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2.
Clin Podiatr Med Surg ; 37(1): 39-51, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735268

RESUMO

Understanding of medial column biomechanics is paramount to a successful outcome in both conservative and surgical treatment. Dysfunctions of the dynamic stabilizers as well as the static stabilizers of the medial column play a role in pathomechanics. Conservative options for addressing the medial column include custom foot orthotics and bracing. Options for addressing the medial column surgically with the goal to restore a stable tripod configuration, include first tarsometatarsal joint arthrodesis, opening plantarflexory medial cuneiform osteotomy, and naviculocuneiform arthrodesis.


Assuntos
Artrodese , Pé Chato/cirurgia , Órtoses do Pé , Osteotomia , Pé Chato/diagnóstico por imagem , Pé Chato/fisiopatologia , Articulações do Pé/cirurgia , Humanos , Ossos do Tarso/cirurgia
3.
J Pediatr Orthop ; 40(1): e25-e29, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30969199

RESUMO

BACKGROUND: Foot abduction orthoses (FAO) are believed to decrease recurrence following treatment of congenital talipes equinovarus (CTEV) as described by Ponseti. The purpose of this project is to examine the outcomes of FAO bracing following treatment by the Ponseti method in a cohort of idiopathic CTEV patients. METHODS: After IRB approval, a cohort of patients aged 3 to 46 days with idiopathic CTEV was identified in a previous prospective study of brace compliance by family report and sensor. Dimeglio score and family demographic information were collected. Initial treatment was by the Ponseti method, with or without Achilles tenotomy. Following correction, patients had three months of full-time FAO bracing during which parents kept a log of compliance. Patients were followed until recurrence (need for further treatment) or age 5. RESULTS: In total, 42 patients with 64 affected feet met the above criteria and were included in the final analysis. Twenty-six feet (40%) went on to develop recurrence requiring further treatment, including casting, bracing, or surgery. Because of poor tolerance of the original FAO, 20 feet were transitioned to an alternative FAO, and 14 of these (70%) went on to recur (P<0.01). The casting duration (P=0.02) had a statistically significant relationship to recurrence. Patients who were casted for 9 weeks or more had a higher rate of recurrence (57.1% vs. 27.8%; P=0.02). Age at treatment start, Dimeglio score, demographic factors, and compliance during full-time bracing, whether by report or sensor, did not show a significant relationship with recurrence. CONCLUSIONS: The study showed a statistically significant relationship between the difficulty of CTEV correction and the risk of recurrent deformity requiring treatment. This relationship could be used to provide prognostic information for patients' families. Caregiver-reported compliance was not significantly related to recurrence. LEVEL OF EVIDENCE: Level III-Prognostic Retrospective Cohort Study.


Assuntos
Moldes Cirúrgicos , Pé Torto Equinovaro/terapia , Órtoses do Pé , Tendão do Calcâneo/cirurgia , Braquetes , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Cooperação do Paciente , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Tenotomia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(44): e17865, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689879

RESUMO

RATIONALE: Most cases of foot drop are known to result from lower motor neuron pathologies, particularly lumbar radiculopathy and peripheral neuropathy, including common peroneal neuropathy. To improve the prognosis of foot drop, it is important to quickly and accurately diagnose the etiology and provide appropriate treatment. PATIENT CONCERNS: A 65-year-old female patient with a history of L4-5 intervertebral disc herniation presented with right foot drop that had developed 1 month previously. DIAGNOSIS: Electrodiagnostic examination revealed common peroneal neuropathy combined with L5 radiculopathy, with the former being the main cause of the foot drop. MRI of the right knee was performed to identify the cause of the peroneal nerve lesion, which revealed an intraneural ganglion cyst in the common peroneal nerve. INTERVENTIONS: The patient was treated by ultrasound-guided percutaneous cyst aspiration and corticosteroid injection into the decompressed ganglion, followed by strengthening exercise, electrical stimulation therapy, and prescription of an ankle foot orthosis. OUTCOMES: We confirmed regeneration of the injured peroneal nerve at the follow-up electrodiagnostic examination 12 weeks after the intervention. In addition, the manual motor power test demonstrated an increase in the ankle dorsiflexor function score by one grade. LESSONS: Diagnosing the cause of foot drop can be difficult with multiple co-existing pathologies, and consideration of various possible etiologies is the key for appropriate diagnosis and treatment. In addition to imaging modalities such as MRI, electrodiagnostic examination can help to improve diagnostic accuracy. Intraneural ganglion cyst of the common peroneal nerve is rare, but should be considered as a possible cause of foot drop.


