A case-series study to explore the efficacy of foot orthoses in treating first metatarsophalangeal joint pain

Background: First metatarsophalangeal (MTP) joint pain is a common foot complaint which is often considered to be a consequence of altered mechanics. Foot orthoses are often prescribed to reduce 1 stMTP joint pain with the aim of altering dorsiflexion at propulsion. This study explores changes in 1 stMTP joint pain and kinematics following the use of foot orthoses.Methods: The effect of modified, pre-fabricated foot orthoses (X-line ®) were evaluated in thirty-two patients with 1 stMTP joint pain of mechanical origin. The primary outcome was pain measured at baseline and 24 weeks using the pain subscale of the foot function index (FFI). In a small sub-group of patients (n = 9), the relationship between pain and kinematic variables was explored with and without their orthoses, using an electromagnetic motion tracking (EMT) system.Results: A significant reduction in pain was observed between baseline (median = 48 mm) and the 24 week endpoint (median = 14.50 mm, z = -4.88, p < 0.001). In the sub-group analysis, we found no relationship between pain reduction and 1 stMTP joint motion, and no significant differences were found between the 1 stMTP joint maximum dorsiflexion or ankle/subtalar complex maximum eversion, with and without the orthoses.Conclusions: This observational study demonstrated a significant decrease in 1 stMTP joint pain associated with the use of foot orthoses. Change in pain was not shown to be associated with 1 stMTP joint dorsiflexion nor with altered ankle/subtalar complex eversion. Further research into the effect of foot orthoses on foot function is indicated. © 2010 Welsh et al; licensee BioMed Central Ltd

Efficacy of customised foot orthoses in the treatment of achilles tendinopathy : study protocol for a randomised trial

BACKGROUND: Achilles tendinopathy is a common condition that can cause marked pain and disability. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. The exception to this is eccentric calf muscle exercises, which have become a standard non-surgical intervention for Achilles tendinopathy. Foot orthoses have also been advocated as a treatment for Achilles tendinopathy, but the long-term efficacy of foot orthoses for this condition is unknown. This manuscript describes the design of a randomised trial to evaluate the efficacy of customised foot orthoses to reduce pain and improve function in people with Achilles tendinopathy. METHODS: One hundred and forty community-dwelling men and women aged 18 to 55 years with Achilles tendinopathy (who satisfy inclusion and exclusion criteria) will be recruited. Participants will be randomised, using a computer-generated random number sequence, to either a control group (sham foot orthoses made from compressible ethylene vinyl acetate foam) or an experimental group (customised foot orthoses made from semi-rigid polypropylene). Both groups will be prescribed a calf muscle eccentric exercise program, however, the primary difference between the groups will be that the experimental group receive customised foot orthoses, while the control group receive sham foot orthoses. The participants will be instructed to perform eccentric exercises 2 times per day, 7 days per week, for 12 weeks. The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire. The secondary outcome measures will be participant perception of treatment effect, comfort of the foot orthoses, use of co-interventions, frequency and severity of adverse events, level of physical activity and health-related quality of life (assessed using the Short-Form-36 questionnaire - Version two). Data will be collected at baseline, then at 1, 3, 6 and 12 months. Data will be analysed using the intention to treat principle. DISCUSSION: This study is the first randomised trial to evaluate the long-term efficacy of customised foot orthoses for the treatment of Achilles tendinopathy. The study has been pragmatically designed to ensure that the study findings are generalisable to clinical practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number: ACTRN12609000829213

Comparative shoulder kinematics during free standing, standing depression lifts and daily functional activities in persons with paraplegia: Considerations for shoulder health

Study design: Case series; nonparametric repeated-measures analysis of variance. Objective: To compare and contrast three-dimensional shoulder kinematics during frequently utilized upper extremity weight-bearing activities (standing depression lifts used in brace walking, weight-relief raises, transfers) and postures (sitting rest, standing in a frame) in spinal cord injury (SCI). Setting: Movement Analysis Laboratory, Department of Physical Therapy, Ithaca College, Rochester, NY, USA. Methods: Three female and two male subjects (39.2±6.1 years old) at least 12 months post-SCI (14.6±6.7 years old), SCI distal to T2 and with an ASIA score of A. The Flock of Birds magnetic tracking device was used to measure three-dimensional positions of the scapula, humerus and thorax during various activities. Results: Standing in a frame resulted in significantly less scapular anterior tilt (AT) and greater glenohumeral external rotation (GHER) than standing depression lifts and weight-relief raises. Conclusions: Standing frame posture offers the most favorable shoulder joint positions (less scapular AT and greater GHER) when compared to sitting rest posture, weight-relief raises, transfers and standing depression lifts. Knowledge of kinematic patterns associated with each activity is an essential first step to understanding the potential impact on shoulder health. Choosing specific activities or modifying techniques within functional activities that promote favorable shoulder positions may preserve long-term shoulder health. Sponsorship: National Institute of Health (R15HD41379-01) and the Spinal Cord Research Foundation (2251-01). © 2008 International Spinal Cord Society All rights reserved

Reliability and validity of first metatarsophalangeal joint orientation measured with an electromagnetic tracking device

