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Individuals with myelomeningocele (MMC) present with neurological and orthopaedic deficiencies, requiring orthoses during walking. Orthoses for counteracting dorsiflexion may restrict activities such as rising from a chair. How are sit-to-stand (STS) movements performed with ankle joint-restricted ankle-foot orthoses (AFO) and knee-ankle-foot orthoses with a free-articulated knee joint (KAFO-F)? Twenty-eight adults with MMC, mean age 25.5 years (standard deviation: 3.5 years), were divided into an AnkleFree group (no orthosis or a foot orthosis) and an AnkleRestrict group (AFOs or KAFO-Fs). Study participants performed the five times STS test (5STS) while their movements were simultaneously captured with a three-dimensional motion system. Centre of mass (CoM) trajectories and joint kinematics were analysed using statistical parametric mapping. The AnkleRestrict group performed the STS slower than the AnkleFree group, median 8.8 s (min, max: 6.9, 14.61 s) vs 15.0 s (min, max: 7.5, 32.2 s) (p = 0.002), displayed reduced ankle dorsiflexion (mean difference: 6°, p = 0.044) (74–81 % of the STS cycle), reduced knee extension (mean difference: 14°, p = 0.002) (17–41 % of the STS cycle), larger anterior pelvic tilt angle (average difference: 11°, p = 0.024) (12–24 % of the STS cycle), and larger trunk flexion angle (on average 4°, p = 0.029) (6–15 % of the STS cycle). The differences between the AnkleFree and AnkleRestrict groups in performing the STS seem consistent with the participants functional ambulation: community ambulation in the AnkleFree group, and household and nonfunctional ambulation with less hip muscle strength in the majority of the AnkleRestrict group. No differences in the 5STS CoM trajectories or the kinematics were found with respect to the AFO and KAFO-Fs groups. Because orthoses are constructed to enable walking, the environment needs to be adjusted for activities in daily living such as the STS movement. • Orthoses for walking require restricted ankle dorsiflexion in individuals with MMC. • A blocked ankle hampers forward movement altering sit-to-stand (STS) movements. • The effort required to perform STS in everyday activities should be acknowledged. • The findings highlight the importance of adjusting the environment with external support. [ABSTRACT FROM AUTHOR]

Exercises strengthening foot muscles and customized arch support insoles are recommended for improving foot posture in flexible flatfoot. However, it is not known what the effects of exercises and insoles on plantar force distribution obtained during walking at different speeds. Also, randomized controlled trials comparing the effects of exercises and insoles are limited. What are the effects of foot exercises, customized arch support insoles, and exercises plus insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot? Do exercises, insoles, and exercises plus insoles affect outcome measures differently? Forty-five people with flexible flatfoot were randomly divided into three groups and 40 of those completed the study. The exercise group performed tibialis posterior strengthening and short foot exercises three days a week for six weeks. The insole group used their customized arch support insoles for six weeks. The exercise plus insole group received both interventions for six weeks. The assessments were performed three times: before the interventions and at the 6th and 12th weeks. Outcome measures were (1) foot posture, (2) plantar force distribution in the following conditions: static standing, barefoot walking at different speeds, and walking immediately after the heel-rise test, and (3) balance. Foot posture improved in all groups, but insole was less effective than exercise and exercise plus insole (p<0.05). Plantar force variables obtained during standing and walking changed in all groups (p<0.05). The superiority of the interventions differed according to the plantar regions and walking speed conditions (p<0.05). Static balance improved in all groups, but limits of stability improved in the exercise plus insole and exercise groups (p<0.05). The superiority of the interventions differed according to the assessed parameter. The management of flexible flatfoot should be tailored based on the assessment results of each individual. • Exercises and exercises plus insoles were more effective than insoles for posture. • Exercises and exercises plus insoles improved dynamic balance, but insoles did not. • Exercises plus insoles can be used to provide plantar force lateralization. • Insoles can be used to decrease loading on the midfoot. [ABSTRACT FROM AUTHOR]

The effects of foot orthoses on lower limb biomechanics during walking have been studied extensively. However, the lack of knowledge regarding the effects of various foot orthoses models for the same population complicates model selection in clinical practice and research. Additionally, there is a critical need to enhance our ability to predict the outcomes of foot orthoses using clinical tests, such as the supination resistance test. What are the effects of two commonly prescribed types of FO (thin-flexible and medially wedged) on lower limb biomechanics during gait? Is there a correlation on these effects with the results of the supination resistance test? Twenty-three participants with flat feet were enrolled in this cross-sectional descriptive study. Participants underwent walking trials under three conditions: shod, thin-flexible FOs and medially wedged FOs. Midfoot, ankle, knee and hip angles, moments were calculated. Repeated measure ANOVAs were employed for within-group comparison across conditions. Correlations between the effects of FOs on foot and ankle angles/moments and supination resistance were determined using regression analyses using a statistical parametric mapping approach. Thin-flexible and medially wedged FOs reduced midfoot dorsiflexion angles and ankle inversion moments. Medially wedged FOs also decreased midfoot and ankle abduction angles, midfoot plantarflexion moments compared to thin-flexible FOs and shoes. Moderate to good correlations between the supination resistance test and the medially wedged FOs were observed for the frontal and transverse ankle angles and moments. Medially wedged FOs are more effective in modifying lower limb biomechanics during walking compared to thin-flexible FOs. Greater supination resistance was associated with more pronounced effects for medially wedged FOs on foot and ankle biomechanics. These findings hold promise for refining orthotic prescription strategies, potentially offering advantages to individuals with musculoskeletal disorders. • Medially wedged foot orthoses generated the greater biomechanical effects. • Foot orthoses primarily impacted the distal segments of the lower limb. • Moderate correlations were observed between SRT and the biomechanical effects. • The supination resistance test will help in the foot orthoses selection process. [ABSTRACT FROM AUTHOR]

