1000 Norms Project: Protocol of a cross-sectional study cataloging human variation

Background Clinical decision-making regarding diagnosis and management largely depends on comparison with healthy or ‘normal’ values. Physiotherapists and researchers therefore need access to robust patient-centred outcome measures and appropriate reference values. However there is a lack of high-quality reference data for many clinical measures. The aim of the 1000 Norms Project is to generate a freely accessible database of musculoskeletal and neurological reference values representative of the healthy population across the lifespan. Methods/design In 2012 the 1000 Norms Project Consortium defined the concept of ‘normal’, established a sampling strategy and selected measures based on clinical significance, psychometric properties and the need for reference data. Musculoskeletal and neurological items tapping the constructs of dexterity, balance, ambulation, joint range of motion, strength and power, endurance and motor planning will be collected in this cross-sectional study. Standardised questionnaires will evaluate quality of life, physical activity, and musculoskeletal health. Saliva DNA will be analysed for the ACTN3 genotype (‘gene for speed’). A volunteer cohort of 1000 participants aged 3 to 100 years will be recruited according to a set of self-reported health criteria. Descriptive statistics will be generated, creating tables of mean values and standard deviations stratified for age and gender. Quantile regression equations will be used to generate age charts and age-specific centile values. Discussion This project will be a powerful resource to assist physiotherapists and clinicians across all areas of healthcare to diagnose pathology, track disease progression and evaluate treatment response. This reference dataset will also contribute to the development of robust patient-centred clinical trial outcome measures

Moving from a Splint to a Functional Midfoot Shoe Design for Children

Emerging evidence suggests that shoes have a splinting effect on the midfoot, reducing midfoot plantarflexion during the propulsive period of gait. This thesis explores the splinting effect of shoes on midfoot plantarflexion during propulsion via the development of a flexible shoe to facilitate midfoot plantarflexion during propulsion. The reduction in midfoot plantarflexion in conventional shoes reduces midfoot power generation and is partially compensated by an increase in ankle power generation. The novel flexible shoe proposed in this thesis increases midfoot plantarflexion and power generation compared to a conventional shoe, but does not match midfoot plantarflexion or power generation while barefoot

Effect of work boot shaft stiffness and sole flexibility on lower limb muscle activity and ankle alignment at initial foot-ground contact when walking on simulated coal mining surfaces: Implications for reducing slip risk

Design features of safety work boots have the potential to influence how underground coal miners\u27 feet interact with the challenging surfaces they walk on and, in turn, their risk of slipping. Despite the importance of work boot design in reducing the risk of miners slipping, limited research has investigated how boot design features, such as shaft stiffness and sole flexibility, affect the way miners walk. Therefore, this study aimed to investigate the effects of systematic variations to boot shaft stiffness and sole flexibility on lower limb muscle activity and ankle motion in preparation for initial foot-ground contact when 20 males walked across two simulated coal mining surfaces under four mining boot conditions. It was concluded that a boot which has different flexibility and stiffness between the shaft and sole is a better design option to reduce underground coal miners\u27 slip risk than a boot that has a stiff shaft and stiff sole or flexible shaft and flexible sole

Effect of neutral-cushioned running shoes on plantar pressure loading and comfort in athletes with cavus feet : a crossover randomized controlled trial

Background: High injury rates observed in athletes with cavus feet are thought to be associated with elevated plantar pressure loading. Neutral-cushioned running shoes are often recommended to manage and prevent such injuries. Purpose: To investigate in-shoe plantar pressure loading and comfort during running in 2 popular neutral-cushioned running shoes recommended for athletes with cavus feet. Study Design: Controlled laboratory study. Methods: Plantar pressures were collected using the in-shoe Novel Pedar-X system during overground running in 22 athletes with cavus feet in 2 neutral-cushioned running shoes (Asics Nimbus 6 and Brooks Glycerin 3) and a control condition (Dunlop Volley). Comfort was measured using a validated visual analog scale. Results: Compared with the control, both neutral-cushioned running shoes significantly reduced peak pressure and pressure-time integrals by 17% to 33% (P <.001). The Brooks Glycerin most effectively reduced pressure beneath the whole foot and forefoot (P <.01), and the Asics Nimbus most effectively reduced rearfoot pressure (P <.01). Both neutral-cushioned running shoes reduced force at the forefoot by 6% and increased it at the midfoot by 12% to 17% (P <.05). Contact time and area increased in both neutral-cushioned running shoes (P <.01). The Asics Nimbus was the most comfortable, although both neutral-cushioned running shoes were significantly more comfortable than the control (P <.001). Conclusion: Two popular types of neutral-cushioned running shoes were effective at reducing plantar pressures in athletes with cavus feet. Clinical Relevance: Regional differences in pressure reduction suggest neutral-cushioned running shoe recommendation should shift from being categorical in nature to being based on location of injury or elevated plantar pressure

Effect of children's shoes on gait: a systematic review and meta-analysis

Abstract Background The effect of footwear on the gait of children is poorly understood. This systematic review synthesises the evidence of the biomechanical effects of shoes on children during walking and running. Methods Study inclusion criteria were: barefoot and shod conditions; healthy children aged ≤ 16 years; sample size of n > 1. Novelty footwear was excluded. Studies were located by online database-searching, hand-searching and contact with experts. Two authors selected studies and assessed study methodology using the Quality Index. Meta-analysis of continuous variables for homogeneous studies was undertaken using the inverse variance approach. Significance level was set at P 2. Where I2 > 25%, a random-effects model analysis was used and where I2 Results Eleven studies were included. Sample size ranged from 4-898. Median Quality Index was 20/32 (range 11-27). Five studies randomised shoe order, six studies standardised footwear. Shod walking increased: velocity, step length, step time, base of support, double-support time, stance time, time to toe-off, sagittal tibia-rearfoot range of motion (ROM), sagittal tibia-foot ROM, ankle max-plantarflexion, Ankle ROM, foot lift to max-plantarflexion, 'subtalar' rotation ROM, knee sagittal ROM and tibialis anterior activity. Shod walking decreased: cadence, single-support time, ankle max-dorsiflexion, ankle at foot-lift, hallux ROM, arch length change, foot torsion, forefoot supination, forefoot width and midfoot ROM in all planes. Shod running decreased: long axis maximum tibial-acceleration, shock-wave transmission as a ratio of maximum tibial-acceleration, ankle plantarflexion at foot strike, knee angular velocity and tibial swing velocity. No variables increased during shod running. Conclusions Shoes affect the gait of children. With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern. The long-term effect of these changes on growth and development are currently unknown. The impact of footwear on gait should be considered when assessing the paediatric patient and evaluating the effect of shoe or in-shoe interventions.</p