Assuntos
Cistos Glanglionares/complicações , Neuropatias Fibulares/etiologia , Radiculopatia/complicações , Corticosteroides/uso terapêutico , Idoso , Terapia Combinada , Terapia por Estimulação Elétrica , Eletrodiagnóstico , Terapia por Exercício , Feminino , Órtoses do Pé , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/terapia , Humanos , Vértebras Lombares , Imagem por Ressonância Magnética , Paracentese , Neuropatias Fibulares/terapia , Radiculopatia/diagnóstico , Radiculopatia/terapia
5.
J Am Podiatr Med Assoc ; 109(6): 431-436, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755770

RESUMO

BACKGROUND: The aim of this study was to observe the pressure changes in the felt padding used to off-load pressure from the first metatarsal head, the effects obtained by different designs, and the loss of effectiveness over time. METHOD: With a study population of 17 persons, two types of 5-mm semicompressed felt padding were tested: one was C-shaped, with an aperture cutout at the first metatarsophalangeal joint, and the other was U-shaped. Pressures on the sole of the foot were evaluated with a platform pressure measurement system at three time points: before fitting the felt padding, immediately afterward, and 3 days later. RESULTS: In terms of decreased mean pressure on the first metatarsal, significant differences were obtained in all of the participants (P < .001). For plantar pressures on the central metatarsals, the differences between all states and time points were significant for the C-shaped padding in both feet (P < .001), but with the U-shaped padding the only significant differences were between no padding and padding and at day 3 (P = .01 and P = .02). CONCLUSIONS: In healthy individuals, the U-shaped design, with a padding thickness of 5 mm, achieved a more effective and longer-lasting reduction in plantar pressure than the C-shaped design.


Assuntos
Desenho de Equipamento , Pé/fisiologia , Ossos do Metatarso/fisiologia , Articulação Metatarsofalângica/fisiologia , Pressão , Adolescente , Feminino , Órtoses do Pé , Humanos , Masculino , Pessoa de Meia-Idade , Caminhada/fisiologia , Adulto Jovem
6.
Med Sci Monit ; 25: 7720-7727, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31611547

RESUMO

BACKGROUND Unbalanced standing and gait asymmetry are common in individuals with musculoskeletal disorders. Achieving symmetrical posture and gait is an important goal of rehabilitation. This study investigated the biomechanical differences in the lower extremities observed immediately after an insole was used and without the use of different one-sided insoles. MATERIAL AND METHODS Thirty young, healthy adult males received 3 different insole interventions: experimental group A had a customized 3-dimensional (3D)-printed single-sided lateral wedge insole (CLWI) inserted on the left side, and experimental group B had on the left side, a traditional single insert. The control had unilateral flat insoles; no insole inserted into the socks. Motion mechanics and gait parameters were collected at the 2-time points, after insertion of the insole and after 20 minutes of walking with the insole. RESULTS Asymmetric posture and gait appeared immediately after using the 2 insoles (lower joint moment, P<0.05). Compared with the control group, the abnormal posture and gait of experimental group B after wearing the traditional insole for 20 minutes were not obvious (P>0.05). However, the asymmetrical posture and gait remained in experimental group A after wearing the CLWI for 20 minutes (P<0.05). The center of pressure (COP) trajectory of the left foot of experimental group A was significantly higher than that of experimental group B and the control group at the 2-time points (P<0.05). CONCLUSIONS The asymmetry of posture and gait can be observed in a short time using a customized 3D-printed single-sided lateral wedge insole. This experiment provides guidance for the application of customized 3D-printed single-sided lateral wedge insoles for gait rehabilitation.


Assuntos
Órtoses do Pé/tendências , Marcha/fisiologia , Postura/fisiologia , Adulto , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , China , Pé/fisiologia , Voluntários Saudáveis , Humanos , Articulação do Joelho/fisiologia , Extremidade Inferior/fisiologia , Masculino , Impressão Tridimensional , Caminhada/fisiologia
7.
Am J Case Rep ; 20: 1454-1459, 2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31578314

RESUMO

BACKGROUND The purpose of this study was to compare gait abilities in a child with spastic diplegia according to different dorsiflexion angles on hinged ankle-foot orthosis (hinged AFO). CASE REPORT This study is a case report of a child who was diagnosed with spastic diplegia and ambulated independently with the use of a hinged AFO. For gait analysis, the GAITRite® was used under 3 different conditions including barefoot, wearing regular of hinged AFO, and wearing a dorsiflexion 10° hinged AFO. The gait velocity and cadence were collected as temporal parameters, while step length, stride length, and single and double leg support time were collected as temporal spatial parameters. As a result, when a regular hinged AFO was worn on the barefoot, the gait velocity and cadence per minute were increased, whereas the step length and stride length, the single and double leg support time decreased. The gait velocity, cadence, step length, and stride length were significantly increased when dorsiflexion 10° hinged AFO was applied compared to barefoot. The gait velocity, cadence, step length, and stride length increased with dorsiflexion 10° hinged AFO compared to regular hinged AFO. CONCLUSIONS The results of this study demonstrated that wearing a dorsiflexion 10° hinged AFO would have a positive effect on improving gait ability of a child with cerebral palsy rather than wearing a bare foot and a general hinged AFO.


Assuntos
Paralisia Cerebral/reabilitação , Órtoses do Pé , Transtornos Neurológicos da Marcha/reabilitação , Criança , Desenho de Equipamento , Feminino , Humanos
8.
BMC Musculoskelet Disord ; 20(1): 442, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604431

RESUMO

BACKGROUND: Insoles are often applied as preventive therapy of flatfoot deformity, but the therapeutic effects on obese individuals are still controversial. We aimed to investigate the effect of insole use on time-dependent changes in the foot arch during a repeated-loading simulation designed to represent 20,000 contiguous steps in individuals with a BMI value in the range of 30-40 kg/m2. METHODS: Eighteen cadaveric feet were randomly divided into the following three groups: normal, obese, and insole. Ten thousand cyclic loadings of 500 N (normal group) or 1000 N (obese and insole groups) were applied to the feet. We measured time-dependent change in arch height and calculated the bony arch index (BAI), arch flexibility, and energy absorption. RESULTS: The normal group maintained more than 0.21 BAI, which is the diagnostic criterion for a normal arch, throughout the 10,000 cycles; however, BAI was less than 0.21 at 1000 cycles in the obese group (mean, 0.203; 95% confidence interval [CI] 0.196-0.209) and at 6000 cycles in the insole group (mean, 0.200; 95% CI, 0.191-0.209). Although there was a significant time-dependent decrease in flexibility and energy absorption in both the obese and insole groups (P < 0.001), the difference between 1 and 10,000 cycles were significantly smaller in the insole group than in the obese group (P = 0.024). CONCLUSIONS: Use of insoles for obese individuals may help to slow time-dependent foot structural changes. However, the effect was not enough to maintain the foot structure against repeated hyper loadings.


