Quantifying lower limb inter-joint coordination and coordination variability after four-month wearing arch support foot orthoses in children with flexible flat feet

Introduction: Flat feet in children negatively affect lower limb alignment and cause adverse health-related problems. The long-term application of foot orthoses (FOs) may have the potential to improve lower limb coordination and its variability. Aim: To evaluate the effects of long-term use of arch support FOs on inter-joint coordination and coordination variability in children with flexible flat feet. Methods: Thirty boys with flexible flat feet were randomly assigned to the experimental (EG) and control groups. The EG used medial arch support FOs during daily activities over a four-month period while the control group received a flat 2-mm-thick insole for the same time period. Lower-limb coordination and variability during the 3 sub-stance phases were quantified using a vector coding technique. Results: Frontal plane ankle-hip coordination in EG during mid-stance changed to an anti-phase pattern (156.9) in the post-test compared to an in-phase (221.1) in the pre-test of EG and posttest of CG (222.7). Frontal plane knee-hip coordination in EG during loading response (LR) changed to an anti-phase pattern (116) in the post-test compared to an in-phase (35.5) in the pre-test of EG and post-test of CG (35.3). Ankle inversion/eversion-knee internal/external rotation joint coupling angle in EG changed to an in-phase pattern (59) in the post-test compared to a proximal phase (89) in the pre-test. Coupling angle variability increased in the post-test of EG for sagittal plane ankle-hip during push-off, transverse plane ankle-hip during LR and mid-stance, and transverse plane knee-hip during LR and mid-stance compared to pre-test of EG and post-test of CG. Conclusion: The long-term use of arch support FOs proved to be effective to alter lower limb coordination and coordination variability during walking in children with flexible flat feet. This new insight into coordinative function may be useful for improving corrective exercise strategies planned for children with flat feet

The effect of prefabricated wrist-hand orthoses on grip strength

Prefabricated wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit and compromised grip strength as a result of rheumatoid changes. It is thought that an orthosis which improves wrist extension, reduces synovitis and increases the mechanical advantage of the flexor muscles will improve hand function. Previous studies report an initial reduction in grip strength with WHO use which may increase following prolonged use. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on grip strength was measured using a Jamar dynamometer. Tests were performed with and without WHOs by right-handed, female subjects, aged 20-50 years over a ten week period. During each test, a wrist goniometer and a forearm torsiometer were used to measure wrist joint position when maximum grip strength was achieved. The majority of participants achieved maximum grip strength with no orthosis at 30° extension. All the orthoses reduced initial grip strength but surprisingly the restriction of wrist extension did not appear to contribute in a significant way to this. Reduction in grip must therefore also be attributable to WHO design characteristics or the quality of fit. The authors recognize the need for research into the long term effect of WHOs on grip strength. However if grip is initially adversely affected, patients may be unlikely to persevere with treatment thereby negating all therapeutic benefits. In studies investigating patient opinions on WHO use, it was a stable wrist rather than a stronger grip reported to have facilitated task performance. This may explain why orthoses that interfere with maximum grip strength can improve functional task performance. Therefore while it is important to measure grip strength, it is only one factor to be considered when evaluating the efficacy of WHOs

Use of stance control knee-ankle-foot orthoses : a review of the literature

The use of stance control orthotic knee joints are becoming increasingly popular as unlike locked knee-ankle-foot orthoses, these joints allow the limb to swing freely in swing phase while providing stance phase stability, thus aiming to promote a more physiological and energy efficient gait. It is of paramount importance that all aspects of this technology is monitored and evaluated as the demand for evidence based practice and cost effective rehabilitation increases. A robust and thorough literature review was conducted to retrieve all articles which evaluated the use of stance control orthotic knee joints. All relevant databases were searched, including The Knowledge Network, ProQuest, Web of Knowledge, RECAL Legacy, PubMed and Engineering Village. Papers were selected for review if they addressed the use and effectiveness of commercially available stance control orthotic knee joints and included participant(s) trialling the SCKAFO. A total of 11 publications were reviewed and the following questions were developed and answered according to the best available evidence: 1. The effect SCKAFO (stance control knee-ankle-foot orthoses) systems have on kinetic and kinematic gait parameters 2. The effect SCKAFO systems have on the temporal and spatial parameters of gait 3. The effect SCKAFO systems have on the cardiopulmonary and metabolic cost of walking. 4. The effect SCKAFO systems have on muscle power/generation 5. Patient’s perceptions/ compliance of SCKAFO systems Although current research is limited and lacks in methodological quality the evidence available does, on a whole, indicate a positive benefit in the use of SCKAFOs. This is with respect to increased knee flexion during swing phase resulting in sufficient ground clearance, decreased compensatory movements to facilitate swing phase clearance and improved temporal and spatial gait parameters. With the right methodological approach, the benefits of using a SCKAFO system can be evidenced and the research more effectively converted into clinical practice