Foot orthoses (FOs) are often prescribed by clinicians to treat foot and ankle conditions, prevent running injuries, and enhance performance. However, the lack of higher-order synthesis of clinical trials makes it challenging for clinicians to adopt an evidence-based approach to FOs' prescriptions. Research question : Do FOs with different modifications alter lower extremity running kinematics and kinetics? A systematic search of seven databases was conducted from inception to February 2023. The analysis was restricted to healthy adults without foot musculoskeletal impairments and studies that compared the FOs effects with the controls. The methodological quality of the 35 studies that met the eligibility criteria was evaluated using the modified Downs and Black checklist. The random effects model estimated the standardized mean difference (SMD) with 95% confidence intervals and effect sizes. Sub-group analyses based on FOs type were performed to assess the potential effects of the intervention. Our findings indicated that both custom and off-the-shelf arch-support FOs reduced peak plantar pressure at the medial heel (SMD=−0.35, and SMD=−1.03), lateral heel (SMD=−0.50, and SMD=−0.53), and medial forefoot (SMD=−0.20, and SMD=−0.27), but increased plantar pressure at the mid-foot (SMD=0.30, and SMD=0.56). Compared with the controls, significant increases (SMD=0.36) in perceived comfort were found with custom FOs. A reduction (SMD=−0.58) in initial ankle inversion was found when a raised heel cup was integrated with arch-support FOs. A medial post integrated with arch support exhibited a reduced ankle (SMD=−1.66) and tibial (SMD=−0.63) range of motion. Custom FOs, however, unfavorably affected the running economy (SMD=−0.25) and perceived exertion (SMD=0.20). Significance : Although FOs have been reported to have some positive biomechanical effects in healthy populations without musculoskeletal impairments or running-related issues, they need to be optimized and generalized to achieve better running performance and prevent injury. • Foot orthoses have both positive and negative effects on running kinetics and kinematics. • Foot orthoses reduce peak plantar pressure as well as ankle and tibial moments. • Foot orthoses control ankle and tibial motion at coronal and transverse planes. • Effects of foot orthoses on hip and knee kinematics were not evident. [ABSTRACT FROM AUTHOR]

Plantar flexor weakness reduces ankle push-off work during walking, causing inefficient proximal joint compensations to provide power for forward propulsion (1). To support ankle push-off work and reduce compensations, spring-like ankle foot orthoses (AFOs) can be applied (2). In people with plantarflexor weakness due to a neuromuscular disease, spring-like AFOs can increase push-off work, which is often accompanied by increases in walking speed (3). The higher walking speed likely also leads to higher proximal joint work demands. Consequently, it is unknown whether the higher push-off work leads to a reduction in compensatory joint work. Furthermore, not all patients increase push-off work with the AFO and understanding of who is able to increase push-off work is warranted for clinical decision-making. 1) Do spring-like AFOs redistribute lower limb joint work during walking in people with bilateral plantar flexor weakness compared to shoes-only? 2) Is ankle work when walking without AFO related with the effect of spring-like AFOs on ankle and hip work? In 18 people with bilateral plantar flexor weakness, we performed a 3D gait analysis at self-selected walking speed for walking without and with a spring-like AFO with individually tuned stiffness. We compared the relative joint work generated at the hip, knee and ankle between conditions. Furthermore, the association between ankle work without orthosis and joint work using the AFO were tested with Pearson's correlations. No difference in the relative contribution of ankle, knee and hip work to total joint work over the gait cycle was found between walking with and without AFO (p >0.499). Relative ankle work generated during pre-swing increased with the AFO (Shoes: 72.4±27.1% vs AFO: 85.3±9.1% of total ankle work, p =0.026). At the hip, relative less work was generated in pre-swing (Shoes: 34.1±10.4% vs AFO: 31.9±7.4% of total hip work, p =0.038) and more in loading response (Shoes: 11.9±9.8% vs AFO: 18.0±11.0%, p =0.022). Ankle work without AFO was inversely correlated with increased ankle work with the AFO (r=0.839, p <0.001) and this increase correlated with a larger reduction in hip work (r=-0.650, p =0.004). Although spring-like AFOs increased relative ankle work and reduced hip work during push-off, the relative hip and knee work did not reduce as hip extensor work in early stance increased. However, a higher ankle push-off deficit without AFO was related with more AFO support and higher reductions in compensatory hip work, which indicates that people with more severe push-off deficits benefit more from the energy storing-and-releasing capacity of spring-like AFOs. [ABSTRACT FROM AUTHOR]

Customized foot orthoses (CFOs) are often recommended for the management of plantar heel pain. However, there is a lack of information regarding lower limb and multi-segment foot motion during gait. This study aimed to determine the effects of heat moulded CFOs on foot and lower limb kinematics when compared with prefabricated foot orthoses (PFOs) and wearing no orthoses (shod condition), and to determine the short-term effects of CFOs on pain intensity and foot function. The immediate effects of CFOs on the lower limb and multi-segment foot motion were assessed. Participants were then asked to use the CFOs for one month and foot pain, function, and temporal-spatial parameters were assessed at baseline and at one month follow up. Thirty-five participants (22 females), aged 40.1 (10.5) years, with a mean duration of symptoms of 12.59 months were recruited. The symptomatic limbs showed a higher forefoot varus angle and greater rearfoot and forefoot corrections were required compared to the non-symptomatic limbs. When compared with PFOs and shod conditions, CFOs provided the least forefoot and knee motion in the transverse plane during contact phase (P < 0.05, d=0.844–1.720), least rearfoot motion in the coronal plane during midstance (P < 0.05, d=0.652), and least forefoot motion in the frontal plane, knee motion in the transverse plane, and hallux motion during the propulsive phase (P < 0.05, d=0.921–1.513). Significant improvements were seen for foot pain and function (P < 0.05, d=1.390–2.231) with significant increases in cadence and walking velocity after one month of CFO use (P < 0.05, d=0.315–0.353), and those most likely to respond had greater pain and less ankle eversion (P < 0.05, d=0.855–1.115). CFOs appear to improve pathological biomechanics associated with plantar heel pain. After one month follow up, the CFOs decreased pain intensity and increased foot function, and showed significant improvements in temporal and spatial parameters of gait. • Foot orthoses could reduce pathological biomechanics related to plantar heel pain. • After follow up, foot orthoses provide positively subjective and objective outcomes. • This study offers new insights into the action of customized foot orthoses. • Present results support the foot orthosis as an intervention of plantar heel pain. [ABSTRACT FROM AUTHOR]

Markerless motion capture systems have the potential to make clinical gait analysis more efficient and convenient. Theia3D is a commercially available markerless system that may serve as an alternative to traditional gait analysis for clinical gait laboratories. What is the concurrent validity of markerless gait analysis using Theia3D compared to traditional marker-based gait analysis in pediatric clinical gait patients? Thirty-six patients (20 male, age 2–25 years) with a range of diagnoses underwent clinical gait analysis with data being captured concurrently by a traditional marker-based motion capture system (Vicon Nexus) and a commercial markerless system (Theia3D). Multiple left strides were averaged for each subject, and the difference in kinematics (Theia - Vicon) was calculated over the gait cycle and evaluated using root mean square difference (RMSD), mean difference, and RMSD after subtracting the mean value across the gait cycle (RMSD offset). Sub-analysis was performed for 25 patients with foot deformities, 9 wearing ankle-foot orthoses, and 6 walking with assistance (cane, crutches, walker, or handheld). Kinematics showed similar patterns between the marker-based and markerless systems. RMSD was < 6° except for pelvic tilt, hip flexion, ankle inversion, foot progression, and transverse plane rotation of the hip, knee, and ankle. These measures mainly differed due to an offset between the curves. After adjusting for offsets, all RMSD offset were < 6°. RMSD was larger for patients with foot deformities, wearing orthoses, or using assistive devices, but all RMSD offset were still < 8°. In some cases, however, the markerless system had greater trial-to-trial variability, showed a larger knee varus "bump" in swing, or failed to track the subject. This study provides preliminary evidence of concurrent validity of Theia3D for pediatric patients with abnormal gait. However, some questions remain regarding identification of the knee axis and for patients with foot deformity or assistive devices. • Theia3D and Plug-in-Gait produce similar kinematic patterns. • Markerless kinematic curves are offset from marker-based for some variables. • Systems differ more with foot deformity, orthotics, and assistive devices. • Questions remain about Theia3D knee axis definition and hip rotation. [ABSTRACT FROM AUTHOR]

Background: Greater trochanteric pain syndrome (GTPS), including gluteal tendinopathy and bursitis, is a common, painful and debilitating condition. It is thought to involve overload of the gluteal tendons, which may be amplified through increased hip adduction moment (HAM) seen during gait in these individuals. Reducing the aberrant HAM may improve pain and function in this population. We aimed to determine if medially-posted foot orthoses immediately reduce HAM and pain in females with GTPS during walking gait.Methods: A double-blind, repeated-measures trial with randomised intervention order compared three conditions in 53 women with GTPS. Participants acted as their own control during baseline (everyday-shoe insole), medially-posted (active) orthosis, or flat insert (sham orthosis) walking. Data were collected via three-dimensional gait analysis for HAM, hip, pelvic, and thorax kinematics; as well as ground reaction force; and pain via the numerical rating scale. Subgroup analysis was performed based on a pronated foot-posture defined by the Foot Posture Index.Results: A small pain reduction was found between the active orthosis and flat insert (mean difference = -0.444, p = 0.017). No difference was detected for pain between other condition comparisons. Thoracic lateral flexion increased at second-peak HAM between the baseline and active conditions (mean difference = -0.917, p = 0.040). No differences were detected for HAM, remaining kinematic or kinetic variables, or ground reaction force data across the three conditions. No significant differences were detected between any of the three conditions for biomechanical or pain data in the pronated-foot subgroup.Significance: A medially-posted foot orthosis did not immediately alter gait biomechanics or provide a clinically meaningful pain reduction in women with GTPS. There is uncertainty regarding the clinical benefit of orthoses in the management of GTPS. Longer-term follow-up or the use of customised orthoses may produce different outcomes and should be explored in future research. [ABSTRACT FROM AUTHOR]

Background: Prefabricated and customized insoles are used in clinical practice to reduce foot pronation. Although data exist on the effects at key points within the stance phase, exploring the impact of different insoles using time series analysis may reveal more detail about their efficacy.Research Question: What are the effects revealed by a time series analysis of arch-supported prefabricated insoles (PREFABRICATED) versus arch-supported prefabricated insoles customized with a 6º medial wedge (CUSTOMIZED) on the lower limb biomechanics during walking, stepping up and down tasks in individuals with pronated feet?Methods: Nineteen individuals with excessive foot pronation performed walking, stepping up and down tasks using three insoles: CONTROL (flat insole), CUSTOMIZED, and PREFABRICATED. Angles and moments of ankle and knee coronal and hip transverse planes were compared between conditions using statistical parametric mapping (SPM).Results: For walking, CUSTOMIZED reduced ankle eversion moment compared to CONTROL during midstance and PREFABRICATED during propulsion. CUSTOMIZED decreased KAM during midstance and propulsion compared to PREFABRICATED. Compared to CONTROL, CUSTOMIZED and PREFABRICATED reduced hip internal rotation during propulsion and loading response, respectively. CUSTOMIZED decreased eversion movement during midstance and propulsion for the stepping up task. PREFABRICATED reduced eversion movement during midstance in comparison to CONTROL. For the stepping down task, CUSTOMIZED increased eversion movement during propulsion compared to PREFABRICATED. CUSTOMIZED reduced hip internal rotation angle for stepping up task during propulsion, decreased medial rotation movement during midstance compared to CONTROL, and reduced medial rotation during midstance compared to PREFABRICATED. CUSTOMIZED increased KAM for stepping up and down tasks during propulsion.Significance: These findings suggest that both CUSTOMIZED and PREFABRICATED reduce foot pronation. However, non-local effects, such as changes in KAM and hip internal rotation, were seen only in the CUSTOMIZED. Therefore, CUSTOMIZED may be preferable if the objective is to modify the knee and hip mechanics. [ABSTRACT FROM AUTHOR]

Background: Nonarticulated and low-temperature thermoplastic ankle-foot orthoses (AFOs) have a semirigid design and are effective in improving the postural control mechanism (PCM) in individuals with poststroke hemiparesis. AFOs with an anterior leaf (AAFOs) are more often prescribed than are AFOs with a posterior leaf (PAFOs); however, the effects of AAFOs on the PCM during sit-to-stand transfer (STST) have not been explored.Research Questions: Do AAFOs and PAFOs change the PCM differently during STST?Methods: A cross-sectional quasi-experimental design was adopted in this study. Fourteen individuals with poststroke hemiparesis (10 men and 4 women, aged between 38 and 71 years, stroke onset between 1 and 17 months) performed STST with shoes only, an AAFO with shoes, or a PAFO with shoes. Vertical ground reaction force (VGRF) and center-of-pressure (CoP) coordinates were collected using a pressure mat to calculate PCM parameters. A single-factor repeated measures analysis of variance was performed to answer the research question.Results: (1) The weight-bearing percentage of the paretic leg was significantly lower when the participants wore a PAFO (p = 0.018) than when they wore an AAFO (p = 0.019) during the first 5 and 5-10 s after rising. (2) A small rate of change of the VGRF increment (dF/dT) was detected when participants wore AFOs, particularly AAFO. (3) The maximum mediolateral displacement of the CoP when standing up was significantly different among the three conditions (p = 0.012).Significance: For patients with poststroke hemiparesis, AAFO and PAFOs change the PCM during STST performance. Only AAFO improved the PCM possibly because of the rigidity and clearance of the heel region, which provide somatic sensory feedback. Therefore, rehabilitation professionals should educate hemiplegic patients who use AAFOs or PAFOs to perform dynamic daily tasks slowly for their safety. [ABSTRACT FROM AUTHOR]

Background: Figure-8 straps are commonly used in ankle orthoses, which are provided to reduce the risks of primary and recurrent sprain by providing functional support. Functional treatment with ankle orthoses can provide better rehabilitation than immobilization for a mild ankle sprain. However, it is not known how much tension should be applied to the straps while donning the orthosis to optimize its effectiveness.Research Question: The aim of this study was to investigate the effects of figure-8 strap tension of a soft ankle orthosis on ankle joint kinematics in the sagittal, coronal, and transverse planes during gait in healthy young adults.Methods: Ten healthy adults (five males and five females) were enrolled in this study. The 3-dimensional motion analysis system was used to evaluate the ankle kinematics of the participants during gait under five conditions: no soft ankle orthosis, soft ankle orthosis with no figure-8 straps tension (lace-up only), 50 N, 80 N, and 110 N tension of the figure-8 straps, respectively. All participants walked in a straight path at a comfortable speed.Results: Plantarflexion angles were significantly reduced with 110 N of tension in the figure-8 straps when compared to the lace-up only and a moderate correlation with r = 0.34 (p = 0.03) was observed between the tensions of figure-8 straps and maximum plantarflexion angles at pre-swing of a gait cycle. No significant effects on ankle joint angles were demonstrated in the coronal and transverse planes.Significance: This study showed that increasing the tension of the figure-8 straps could restrict the ankle joint plantarflexion angle during pre-swing in gait. However, it might not affect inversion/eversion or internal/external rotation angles of the ankle joint in individuals without ankle pathologies. [ABSTRACT FROM AUTHOR]

Purpose: The main aim of this review is to report the effect of different types of in-shoe and barefoot wedges on the distribution of the plantar loading of the human foot. We hypothesise that frontal plane wedges modify this parameter.Methods: A systematic review was performed, using the PubMed, CINAHL, Prospero and Scopus databases, consulted from their date of first publication to May 2020. Only observational (cross-over studies), randomised controlled trials (RCTs) and quasi-experimental studies addressing the effects of in-shoe and barefoot frontal plane wedges on plantar loading were included. All articles were subjected to quality assessment, using the Newcastle-Ottawa scale for the observational (cross-over) studies, TREND for quasi-experimental studies and the Cochrane Collaboration's tool for the RCTs.Results: Eleven papers were included in the final review. Four were cross-over studies, other four were quasi-experimental studies and three were RCTs. These eleven studies included 320 patients, with ages ranging from 20 to 60 years. Regarding the risk of bias, most of the observational studies and RCTs had a moderate level of quality.Conclusions: The results suggest that lateral wedges are more effective, producing a lateral shift of the centre of pressure and increasing the pressure. Regarding the impact on the peak impact force there seems to be less consensus among the published data. [ABSTRACT FROM AUTHOR]

