Effects of insoles adapted in flip-flop sandals in patients with persistent plantar heel pain: A sham-controlled randomised trial.

OBJECTIVE: To evaluate the use of custom-made insoles adapted to flip-flops on pain intensity, foot function, and functional walking ability in individuals with persistent plantar heel pain in the short and medium term. DESIGN: Randomised controlled trial. SETTING: Flip-flop sandals in patients with persistent plantar heel pain. MAIN MEASURES: Participants (n = 80) were assessed at baseline, six and 12 weeks after the intervention, and 4 weeks post-intervention. RESULTS: For the primary outcomes, after 6 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.4 (95% confidence intervals = -1.5 to 0.8). Similarly, after 12 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.7 (95% confidence intervals = -1.9 to 0.6). Finally, at 4 weeks after the end of the intervention, there was no between-group difference in morning pain or pain on walking, mean difference = 0.01 (95% confidence intervals = -1.4 to 1.4). All differences and confidence intervals were smaller than the minimum clinically important difference for pain (2 points). There were no differences between the groups for the secondary outcomes. In addition, the mean differences were smaller than the minimum clinically important differences for pain intensity, foot function and functional walking ability. CONCLUSION: Custom-made insoles fitted to flip-flops did not differ from flip-flops with sham insoles in improving pain intensity, foot function and functional walking ability in people with persistent heel pain.Trial registration: ClinicalTrials.gov (Identifier: NCT04784598). Data of registration: 2023-01-20.

The effects of foot orthoses on radiological parameters and pain in children with flexible flat feet: a systematic review and meta-analysis.

Objective: This study aimed to investigate the impact of foot orthoses on foot radiological parameters and pain in children diagnosed with flexible flatfoot. Methods: A comprehensive search was conducted across several databases, including PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO, covering publications from the inception of each database up to 8 June 2024. The study focused on randomized controlled trials investigating the use of foot orthoses for treating flexible flat feet in children. Four researchers independently reviewed the identified literature, extracted relevant data, assessed the quality of the studies, and performed statistical analyses using RevMan 5.4 software. Results: Six studies involving 297 participants were included. The methodological quality of the included literature ranged from moderate to high. Radiological parameters of the foot improved significantly in older children with flexible flat feet following foot orthotic intervention compared to controls, particularly in the lateral talar-first metatarsal angle [mean difference (MD) = -2.76, 95% confidence interval (95% CI) -4.30 to -1.21, p = 0.0005], lateral talo-heel angle (MD = -5.14, 95% CI -7.76 to -2.52, p = 0.0001) and calcaneal pitch angle (MD = 1.79, 95% CI 0.88-2.69, p = 0.0001). These differences were statistically significant. Additionally, foot orthoses significantly improved the ankle internal rotation angle and reduced foot pain in children with symptomatic flexible flatfoot (MD = -2.51, 95% CI -4.94 to -0.07, p = 0.04). Conclusion: The use of foot orthoses positively impacts the improvement of radiological parameters of the foot and reduces pain in older children with flexible flat feet. However, in younger children with flexible flat feet, the improvement from foot orthoses was not significant, likely due to challenges in radiological measurements caused by the underdevelopment of the ossification centers in the foot. Further studies are needed. Consequently, the results of this meta-analysis support the implementation of an early intervention strategy using foot orthoses for the management of symptomatic flat feet in older children. Systematic Review Registration: https://www.crd.york.ac.uk/, PROSPERO [CRD42023441229].

The experiences of podiatrists prescribing custom foot orthoses and patients using custom foot orthoses for foot pain management in the United Kingdom: A focus group study.