No Effect of EVA and TPU Custom Foot Orthoses on Mechanical Asymmetries during Acute Intense Fatigue

From Crossref journal articles via Jisc Publications RouterHistory: epub 2023-03-11, issued 2023-03-11Article version: VoRPublication status: PublishedFunder: QNRF; FundRef: 10.13039/100008982; Grant(s): NPRP 4-760-3-217This study examined the impact of custom foot orthoses made of ethyl-vinyl acetate (EVA) and expanded thermoplastic polyurethane (TPU) materials, both compared to a control condition (CON; shoes only), on mechanical asymmetries during repeated treadmill sprints. Eighteen well-trained male runners executed eight, 5-s sprints (rest: 25 s) on an instrumented motorized treadmill in three footwear conditions (EVA, TPU, and CON). We evaluated the group mean asymmetry scores using the ‘symmetry angle’ (SA) formula, which assigns a score of 0% for perfect symmetry and a score of 100% for perfect asymmetry. There was no condition (all p ≥ 0.053) or time (p ≥ 0.074) main effects, nor were there any significant time × condition interactions on SA scores for any variables (p ≥ 0.640). Mean vertical, horizontal, and total forces presented mean SA values (pooled values for the three conditions) of 2.6 ± 1.9%, 2.9 ± 1.6%, and 2.4 ± 1.8%, respectively. Mean SA scores were ~1–3% for contact time (1.5 ± 0.5%), flight time (3.0 ± 0.3%), step frequency (1.1 ± 0.5%), step length (1.9 ± 0.7%), vertical stiffness (2.1 ± 0.9%), and leg stiffness (2.4 ± 1.1%). Mean SA scores were ~2–6.5% for duration of braking (4.1 ± 1.6%) and propulsive (2.4 ± 1.0%) phases, and peak braking (6.2 ± 2.9%) and propulsive (2.1 ± 1.4%) forces. In well-trained runners facing intense fatigue, wearing custom foot orthoses did not modify the observed low-to-moderate natural stride mechanical asymmetries.pubpu

The effect of prefabricated wrist-hand orthoses on performing activities of daily living

Wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit associated with the wrist as a result of rheumatoid changes. The common presentation of the wrist is one of flexion and radial deviation with ulnar deviation of the fingers. This wrist position Results in altered biomechanics compromising hand function during activities of daily living (ADL). A paucity of evidence exists which suggests that improvements in ADL with WHO use are very task specific. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on performing five ADLs tasks was investigated. The tasks were selected to represent common grip patterns and tests were performed with and without WHOs by right-handed, females, aged 20-50 years over a ten week period. The time taken to complete each task was recorded and a wrist goniometer, elbow goniometer and a forearm torsiometer were used to measure joint motion. Results show that, although orthoses may restrict the motion required to perform a task, participants do not use the full range of motion which the orthoses permit. The altered wrist position measured may be attributable to a modified method of performing the task or to a necessary change in grip pattern, resulting in an increased time in task performance. The effect of WHO use on ADL is task specific and may initially impede function. This could have an effect on WHO compliance if there appears to be no immediate benefits. This orthotic effect may be related to restriction of wrist motion or an inability to achieve the necessary grip patterns due to the designs of the orthoses

Effect of 3D printed foot orthoses stiffness on muscle activity and plantar pressures in individuals with flexible flatfeet : a statistical non-parametric mapping study

