoe (p < .001). In >83% of cases with the reinforced shoe and >71% with the non-reinforced shoe metatarsal head peak pressures were <200 kPa. At the hindfoot, peak pressures were significantly higher (by a median 24 kPa) with the reinforced shoe (p = .001). No significant shoe effects were found for the toes. No significant shoe effects were found for walking comfort: median 6.1 for the reinforced shoe versus 5.6 for the non-reinforced shoe. SIGNIFICANCE: Adding a full-length carbon reinforcement to the outsole of a diabetes-specific shoe significantly reduces peak pressures at the metatarsal heads, where ulcers often occur, in high-risk people with diabetes, and this does not occur at the expense of patient-perceived walking comfort.

The apex angle of the rocker sole affects the posture and gait stability of healthy individuals.

BACKGROUND: Rocker sole (RS) shoes have been linked to impaired postural control. However, which features of RS design affect balance is unclear. RESEARCH QUESTION: Which RS design features affect standing balance and gait stability? METHODS: This study utilized an intervention and cross-over design. Twenty healthy young adults (10 males and 10 females) participated in this study. Standing balance and gait stability were measured using a single force platform and three-dimensional motion analysis system, respectively. The experimental conditions included the control shoe and five RS shoes in the combination of apex position (%) and apex angle (degree) for RS50-95, RS60-95, RS70-95, RS60-70, and RS60-110. The main outcome measures were the area surrounding the maximal rectangular amplitude, mean path length, average displacement of the center of pressure along the lateral and anterior/posterior directions, and maximal center of pressure excursion as the standing balance and lateral margin of stability as the gait stability. Statistical analyses were conducted using a two-way split-plot analysis of variance with repeated measures (with RS design as the within-subject factor and sex as the between-subject factor) and the Bonferroni post hoc test (α = .05). RESULTS: Regarding the mean path length, RS60-70 was significantly longer than the control shoe, and it showed a significantly increased lateral margin of stability. Thus, RS60-70 was shown to affect standing balance, limit of stability, and gait stability of the frontal plane during gait. SIGNIFICANCE: These results suggest that the apex angle of the RS design feature affects standing balance and gait stability, and RS60-70 is detrimental to stability. Therefore, when RS with a small apex angle is prescribed, it is necessary to consider the patient's balance ability.

Running barefoot leads to lower running stability compared to shod running - results from a randomized controlled study.

Local dynamic running stability is the ability of a dynamic system to compensate for small perturbations during running. While the immediate effects of footwear on running biomechanics are frequently investigated, no research has studied the long-term effects of barefoot vs. shod running on local dynamic running stability. In this randomized single-blinded controlled trial, young adults novice to barefoot running were randomly allocated to a barefoot or a cushioned footwear running group. Over an 8-week-period, both groups performed a weekly 15-min treadmill running intervention in the allocated condition at 70% of their VO2 max velocity. During each session, an inertial measurement unit on the tibia recorded kinematic data (angular velocity) which was used to determine the short-time largest Lyapunov exponents as a measure of local dynamic running stability. One hundred running gait cycles at the beginning, middle, and end of each running session were analysed using one mixed linear multilevel random intercept model. Of the 41 included participants (48.8% females), 37 completed the study (drop-out = 9.7%). Participants in the barefoot running group exhibited lower running stability than in the shod running group (p = 0.037) with no changes during the intervention period (p = 0.997). Within a single session, running stability decreased over the course of the 15-min run (p = 0.012) without differences between both groups (p = 0.060). Changing from shod to barefoot running reduces running stability not only in the acute phase but also in the longer term. While running stability is a relatively new concept, it enables further insight into the biomechanical influence of footwear.

Increasing the midsole bending stiffness of shoes alters gastrocnemius medialis muscle function during running.