INTRODUCTION: Foot pain can be a significant burden for patients. Custom foot orthoses (CFOs) have been a mainstay in podiatry treatment for foot pain management and improving foot function. However, little is known about podiatrists' experience of prescribing CFOs or patient experience of using foot orthoses (FOs), including CFOs, for foot pain. METHODS: A focus group (FG) discussion with three FOs users (Female = 2 and Male = 1) was conducted in November 2022 within a private podiatry practice. This group represented non-experts from the general local population of individuals with existing or previous foot pain who have personally experienced using either over-the-counter FOs or CFOs. An online FG discussion with five musculoskeletal (MSK) specialist podiatrists (Female = 2 and Male = 3) was also conducted in December 2022. This group represented podiatrists with specialist knowledge in foot biomechanics and clinical experience in CFO provision. The FG discussions were recorded and lasted 49 and 57 min respectively. Transcribed data was manually coded, and a thematic analysis was undertaken to identify patterns within the collected data. RESULTS: The participants in the patient FG detailed mixed experiences of the prescription process and CFOs received, with reports of limited involvement/input in their prescription, the need for frequent adjustments and high costs. The impact on footwear choices, replicability and transferability of CFOs into different types of shoes and technologies to aid design were also highlighted. In the podiatrist FG, lack of confidence in design and manufacture processes, prescription form language, relationship and communication building with manufacturers, variability in the CFOs issued and the need for better student education in CFO provision emerged as key themes. CONCLUSION: Patients and podiatrists shared similar views on CFO provision, namely poor communication with manufacturers leading to dissatisfaction with the CFOs prescribed causing negative impacts on patient experiences. Podiatrists called for greater education at registration level to increase new graduate podiatrist knowledge in CFO design and manufacture and better collaboration with manufacturing companies.

Low Back Pain Caused by Traction Peripheral Neuropathy Due to Chronic Ankle Instability: Three Clinical Cases.

Non-specific low back pain without identifiable causes on imaging is a common and frustrating problem for both patients and physicians. While proximal symptoms such as shoulder pain from distal upper extremity neuropathies such as carpal tunnel syndrome are well-known, peripheral neuropathy of the foot or ankle is rarely considered in the differential diagnosis for low back pain. This study aims to highlight the potential link between chronic ankle instability (CAI) and low back pain. We present three cases: a 32-year-old woman with chronic low back pain for over 10 years, a 59-year-old woman with transient low back pain after long drives, and a 42-year-old woman with acute low back pain while gardening. All patients had normal imaging studies but exhibited CAI on examination. Diagnostic modalities included the ankle anterior drawer test, application of ankle brace, superficial peroneal nerve (SPN) blocks, and assessment of the active straight leg raise (aSLR) angle. In the first case, low back pain disappeared after SPN neurolysis and ankle ligament reconstruction. The second case showed significant improvement in aSLR and pain reduction with SPN block and ankle brace. The third case experienced substantial pain relief with the use of an ankle brace. These findings suggest that addressing ankle instability and associated traction neuropathy can significantly alleviate low back pain symptoms. CAI may be an underrecognized cause of non-specific low back pain. Interventions such as ankle brace, SPN blocks, SPN decompression, and ankle ligament reconstruction can be effective for diagnosis and treatment, potentially offering relief for patients with chronic low back pain.

Physicians' experiences with indications and prescriptions of foot orthoses-A cross-sectional study in northern Germany.

Background: Foot orthoses (FOs) are prescribed by general practitioners (GPs) and orthopedic surgeons for various complaints. As there are very limited medical guidelines and checklists, the prescription of FOs is often inconsistent. Therefore, our study to evaluate the general prescription behavior and indication experiences with FOs from the perspective of GPs and orthopedists. Methods: A survey was carried out using a questionnaire from October to December 2021. GPs and orthopedic surgeons in northern Germany were included. The focus of the survey was to examine which foot problems would lead GPs and orthopedic surgeons to prescribe FOs and to evaluate what factors these physicians included in their diagnostic analysis. Apart from descriptive analyses, a stepwise linear regression analysis was performed to explore potential associations of the primary outcome variable 'specific effect on the prescription of FOs', which was introduced to shed light upon the estimated added value of the prescription of FOs. Results: Out of the 790 questionnaires distributed, 184 questionnaires were returned by GPs (n = 95) and orthopedic surgeons (n = 74) (response rate 23 %). FOs were most frequently prescribed for talipes valgus (96 %) and heel spur (54 %). Diagnostic analysis was mainly carried out clinically. Custom-made FOs (82 %) were prescribed more frequently than prefabricated FOs (6 %). Regular interaction within the prescription process was most commonly with orthopedic technicians (61 %). The estimation of the specific effect on FO prescription was assessed by a mean of 66 % of the participants, 82 % recommended self-exercises as an additional therapy. Conclusions: FOs are a specific and well-established aid prescribed by many GPs and orthopedic surgeons for a variety of foot complaints. Despite being one of the most frequently prescribed orthopedic devices, the utilization of FOs is predominantly explorative due to a growing but nevertheless still deficient body of well-researched evidence. There is a clear need for a uniform approach to the indication and prescription of FOs among physicians.