Background The 3D printing technology allows to produce custom shapes and add functionalities to foot orthoses which offers better options for the treatment of flatfeet. This study aimed to assess the effect of 3D printed foot orthoses stiffness and/or a newly design posting on muscle activity, plantar pressures, and center of pressure displacement in individuals with flatfeet. Methods Nineteen individuals with flatfeet took part in this study. Two pairs of foot orthoses with different stiffness were designed for each participant and 3D printed. In addition, the flexible foot orthoses could feature an innovative rearfoot posting. Muscle activity, plantar pressures, and center of pressure displacement were recorded during walking. Findings Walking with foot orthoses did not alter muscle activity time histories. Regarding plantar pressures, the most notable changes were observed in the midfoot area, where peak pressures, mean pressures and contact area increased significantly during walking with foot orthoses. The latter was reinforced by increasing the stiffness. Concerning the center of pressure displacement, foot orthoses shifted the center of pressure forward and medially at early stance. At the end of the stance phase, a transition of the center of pressure in posterior direction was observed during the posting condition. No effect of stiffness was observed on center of pressure displacement. Interpretation The foot orthoses stiffness and the addition of posting influenced plantar pressures during walking. The foot orthoses stiffness mainly altered the plantar pressures under the midfoot area. However, posting mainly acted on peak and mean pressures under the rearfoot area

Biomechanical Comparison of Lower Limb Unloading Between Common Modalities of Ankle Foot Orthoses

Tibial stress fractures and other lower extremity injuries can be treated using an ankle foot orthosis (AFO). AFOs are popular because they allow the patient to ambulate somewhat naturally while reducing weight bearing on the injured limb. Despite their popularity, it is currently unclear how well AFOs reduce lower extremity weight bearing. The first objective of this investigation was to examine the ability of three commonly used ankle foot orthoses to reduce weight bearing within the lower limb by comparing the ground reaction force measured from a force platform to the force measured from an insole pressure measurement device inside the AFO. Results indicated that the corset-style AFO was more effective in reducing the load compared to the camwalker and patellar-tendon bearing AFOs. The second objective was to examine and quantify the kinematic and kinetic changes made in the natural gait pattern of the participants when wearing an AFO. Wearing an AFO alters the geometry and inertial properties of the limb which causes the wearer to alter their natural gait pattern which could lead to addition problems such as low back pain. Results indicated that the camwalker AFO changed gait the most, the patellar-tendon bearing AFO altered gait to some extent, and the corset-style AFO changed gait minimally

Tractament de la síndrome de la hipermobilitat articular generalitzada en nens. Revisió bibliogràfica

Treball Final de Grau de Podologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, curs: 2021-2022, Tutor: Laura Pérez PalmaIntroducció: La hipermobilitat articular (HA) es defineix com el moviment més enllà del normal en una articulació causant una menor rigidesa. Els nens són més hipermòbils que els adults, mantenint una relació inversa amb l’edat. Per al seu diagnòstic s’utilitza els criteris de Beigthon avaluant la mobilitat d’extremitats superiors i els de LLAS per les extremitats inferiors. La flexibilitat articular s’associa amb el canvi de posició del peu, creant alteracions biomecàniques. Objectius: Determinar el tractament més efectiu per la síndrome d’hipermobilitat articular generalitzada en nens, així com analitzar els diferents tractaments utilitzats per aquesta síndrome i realitzar un protocol d’acció podològica. Material i mètodes: Es realitza una cerca sistèmica en les bases de dades de Medline, Scopus, Dialnet i Scielo fins al març del 2022. Es van seleccionar un total de 35 articles per la realització del treball. Resultats: L’anàlisi dels articles seleccionats mostren que el tractament més usat és el multidisciplinari enfront del fisioterapèutic. El dolor percebut pel nen és el criteri més valorat, aconseguint una satisfacció en diferent percentatge en cada programari. En els estudis utilitzats EVA es veu un 63% de millora amb un multidisciplinari en vers a un 36%-39% d’un fisioterapèutic. Referent a la relació entre la HA i peu pla flexible (PPF) tots els autors estan d’acord en la seva correlació i en la major part, en el bon resultat del seu tractament