Effectiveness of gait plate insole and lateral sole wedged shoes on foot progression angle in children with in-toeing gait: A prospective randomized control trial.

BACKGROUND: In-toeing gait is defined as the internal rotation of the long axis of the foot to the line of progression. Although most of the time it is corrected spontaneously but sometimes causes torsional misalignment syndrome and maybe patellofemoral instability and arthritis of the knee. RESEARCH QUESTION: What is the effect of gait plate insoles and lateral sole wedged shoes on foot progression angle (FPA) in children with in-toeing? METHOD: In this study, a randomized control trial was conducted with 11 participants (18 feet) who were girls aged between seven and ten years old. They were randomly assigned to either the gait plate group (6 girls, 11 feet) or the lateral sole wedge group (5 girls, 11 feet). The foot progression angle was measured using the RS scanner pressure platform before and after four weeks of intervention, both with and without interventions. The interaction effects of time and group on outcomes were analyzed using Mixed ANOVA and post-hoc complementary tests with a confidence interval of 95%. RESULTS: It was observed that none of the interventions had an immediate impact on the FPA (P > 0.05). However, after four weeks, the FPA increased by 9.96 degrees with the lateral sole wedge and by 3.51 degrees with the gate plate insole. During the immediate and short-term evaluation, no significant difference was noticed between the two groups (P > 0.05). However, there was a large effect size (eta square = 0.269) observed in the time group interaction between the two groups (P = 0.028). SIGNIFICANCE: Conservative methods like using a gait plate insole or modifying shoes with a lateral sole wedge can improve the foot progression angle in children with in-toeing gait. However, longer studies with larger sample sizes are needed to reach a conclusion.

Investigating the effects of volar wrist cock-up splint and dorsal lock wrist hand orthosis in reducing signs of carpal tunnel syndrome.

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy presenting with sharp pain, parenthesis, dysfunction of the hand in coordination and gripping. Splinting is the most common conservative intervention to improve pain and enological symptom of this Syndrome (CTS). With regard to the importance of these interventions and controversies about different designs of splints, the aim of this study was to compare the therapeutic effects of volar wrist cock-up orthosis and dorsal lock wrist hand orthosis on pain, sensory and motor latency in carpal tunnel syndrome. Methods: In this Randomized controlled trial study, 30 patients diagnosed with mild to moderate CTS were recruited. The subjects were randomly divided into two equal groups. Both groups received one form of splints for three weeks. Before receiving the splints, Electromyography (EMG) and Visual analog scale (VAS) were performed. Then, two different designs of splints were used for a period of three weeks. After that, EMG and Numerical Rating Scale (NRS-11) were repeated to reveal the effects of splints on reducing pain, sensory and motor latency in CTS. Independent t and paired t-tests were done uding SPSS software version 19.0. P-value was set at 0.05. Results: All the variables in both groups showed significant improvement. The NRS-11 test was significantly improved in the dorsal lock wrist hand orthosis group (p<0.05). Conclusion: This study showed that the use of the dorsal lock wrist hand orthosis for about three weeks was significantly improved pain and neurological symptoms of patients with CTS because of maintaining the wrist in the neutral position. Knowing this fact helps us to design and make a less cumbersome and restrictive splint with an accurate position for the wrist and distal joints.

A systematic review on the validity and reliability of tape measurement method in leg length discrepancy.

Background: Leg length discrepancy measurement is an essential part of musculoskeletal clinical assessment, and tape measurement is a common clinical method. This study aimed to systematically review the results of the findings of studies on validity and reliability of the tape measurement method and the quality of reporting the literature on this topic. Methods: A search was performed in PubMed, EBSCO, Science Direct, Web of Knowledge, Scopus, Embase, and Google Scholar using selected keywords from inception to December 2017.This systematic review was based on the PRISMA guideline. After a systematic selection process, the quality of the included studies was assessed independently by 2 reviewers using the Brink and Louw Scale for quality assessment. Results: A total of 11 studies were finally considered for this systematic review. Two studies were about the validity of (a measurement tool) studies and 4 were reliability analysis only. Validity and reliability analyses were simultaneously applied to 5 studies. Also, 9 out of 11 studies were deemed to be of high quality based on Brink and Louw Scale. Studies showed high (ICC=0.7) to very high (ICC=0.9) levels of interrater and intrarater reliability. The validity of the methods ranged from low to very high depending on subjects. Conclusion: Tape measurement method has acceptable reliability and validity in healthy people, but it does not have acceptable validity in measuring obese people and patients with musculoskeletal disorders. Thus, using a suitable method for LLD leg length discrepancy measurement seems to be necessary for obese and individuals with leg length discrepancy.

Efficacy of different techniques of AFO construction for hemiplegia patients: A systematic review.

Background: Ankle foot orthoses (AFOs) are frequently prescribed to improve gait deviation and normalize walking pattern in patients with drop foot hemiplegia disorder. This study was to review the efficacy of different techniques of AFO construction and biomechanics parameters of AFOs. Furthermore, this study aimed to provide a guideline for researchers in detail and help them choose a sufficient measurement instrument. Methods: Information sources included MEDLINE, CINAHL, Scopus, PubMed, and the Full Cochrane Library up to December 25, 2015. The inclusion criteria include: (1) type and method of controlled clinical trial studies; (2) age of hemiplegia groups (3); AFOs as an intervention; and (4) kinetic and kinematic parameters, and energy expenditure as an intervention of gait performance. Results: Considering eligibility criteria such as study design, setting, time frame and Language 9 papers with Pedro scores of 5 to 8 for methodological quality were included in the review. Conclusion: The findings of this review can help to develop guidelines for the best AFO reporting as an intervention and to prevent vagueness of results in the different types of AFOs.

Ergonomic Latex Pillows as a Part of a Multimodal Intervention or as an Adjunct to Rehabilitation Programs in Cervical Spondylosis: Are They Useful?: A Randomized Controlled Trial.

OBJECTIVE: This study evaluated the effectiveness of ergonomic latex pillows in terms of clinical and biomechanical (cervical range of motion) outcome measures in patients with cervical spondylosis. DESIGN: This parallel-group randomized controlled trial randomly assigned 42 patients with cervical spondylosis to the experimental and control groups. Both groups received 12 sessions of routine physical therapy for 4 wks. While the experimental group received an ergonomic latex pillow, the control group slept on their own usual pillow during the mentioned 4-wk period. Pain intensity, functional disability, medication use, and cervical range of motion were measured before and after 4 wks of intervention. RESULTS: After 4 wks of intervention, the experimental group showed pain relief, decreased disability, and significantly increased range of motion in all directions. The simultaneous use of an ergonomic latex pillow and physical therapy could more successfully decrease pain intensity compared with routine physical therapy alone. In addition, extension and right lateral flexion variables significantly increased in the experimental group compared with the control group. CONCLUSIONS: The administration of an ergonomic latex pillow can ameliorate treatment outcome in patients with cervical spondylosis.

The Effect of Ergonomic Latex Pillow on Head and Neck Posture and Muscle Endurance in Patients With Cervical Spondylosis: A Randomized Controlled Trial.

OBJECTIVES: Cervical pillows have frequently been reported to attenuate the symptoms of pain and disability. Although the main role of pillows is to optimize head and neck posture and relax the neck muscles, limited studies have examined the effectiveness of pillows from aspects beyond subjective outcome measures, especially their effect on head and neck posture and muscle performance. This study examines the effect of ergonomic latex pillow on the craniovertebral (CV) angle and cervical flexor and extensor muscle endurance in patients with cervical spondylosis. METHODS: This parallel-group, randomized, controlled trial was conducted from January to June 2017. The patients with cervical spondylosis were randomly allocated to the experimental and control groups, who both received identical standard physiotherapy 3 × a week for 4 weeks. The experimental group received an ergonomic latex pillow, but the control group was asked to continue sleeping on their usual pillow. The CV angle and flexor and extensor muscle endurance were measured before and after the intervention. The independent-sample t test was used to compare changes in the CV angle, whereas the Mann-Whitney test was used to compare changes in flexor and extensor muscle endurance between the groups, respectively. RESULTS: The experimental group showed significant changes in the CV angle and extensor muscle endurance. A significant increase was observed in extensor muscle endurance in the experimental group compared with the control group. CONCLUSION: The ergonomic latex pillow may affect neck extensor muscle endurance and CV angle in patients with cervical spondylosis, although further studies are needed before any recommendations.

A preliminary study: The effect of ergonomic latex pillow on pain and disability in patients with cervical spondylosis.

Background: Cervical pillows are considered to be part of the therapeutic strategy in cervical spondylosis, but there is little or no convincing scientific evidence on the effectiveness of these pillows in relieving pain and disability in these patients. Hence, this study investigated the effects of ergonomic latex pillow in conjunction with routine physiotherapy versus routine physiotherapy alone on disability and pain intensity in patients with cervical spondylosis. Methods: 22 patients with cervical spondylosis in a single-blinded pilot study with a pre/post-test design were randomly assigned to experimental and control groups. Both groups received 12 sessions of physiotherapy for four weeks. In the experimental group, participants were given an ergonomic latex pillow to sleep it for four weeks. Participants in the control group slept on their own usual pillow. All the participants filled out the Neck Disability Index questionnaire, and scored their neck pain intensity on the Numerical Pain Rating Scale before and after the intervention. Changes of variables (pain and disability) within and between groups were compared by Paired T-test and the Independent Sample T-test, respectively via SPSS v.20 (p<0.05). Results: Numerical Pain Rating Scale and Neck Disability Index scores were decreased statistically significant within groups. In the experimental group, neck disability scores were significantly lower than those in the control group (p=0.038). However, pain intensity scores were not significantly different between groups. Conclusion: Ergonomic latex pillows can significantly decrease disability related to neck pain in patients with cervical spondylosis after four weeks.

