Foot orthotics in the treatment of lower limb conditions: a musculoskeletal physiotherapy perspective

Abstract Orthotic therapy is frequently advocated for the treatment of musculoskeletal pain and injury of the lower limb. The clinical efficacy, mechanical effects, and underlying mechanism of the action of foot orthotics has not been conclusively determined making it difficult for practitioners to agree on a reliable and valid clinical approach to their application and indeed even their fabrication. This problem is compounded by evidence suggesting that the most commonly used approach for orthotic prescription, the (Biomechanical Evaluation of the Foot. Vol. 1. Clinical Biomechanics Corporation, Los Angeles, 1971) approach, has poor validity and many of the associated clinical measurements of that approach lack adequate levels of reliability. This paper proposes a new approach that is based on two key elements. One is the identification, verification and quantification of physical tasks that serve as client specific outcome measures. The second is the application of specific physical manipulations during the performance of these physical tasks. The physical manipulations are selected on the basis of motion dysfunction and their immediate effects on the client specific outcome measures serve as the basis to making an informed decision on the propriety of using orthotics in individual clients. The motion dysfunction also guides the type of orthotic that is applied. Practical case examples as well as generic and specific guidelines to the application of this clinical assessment process and orthotics are provided in this paper.

Bilateral Cervical Dysfunction in Patients With Unilateral Lateral Epicondylalgia Without Concomitant Cervical or Upper Limb Symptoms: A Cross-Sectional Case-Control Study

Objective: The purposes of this study were to examine the prevalence and distribution of spinal and neurodynamic dysfunction in a population with unilateral lateral epicondylalgia (LE) without concomitant cervical or upper limb symptoms, compare with cervical examination in a healthy control population, and investigate potential associations with clinical and demographic factors. Methods: This cross-sectional study included 165 patients with LE along with 62 healthy controls. Manual examination (C4-T2) was performed by an unblinded examiner with dysfunction defined as pain of 3 or higher on a numerical rating scale in the presence of a severe or moderate hypomobility or hypermobility. Neurodynamic testing (radial nerve) was classified positive if LE symptoms were reproduced and altered by sensitization maneuver. Repeated-measures analysis of variance was used to compare sides, segmental levels, and groups. Regression analysis was used to determine associations between variables. Results: Thirty-six percent of patients had dysfunction of at least 1 spinal palpation site, and 41% had a positive neurodynamic test. Significant group-by-level (P = .02) and group-by-side (P = .04) interactions were found for spinal examination, with greater dysfunction bilaterally at C4-7 (P < .01) in LE compared with control arms. The number of positive palpation sites was associated with injury duration (P = .03), whereas neurodynamic response was associated with severity of resting pain (P = .04). Conclusions: Cervical dysfunction is evident in individuals with LE without obvious neck pain and may reflect central sensitization mechanisms. Further study of the nature of the relationship between cervical dysfunction and LE is required

Thermal hyperalgesia distinguishes those with severe pain and disability in unilateral lateral epicondylalgia

Objectives: To evaluate if sensory, motor, and psychological factors are different in severe lateral epicondylalgia compared with less severe cases and control

Capturing patient-reported area of knee pain: a concurrent validity study using digital technology in patients with patellofemoral pain

Background Patellofemoral pain (PFP) is often reported as a diffuse pain at the front of the knee during knee-loading activities. A patient’s description of pain location and distribution is commonly drawn on paper by clinicians, which is difficult to quantify, report and compare within and between patients. One way of overcoming these potential limitations is to have the patient draw their pain regions using digital platforms, such as personal computer tablets. Objective To assess the validity of using computer tablets to acquire a patient’s knee pain drawings as compared to paper-based records in patients with PFP. Methods Patients (N = 35) completed knee pain drawings on identical images (size and colour) of the knee as displayed on paper and a computer tablet. Pain area expressed as pixel density, was calculated as a percentage of the total drawable area for paper and digital records. Bland–Altman plots, intraclass correlation coefficient (ICC), Pearson’s correlation coefficients and one-sample tests were used in data analysis. Results No significant difference in pain area was found between the paper and digital records of mapping pain area (p = 0.98), with the mean difference = 0.002% (95% CI [−0.159–0.157%]). A very high agreement in pain area between paper and digital pain drawings (ICC = 0.966 (95% CI [0.93–0.98], F = 28.834, df = 31, p < 0.001). A strong linear correlation (R2 = 0.870) was found for pain area and the limits of agreement show less than ±1% difference between paper and digital drawings. Conclusion Pain drawings as acquired using paper and computer tablet are equivalent in terms of total area of reported knee pain. The advantages of digital recording platforms, such as quantification and reporting of pain area, could be realized in both research and clinical settings