Cytocompatibility of Polymers for Skin-Contact Applications Produced via Pellet Extrusion.

Orthoses and prostheses (O&P) play crucial roles in assisting individuals with limb deformities or amputations. Proper material selection for these devices is imperative to ensure mechanical robustness and biocompatibility. While traditional manufacturing methods have limitations in terms of customization and reproducibility, additive manufacturing, particularly pellet extrusion (PEX), offers promising advancements. In applications involving direct contact with the skin, it is essential for materials to meet safety standards to prevent skin irritation. Hence, this study investigates the biocompatibility of different thermoplastic polymers intended for skin-contact applications manufactured through PEX. Surface morphology analysis revealed distinct characteristics among materials, with TPE-70ShA exhibiting notable irregularities. Cytotoxicity assessments using L929 fibroblasts indicated non-toxic responses for most materials, except for TPE-70ShA, highlighting the importance of material composition in biocompatibility. Our findings underscore the significance of adhering to safety standards in material selection and manufacturing processes for medical devices. While this study provides valuable insights, further research is warranted to investigate the specific effects of individual ingredients and explore additional parameters influencing material biocompatibility. Overall, healthcare practitioners must prioritize patient safety by meticulously selecting materials and adhering to regulatory standards in O&P manufacturing.

Immediate Effects of Wearing an Ankle Bandage on Fine Coordination, Proprioception, Balance and Gait in the Subacute Phase of Ankle Sprains.

Ankle sprains are the most frequently occurring musculoskeletal injuries among recreational athletes. Ankle support through bandages following the initial orthotic treatment might be beneficial for rehabilitation purposes. However, the literature is sparse regarding the use of an ankle support directly after the acute phase of an ankle sprain. Therefore, this study investigates the hypothesis that wearing an ankle bandage immediately after an acute ankle sprain improves motor performance, stability and reduces pain. In total, 70 subjects with acute unilateral supination trauma were tested. Subjects were tested five weeks post-injury to assess immediate effects of the ankle bandage. On the testing day, subjects completed rating questionnaires and underwent comprehensive biomechanical assessments. Biomechanical investigations included fine coordination and proprioception tests, single leg stances, the Y-Balance test, and gait analysis. All biomechanical investigations were conducted for the subject's injured leg with and without a bandage (MalleoTrain® Bauerfeind AG, Zeulenroda-Triebes, Germany) and the healthy leg. Results indicated moderate to strong improvements in ankle stability and pain relief while wearing the bandage. Wearing the bandage significantly normalized single leg stance performance (p < 0.001), stance phase duration (p < 0.001), and vertical ground reaction forces during walking (p < 0.05). However, the bandage did not have a clear effect on fine coordination and proprioception. The findings of our study suggest that ankle bandages may play a crucial role in early-stage rehabilitation by enhancing motor performance and reducing pain.

Textured insoles may improve some gross motor balance measures but not endurance measures in children with motor coordination issues. A randomised controlled feasibility trial.

BACKGROUND: Motor coordination concerns are estimated to affect 5%-6% of school-aged children. Motor coordination concerns have variable impact on children's lives, with gait and balance often affected. Textured insoles have demonstrated positive impact on balance and gait in adults with motor coordination disorders related to disease or the ageing process. The efficacy of textured insoles in children is unknown. Our primary aim was to identify the feasibility of conducting a randomised controlled trial involving children with motor control issues. The secondary aim was to identify the limited efficacy of textured insoles on gross motor assessment balance domains and endurance in children with movement difficulties. METHODS: An assessor-blinded, randomised feasibility study. We advertised for children between the ages of 5-12 years, with an existing diagnosis or developmental coordination disorder or gross motor skill levels assessed as 15th percentile or below on a norm-referenced, reliable and validated scale across two cities within Australia. We randomly allocated children to shoes only or shoes and textured insoles. We collected data across six feasibility domains; demand (recruitment), acceptability (via interview) implementation (adherence), practicality (via interview and adverse events), adaptation (via interview) and limited efficacy testing (6-min walk test and balance domain of Movement ABC-2 at baseline and 4 weeks). RESULTS: There were 15 children randomised into two groups (eight received shoes alone, seven received shoes and textured insoles). We experienced moderate demand, with 46 potential participants. The insoles were acceptable, however, some parents reported footwear fixture issues requiring modification. The 6-min walk test was described as problematic for children, despite all but one child completing. Social factors impacted adherence and footwear wear time in both groups. Families reported appointment locations and parking impacting practicality. Underpowered, non-significant small to moderate effect sizes were observed for different outcome measures. Improvement in balance measures favoured the shoe and insole group, while gait velocity increase favoured the shoe only group. CONCLUSION: Our research indicates that this trial design is feasible with modifications such as recruiting with a larger multi-disciplinary organisation, providing velcro shoe fixtures and using a shorter timed walk test. Furthermore, progressing to a larger well-powered randomised control trial is justified considering our preliminary, albeit underpowered, efficacy findings. TRIAL REGISTRATION: This trial was retrospectively registered with the Australian and New Zealand Clinical Trial Registration: ACTRN12624000160538.

