Use and usability of custom-made orthopedic shoes

The goal of this study was to investigate the use of custom-made orthopedic shoes (OS) and the association between the use of OS and the most relevant aspects of their usability. Over a 6-month period, patients meeting the inclusion criteria were recruited by 12 orthopedic shoe companies scattered throughout the Netherlands and asked to complete a questionnaire composed of a pre- and post-OS section. Patients with different pathologies were included in the study (n = 339; response 67%). Mean age of the patients was 63 +/- 15 years, and 38% were male. Three months after delivery, 81% of the patients used their OS frequently (4-7 days/week), 13% occasionally (1-3 days/week), and 6% did not use their OS. Associations were found between use and all measured aspects of usability (p-values varied from <0.001 to 0.028). Patients who used their OS more often had a more positive opinion regarding all the aspects of usability. We conclude that all aspects of the usability of OS are relevant in relation to their use and should be taken into account when prescribing and evaluating OS

Prevalence and factors associated with musculoskeletal complaints and disability in individuals with brachial plexus injury:a cross-sectional study

Purpose (1) To determine the prevalence of musculoskeletal complaints (MSCs) in the non-affected bodily structures in individuals with brachial plexus injury (BPI) and (2) to analyse factors associated with MSCs and disability. Methods Survey among individuals with BPI and a control group. Multivariable logistic and linear regression analyses were used to identify factors associated with MSCs or disability. Results Forty-nine percent of individuals (34/70) with BPI experienced MSC, which was not significantly different from controls (35%, n = 40/113). Complaints were most often located in high back (OR = 3.6) or non-affected limb (OR = 2.2) or neck (OR = 2.1). Greater disability was associated with the presence of MSC in individuals with BPI (OR = 1.1, 95% confidence interval (95% CI) = 1.0; 1.1). Those with no or a low level of education (B = -10.2, 95% CI = -19.6; -1.4), a history of nerve surgery (B = 11.1, 95% CI = -0.2; 20.9), and moderately affected active range of motion (AROM) of the affected limb (B = 20.7, 95% CI = 8.8; 31.0) experienced most disability. Individuals with severely affected AROM showed a wide range of experienced disability. Conclusions Clinicians should be aware that almost half of individuals with BPI have MSCs in the non-affected bodily structures, which was associated with increased disability.</p

A Review of the State of Art in Applying Biot Theory to Acoustic Propagation through the Bone

Understanding the propagation of acoustic waves through a liquid-perfused porous solid framework such as cancellous bone is an important pre-requisite to improve the diagnosis of osteoporosis by ultrasound. In order to elucidate the propagation dependence upon the material and structural properties of cancellous bone, several theoretical models have been considered to date, with Biot-based models demonstrating the greatest potential. This paper describes the fundamental basis of these models and reviews their performance

Effect of awareness of being monitored on wearing of orthopaedic footwear

OBJECTIVE: To investigate the effect of awareness of being monitored on wearing time and adherence to wearing orthopaedic footwear. Quantitative assessment of wearing time was made using direct measurement with temperature sensors during the first 3 months after provision of footwear. DESIGN: Randomized controlled trial. INTERVENTION: Awareness that the temperature sensor is used for measuring wearing time. METHODS: All 55 participants had a temperature sensor built into the medial arch of the left insole of their orthopaedic footwear. Participants were assigned randomly to either an "awareness group" (n = 25, mean age 67 years) and knew they were being monitored for wearing time, or a "no awareness group" (n = 30, mean age 65 years) and only knew their shoe temperature was being measured. Differences were assessed with a linear mixed model. RESULTS: Mean (standard deviation; SD) wearing time in the intervention group was 7.32 h/day (SD 4.2), and 6.11 h/day (SD 4.1) in the control group (p = 0.017). A significant interaction effect was found between awareness and pathology group on wearing time (p = 0.036). The difference was especially large (7.0 (SD 4.7) vs 2.4 (SD 2.2) h/day) in the subgroup of people with diabetes. CONCLUSION: Awareness of being monitored increases wearing time and wearing of orthopaedic footwear

The genetics of situs inversus without primary ciliary dyskinesia

Situs inversus (SI), a left-right mirror reversal of the visceral organs, can occur with recessive Primary Ciliary Dyskinesia (PCD). However, most people with SI do not have PCD, and the etiology of their condition remains poorly studied. We sequenced the genomes of 15 people with SI, of which six had PCD, as well as 15 controls. Subjects with non-PCD SI in this sample had an elevated rate of left-handedness (five out of nine), which suggested possible developmental mechanisms linking brain and body laterality. The six SI subjects with PCD all had likely recessive mutations in genes already known to cause PCD. Two non-PCD SI cases also had recessive mutations in known PCD genes, suggesting reduced penetrance for PCD in some SI cases. One non-PCD SI case had recessive mutations in PKD1L1, and another in CFAP52 (also known as WDR16). Both of these genes have previously been linked to SI without PCD. However, five of the nine non-PCD SI cases, including three of the left-handers in this dataset, had no obvious monogenic basis for their condition. Environmental influences, or possible random effects in early development, must be considered

Frontal plane roll-over analysis of prosthetic feet

In prosthetic walking mediolateral balance is compromised due to the lack of active ankle control, by moments of force, in the prosthetic limb. Active control is reduced to the hip strategy, and passive mechanical stability depends on the curvature of the prosthetic foot under load. Mediolateral roll-over curvatures of prosthetic feet are largely unknown. In this study we determined the mediolateral roll-over characteristics of various prosthetic feet and foot-shoe combinations. Characteristics were determined by means of an inverted pendulum-like apparatus. The relationship between the centre of pressure (CoP) and the shank angle was measured and converted to roll-over shape and effective radius of curvature. Further, hysteresis (i.e., lagging in CoP displacement due to material compliance or slip) at vertical shank angle was determined from the hysteresis curve. Passive mechanical stability varied widely, though all measured foot-shoe combinations were relatively compliant. Mediolateral motion of the CoP ranged between 4 mm and 40 mm, thereby remaining well within each foot's physical width. Derived roll-over radii of curvature are also small, with an average of 102 mm. Hysteresis ranges between 20% and 115% of total CoP displacement and becomes more pronounced when adding a shoe. This may be due to slipping of the foot core in its cosmetic cover, or the foot in the shoe. Slip may be disadvantageous for balance control by limiting mediolateral travel of the CoP. It may therefore be clinically relevant to eliminate mediolateral slip in prosthetic foot design

Effects of Longitudinal Bending Stiffness of forefoot rocker profile shoes on ankle kinematics and kinetics

INTRODUCTION: Rocker profile shoes with a proximally placed apex are currently one of the most prescribed shoe modifications for treatment and prevention of lower leg deficits. Three geometrical rocker design parameters apex position (AP), apex angle (AA) and rocker radius (RR) influence both plantar pressure redistribution and kinetic and kinematic alterations of the lower leg. In addition, longitudinal bending stiffness (LBS) of the outsole influences these parameters as well. This study aims to investigate the effects of the LBS in combination with different forefoot radii of rocker shoes on kinematics and kinetics of the lower limb. METHODS: 10 participants walked in standard shoes and six experimental shoe conditions with high and low LBS and three different forefoot rocker radii with the same (proximal) AP and AA. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with a repeated measures ANOVA and Statistical Parametric Mapping (SPM) (α = .05; post hoc α = .05/6). RESULTS: SPM analyses revealed no significant differences for LBS and interaction LBS*RR for most research variables in terminal stance (ankle angle, ankle moment, ankle power, foot-to-horizontal angle, shank-to-vertical angle, external ankle moment, ground reaction force angle). A significant LBS effect was found for anterior-posterior position of the centre of pressure during pre-swing and peak ankle dorsiflexion angle. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle between low and high LBS. CONCLUSION: This study showed that longitudinal bending stiffness does not affect the biomechanical working mechanism of rocker profile shoes as long as toe plantarflexion is restricted. Providing that the forefoot rocker radius supports at least a normal foot-to-horizontal angle at toe-off, there is no reason to increase sole stiffness to change ankle kinematics and kinetics