Altered movement patterns but not muscle recruitment in moderately trained triathletes during running after cycling

Previous studies have shown that cycling can directly influence neuromuscular control during subsequent running in some highly trained triathletes, despite these triathletes\u27 years of practice of the cycle-run transition. The aim of this study was to determine whether cycling has the same direct influence on neuromuscular control during running in moderately trained triathletes. Fifteen moderately trained triathletes participated. Kinematics of the pelvis and lower limbs and recruitment of 11 leg and thigh muscles were compared between a control run (no prior exercise) and a 30 min run that was preceded by a 15 min cycle (transition run). Muscle recruitment was different between control and transition runs in only one of 15 triathletes (&lt;7%). Changes in joint position (mean difference of 3&deg;) were evident in five triathletes, which persisted beyond 5 min of running in one triathlete. Our findings suggest that some moderately trained triathletes have difficulty reproducing their pre-cycling movement patterns for running initially after cycling, but cycling appears to have little influence on running muscle recruitment in moderately trained triathletes. <br /

REPEATABILlTY OF INTRAMUSCULAR ELECTROMYOGRAPHIC RECORDINGS DURING CYCLING

Fine-wire electromyographic (fEMG) techniques are indicated for the study of distal lower limb muscle recruitment during cycling, but evidence to support the repeatability of fEMG recordings is contradictory. This study investigated the repeatability of fEMG recordings from tibialis anterior (TA), tibialis posterior (TP), peroneus longus (PL), gastrocnemius lateralis (GL) and soleus (SOL) during cycling. The repeatability of fEMG recordings normalised to maximum measured EMG amplitude was high, with mean coefficients of multiple correlation (CMC) ranging from .82 .15 (GL) to .89 .09 (TA). The repeatability of fEMG recordings increased with greater test-retest intervals (p < .008). Data normalised to maximal or submaximal contractions were less repeatable (p < .001). These findings support the use of fEMG techniques to investigate distal lower limb muscle recruitment during cycling

Can foot anthropometric measurements predict dynamic plantar surface contact area?

<p>Abstract</p> <p>Background</p> <p>Previous studies have suggested that increased plantar surface area, associated with pes planus, is a risk factor for the development of lower extremity overuse injuries. The intent of this study was to determine if a single or combination of foot anthropometric measures could be used to predict plantar surface area.</p> <p>Methods</p> <p>Six foot measurements were collected on 155 subjects (97 females, 58 males, mean age 24.5 ± 3.5 years). The measurements as well as one ratio were entered into a stepwise regression analysis to determine the optimal set of measurements associated with total plantar contact area either including or excluding the toe region. The predicted values were used to calculate plantar surface area and were compared to the actual values obtained dynamically using a pressure sensor platform.</p> <p>Results</p> <p>A three variable model was found to describe the relationship between the foot measures/ratio and total plantar contact area (<it>R</it>²= 0.77, <it>p </it>< 0.0001)). A three variable model was also found to describe the relationship between the foot measures/ratio and plantar contact area minus the toe region (<it>R</it>²= 0.76, <it>p </it>< 0.0001).</p> <p>Conclusion</p> <p>The results of this study indicate that the clinician can use a combination of simple, reliable, and time efficient foot anthropometric measurements to explain over 75% of the plantar surface contact area, either including or excluding the toe region.</p

MULTIDISCIPLlNE TRAINING DEMANDS MAY IMPAIR ADAPTATION OF THE NEUROMUSCULAR SYSTEM IN TRIATHLETES

Muscle recruitment during cycling is highly consistent and constrained in trained cyclists relative to novice cyclists (Chapman et aI., 2004). This is consistent with previous evidence that adaptation of the neuromuscular system occurs with repeated performance of a motor task. Muscle recruitment in triathletes has not been investigated. Triathletes undertake similar cycling training loads to specialist cyclists, but must also undertake very high running and swimming training loads. The influence of these multidiscipline training demands on muscle recruitment remains unknown. This study compared patterns of distal lower limb muscle recruitment during cycling in triathletes, trained cyclists and novice cyclists