Objective. To establish the reliability and validity of measurements of sagittal plane orientation of the first metatarsophalangeal joint using the Flock of Birds® electromagnetic tracking device. Design. Different joint orientations were reproduced on cadaver specimens in a specially designed jig with skin and skeletal application of the sensors. Background. The Flock of Birds® provides a means for quantifying first metatarsophalangeal joint motion, however, the reliability and validity of such an application has not been determined. Methods. Joint orientation was measured in five cadaver feet with skin and skeletal sensor application. A specially designed jig allowed simulation of clinical tests of range of motion. Sagittal plane orientation was determined from 3-D, anatomically-based, reference frames embedded in the first metatarsal and proximal hallux. Results. Reliability of all measurements was high for skin and skeletal sensor application. There were no significant differences in joint orientation between either technique for any of the simulated motion tests. Conclusions. The Flock of Birds® provides reliable and valid measures of first metatarsophalangeal joint orientation with the sensors applied to the skin over the first metatarsal and proximal hallux

Forefoot and rearfoot contributions to the lunge position in individuals with and without insertional Achilles tendinopathy

Background Clinicians use the lunge position to assess and treat restricted ankle dorsiflexion. However, the individual forefoot and rearfoot contributions to dorsiflexion and the potential for abnormal compensations are unclear. The purposes of this case-control study were to 1) compare single- (representing a clinical lunge position measure) versus multi-segment contributions to dorsiflexion, and 2) determine if differences are present in patients with tendinopathy. Methods 32 individuals (16 with insertional Achilles tendinopathy and 16 age- and gender-matched controls) participated. Using three-dimensional motion analysis, the single-segment model was defined as tibial inclination relative to the whole foot. The multi-segment model consisted of rearfoot (tibia relative to calcaneus) and forefoot (1st metatarsal relative to calcaneus) motion. Two-way (kinematic model and group) analyses of variance were used to assess differences in knee bent and straight positions. Associations between models were tested with Pearson correlations. Findings Single-segment modeling resulted in ankle DF values 5° greater than multi-segment modeling that isolated rearfoot dorsiflexion for knee bent and straight positions (P \u3c 0.01). Compared to controls, the tendinopathy group had 10° less dorsiflexion with the knee bent (P \u3c 0.01). For the tendinopathy group, greater dorsiflexion was strongly associated with greater rearfoot (r = 0.95, P \u3c 0.01) and forefoot (r = 0.81, P \u3c 0.01) dorsiflexion. For controls, dorsiflexion was strongly associated with rearfoot (r = 0.87, P \u3c 0.01) but not forefoot dorsiflexion (r = 0.23, P = 0.39). Interpretation Clinically used single-segment models of ankle dorsiflexion overestimate rearfoot dorsiflexion. Participants with insertional Achilles tendinopathy may compensate for restricted and/or painful ankle dorsiflexion by increased lowering of the medial longitudinal arch (forefoot dorsiflexion) with the lunge position

Biomechanics of sitting pivot transfers among individuals with a spinal cord injury: A review of the current knowledge

The performance of sitting pivot transfers (SPTs) is demanding for the upper limbs (ULs) in individuals with a spinal cord injury (SCI). Recent biomechanical research has contributed to greater insight in the performance of SPT tasks. This article highlights the current knowledge on the biomechanics of SPTs among individuals with SCI, especially among those with paraplegia. Current clinical practice recommendations related to SPTs are reviewed along with suggested revisions and additions based on recent evidence. Suggestions for optimizing SPT performance, while simultaneously minimizing UL risk exposure, are proposed. Last, research opportunities related to the performance of SPTs among individuals with SCI are addressed. © 2009 Thomas Land Publishers, Inc

Three-dimensional shoulder kinematics during a pressure relief technique and wheelchair transfer

Objective: To assess 3-dimensional scapulothoracic and glenohumeral kinematics in able-bodied subjects during a weight-relief raise and while transferring to and from a wheelchair. Design: Repeated-measures analysis of variance. Setting: Research laboratory. Participants: Twenty-five able-bodied subjects without spinal cord injury or shoulder symptoms (20 men, 5 women; age range, 20-37y). Interventions: Completion of weight-relief raise and transfer tasks. Main Outcome Measures: An electromagnetic motion capture system tracked 3-dimensional position and orientation of the thorax, scapula, and humerus. Absolute angular values assessed included scapular downward and upward rotation, internal and external rotation, and posterior and anterior tipping all relative to the thorax, as well as humeral internal and external rotation relative to the scapula. Data were compared across 3 phases of the weight-relief raise and for transfer direction (leading arm, trailing arm). Results: Key findings included significantly increased anterior tipping and internal rotation of the scapula and decreased scapular upward rotation and external rotation of the humerus during the weight-relief raise. The leading arm showed significantly greater scapular anterior tipping and internal rotation and less scapular upward rotation and humeral external rotation than the trailing arm during the final phase of the transfer. Conclusions: Both the weight-relief raise and transfer result in scapular and humeral positions and directions of motion that may negatively impact the available subacromial space. This may present increased risk for injury or progression of shoulder pain in persons who must routinely perform these tasks. © 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation