BIOMECHANICAL EFFECTS OF ORTHOTIC WEDGING ON SPORTS AND ACTIVITIES IN PATIENTS WITH PLANTAR FASCIITIS

Plantar Fasciitis is an inflammatory stress syndrome of the plantar fascia and the most common hind foot problem in runners (Anderson, 2000). It is related to the stress on the plantar fascia from the weight of and the activity combined with weight transfer up onto the toes which leads to metatarsophalangeal joint extension and causes a “windlass” effect on the plantar fascia. Different conditions such as excessive tightness of Achilles tendon, excessive or prolonged pronation, pes cavus, or obesity can overload the plantar fascia origin on the anteromedial aspect of the calcaneus during weight bearing activities (Taunton et al, 1996)

Orthoses for Spinal Cord Injury Patients

There are some limitations for patients with spinal cord injury (SCI) when walking with assistive devices. Heavy energy expenditure and walking high loads on the upper limb joints are two main reasons of high rejection rate of orthosis by these patients . Many devices have been designed to enable people with paraplegia to ambulate in an upright position as a solution of these limitations such as mechanical orthoses, hybrid orthoses and powered orthoses. All these devices are designed to solve the problem of standing and walking, but there are some other important notes, which should be considered. For example, the size and weight of external orthoses, donning and doffing, cumbersomeness and independency for using are very important

The physiological cost index of walking with a powered knee ankle foot orthosis in subjects with poliomyelitis : A pilot study

Background: A powered knee ankle foot orthosis (KAFO) was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. Objectives: The purpose of this study was to determine its effect on the physiological cost index (PCI), walking speed and the distance walked in people with poliomyelitis compared to when walking with a KAFO with drop lock knee joints. Methods: Seven subjects with poliomyelitis volunteered for the study, and undertook gait analysis with both types of KAFO. Results: Walking with the powered KAFO significantly reduced walking speed (p=0.015) and the distance walked (p=0.004), and also it did not improve PCI values (p =0.009) compared to walking with the locked KAFO. Conclusion: Using a powered KAFO did not significantly improve any of the primary outcome measures during walking for poliomyelitis subjects

Evaluation of gait symmetry in poliomyelitis subjects : Comparison of a conventional knee ankle foot orthosis (KAFO) and a new powered KAFO.

Background: Compared to able-bodied subjects, subjects with post polio syndrome and poliomyelitis demonstrate a preference for weight-bearing on the non-paretic limb, causing gait asymmetry. Objectives: The purpose of this study was to evaluate the gait symmetry of the poliomyelitis subjects when ambulating with either a drop- locked knee ankle foot orthosis (KAFO) or a newly developed powered KAFO. Methods: Seven subjects with poliomyelitis who routinely wore conventional KAFOs participated in this study, and received training to enable them to ambulate with the powered KAFO on level ground, prior to gait analysis. Results: There were no significant differences in the gait symmetry index (SI) of step length (P=0.085), stance time (P=0.082), double limb support time (P=0.929) or speed of walking (p=0.325) between the two test conditions. However, using the new powered KAFO improved the SI in step width (P=0.037), swing time (P=0.014), stance phase percentage (P=0.008) and knee flexion during swing phase (p≤0.001) compared to wearing the dropped locked KAFO. Conclusion: The use of a powered KAFO for ambulation by poliomyelitis subjects affects gait symmetry in the base of support, swing time, stance phase percentage and knee flexion during swing phase

Comparison of the efficacy of a neutral wrist splint and wrist splint with lumbrical unit for the treatment of patients with carpal tunnel syndrome

Purpose: The purpose of this study was to compare the effect of a neutral wrist splint or a wrist splint with an additional metacarpophalangeal (MCP) unit on pain, function, grip and pinch strength in patients with mild-to-moderate carpal tunnel syndrome (CTS). Methods: Twenty four patients received conservative treatment using either the neutral wrist splint or wrist splint with the MCP unit for a period of 6 weeks. Primary outcome measures were pain, function, grip and pinch strength. Data was collected immediately before and after using the two types of splints at baseline (0 weeks) and 6 weeks. Statistical analysis was performed using the paired t-test and independent T-test. Results: Compared to baseline, both the neutral wrist splint and the wrist splint with an MCP unit significantly decreased pain, increased function and pinch and grip strength. Comparisons of the two types of splints for grip (P =0.675) and pinch strength (P =0.650) revealed that there were no significant differences between the two after 6 weeks of wear. However, there were significant differences in pain levels (P =0.022) and the DASH score (P =0.027) between the two types of splints from baseline to 6 weeks. Conclusion: The wrist splint with an MCP unit was more effective than the neutral wrist splint in pain reduction and improvement of function

Efficacy of Different Types of Foot Orthoses on Postural Control in Subjects With Lateral Ankle Sprain: A Systematic Review

Objectives: Lateral ankle sprain is one of the most common injuries to the musculoskeletal system, especially among active people. This injury causes complex complications, such as recurrent sprain because of reduced postural control. Foot orthoses are among the interventions used to improve postural control in this population. This review aims to investigate foot orthoses to improve postural control among patients with an acute or chronic lateral ankle sprain.  Methods: Four electronic databases (Scopus, PubMed, Web of Sciences, and Google scholar) were searched for experimental studies. Articles were selected using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method. The articles were reviewed for their quality based on the standards for reporting diagnostic accuracy statements and then entered into this review. Results: The search results in all databases provided a total of 48 articles. After reviewing the documents, we excluded 38 articles that did not pass the inclusion criteria, resulting in 10 remaining articles. Data extraction from population, interventions, and outcome measures was done for these 10 articles. Discussion: Foot orthoses are effective in improving the postural control of individuals with an acute or chronic lateral ankle sprain. Considering the existence of mechanical and functional instability, foot orthosis which is made to affect the proprioception and follow the biomechanics of the body seems to be the most effective in this field; however, more studies are required to confirm thi