Background: Foot orthoses (FOs) are used to manage foot pathologies such as plantar fasciopathy. 3D printed custom-made FOs are increasingly being manufactured. Although these 3D-printed FOs look like traditionally heat-moulded FOs, there are few studies comparing FOs made using these two different manufacturing processes.Research Question: How effective are 3D-printed FOs (3D-Print) compared to traditionally-made (Traditional) or no FOs (Control), in changing biomechanical parameters of flat-footed individuals with unilateral plantar fasciopathy?Methods: Thirteen participants with unilateral plantar fasciopathy walked with shoes under three conditions: Control, 3D-print, and Traditional. 2 × 3 repeated measures analysis of variance (ANOVAs) with Bonferroni post-hoc tests were used to compare discrete kinematic and kinetic variables between limbs and conditions. Waveform analyses were also conducted using statistical parametric mapping (SPM).Results: There was a significant condition main effect for arch height drop (p = 0.01; ηp2 =0.54). There was 0.87 mm (95% CI [-1.84, -0.20]) less arch height drop in 3D-print compared to Traditional. The SPM analyses revealed condition main effects on ankle moment (p < 0.001) and ankle power (p < 0.001). There were significant differences between control condition and both 3D-print and Traditional conditions. For ankle moment and power, there were no differences between 3D-print and Traditional conditions.Significance: 3D-printed FOs are more effective in reducing arch height drop, whist both FOs lowered ankle plantarflexion moment and power compared to no FOs. The results support the use of 3D-printed FOs as being equally effective as traditionally-made FOs in changing lower limb biomechanics for a population of flat-footed individuals with unilateral plantar fasciopathy. [ABSTRACT FROM AUTHOR]

Background: Knee braces and lateral wedge foot orthoses are two treatment options recommended for medial knee osteoarthritis, but the combination of both of them could further improve their effectiveness.Research Question: The aim was to evaluate whether the combination of lateral wedge foot orthoses with two types of knee brace enhances the biomechanical effects and pain relief during the stance phase of gait while maintaining comfort.Methods: Ten patients with medial knee osteoarthritis were fitted with a standard valgus brace, an unloader brace with valgus and external rotation functions, and 7° lateral wedge foot orthoses. The pain relief, comfort, kinematics and kinetics of the lower limb were measured during walking without orthotics, with the combined and with the isolated treatments.Results: The valgus and external rotation brace significantly reduced the knee adduction moment and allowed more knee flexion both in isolation and in combination to foot orthoses compared to the valgus brace or without treatment. Pain relief was not significant with the different orthotic treatment modalities. The valgus brace and combined treatment with either brace significantly increased the discomfort level, whereas the valgus and external rotation brace or foot orthoses in isolation did not induce significant discomfort.Significance: Amongst the tested orthotic treatment modalities, the valgus and external rotation brace obtained better biomechanical outcomes while maintaining comfort. The combined treatment with foot orthoses enhanced the effectiveness of the valgus brace, however foot orthoses may be unnecessary with the valgus and external rotation brace. [ABSTRACT FROM AUTHOR]

Background: Pes Planus or Flat feet is one of the most common lower limb abnormalities. When runners with this abnormality participate in recreational running, interventional therapies could help in pain alleviation and enhance performance. To determine the most effective treatment, however, a biomechanical examination of the effects of each treatment modality is required.Research Question: The aim of the present study was to investigate the effects of Foot Orthoses (FOs) and Low-Dye Tape (LDT) on lower limb joint angles and moments during running in individuals with pes planus.Methods: kinematic and kinetic data of 20 young people with pes planus were measured during running in three conditions: (1) SHOD (2) with shoes and FOs (3) with shoes and LDT. One-way repeated measure ANOVA was used to investigate the impacts of the FOs and LDT on the lower limb joint angles and moments throughout the stance phase of the running cycle.Results: The results showed that FOs reduced ankle eversion compared to SHOD and LDT (P < 0.001) and decreased the dorsiflexion angle (P = 0.005) and the plantarflexor moment compared to the SHOD (P < 0.001). FOs increased knee adduction angle (P = 0.021) and knee external rotator moment (P < 0.001) compared to both conditions and increased knee extensor and abductor moments compared to SHOD (P < 0.001). At the hip joint, FOs only increased hip external rotation compared with the LDT condition (P = 0.031); and LDT increased hip extensor moment compared to SHOD and FOs (P = 0.037) and also increased hip adduction angle compared to SHOD (P = 0.037).Significance: FOs with a medial wedge appears to increase the external knee adduction moment and knee adduction angles, which are risk factors for the development and progression of knee osteoarthritis. Further, usage of FOs seems to reduce the ankle joint role in propulsion as it impacts the ankle sagittal angles and moments. [ABSTRACT FROM AUTHOR]

Background: Children with the most common inherited neuropathy, Charcot-Marie-Tooth disease (CMT), are often prescribed ankle-foot orthoses (AFOs) to improve walking ability and prevent falls by reducing foot drop, postural instability, and other gait impairments. These externally worn assistive devices are traditionally custom-made using thermoplastic vacuum forming. This labour-intensive manufacturing process often results in AFOs which are cumbersome due to limited design options, and are associated with low acceptability, discomfort, and suboptimal impact on gait. The aim of this study was to determine how 3D printing can be used to replicate and redesign AFOs in children with CMT.Methods: Traditional AFOs, 3D printed replica AFOs (same design as traditional AFOs), 3D printed redesigned AFOs and a shoes only control condition were compared in 12 children with CMT. 3D printed AFOs were manufactured using material extrusion in Nylon-12. 3D gait analysis (temporal-spatial, kinematic, kinetic), in-shoe pedobarography and self-reported satisfaction were used to compare conditions. The primary kinematic and kinetic outcome measures were maximum ankle dorsiflexion in swing and maximum ankle dorsiflexor moment in loading response, to capture foot drop and an absent of heel rocker.Results: The 3D printed replica AFOs were comparable to traditional AFOs for all outcomes. The 3D printed replica AFOs improved foot position at initial contact and during loading response and significantly reduced pressure beneath the whole foot, rearfoot and forefoot compared to the shoes only. The 3D printed redesigned AFOs produced a device that was significantly lighter (mean -35.2, SD 13.3%), and normalised maximum ankle dorsiflexor moment in loading response compared to shoes only and traditional AFOs.Significance: 3D printing can be used to replicate traditional handmade AFOs and to redesign AFOs to produce a lighter device with improved biomechanics by incorporating novel design features. [ABSTRACT FROM AUTHOR]

Background: The sagittal plane alignment of ankle-foot orthoses (AFO) and AFO footwear combinations (AFO-FC) has been shown to influence gait outcomes. As such, clinicians often target a particular alignment during the fabricating and fitting of an AFO to maximize outcomes.Research Question: How does the alignment of an AFO change during the fabrication and fitting process with respect to the intended, benchmark sagittal plane alignment identified by the consulting orthotist?Study Design: Prospective METHODS: The assessment of AFO alignment was performed using a convenience sample of 125 custom molded AFOs from 68 individuals fabricated at our center (57 bilateral AFOs, 11 unilateral AFOs). The alignment of each AFO was measured at 5 distinct steps during the fabrication and fitting process using a recently validated method to measure AFO neutral angle using differential inclinometers.Results: Prior to fabrication, the intended, benchmark alignment set by the consulting orthotist was 90 degrees for 92% of AFOs, was between 1 and 7 degrees of dorsiflexion for 7% of AFOs and was 5 degrees of plantarflexion for 1% of AFOs. Repeated measures ANOVA showed that AFO alignment changed between all fabrication and fitting steps. Overall, paired t-tests confirmed that AFO alignment was consistently 2-5 degrees more dorsiflexed than the benchmark alignment. Prior to fitting shoes, 55% of fabricated AFOs measured more than 2 degrees from the benchmark alignment. After fitting shoes, nearly 87% of AFO-FCs were more than 2 degrees from the benchmark alignment.Significance: The finding of systematic dorsiflexion bias and changes in AFO alignment throughout the fabrication and fitting process indicates the need to improve AFO fabrication precision. The neutral angle measurement methodology - using differential inclinometers - provides a means to improve this precision by enabling orthotists to precisely quantify and make appropriate adjustments to AFO alignment throughout the entire fabrication and fitting process. [ABSTRACT FROM AUTHOR]

Background: Children with juvenile idiopathic arthritis (JIA) can experience significant physical impairment of the lower extremity. Prolonged joint disease and symptoms may cause gait alterations such as reduced walking speed and increased plantar pressures in diseased areas of their feet. There is limited robust clinical trials investigating the effect of non-invasive mechanical therapies such as foot orthoses (FOs) on improving gait parameters in children with JIA.Research Question: Are customised preformed FOs effective in improving gait parameters in children with JIA?Methods: A multicentre, parallel design, single-blinded randomised clinical trial was used to assess the gait impacts of customised preformed FOs on children with JIA. Children with a diagnosis of JIA, exhibiting lower limb symptoms and aged 5-18 were eligible. The trial group received a low-density full length, Slimflex Simple device which was customised chair side and the control group received a sham device. Peak pressure and pressure time integrals were used as the main gait outcomes and were measured using portable Tekscan gait analysis technology at baseline, 3 and 6 months. Differences at each follow-up were assessed using the Wilcoxon rank sum test.Results: 66 participants were recruited. Customised preformed FOs were effective in altering plantar pressures in children with JIA versus a control device. Reductions of peak pressures and pressure time integrals in the heel, forefoot and 5th metatarsophalangeal joint were statistically significant in favour of the trial group. This was associated with statistically significant increased midfoot contact with the trial device at baseline, 3 and 6-month data collections. The trial intervention was safe and well accepted by participants, which is reflected in the high retention rate (92%).Significance: Clinicians may prescribe customised preformed FOs in children with JIA to deflect pressure from painful joints and redistribute from high pressure areas such as the rearfoot and forefoot. [ABSTRACT FROM AUTHOR]

Background: Foot pain is frequent among people with rheumatoid arthritis (RA). Foot orthoses (FO) are commonly prescribed with the intention to reduce pain symptoms and improve function.Research Question: How do a custom-made FO affect pain, gait biomechanics and daily activity among people with RA?Methods: Twenty-five participants with RA and foot pain completed this quasi-experimental study using a control insole for four weeks and then a custom-made FO in the following four weeks. The foot orthoses were customized by plantar foot shape targeting optimal restoration of normal arch height. A visual analog scale was used to monitor changes in ankle/foot, knee, hip joints, and global arthritis pain. In addition, the perceived pain area was measured using a body chart analysis. Kinematics and kinetics of the hip, knee and ankle joints during gait were analyzed using 3D-motion capture. Daily steps were measured with a wrist-based activity tracker for both the control insole and custom-made FO period, respectively.Results: In comparison to the control insole, the custom-made FO reduced ankle/foot pain intensity (p < 0.001) in addition to a reduction of the perceived pain areas in the feet (p < 0.001), legs (p = 0.012), as well as the arms and hands (p = 0.014). Ankle plantar flexion and eversion moments were also reduced (p < 0.001). No difference in daily steps was observed between the two periods (p = 0.657).Significance: This study has demonstrated an ankle/foot pain-relieving effect in conjunction with alterations of the ankle joint moments in people with RA using custom-made FO. The pain relief is plausibly attributed to alterations of the ankle joint moments when using the custom-made FO. However, future studies are needed to explore further into therapeutic implication of custom-made FO in pain management of people with RA. [ABSTRACT FROM AUTHOR]