Assuntos
Pé Chato/prevenção & controle , Órtoses do Pé , Pé/fisiopatologia , Obesidade/complicações , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Pé Chato/etiologia , Pé Chato/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Suporte de Carga/fisiologia
9.
Gait Posture ; 74: 242-249, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31574408

RESUMO

BACKGROUND: Excessive foot pronation during running in individuals with foot varus alignment may be reduced by medially wedged insoles. RESEARCH QUESTION: This study investigated the effects of a medially wedged insole at the forefoot and at the rearfoot on the lower limbs angles and internal moments of runners with excessive foot pronation and foot varus alignment. METHODS: Kinematic and kinetic data of 19 runners (11 females and 8 males) were collected while they ran wearing flat (control condition) and medially wedged insoles (insole condition). Both insoles had arch support. We used principal component analysis for data reduction and dependent t-test to compare differences between conditions. RESULTS: The insole condition reduced ankle eversion (p = 0.003; effect size = 0.63); reduced knee range of motion in the transverse plane (p = 0.012; effect size = 0.55); increased knee range of motion in the frontal plane in early stance and had earlier knee adduction peak (p = 0.018; effect size = 0.52); reduced hip range of motion in the transverse plane (p = 0.031; effect size = 0.48); reduced hip adduction (p = 0.024; effect size = 0.50); reduced ankle inversion moment (p = 0.012; effect size = 0.55); and increased the difference between the knee internal rotation moment in early stance and midstance (p = 0.012; effect size = 0.55). SIGNIFICANCE: Insoles with 7˚ medial wedges at the forefoot and rearfoot are able to modify motion and moments patterns that are related to lower limb injuries in runners with increased foot pronation and foot varus alignment with some non-desired effects on the knee motion in the frontal plane.


Assuntos
Órtoses do Pé , Pé/fisiologia , Extremidade Inferior/fisiologia , Pronação/fisiologia , Corrida/fisiologia , Sapatos , Adulto , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Feminino , Articulação do Quadril/fisiologia , Humanos , Cinética , Articulação do Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Análise de Componente Principal , Amplitude de Movimento Articular
10.
Medicine (Baltimore) ; 98(39): e17317, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574862

RESUMO

INTRODUCTION: Stroke is the principal cause of impairment in the motor function and gait of adults. One of the resources used in rehabilitation to optimize gait is a prescription of ankle-foot orthosis (AFO), and the most prescribed AFOs are Fixed AFO and Articulated AFO; however, it is not known which of these options is more effective for these individuals. The aim of this study is to evaluate the impact of different types of ankle-foot orthosis functional mobility and dynamic balance in stroke patients. METHODS: Prospective randomized controlled clinical trial with 2 parallel groups will be conducted, and the aim is to recruit 50 patients with stroke diagnosis within 1 year, who indicated that they use both types of orthotics, who had a previous Rankin score less than or equal to 3, and who obtained AFO orthosis through the Hospital Clinics at the Botucatu Medical School (HCBMS) São Paulo, Brazil. After a specific evaluation by a physiotherapist, the patient will receive 1 of the AFO types via randomization. After 30 days, the patient will be reevaluated. The primary outcomes will be balance and mobility, which will be evaluated by the Time Up Go Test (TUG) and Tinetti's Scale of Mobility and Balance (TSMB). The secondary outcomes will be quality of life and the levels of anxiety and depression, which will be evaluated with the European (5D) Quality of Life Scale (Euroqol) and Hospital Anxiety and Depression Scale (HADS). Group allocation will be not concealed because the blinding of participants and of therapists that provide intervention is not possible, and all analyses will be based on an intention-to-treat principle. This study was approved by the Human Research Ethics Committee of the São Paulo State University UNESP, number 2.367.953. The results will be published in relevant journal. DISCUSSION: The results of this study will contribute to clinical practice by identifying the type of AFO orthosis that is more suitable for this condition, helping to standardize prescription of these orthoses by professionals, and guiding future research studies on this subject, which is still incompletely defined in the literature. TRIAL REGISTRATION: RBR-6SF2VV (March 5, 2018).