The efficiency of gait plate insole for children with in-toeing gait due to femoral antetorsion.

BACKGROUND: One of the most common gait disorders in children is in-toeing. Few studies have examined the efficacy gait plate insole in in-toeing. we used more precise apparatus than previous studies. OBJECTIVES: The aim of this study was to investigate the immediate effect of gait plate insole on the angle of gait and center of pressure displacement in children with in-toeing gait. STUDY DESIGN: Quasi-experimental before -after study. METHODS: The angle of gait and center of pressure displacement were measured in 17 children aged 4-10 years with in-toeing gait. The RS scan pressure platform was employed to perform walking tests in three conditions including barefoot, with shoes only, and gait plate insole with shoes. RESULTS: The gait plate insole with shoes as well as shoes alone produced a significant 11.1° and 3.85° increase in the angle of gait in in-toeing children respectively ( p < 0.05). The medial-lateral displacement of center of pressure showed a significant difference (3 mm) in shoes only condition when compared with barefoot condition. The shoes only and gait plate insole compared with barefoot condition increased the anterior-posterior displacement by 28 and 30 mm respectively. CONCLUSION: The gait plate insole with ordinary shoes and shoes only were able to increase angle of gait and the center of pressure displacement in the anterior-posterior direction in children with in-toeing gait due to excessive femoral anteversion. Clinical relevance The use of a gait plate insole inserted in ordinary shoes can improve gait appearance in children with in-toeing gait caused by Excessive femoral anteversion.

The influence of foot orthoses on foot mobility magnitude and arch height index in adults with flexible flat feet.

BACKGROUND: Flexible flat foot is described as a reduction in the height of the medial longitudinal arch and may occur from abnormal foot pronation. A foot orthosis is thought to modify and control excessive pronation and improve arch height. OBJECTIVE: To compare the immediate effect of three types of orthoses on foot mobility and the arch height index in subjects with flexible flat feet. STUDY DESIGN: A quasi-experimental study. METHOD: The dorsal arch height, midfoot width, foot mobility and arch height index were assessed in 20 participants with flexible flat feet (mean age = 23.2 ± 3 years) for three different foot orthosis conditions: soft, semi-rigid and rigid University of California Biomechanics Laboratory (UCBL). RESULTS: Maximum midfoot width at 90% with arch mobility in the coronal plane was shown in the semi-rigid orthosis condition. The semi-rigid orthosis resulted in the highest mean foot mobility in 90% of weight bearing, and the rigid orthosis (UCBL) had the lowest mean foot mobility. The soft orthosis resulted in foot mobility between that of the rigid and the semi-rigid orthosis. UCBL orthosis showed the highest arch height index, and the semi-rigid orthosis showed the lowest mean arch height index. CONCLUSION: Due to its rigid structure and long medial-lateral walls, the UCBL orthosis appears to limit foot mobility. Therefore, it is necessary to make an orthosis that facilitates foot mobility in the normal range of the foot arch. Future studies should address the dynamic mobility of the foot with using various types of foot orthoses. CLINICAL RELEVANCE: Although there are many studies focussed on flat foot and the use of foot orthoses, the mechanism of action is still unclear. This study explored foot mobility and the influence of foot orthoses and showed that a more rigid foot orthosis should be selected based on foot mobility.

Immediate effect of orthopedic shoe and functional foot orthosis on center of pressure displacement and gait parameters in juvenile flexible flat foot.

BACKGROUND: Flat foot in children is a common deformity in which the medial longitudinal arch is reduced or eliminated. OBJECTIVES: The objective of this article was to compare flat foot and healthy children on the displacement of the center of pressure and walking parameters in children with two common orthoses (functional foot orthosis and medical shoe). STUDY DESIGN: Comparative study. METHODS: This study included 30 children with flat foot and 20 healthy children as a control group. The step length and width, walking velocity, symmetry, and center of pressure (CoP) displacements were recorded and compared for three conditions: functional foot orthosis and regular shoe, a medical shoe and barefoot. RESULTS: The results from the CoP displacements showed that the regular shoe with functional foot orthosis caused a significant decrease in the level of displacement of the CoP in flat foot children. The findings indicated a significant improvement in symmetry of steps and walking speed with the functional foot orthosis in comparison to the medical shoe in flat foot children. CONCLUSION: The CoP displacement was decreased and the percentage of gait symmetry and walking speed were increased by the use of regular shoes with a functional foot orthosis in comparison to the medical shoes. CLINICAL RELEVANCE: An orthopaedic shoe can be expensive, and in particular heavy with most children reluctant to wear it. This study focussed on the CoP displacement and selected gait parameters with an orthopaedic shoe and functional foot orthosis, and showed that a combined prescription of a functional foot orthosis and with regular shoes may be a useful alternative for children with moderate flat foot.