Background: A lot of authors have been studied the consequence of postural control strategies through investigating the effects of foot-surface contact. In this context an important variable of textured surfaces or insoles could be related to material stiffness. We apply a particular textured insoles to evaluate neuromuscular response of plantar stimulation during walking.Research Question: Could textured insoles alter the human locomotion during walking at different speeds?Methods: Ten adults (age: 27 ± 5 years) completed three trials on the multifunction treadmill at 0.42 ms-1, 0.89 ms-1, and 1.5 ms-1 walking speed. Temporal-spatial parameters, gait line, and kinetic parameters were analyzed. The Co-Contraction Index (CCI) and electromyography (EMG) of the right leg muscles were assessed during four phases of gait: first half stance (FHS), half stance (HS), second half stance (SHS), swing phase (SP). Textured insole and soft control insole were worn while walking.Results: Plantar stimulation improved cadence, stride time, stride length and gait line parameters with increasing speed. First force peaks and maximum force forefoot were always significant. The maximum force midfoot was significant at 0.42 and 0.89 ms-1. The maximum force heel only was significant in lower velocity. The maximum pressure showed different significant values except for the heel. Significant differences in the CCI were always found in the FHS and SHS for the plantar muscles, and in the FHS and HS for the knee muscles. The differences in gait analysis in biomechanical and in electromyographic parameters were more significant in the higher speed tested.Significance: The perception of shape and texture through its linear response to skin deformation over a wide range of deformations could be the reason why the significant differences increase in the higher speed. In conclusion, sensory interventions fallowing appropriate insoles can influence significantly gait. Walking strategy positively adjusts locomotion with high efficiency. [ABSTRACT FROM AUTHOR]

Background: Textured insoles have been suggested to enhance foot sensation, which contributes to controlling upright balance. However, the interaction between plantar callosity and the textured surface has not been studied.Research Question: Firstly, to compare the efficacy of textured insoles on balance performance and foot position sense between two groups of older people: one group had plantar callosity, and the other did not. Secondly, to investigate the efficacy of textured insoles within each study group.Methods: Thirty older people with a history of falls (15 with plantar callosity and 15 without callosity) participated in this study. All participants underwent assessments of postural sway on a force plate, joint position sensation of the ankle with a slope box, and mobility using the "Timed Up and Go" test under three insole surface conditions: 1) smooth (control), 2) placebo and 3) textured surface. Two-way analyses of variance were used to compare the outcomes of the two groups and three conditions.Results: Older people with plantar callosity had worse ankle joint position sense and slower antero-posterior and mediolateral postural sway velocity than their peers who did not have plantar callosity. The textured insoles improved ankle joint position sense and mobility regardless of callus status in the plantar surface of older peoples' feet. The insole-callosity interaction was not significant for any study outcome.Significance: Textured insoles could be beneficial to older people with and without callosity as they have shown immediate improvements in ankle joint position sense and mobility. [ABSTRACT FROM AUTHOR]

Background: Leg length discrepancy (LLD) is commonly associated with compensatory gait strategies leading to musculoskeletal disorders of the lower extremity and lumbar spine. Orthotic insole (OI) is considered as a conservative treatment for patients with mild LLD, especially for children. However, the restoration of normal gait when wearing OI with foot lift are still poorly understood.Research Question: What are the immediate effects of OI on the gait patterns in children with mild LLD?Methods: Gait data and plantar pressure data were collected for 12 children with mild anatomical LLD in barefoot and OI conditions. Paired t-test was performed to determine the changes in gait between these two conditions, and also the symmetry between limbs in the same condition for spatiotemporal, kinematic, and kinetic variables.Results: Children with mild LLD showed an immediate gait improvement confirmed by increased step length and velocity, decreased peak plantar pressure in both limbs with OI. Additionally, the significant between-limb differences disappeared for peak ankle dorsiflexion, hip adduction, pelvis upward obliquity and also second peak plantar pressure with OI, which improved gait symmetry.Significance: This study provides a better understanding of the immediate effect of OI with foot lift on biomechanical changes in gait, which identify that OI with foot lift could be a potential therapeutic option for children with mild structural LLD to improve gait metrics. [ABSTRACT FROM AUTHOR]

Background: Collapse of the foot arch is a one of the risk factors in medial tibial stress syndrome. Custom-made foot orthoses are used to reduce the collapse of foot arch, but the orthoses are designed for a specific shoe and cannot be used in other shoes. We developed an elastic foot orthosis that is highly fitted on the foot using thin films, is lightweight, and can be used with any shoe or without shoes. The purpose of this study was to investigate foot kinematics with our elastic foot orthosis during walking and running.Methods: We recruited 30 participants with asymptomatic flatfoot for this study. Foot kinematic data were recorded for treadmill walking, treadmill running, and over-ground walking. Foot kinematics were recorded in three conditions, barefoot (BF), with the elastic foot orthosis (EFO), and with sham foot orthosis (SFO), and foot strain was measured using a stretch strain sensor. The difference in foot strain from initial contact to maximum strain during gait was calculated as loading arch strain, which was reflected as forefoot eversion excursion. A one-way analysis of variance with Bonferroni test was performed to compare the loading arch strain among the three conditions.Results: In all tasks, loading arch strain with the EFO was significantly less than that in the BF and SFO conditions. Loading arch strain with the SFO was significantly more than that of BF in the treadmill gait condition.Conclusion: Our results indicate that the EFO decreased foot strain during locomotion compared to without the EFO and is capable of supporting the foot arch during locomotion. [ABSTRACT FROM AUTHOR]

Background: Foot orthoses are widely used in runners with pronated feet, who are characterized with large forefoot abduction and arch deformation during gait. However, the relationship between the amount of forefoot and arch orthotic correction and the alterations in foot biomechanics remains unclear.Research Question: This study aimed to determine dose-response effects of foot orthoses with forefoot wedge and arch support components on the center of pressure (COP) trajectories and pressure distribution during running in symptomatic pronated feet.Methods: Fifteen recreational runners participated in this study. A pressure plate was used to measure plantar pressures during running with control shoe only and ten foot orthoses, varying in forefoot wedges (5 levels) and arch supports (2 levels). The COP trajectory across the entire stance phase was compared between orthotic and control conditions using one-dimensional statistical parametric mapping. The differences in the force-time integral (FTI) and temporal variables were explored between conditions using repeated measures ANOVAs. The main effect of the two orthotic components and their interaction on tested variables were examined using two-way ANOVAs.Results: A forefoot wedge, whether laterally or medially located, shifted the COP trajectory laterally during some subphases of running (p < 0.05), while using an arch support only had minimal effect on the COP. Almost all orthoses reduced the FTI on the 2nd metatarsal and medial heel, and only medial forefoot wedges reduced the FTI on the hallux. There was a linear effect of forefoot wedges on the medial-lateral COP displacements during the propulsion phase, but no interactions were found between two orthotic components.Significance: These findings suggest that forefoot orthotic components rather than arch supports are effective in altering forefoot dynamics in runners with pronated feet. This study could have implications for foot orthotic prescription and running-related injury prevention for individuals with pronated feet. [ABSTRACT FROM AUTHOR]