Assuntos
Tornozelo/fisiopatologia , Órtoses do Pé/normas , Transtornos Neurológicos da Marcha , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Adulto , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Desenho de Equipamento , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Masculino , Equilíbrio Postural , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/psicologia
11.
Medicine (Baltimore) ; 98(37): e17168, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517869

RESUMO

BACKGROUND: Functional limitations and pain are common presenting complaints for people suffering from knee osteoarthritis. Wedge insole can be sued for treatment of knee osteoarthritis. Hence, we conducted a systematic review and meta-analysis to explicit the efficacy of wedge insole in the treatment of knee osteoarthritis. METHODS: A systematic literature search for studies will be performed in MEDLINE, Embase, the Chinese National Knowledge Infrastructure Database (CNKI), Cochrane Library, Web of Science. The methodological quality of the included studies using the risk bias assessment tool of Cochrane. Funnel plot will be used to assess the reporting bias. And the level of evidence for results are assessed by the GRADE method. Statistical analysis is conducted with Revman 5.3. RESULTS: This systematic review and meta-analysis will provide a synthesis of evidences for wedge insole on knee osteoarthritis. CONCLUSION: The conclusion of this study will provide recommendations to assess effectiveness of exercise on knee osteoarthritis, which may further guide clinical practice. PROSPERO REGISTRATION NUMBER: CRD42018096804.


Assuntos
Órtoses do Pé , Metanálise como Assunto , Osteoartrite do Joelho/terapia , Revisão Sistemática como Assunto , Humanos
12.
Med Sci Monit ; 25: 7175-7181, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31549689

RESUMO

BACKGROUND 3D-printed insoles are widely used. This study was conducted to test a customized three-dimensional (3D)-printed heel support insole based on arch lift and to investigate whether the pressure distribution on the sole was improved while maintaining foot function. MATERIAL AND METHODS The design was based on a 3D plantar contour scanning modeling technique. Thirty healthy male participants walked along a 10-m track under 3 self-controlled interventions. A customized 3D-printed heel support insole based on arch lift was inserted into the socks for the experimental condition A. For condition B, a customized 3D-printed heel-supporting insole was inserted into the socks, and a standardized pre-made heel-supporting insole was inserted into the socks as a control (condition C). We used the Footscan® pressure plate to measure the plantar parameters in the forefoot contact and foot flange phases in each condition. RESULTS Compared with condition B and the control condition, the peak pressure under the heel was significantly lower in condition A (P<0.05), and the peak pressure in the midfoot region was not significantly increased (P>0.05). CONCLUSIONS The biomechanical properties of the customized 3D-printed heel support are better than those of the traditional heel support insole, especially when there is a need for an additional increase in heel height. Patients do not decrease midfoot motion function while using this customized insole.


Assuntos
Desenho de Equipamento/métodos , Órtoses do Pé/tendências , Calcanhar/fisiopatologia , China , , Voluntários Saudáveis , Humanos , Masculino , Pressão , Impressão Tridimensional/instrumentação , Sapatos , Caminhada
13.
J Pediatr Orthop B ; 28(6): 564-571, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31503104

RESUMO

We investigated the impact of changes in bar length of Steenbeek foot abduction brace on foot and ankle range of motion in 150 children. The ankle dorsiflexion and foot abduction was measured without brace, with standard brace size (0) as depicted in Steenbeek manual and after variations in bar length (-2˝ to +2˝). The bar length (0) was also compared with shoulder width for Indian population. The Steenbeek foot abduction brace bar length in current use (11.53±1.2˝) was longer than shoulder size (8.14±1.18˝) with no true correlation. Steenbeek foot abduction brace usefulness was evident for foot abduction (46°) but not for dorsiflexion. The varied bar lengths tested did not significantly altered available dorsiflexion or abduction. The currently used Steenbeek foot abduction brace were larger than shoulder widths. The Steenbeek foot abduction brace was dynamic but required prefabrication for its effectiveness. The changes in bar length did not significantly alter foot dynamics occurring with brace.


Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Pé Torto Equinovaro/diagnóstico por imagem , Desenho de Equipamento/normas , Órtoses do Pé , Pé/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Braquetes/normas , Criança , Pré-Escolar , Pé Torto Equinovaro/terapia , Estudos Transversais , Feminino , Órtoses do Pé/normas , Humanos , Lactente , Masculino , Projetos Piloto
14.
Clin Rehabil ; 33(12): 1898-1907, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505943

RESUMO

OBJECTIVE: To assess the effectiveness of customized insole in patients with Morton's neuroma. DESIGN: Double-blind randomized controlled trial with intent-to-treat analysis. SETTING: Outpatients, University Hospital. SUBJECTS: A total of 72 patients with Morton's neuroma met the inclusion criteria and were randomly allocated to either the study group (n = 36) or the control group (n = 36). INTERVENTIONS: The study group was assigned to use a customized insole with metatarsal and arch support made of ethyl vinyl acetate and the control group received a flat insole of the same material, color, and density. MAIN MEASURES: The primary outcome measure was walking pain intensity measured by the visual analogue scale. The secondary outcomes were as follows: pain at rest, palpation, and paresthesia (visual analogue scale); functional disability (6-minute walk test, Foot Function Index, and Foot Health Status Questionnaire); quality of life (Health Survey Short Form-36 (SF-36)); and foot pressure (AM Cube FootWalk Pro program). RESULTS: In the comparison between the groups over time, a statistically significant difference, with improvement in favor of the experimental group, was found for pain during walking (P = 0.048); in the general health domains (P < 0.001) and physical activity (P = 0.025) of the Foot Health Status Questionnaire; in the general Foot Function Index score (P = 0.012); and in the functional capacity domain of the SF-36 questionnaire (P = 0.046). For the other parameters, no difference was found between groups. CONCLUSION: The study demonstrated that customized insole with metatarsal and arch support relieved walking pain and improved patient-reported measures of function in patients with Morton's neuroma.


Assuntos
Órtoses do Pé , Neuroma Intermetatársico/terapia , Adulto , Método Duplo-Cego , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Inquéritos e Questionários , Escala Visual Analógica , Suporte de Carga
15.
Gait Posture ; 74: 154-161, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31525653

RESUMO

BACKGROUND: Abnormal peak plantar pressure in neuropathic diabetic foot during walking activities is well managed through the use of appropriate design and material selection for the fabrication of custom made insoles (CMI). The redistribution of plantar pressure is possible by selecting an appropriate material for the fabrication of CMI. The walking activities may alter the plantar pressure distribution; which may differ while using CMI with different materials. OBJECTIVE: The objective of the study was to evaluate the effectiveness of CMI's materials on plantar pressure distribution during different walking activities, in diabetic feet with neuropathy. METHODS: The study was conducted on sixteen diabetic neuropathic subjects. The subjects were provided with two types of CMI; CMI-A (Plastazote® and microcellular rubber) and CMI-B (Multifoam, Plastazote® and microcellular rubber). Maximum peak plantar pressure and plantar pressure distribution were determined by Pedar-X® sensor insole during level walking, ramp walking and stair walking. RESULTS: The CMI-B lessened the maximum peak plantar pressure from the forefoot throughout the walking activities compared to CMI-A. The contact area was observed as lower using CMI-A compared to CMI-B, while performing walking activities. CONCLUSION: CMI-B, with multifoam as an additional top layer, provided more effective peak plantar pressure reduction at forefoot and it had better plantar pressure distribution compared to CMI-A during level walking and ramp ascending in diabetic foot with neuropathy.


Assuntos
Diabetes Mellitus/fisiopatologia , Pé Diabético/fisiopatologia , Órtoses do Pé , Pé/fisiopatologia , Caminhada/fisiologia , Suporte de Carga/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Sapatos
16.
Medicine (Baltimore) ; 98(36): e17074, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490409

RESUMO

Flatfoot is a common reason for parents to seek help from health care professionals, and limited evidence is available regarding the effects of insoles on preschool-aged children. This study mainly investigated the effect of insoles on symptomatic flatfoot in preschool-aged children and followed up the changes in footprints after 1 year.This study was a prospective, observational cohort study. Children aged 3 to 5 years old who exhibit the signs of flatfoot feet were recruited from the kindergartens in the central Taiwan between March 2010 and December 2013. The Chippaux-Smirak index (CSI) was used to determine whether the footprints of children were associated with flatfoot. The children were divided into an insole group and a no-insole group according to diagnoses by doctors. This study used the modified shoe insole as the intervention, and the CSI measured and followed up the changes in footprints after 1 year.A total of 466 preschool-aged children aged 3 to 5 years old with flatfoot completed the 1-year follow-up study. Of these, 123 children (men 77; women 46) were in the insole group and 343 children (men 187; women 156) were in the no-insole group. After the insoles were worn for 1 year, the CSI values of the children with symptomatic flatfoot decreased by 9.7%, and the 5-year-old children had the biggest change (effect size = 1.25). In the insole group, 34.1% of the footprints were determined as normal at 1-year follow-up, and CSI values decreased by 17.5%. High prevalence of joint laxity was found in both groups (insole group: 34.5%; no-insole group: 35.1%). Of the children in the insole group, the proportion of joint laxity was significantly higher in the flatfoot group (43.1%) than in the normal group (17.7%).This study showed that wearing insoles indeed can reduce the signs of flatfoot in preschool-aged children, and the effect is better in 5-year-old children. It is suggested that insoles can be provided as a conservative treatment for preschool-aged children with symptomatic flatfoot.


Assuntos
Pé Chato/terapia , Órtoses do Pé/estatística & dados numéricos , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos
17.
Gait Posture ; 73: 233-238, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31376749

RESUMO

BACKGROUND: Orthopaedic walking boots are commonly prescribed following injury and surgery. The boot creates a leg length discrepancy which is thought to affect limb symmetry and gait mechanics. This study aimed to examine the effects of a corrective heel lift for the contralateral limb on the mechanics and symmetry of walking with an orthopaedic walking boot. RESEARCH QUESTION: Does a corrective heel lift reduce biomechanical alterations and asymmetries caused by an orthopaedic boot during gait? METHODS: Healthy males (n=17) walked with normal shoes (Shod), an orthopaedic boot (Boot), and a corrective heel lift on the contralateral limb to the boot (Lift). A 10-camera motion capture system (Vicon, 100Hz) and four force platforms (AMTI, 1000 Hz) recorded lower extremity biomechanics. Pairwise statistics tested for differences in hip and knee kinematics and kinetics, and a symmetry index quantified limb symmetry. FINDINGS: The Boot affected the sagittal and frontal plane hip mechanics and transverse plane knee mechanics (p<0.05), and increased the asymmetry compared to the Shod condition. The Lift improved the symmetry of some measures but increased the frontal plane hip asymmetry compared to the Boot. However, introducing the Lift did not change all kinematic variables affected by the boot. SIGNIFICANCE: The Lift reduced some of the asymmetries introduced by the Boot, but also introduced new asymmetry in the hip frontal plane motion. The leg length discrepancy caused by the boot is probably not the only cause of altered gait mechanics. Prescribing a heel lift to a patient with an orthopaedic walking boot should be based on the individual patient's needs.