In recent years, increasing the midsole bending stiffness (MBS) of running shoes by embedding carbon fibre plates in the midsole resulted in many world records set during long-distance running competitions. Although several theories were introduced to unravel the mechanisms behind these performance benefits, no definitive explanation was provided so far. This study aimed to investigate how the function of the gastrocnemius medialis (GM) muscle and Achilles tendon is altered when running in shoes with increased MBS. Here, we provide the first direct evidence that the amount and velocity of GM muscle fascicle shortening is reduced when running with increased MBS. Compared to control, running in the stiffest condition at 90% of speed at lactate threshold resulted in less muscle fascicle shortening (p = 0.006, d = 0.87), slower average shortening velocity (p = 0.002, d = 0.93) and greater estimated Achilles tendon energy return (p ≤ 0.001, d = 0.96), without a significant change in GM fascicle work (p = 0.335, d = 0.40) or GM energy cost (p = 0.569, d = 0.30). The findings of this study suggest that running in stiff shoes allows the ankle plantarflexor muscle-tendon unit to continue to operate on a more favourable position of the muscle's force-length-velocity relationship by lowering muscle shortening velocity and increasing tendon energy return.

A center of pressure progression model for walking with non heeled and heeled footwear.

BACKGROUND: Heeled footwear benefits people with movement disorder in the form of shoe lifts, wedges and inserts while its prolonged use causes foot injury in healthy people. There lies a need to detect parameters that affect COP progression of the foot and gait stability due to footwear. RESEARCH QUESTION: Do we have bipedal models that can estimate gait parameters corresponding to different center of pressure (COP) trajectories? METHOD: In this study, we propose a COP translation model that can account for non heeled to heeled footwear. We describe the COP progression as a function of the center of mass (COM) state. This model is used to generate stable steady state walking solutions for different COP profiles. We compare these model solutions with experimental data on non-heeled and heeled-gait. RESULTS: The bipedal model shows stability across different COP profiles. The model estimates GRF profile (R2=0.83 for 1.3 m/s ) for non heeled normal walking qualitatively and on the temporal scale. It estimates GRF due to heeled gait (R2=0.83 for 1.08 m/s) but is limited in estimation of heeled gait parameters. SIGNIFICANCE: A bipedal model that can generate stable steady state walking solutions for different forward progressing COP profiles can help in design of foot orthotics for patients with gait disorder and understand injuries occurring due to prolonged wear of rigid heeled footwear.

Does running speed affect the response of joint level mechanics in non-rearfoot strike runners to footwear of varying longitudinal bending stiffness?

BACKGROUND: Modifying the longitudinal bending stiffness (LBS) of footwear has become a popular method to improve sport performance. It has been demonstrated to influence running economy by altering lower extremity joint level mechanics. Previous studies have only examined within-participant effects at one running speed. RESEARCH QUESTION: Do joint level mechanics differ in response to varying footwear LBS at a range of running speeds? METHODS: This study utilized a cross-sectional repeated measure study design using a convenience sample. Ten well trained non-rearfoot strike male distance runners ran at 3.89, 4.70, and 5.56 m/s (14, 17, 20 km/hr) in footwear of three different LBS levels. Mechanics and energetics of the metatarsophalangeal joint (MTPJ), ankle, knee, and hip joints during stance phase were assessed using an 8-camera optical motion capture system (fs = 200 Hz), a force instrumented treadmill (fs = 1000 Hz) and standard inverse dynamics theory. RESULTS: Range of motion and negative work decreased and angular stiffness increased for the MTPJ with increasing LBS at all speeds (p < .001). Peak MTPJ moment did not change at any speed in response to increased LBS. Negative work at the ankle decreased in the stiff shoe at 17 km/hr (p = .036). Peak ankle plantar flexion velocity decreased with increasing LBS at all speeds (p < .05). SIGNIFICANCE: While changes in MTPJ mechanics were consistent across speeds, decreased negative ankle work was only observed at 17 km/hr in the stiff shoe, suggesting that perhaps tuned footwear LBS may need to focus primarily on metabolically beneficial changes in ankle plantar flexor mechanical behavior to improve performance in distance runners. Tuning footwear stiffness may also be beneficial to clinical populations, as clinicians seek to optimize their patients' locomotion economy.

Barefoot walking changed relative timing during the support phase but not ground reaction forces in children when compared to different footwear conditions.

BACKGROUND: There is a paucity of available biomechanical kinetic data comparing shod and barefoot conditions in children. RESEARCH QUESTION: Do children wearing footwear have comparable gait velocity, ground reaction forces (GRF), spatiotemporal parameters, propulsive and braking impulses when compared to children walking barefoot? METHODS: Seventy-five children were divided into four groups: Group 1 females aged 4-9 years old (n = 29). Group 2 females aged 3-5 years old (n = 16). Group 3 males aged 6-9 years old (n = 13). Group 4 males aged 4-8 years old (n = 17). Children walked at a self-selected pace over a walkway of force platforms. Each footwear and barefoot represented a separate condition. The order of conditions was randomized. A repeated-measures ANOVA was performed to investigate the effects of the footwear type on gait parameters in each group. Multiple comparisons with Bonferroni corrections were conducted when appropriate. RESULTS: There were no statistical differences in velocity or in vertical and anteroposterior GRF across conditions for all groups. There was a significant effect of the footwear worn on time to loading response peak (p = 0.008), time to midstance force (p = 0.006), and time to propulsive peak (p < 0.001). For Group 3, there was a significant effect of the footwear worn on time to braking peak (p < 0.001) and time to propulsive peak (p < 0.001). Regarding impulses for Group 1, there was a significant effect of the footwear worn on the loading response impulse (p = 0.016) and terminal stance and pre-swing impulse (p = 0.001). For Group 4, there was a significant effect of the footwear worn on the loading response impulse (p = 0.028). SIGNIFICANCE: There is no influence of the evaluated children's footwear on gait velocity or GRF.

Comparing walking biomechanics of older females in maximal, minimal, and traditional shoes.

BACKGROUND: Knee osteoarthritis (OA) is a degenerative joint disease that affects millions of individuals each year. Several biomechanical variables during walking have been identified as risk factors for developing knee OA, including the peak external knee adduction moment (KAM) and the knee flexion angle at initial contact. Many interventions have been studied to help mitigate these risk factors, including footwear. However, it is largely unknown how varying shoe cushioning may affect walking biomechanics related to knee OA risk. RESEARCH QUESTION: What is the effect of maximally and minimally cushioned shoes on walking biomechanics compared to a traditionally cushioned shoe in older females? METHODS: Walking biomechanics in three shoes (maximal, traditional, minimal) were collected on 16 healthy females ages 50-70 using an 8-camera 3D motion capture system and two embedded force plates. Key biomechanical variables related to knee OA disease risk were compared between shoes using repeated measures ANOVAs. RESULTS: The KAM was significantly larger in the maximal shoe (p = 0.005), while the knee flexion angle at initial contact was significantly larger in both the maximal and minimal shoe compared to the traditional shoe (p = .000). Additionally, the peak knee flexion angle (p = .000) and the loading rates of the vertical ground reaction force were (instantaneous: p = 0.001; average: p = .010) were significantly higher in the minimal shoe. SIGNIFICANCE: While these results are specific to the shoes used in this study, clinicians should exercise caution in prescribing maximal or minimal shoes to females in this age group who may be at risk of knee OA given these results. Research is needed on the effect of these shoes in patients with knee OA.

Toe gaps and their assessment in footwear for people with diabetes: a narrative review.

BACKGROUND: Adequate footwear fit is critical in preventing diabetes-related foot ulcers. One important element is the toe gap, the difference between foot length and internal footwear length available to the foot. We summarised the literature on toe gaps in studies assessing footwear worn by people with diabetes, the methods used to measure both foot length and internal footwear length and identify ambiguities which may impact on toe gap assessment in clinical practice, and suggest pragmatic solutions. METHODS: The Google Scholar database was searched to April 2020 for peer-reviewed studies using keywords related to incorrectly fitting or ill-fitting and diabetes, foot and ulcer which returned 979 results. Included studies within this narrative review encompassed toe gap measurement to assess footwear worn by people with diabetes. RESULTS: A total of eight studies were included after full paper review. Toe gap ranges as used in assessments of footwear worn by people with diabetes vary, with a minimum of 1.0-1.6 cm and a maximum of 1.5-2.0 cm, as do methods of measuring internal footwear length. Only three published studies suggested possible measuring devices. CONCLUSIONS: Toe gap ranged as used when assessing footwear fit in people with diabetes vary and a gold standard device for internal footwear length measurement has yet to emerge. International guidelines provide welcome standardisation, but further research is needed to evaluate both the effect of toe gap ranges upon pressure, plantar stress response and ulceration and available measuring devices to facilitate development of toe gap measurement protocols that may further enhance consistency in practical assessments.