The effect of elderly-specific spinal orthoses on muscle function and kyphosis angle in elderly subjects: systematic review and meta-analysis.

PURPOSE: Age-related postural hyper-kyphosis is an exaggerated anterior curvature of the thoracic spine, that impairs balance and increases the risk of falls and fractures in elderly subjects. Our objectives are to review the effect of elderly-specific spinal orthoses on muscle function and kyphosis angle in this subjects. MATERIALS AND METHODS: We searched PubMed, Scopus, ISI web of Knowledge, ProQuest and Cochrane library to identify relevant studies that assessed efficacy of spinal orthoses on muscle function and kyphosis angle of elderly subjects with elderly with hyper-kyphosis. Quality assessment was implemented using the Downs and Black scale. RESULTS: Results for 709 individuals were described in 18 articles which 12 studies involved RCT. There was significant difference for kyphosis angle after use of orthosis of 148 participants (SMD: -3.79, 95% CI -7.02 to -0.56, p < 0.01). Except one study, all of studies showed significantly increased on the back muscle strength when the participants wore the spinal orthosis and this effect was significantly better in long-term follow up (MD: 84.73; 95% CIs, 23.24 to 146.23; p < 0.01). In the outcome of pain, the efficacy brought by orthosis was large and significant (SMD: -1.66; 95% CIs, -2.39 to 0.94; p < 0.01). CONCLUSIONS: Spinal orthosis may be an effective treatment for elderly hyper-kyphosis. However, the small number, and heterogeneity of the included studies, indicate that higher-quality studies should be conducted to verify the effectiveness and orthosis in hyper-kyphosis.

Age-related postural hyper kyphosis is an exaggerated anterior curvature of the thoracic spine, that impairs balance and increases the risk of falls and fractures in elderly subjects.Based on the findings of this review, elderly specific spinal orthoses may be recommended as effective device for elderly hyper kyphotic subjects.Spinal orthoses prescription is important for health practitioners to consider when planning treatment.

The impact of shoes versus ankle-restricted orthoses on sit-to-stand kinematics and centre of mass trajectories in adults with myelomeningocele.

BACKGROUND: Individuals with myelomeningocele (MMC) present with neurological and orthopaedic deficiencies, requiring orthoses during walking. Orthoses for counteracting dorsiflexion may restrict activities such as rising from a chair. RESEARCH QUESTION: How are sit-to-stand (STS) movements performed with ankle joint-restricted ankle-foot orthoses (AFO) and knee-ankle-foot orthoses with a free-articulated knee joint (KAFO-F)? METHODS: Twenty-eight adults with MMC, mean age 25.5 years (standard deviation: 3.5 years), were divided into an AnkleFree group (no orthosis or a foot orthosis) and an AnkleRestrict group (AFOs or KAFO-Fs). Study participants performed the five times STS test (5STS) while their movements were simultaneously captured with a three-dimensional motion system. Centre of mass (CoM) trajectories and joint kinematics were analysed using statistical parametric mapping. RESULTS: The AnkleRestrict group performed the STS slower than the AnkleFree group, median 8.8 s (min, max: 6.9, 14.61 s) vs 15.0 s (min, max: 7.5, 32.2 s) (p = 0.002), displayed reduced ankle dorsiflexion (mean difference: 6°, p = 0.044) (74-81 % of the STS cycle), reduced knee extension (mean difference: 14°, p = 0.002) (17-41 % of the STS cycle), larger anterior pelvic tilt angle (average difference: 11°, p = 0.024) (12-24 % of the STS cycle), and larger trunk flexion angle (on average 4°, p = 0.029) (6-15 % of the STS cycle). SIGNIFICANCE: The differences between the AnkleFree and AnkleRestrict groups in performing the STS seem consistent with the participants functional ambulation: community ambulation in the AnkleFree group, and household and nonfunctional ambulation with less hip muscle strength in the majority of the AnkleRestrict group. No differences in the 5STS CoM trajectories or the kinematics were found with respect to the AFO and KAFO-Fs groups. Because orthoses are constructed to enable walking, the environment needs to be adjusted for activities in daily living such as the STS movement.