The Effect of Modified Floor Reaction Ankle Foot Orthoses on Walking Abilities in Children with Cerebral Palsy

Objectives: This study was designed to evaluate the effectiveness of a modified floor reaction ankle foot orthosis (FRAFO) design on gait performance in children with cerebral palsy. Methods: Eight children with cerebral palsy wore a modified FRAFO bilaterally for six weeks. Motion analysis was used to assess the immediate effectiveness of the orthosis on improving gait and also following six weeks of gradual orthosis use. Primary outcome measures were walking speed, cadence and stride length, plus hip, knee and ankle joint ranges of motion. A paired T test was used to compare primary outcome measures. Results: Cadence, stride length and walking speed were all significantly increased when the children wore the modified FRAFO (P=<0.001 for speed and stride length and P=0.005 for cadence). The children demonstrated a statistically significant reduction in ankle ROM when using the modified FRAFO. The mean knee joint ROM was increased from 36.5&plusmn;13.32 degrees when walking with an orthosis at baseline to 43.5&plusmn;1.19 degrees when walking with an orthosis after six weeks of use. Children with the modified FRAFO also had decreased hip flexion angle at initial contact and an extension shift during stance phase following 6 weeks of orthosis use compared to when initially donning it. Discussion: Children with cerebral palsy can benefit from an improvement in gait parameters when walking with a modified FRAFO

Effects of Custom-mold Insole by Medial Heel Skive Technique on Physical Function in Flexible Flat Foot

Objectives: Flexible Flat Foot (FFF), a common foot deformity decreasing medial longitudinal arch height is often comorbid with subtalar joint pronation causing physical activity difficulties in this population. Among the orthotic insoles prescribed for improving foot function, foot orthoses with medial heel skive technique have a limited research background. The present study aimed to investigate the effects of the custom-mold insole with medial heel skive technique on physical function in FFF. Methods: Eighteen adults with FFF from the University of Social Welfare and Rehabilitation Sciences students and staff participated in this study. Custom-Mold insole with medial heel skive was fabricated for all research participants. Physical function in the activities of daily living and sports was assessed by the Foot and Ankle Ability Measure (FAAM), Activities of Daily Living (ADL) subscale (ADL-FAAM), and SPORT-FAAM questionnaires at the beginning of the study and 6 weeks after. Paired Samples t-test and nonparametric tests were used to compare the collected results. Results: After 6 weeks of using the insole with medial heel skive technique, scores in both ADL and SPORTS activities were significantly improved. Discussion: Foot function improvement was not found in all of the studies assessing foot function in flat feet after using different orthotic insoles, by different questionnaires or other systems. In this study, foot and ankle function was significantly improved per FAAM questionnaire- which had highly limited use in orthotic interventions in flat feet population- using medial heel skive technique; however, further studies are required to accentuate medial heel skive technique effect on flat feet function by comparing this technique with other positive cast modifications to control the flat foot. According to the present study results, custom-mold insole with medial heel skive may improve physical function in FFF and can be prescribed in this group

Effect of Rocker Bar Ankle Foot Orthosis on Functional Mobility in Post-Stroke Hemiplegic Patients: Timed Up and Go and Gait Speed Assessments

Objectives: Ankle Foot Orthoses (AFOs) are widely utilized to improve walking ability in&nbsp;hemiplegic patients. The present study aimed to evaluate the effect of Rocker bar Ankle Foot&nbsp;Orthosis (RAFO) on functional mobility in post-stroke hemiplegic patients. Methods: Fifteen hemiplegic patients (men and women) who were at least 6-months poststroke&nbsp;and able to walk without an assistive device for at least 10 meters voluntarily participated&nbsp;in this study. The patients were examined for three conditions: shoes only, with SAFO and with&nbsp;RAFO. Their functional mobility was evaluated through 10-meter walk test and Timed Up and Go (TUG) test. In addition, paired t-test was used to analyze the obtained data. Results: When the patients used RAFO, their gait speed significantly increased (P<0.05).&nbsp;Moreover, the time of performing TUG test experienced a significant decrease using RAFO&nbsp;compared with utilizing shoe only (P<0.05). Discussion: RAFO led to a significant improvement in functional mobility in hemiplegic&nbsp;patients post stroke. This may be due to the positive effect of rocker modification on improving&nbsp;push off and transferring weight during the stance phase of gait

The effect of floor reaction ankle foot orthosis on postural control in children with spastic cerebral palsy

Background: Children with cerebral palsy (CP) often demonstrate postural control difficulties. Orthotic management may assist in improving postural control in these children. Objective: The purpose of this investigation was to examine the influence of floor reaction ankle foot orthosis (FRAFO) on postural flexion called the crouch position in children with CP. Study Design: Quasi-experimental. Methods: Eight children with spastic diplegic CP and eight matched typically developing children participated in this study. Postural control of children with CP was assessed in a static standing position on a force platform with/without a FRAFO. The parameters used were centre of pressure (CoP) measures, calculated from force platform signals including the standard deviation (SD) of excursion; phase plate portrait and SD of velocity in anteroposterior (AP) and mediolateral (ML) directions. Results: The maximum knee extension was statistically significant in children with CP when barefoot compared to wearing braced footwear (<i>p</i> < 0.05, <i>t</i> = 10.01). AP and ML displacement, AP velocity and AP phase plate portrait of CoP were not statistically significant between children with CP with/without a FRAFO (<i>p</i> < 0.05). Conclusion: FRAFO can improve the alignment of the knee, but may not be helpful in improving postural control in children with CP in a short time period