Acute shoe effects on Achilles tendon loading in runners with habitual rearfoot strike pattern.

OBJECTIVES: Although the overuse injury rate of the Achilles tendon (AT) for running is high, the effect of shoe conditions on AT loading remains unclear. Hence, this study aims to determine the mechanical properties of AT during running under different shoe conditions (minimalist vs. conventional shoes). DESIGN: This work is a controlled laboratory study. METHODS: Sixteen healthy male rearfoot strike runners were recruited to complete over ground running trials at 3.33 m/s (±5%) under two shoe conditions (minimalist shoes: INOV-8 Bare-XF 210; conventional shoes: NIKE AIR ZOOM PEGASUS 34). Sagittal plane ankle kinematics and ground reaction forces were simultaneously recorded. Ankle joint mechanics (ankle joint angle and moment) and the mechanical properties (peak force, impulse, stress, strain, and their corresponding peak rate) of the AT were calculated. RESULTS: In comparison with conventional shoes, wearing minimalist shoes showed significant changes (p < 0.05): (1) decreased strike angle (48.92 ±â€¯9.01 vs. 41.04 ±â€¯8.69°); (2) increased ankle moment (2.34 ±â€¯0.44 vs. 2.55 ±â€¯0.46 Nm/kg); (3) increased peak AT force (5.85 ±â€¯1.22 vs. 6.24 ±â€¯1.13 BW), AT force impulse (0.65 ±â€¯0.13 vs. 0.70 ±â€¯0.13 BW·s), peak AT loading rate (109.94 ±â€¯9.33 vs. 118.84 ±â€¯26.62 BW/s), and average loading rate (48.42 ±â€¯15.64 vs. 54.90 ±â€¯17.47 BW/s); (4) decreased time to peak AT force (126.31 ±â€¯20.68 vs. 117.77 ±â€¯17.62 ms); (5) increased AT stress (66.96 ±â€¯14.59 vs. 71.89 ±â€¯14.74 MPa), strain (8.19 ±â€¯1.77 vs. 8.78 ±â€¯1.80 %), peak AT stress rate (66.96 ±â€¯14.59 vs. 71.89 ±â€¯14.74 MPa/s), and strain rate (148.71 ±â€¯48.52 vs. 167.28 ±â€¯42.82 %/s). CONCLUSION: Increased AT force, loading rate, and stress were observed in runners who habitually wear conventional shoes with rearfoot strike patterns when they wore minimalist shoes. Hence, we recommend a gradual transition to minimalist shoes for runners who habitually wear conventional shoes with rearfoot strike patterns.

Efficacy of Electronic Acupuncture Shoes for Chronic Low Back Pain: Double-Blinded Randomized Controlled Trial.

BACKGROUND: Chronic low back pain is a common problem and is associated with high costs, including those related to health care and indirect costs due to absence at work or reduced productivity. Previous studies have demonstrated that acupuncture or electroacupuncture can relieve low back pain. Electronic acupuncture shoes (EAS) are a novel device designed in this study. This device combines the properties of acupuncture and transcutaneous electrical nerve stimulation for clinical use. OBJECTIVE: The aim of this study was to evaluate the efficacy of EAS in patients with chronic low back pain. METHODS: In this prospective double-blinded randomized controlled study, the data of 83 patients who experienced chronic low back pain were analyzed. Patients came to our clinic for 20 visits and underwent assessment and treatment. Patients were randomly allocated to receive either EAS plus placebo nonsteroidal anti-inflammatory drugs (NSAIDs) (EAS group, n=42) or sham EAS plus NSAIDs (NSAID group, n=41). The visual analog scale (VAS) score and range of motion were assessed at baseline, before and after each EAS treatment, and 2 weeks after the last treatment. The time for achieving pain remission was recorded. Quality of life was assessed at the 2nd, 14th, and 20th visits. RESULTS: After 6 weeks of treatment, the treatment success rate in each visit in the EAS group was higher than that in the NSAID group, as revealed by the intention-to-treat (ITT) and per-protocol (PP) analyses, but significant differences were observed only during the 16th visit in the ITT analysis (EAS group: 31/37, 84% and NSAID group: 21/34, 62%; P=.04). The change in the VAS score from baseline in each visit in the EAS group was greater than that in the NSAID group, as revealed by the ITT and PP analyses, and significant differences were observed in the 5th visit and 9th visit in the ITT analysis (P=.048 and P=.048, respectively). Significant differences were observed in the left rotation in the 2nd visit and 4th visit (P=.049 and P=.03, respectively). No significant differences were observed in the VAS score before and after treatment in each visit and in the quality of life in both groups. CONCLUSIONS: EAS might serve as a reliable alternative therapeutic tool for patients with chronic low back pain who are contraindicated for oral NSAIDs. TRIAL REGISTRATION: ClinicalTrials.gov NCT02468297 https://clinicaltrials.gov/ct2/show/NCT02468297.

Effect of awareness of being monitored on wearing of orthopaedic footwear.

OBJECTIVE: To investigate the effect of awareness of being monitored on wearing time and adherence to wearing orthopaedic footwear. Quantitative assessment of wearing time was made using direct measurement with temperature sensors during the first 3 months after provision of footwear. DESIGN: Randomized controlled trial. INTERVENTION: Awareness that the temperature sensor is used for measuring wearing time. METHODS: All 55 participants had a temperature sensor built into the medial arch of the left insole of their orthopaedic footwear. Participants were assigned randomly to either an "awareness group" (n = 25, mean age 67 years) and knew they were being monitored for wearing time, or a "no awareness group" (n = 30, mean age 65 years) and only knew their shoe temperature was being measured. Differences were assessed with a linear mixed model. RESULTS: Mean (standard deviation; SD) wearing time in the intervention group was 7.32 h/day (SD 4.2), and 6.11 h/day (SD 4.1) in the control group (p = 0.017). A significant interaction effect was found between awareness and pathology group on wearing time (p = 0.036). The difference was especially large (7.0 (SD 4.7) vs 2.4 (SD 2.2) h/day) in the subgroup of people with diabetes. CONCLUSION: Awareness of being monitored increases wearing time and wearing of orthopaedic footwear.

Influence of running shoes on muscle activity.

Studies on the paradigm of the preferred movement path are scarce, and as a result, many aspects of the paradigm remain elusive. It remains unknown, for instance, how muscle activity adapts when differences in joint kinematics, due to altered running conditions, are of low / high magnitudes. Therefore, the purpose of this work was to investigate changes in muscle activity of the lower extremities in runners with minimal (≤ 3°) or substantial (> 3°) mean absolute differences in the ankle and knee joint angle trajectories when subjected to different running footwear. Mean absolute differences in the integral of the muscle activity were quantified for the tibialis anterior (TA), peroneus longus (PL), gastrocnemius medialis (GM), soleus (SO), vastus lateralis (VL), and biceps femoris (BF) muscles during over ground running. In runners with minimal changes in 3D joint angle trajectories (≤ 3°), muscle activity was found to change drastically when comparing barefoot to shod running (TA: 35%; PL: 11%; GM: 17%; SO: 10%; VL: 27%; BF: 16%), and minimally when comparing shod to shod running (TA: 10%; PL: 9%; GM: 13%; SO: 8%; VL: 8%; BF: 12%). For runners who showed substantial changes in joint angle trajectories (> 3°), muscle activity changed drastically in barefoot to shod comparisons (TA: 39%; PL: 14%; GM: 16%; SO: 16%; VL: 25%; BF: 24%). It was concluded that a movement path can be maintained with small adaptations in muscle activation when running conditions are similar, while large adaptations in muscle activation are needed when running conditions are substantially different.