Assuntos
Fixadores Externos , Órtoses do Pé , Marcha/fisiologia , Adulto , Fenômenos Biomecânicos , Análise da Marcha , Voluntários Saudáveis , Calcanhar , Humanos , Joelho , Articulação do Joelho , Extremidade Inferior , Masculino , Sapatos , Adulto Jovem
18.
Prosthet Orthot Int ; 43(5): 478-484, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31378132

RESUMO

BACKGROUND: Comfort of an orthosis is an important characteristic that is likely to dictate use of and satisfaction with a device. However, instruments to assess only orthosis user comfort do not exist. The Prosthetic Socket Fit Comfort Score, developed previously for prosthesis users, may be adapted to serve this purpose. OBJECTIVES: This study's purpose was to assess the validity and reliability of the Orthosis Comfort Score, a self-report instrument adapted from the Prosthetic Socket Fit Comfort Score. STUDY DESIGN: This is a prospective, observational study designed to establish initial evidence of validity and reliability for an outcome measure that assesses comfort. METHODS: Ankle foot orthosis users completed the Orthosis Comfort Score and two validated patient satisfaction questionnaires. An orthotist documented an assessment of fit. Post-visit Orthosis Comfort Scores were documented after the appointment and 2-4 weeks later. Orthosis Comfort Scores were compared to the patient satisfaction questionnaires, assessment of fit and orthosis use (hours per week). RESULTS: There were 46 study participants. Orthosis Comfort Scores had a moderate positive correlation with their orthotist's assessment of fit, very strong positive correlations with patient satisfaction questionnaires and fair positive correlation with orthosis use (all correlations p < 0.05). CONCLUSION: This study demonstrates initial evidence for the validity and reliability of the Orthosis Comfort Score in ankle foot orthosis users. CLINICAL RELEVANCE: The Orthosis Comfort Score is a simple patient-reported outcome measure that can be readily incorporated into clinical practice or research study to obtain a rapid assessment of comfort. It can be used to facilitate communication about device fit, evaluate comfort over time and/or assess changes in comfort with a new device.


Assuntos
Órtoses do Pé , Inquéritos e Questionários , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Reprodutibilidade dos Testes , Autorrelato
19.
IEEE Int Conf Rehabil Robot ; 2019: 13-20, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374600

RESUMO

Our research team has developed two versions of an ankle robot for children with cerebral palsy. Both devices provide three degrees of freedom and are connected to an airplane video game. The child uses his/her foot as the controller for the plane and attempts to fly through a series of hoops arranged to manipulate the foot across the ankle joint. The first device is for lab-based therapy and four children have completed 20 sessions each with the device. The second device is for home-based therapy and two children have completed a 28-day trial using the device at home. Both studies were done under Institutional Review Board approval and all participants improved ankle range of motion. Further studies are ongoing to gather more data and validate the results.


Assuntos
Tornozelo/fisiologia , Paralisia Cerebral/reabilitação , Modalidades de Fisioterapia/instrumentação , Robótica/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Órtoses do Pé , Serviços de Assistência Domiciliar , Humanos , Masculino , Amplitude de Movimento Articular , Interface Usuário-Computador
20.
IEEE Int Conf Rehabil Robot ; 2019: 252-257, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374638

RESUMO

Single-sided motor weakness, also known as hemiparesis, is the most prevalent gait impairment among stroke survivors, which often results in gait asymmetry. Studies on robot-assisted gait training (RAGT) have shown positive effects of force feedback on spatial symmetry; somatosensory stimulation is thought to facilitate recovery of temporal symmetry. Despite the known importance of sensorimotor integration for motor recovery, interventions that incorporate RAGT and somatosensory stimuli have been largely overlooked so far. In this paper, we explore how gait symmetry can be restored in healthy subjects following unilateral foot perturbations, using adaptive assistive forces and plantar vibrotactile stimuli provided by a bilateral powered ankle-foot orthosis. Results suggest that combined force feedback and vibrotactile stimuli may be more effective than force feedback alone in reducing spatial asymmetry. Further, force feedback did not produce significant improvements in temporal symmetry, unlike the combined modality. We discuss possible implications of these preliminary findings for future training paradigms for RAGT.


Assuntos
Terapia por Exercício , Órtoses do Pé , Paresia , Robótica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Caminhada , Adulto , Retroalimentação , Marcha , Humanos , Masculino , Paresia/fisiopatologia , Paresia/reabilitação
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