[Patellofemoral instability in children and adolescents]. / Patellofemorale Instabilität bei Kindern und Jugendlichen.

Patellofemoral instability is a common and clinically relevant disorder of multifactorial causes. Several concomitant problems such as genua valga, hyperlaxity, injuries or sports-related overuse may contribute to the development of instability and recurrent patellar dislocations. A thorough diagnosis is of paramount importance to delineate every contributing factor. This includes radiographic modalities and advanced imaging such as magnetic resonance imaging or torsional analyses. The authors recommend non-operative management (including physiotherapy, gait and proprioceptive training, orthoses) and, whenever non-operative measures fail, surgical patellar stabilization using, e.g. MPFL reconstruction.

Comparison of the effectiveness of peloid therapy and kinesiotaping in patients with unilateral plantar fasciitis: A prospective, randomized controlled study.

Objectives: This study aimed to compare the efficacy of peloid therapy and kinesiotaping for unilateral plantar fasciitis (PF). Patients and methods: In the randomized controlled study, a total of 114 patients (89 females, 25 males; mean age: 45.1±8.3 years; range, 27 to 65 years) diagnosed with unilateral PF between January 2021 and March 2023 were randomly divided into three equal groups: the peloid group (peloid therapy and home-based exercise + heel pad), the kinesiotaping group (kinesiotaping and home-based exercise + heel pad), and the control group (home-based exercise + heel pad). Peloid therapy was performed over two weeks for a total of 10 sessions. Kinesiotaping was applied four times over two weeks. Plantar fascia, calf, and Achilles stretching exercises and foot strengthening exercises were performed, and prefabricated silicone heel insoles were used daily for six weeks. Patients were evaluated three times with clinical assessment scales for pain, the Heel Tenderness Index, and the Foot and Ankle Outcome Score before treatment, at the end of treatment, and in the first month after treatment. Results: Statistically significant improvements were observed for all parameters at the end of treatment and in the first month after treatment compared to the baseline in every group (p<0.001). No superiority was found between the groups. Conclusion: Peloid therapy or kinesiotaping, given as adjuncts to home-based exercise therapy and shoe insoles in patients with unilateral PF, did not result in additional benefits.

Footwear, Orthoses, and Insoles and Their Effects on Balance in Older Adults: A Scoping Review.

BACKGROUND: Footwear, orthoses, and insoles have been shown to influence balance in older adults; however, it remains unclear which features, singular or in combination, are considered optimal. The aim of this scoping review was to identify and synthesise the current evidence regarding how footwear, orthoses, and insoles influence balance in older adults. Four electronic databases (MEDLINE, CINAHL, Embase, and AMED) were searched from inception to October 2023. Key terms such as "shoe*," "orthoses," "postural balance" and "older people" were employed in the search strategy. Studies meeting the following criteria were included: (i) participants had a minimum age ≥60 years, and were free of any neurological, musculoskeletal, and cardiovascular diseases; (ii) an active intervention consisting of footwear, foot orthoses, or insoles was evaluated; and (iii) at least one objective outcome measure of balance was reported. SUMMARY: A total of 56 studies from 17 different countries were included. Three study designs were utilised (cross-sectional study, n = 44; randomised parallel group, n = 6; cohort study n = 6). The duration of studies varied considerably, with 41 studies evaluating immediate effects, 14 evaluating effects from 3 days to 12 weeks, and 1 study having a duration of 6 months. Seventeen different interventions were evaluated, including/consisting of textured insoles (n = 12), heel elevation (n = 8), non-specific standardised footwear and changes in sole thickness or hardness (n = 7 each), sole geometry or rocker soles, contoured or custom insoles and high collar height (n = 6 each), insole thickness or hardness and vibrating insoles (n = 5 each), outsole tread (n = 4), minimalist footwear and slippers (n = 3 each), balance-enhancing shoes, footwear fit, socks, and ankle-foot orthoses (n = 2 each), and eversion insoles, heel cups, and unstable footwear (n = 1 each). Twenty-three different outcomes were assessed, and postural sway was the most common (n = 20), followed by temporo-spatial gait parameters (n = 17). There was uncertainty regarding intervention effectiveness. Overall, features such as secure fixation, a textured insole, a medium-to-hard density midsole and a higher ankle collar, in isolation, were able to positively impact balance. Conversely, footwear with an elevated heel height and the use of socks and slippers impaired balance. KEY MESSAGES: There is a substantial body of literature exploring the effects of footwear, orthoses, and insoles on balance in older adults. However, considerable uncertainty exists regarding the efficacy of these interventions due to variability in methodological approaches. Further high-quality research is necessary to determine whether a singular intervention or a combination of interventions is most effective for enhancing balance in older adults.

Clinical and biomechanical characteristics of responders and non-responders to insoles in individuals with excessive foot pronation during walking.

This study aimed to identify the clinical and biomechanical factors of subjects with excessive foot pronation who are not responsive (i.e., "non-responders") to medially wedged insoles to increase knee adduction external moment. Ankle dorsiflexion range of motion, forefoot-shank alignment, passive hip stiffness, and midfoot passive resistance of 25 adults with excessive bilateral pronation were measured. Also, lower-limb angles and external moments were computed during walking with the participants using control (flat surface) and intervention insoles (arch support and 6° medial heel wedge). A comparison between "responders" (n = 34) and "non-responders" (n = 11) was conducted using discrete and continuous analyses. Compared with the responders, the non-responders had smaller forefoot varus (p = 0.014), larger midfoot passive internal torque peak (p = 0.005), and stiffness measured by the torsimeter (p = 0.022). During walking, non-responders had lower angle peaks for forefoot eversion (p = 0.001), external forefoot rotation (p = 0.037), rearfoot eversion (p = 0.022), knee adduction (p = 0.045), and external hip rotation (p = 0.022) and higher hip internal rotation angle peak (p = 0.026). Participants with small forefoot varus alignment, large midfoot passive internal torque, stiffness, small knee valgus, hip rotated internally, and foot-toed-in during walking did not modify the external knee adduction moment ("non-responders"). Clinicians are advised to interpret these findings with caution when considering the prescription of insoles. Further investigation is warranted to fully comprehend the response to insole interventions among individuals with specific pathologies, such as patellofemoral pain and knee osteoarthritis (OA).

Effects of foot exercises and customized arch support insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot: A randomized controlled trial.

BACKGROUND: Exercises strengthening foot muscles and customized arch support insoles are recommended for improving foot posture in flexible flatfoot. However, it is not known what the effects of exercises and insoles on plantar force distribution obtained during walking at different speeds. Also, randomized controlled trials comparing the effects of exercises and insoles are limited. RESEARCH QUESTION: What are the effects of foot exercises, customized arch support insoles, and exercises plus insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot? Do exercises, insoles, and exercises plus insoles affect outcome measures differently? METHODS: Forty-five people with flexible flatfoot were randomly divided into three groups and 40 of those completed the study. The exercise group performed tibialis posterior strengthening and short foot exercises three days a week for six weeks. The insole group used their customized arch support insoles for six weeks. The exercise plus insole group received both interventions for six weeks. The assessments were performed three times: before the interventions and at the 6th and 12th weeks. Outcome measures were (1) foot posture, (2) plantar force distribution in the following conditions: static standing, barefoot walking at different speeds, and walking immediately after the heel-rise test, and (3) balance. RESULTS: Foot posture improved in all groups, but insole was less effective than exercise and exercise plus insole (p<0.05). Plantar force variables obtained during standing and walking changed in all groups (p<0.05). The superiority of the interventions differed according to the plantar regions and walking speed conditions (p<0.05). Static balance improved in all groups, but limits of stability improved in the exercise plus insole and exercise groups (p<0.05). SIGNIFICANCE: The superiority of the interventions differed according to the assessed parameter. The management of flexible flatfoot should be tailored based on the assessment results of each individual.

The ankle dorsiflexion kinetics demand to increase swing phase foot-ground clearance: implications for assistive device design and energy demands.

BACKGROUND: The ankle is usually highly effective in modulating the swing foot's trajectory to ensure safe ground clearance but there are few reports of ankle kinetics and mechanical energy exchange during the gait cycle swing phase. Previous work has investigated ankle swing mechanics during normal walking but with developments in devices providing dorsiflexion assistance, it is now essential to understand the minimal kinetic requirements for increasing ankle dorsiflexion, particularly for devices employing energy harvesting or utilizing lighter and lower power energy sources or actuators. METHODS: Using a real-time treadmill-walking biofeedback technique, swing phase ankle dorsiflexion was experimentally controlled to increase foot-ground clearance by 4 cm achieved via increased ankle dorsiflexion. Swing phase ankle moments and dorsiflexor muscle forces were estimated using AnyBody modeling system. It was hypothesized that increasing foot-ground clearance by 4 cm, employing only the ankle joint, would require significantly higher dorsiflexion moments and muscle forces than a normal walking control condition. RESULTS: Results did not confirm significantly increased ankle moments with augmented dorsiflexion, with 0.02 N.m/kg at toe-off reducing to zero by the end of swing. Tibialis Anterior muscle force incremented significantly from 2 to 4 N/kg after toe-off, due to coactivation with the Soleus. To ensure an additional 4 cm mid swing foot-ground clearance, an estimated additional 0.003 Joules/kg is required to be released immediately after toe-off. CONCLUSION: This study highlights the interplay between ankle moments, muscle forces, and energy demands during swing phase ankle dorsiflexion, offering insights for the design of ankle assistive technologies. External devices do not need to deliver significantly greater ankle moments to increase ankle dorsiflexion but, they should offer higher mechanical power to provide rapid bursts of energy to facilitate quick dorsiflexion transitions before reaching Minimum Foot Clearance event. Additionally, for ankle-related bio-inspired devices incorporating artificial muscles or humanoid robots that aim to replicate natural ankle biomechanics, the inclusion of supplementary Tibialis Anterior forces is crucial due to Tibialis Anterior and Soleus co-activation. These design strategies ensures that ankle assistive technologies are both effective and aligned with the biomechanical realities of human movement.

Is radial extracorporeal shock wave therapy (rESWT), sham-rESWT or a standardised exercise programme in combination with advice plus customised foot orthoses more effective than advice plus customised foot orthoses alone in the treatment of plantar fasciopathy? A double-blind, randomised, sham-controlled trial.

OBJECTIVES: To assess whether radial extracorporeal shock wave therapy (rESWT), sham-rESWT or a standardised exercise programme in combination with advice plus customised foot orthoses is more effective than advice plus customised foot orthoses alone in alleviating heel pain in patients with plantar fasciopathy. METHODS: 200 patients with plantar fasciopathy were included in a four-arm, parallel-group, sham-controlled, observer-blinded, partly patient-blinded trial. At baseline, before randomisation, all patients received advice plus customised foot orthoses. Patients were randomised to rESWT (n=50), sham-rESWT (n=50), exercise (n=50) or advice plus customised foot orthoses alone (n=50). Patients in the rESWT and sham-rESWT groups received three treatments. The exercise programme comprised two exercises performed three times a week for 12 weeks, including eight supervised sessions with a physiotherapist. Patients allocated to advice plus customised foot orthoses did not receive additional treatment. The primary outcome was change in heel pain during activity in the previous week per Numeric Rating Scale (0-10) from baseline to 6-month follow-up. The outcome was collected at baseline, and 3, 6 and 12 months. RESULTS: The primary analysis showed no statistically significant between-group differences in mean change in heel pain during activity for rESWT versus advice plus customised foot orthoses (-0.02, 95% CI -1.01 to 0.96), sham-rESWT versus advice plus customised foot orthoses (0.52, 95% CI -0.49 to 1.53) and exercise versus advice plus customised foot orthoses (-0.11, 95% CI -1.11 to 0.89) at 6 months. CONCLUSION: In patients with plantar fasciopathy, there was no additional benefit of rESWT, sham-rESWT or a standardised exercise programme over advice plus customised foot orthoses in alleviating heel pain. TRIAL REGISTRATION NUMBER: NCT03472989.

Strategy for the Conservative Treatment of Type-III Camptodactyly in Children with Beals-Hecht Syndrome.

The authors present a successful case in the conservative treatment of type-III camptodactyly in a patient with Beals-Hecht syndrome. Camptodactyly is a flexion deformity of the proximal interphalangeal (PIP) joint, in the anteroposterior direction, painless and bilateral in 2/3 of the cases. Type-III is the most severe and disabling form, as it usually affects several fingers and is associated with syndromes and other malformations. The case herein reported had the correction achieved with the systematic use of static orthoses started at 7 months of age and completed after 23 and a half months of the intervention.

Assessing the Acceptability and Effectiveness of a Novel Therapeutic Footwear in Reducing Foot Pain and Improving Function among Older Adults: A Crossover Randomized Controlled Trial.

INTRODUCTION: Nearly, a quarter of older adults suffer from frequent foot pain, impacting their quality of life. While proper footwear can alleviate this, design issues often hinder regular use. This study evaluated novel therapeutic footwear, designed for aesthetics and custom fit, to reduce foot pain. We hypothesized that older adults would experience less foot pain and favor the new footwear over their own. METHODS: This 12-week crossover randomized controlled trial evaluated the effectiveness of OrthoFeet therapeutic footwear on reducing foot pain in older adults (n = 50, age = 65 ± 5, 18% male) with moderate to severe pain. Participants were assigned to either the AB or BA sequence. In AB, they wore OrthoFeet shoes for 6 weeks and then their own shoes for another 6 weeks; BA followed the reverse order. Pain and function were measured using the Foot Function Index. Acceptability was assessed through a technology acceptance model (TAM) questionnaire. Data collected at baseline, six, and 12 weeks were analyzed using t tests, χ2 tests, and generalized linear model. RESULTS: Compared to participants' own shoes, OrthoFeet shoes significantly reduced foot pain and disability. Notable improvements were observed in "foot pain at its worst," "foot pain at the end of the day," "overall pain score," and "overall Foot Function Index score," all showing statistically significant reductions (p < 0.050). Participants reported high adherence to wearing the OrthoFeet shoes, averaging 8 h per day and 5.8 days per week. TAM scores favored OrthoFeet shoes over participants' own shoes in terms of ease of use, perceived benefit, and intention to recommend. Significant differences were noted in components representing perceived joint pain relief (p < 0.001, χ2 = 21.228) and the intention of use as determined by the likelihood of recommending the shoes to a friend with a similar condition (p < 0.001, χ2 = 29.465). Additionally, a majority of participants valued the appearance of the shoes, with 66% prioritizing shoe appearance and 96% finding the study shoes more stylish than their previous ones. CONCLUSION: This study underscores the significance of design and custom fit in promoting continuous wear for effective foot pain reduction in older adults. More research is needed on the intervention's long-term impacts.

Exploring the relationship between the supination resistance test and the effects of foot orthoses on the foot and ankle biomechanics during walking.

BACKGROUND: The effects of foot orthoses on lower limb biomechanics during walking have been studied extensively. However, the lack of knowledge regarding the effects of various foot orthoses models for the same population complicates model selection in clinical practice and research. Additionally, there is a critical need to enhance our ability to predict the outcomes of foot orthoses using clinical tests, such as the supination resistance test. RESEARCH QUESTION: What are the effects of two commonly prescribed types of FO (thin-flexible and medially wedged) on lower limb biomechanics during gait? Is there a correlation on these effects with the results of the supination resistance test? METHODS: Twenty-three participants with flat feet were enrolled in this cross-sectional descriptive study. Participants underwent walking trials under three conditions: shod, thin-flexible FOs and medially wedged FOs. Midfoot, ankle, knee and hip angles, moments were calculated. Repeated measure ANOVAs were employed for within-group comparison across conditions. Correlations between the effects of FOs on foot and ankle angles/moments and supination resistance were determined using regression analyses using a statistical parametric mapping approach. RESULTS: Thin-flexible and medially wedged FOs reduced midfoot dorsiflexion angles and ankle inversion moments. Medially wedged FOs also decreased midfoot and ankle abduction angles, midfoot plantarflexion moments compared to thin-flexible FOs and shoes. Moderate to good correlations between the supination resistance test and the medially wedged FOs were observed for the frontal and transverse ankle angles and moments. SIGNIFICANCE: Medially wedged FOs are more effective in modifying lower limb biomechanics during walking compared to thin-flexible FOs. Greater supination resistance was associated with more pronounced effects for medially wedged FOs on foot and ankle biomechanics. These findings hold promise for refining orthotic prescription strategies, potentially offering advantages to individuals with musculoskeletal disorders.