Background: In individuals with unilateral plantar flexor weakness, the second peak of the vertical ground reaction force (GRF) is decreased. This leads to a higher ground reaction force, e.g. impact, of the contralateral leg, potentially explaining quadriceps muscle and/or knee joint pain. Energy cost optimized dorsal leaf ankle-foot-orthoses (AFOs) may increase the push-off ground reaction force, which in turn could lead to lower impact forces on the contralateral leg.Research Questions: 1) Are impact forces increased in the contralateral leg of people with unilateral plantar flexor weakness compared to healthy subjects? 2) Do energy cost optimized AFOs reduce impact forces and improve leg impact symmetry compared to walking without AFO in people with unilateral plantar flexor weakness?Methods: Nine subjects with unilateral plantar flexor weakness were provided a dorsal leaf AFO with a stiffness primarily optimized for energy cost. Using 3D gait analyses peak vertical GRF during loading response with and without AFO, and the symmetry between the legs in peak GRF were calculated. Peak GRF and symmetry were compared with reference data of 23 healthy subjects.Results: The contralateral leg showed a significant higher peak vertical GRF (12.0 ± 0.9 vs 11.2 ± 0.6 N/kg, p = 0.005) compared to healthy reference data. When walking with AFO, the peak vertical GRF of the contralateral leg significantly reduced (from 12.0 ± 0.9 to 11.4 ± 0.7 N/kg, p = 0.017) and symmetry improved compared to no AFO (from 0.93 ± 0.06 to 1.01 ± 0.05, p < 0.001).Conclusion: In subjects with unilateral plantar flexor weakness, impact force on the contralateral leg was increased when compared to healthy subjects and dorsal leaf AFOs optimized for energy cost substantially reduced this force and improved impact symmetry when compared to walking without AFO. This indicates that dorsal leaf AFOs may reduce pain resulting from increased impact forces during gait in the contralateral leg in people with unilateral plantar flexor weakness. [ABSTRACT FROM AUTHOR]

Background: Ankle-foot-orthoses (AFOs) and functional electrical stimulators (FES) are commonly prescribed to treat foot-drop in individuals with stroke. Despite well-established positive impacts of AFO and FES devices on balance and gait, AFO and FES-users still fall at a high rate.Objective: The objective of this study was to investigate 1) the underlying biomechanical mechanisms leading to a fall in long-term AFO and FES-users with chronic stroke and 2) the impacts of AFOs and FES devices on fall outcomes and compensatory stepping response of long-term users with chronic stroke.Methods: Fall outcomes as well as kinematics and kinetics of compensatory stepping response of 42 individuals with chronic stroke (14 AFO-users, 10 FES-users, 18 Non-users) were evaluated during trip-like treadmill perturbations. AFO and FES-users were evaluated with and without their device.Results: Chronic AFO and FES-users fell 2.50 and 2.77 times more than Non-users. The most robust differences between AFO/FES-users and Non-users were 1) Reduced capacity to stabilize the trunk through reduction in forward whole-body angular momentum and 2) diminished capability to prepare and generate a second step using the paretic leg. Provocatively, the removal of AFO and FES devices did not decease/increase falls or change kinematics.Significance: It is well-established that AFOs/FES devices have a positive impact on static balance and decrease community falls by increasing toe clearance thus preventing trips/stumbles. However, our results suggest that once a trip occurs, these devices do not adequately assist recovery of balance. Specifically, current AFO and FES devices do not assist with second step generation or trunk control. Future studies should explore new devices or training paradigms that target enhancing trunk control and paretic compensatory stepping to decrease falls in this population. [ABSTRACT FROM AUTHOR]

Background: For individuals with knee osteoarthritis (OA), stair negotiation is a challenging task and the first task during which they report pain due to the high knee loading required. The use of lateral wedge insole (LWI) has been found to reduce loading in patients with OA but not to reduce pain, whereas the use of knee sleeve has been shown to result in good pain reduction. Understanding the effect of combining LWI and knee sleeve use on healthy individuals before testing on individuals with knee OA is an important step.Research Question: The current study aimed to evaluate the effect of combining the use of LWI and knee sleeve and compare the results with the application of each treatment separately and with the control condition.Methods: This randomised cross-over study included 17 healthy participants who underwent 3D gait analysis. Participants performed ascending and descending stair activities with the following four treatment conditions: five-degree LWI, off-the-shelf knee sleeve, both LWI and knee sleeve and control condition. External knee adduction moment (EKAM) and knee frontal plane range of motion (ROM) were evaluated as primary outcomes. Repeated measure ANOVA or the Friedman test was selected based on meeting the assumption followed by multiple pairwise comparisons with Bonferroni correction.Results: In general, the use of LWI reduced the first peak EKAM significantly (p < 0.001) compared to the control condition in stir ascending (12% reduction) but not in stair descending (p > 0.05). Interestingly, knee sleeve use did not result in any reduction in the first peak EKAM compared to the control or any other condition. However, knee sleeve use led to a significant reduction in the knee frontal plane ROM during stair descending. The combined treatment was not superior to the LWI use when compared to control in the EKAM reduction.Significance: Combined knee sleeve and LWI use was not superior to LWI use alone in reducing the knee loading, but it may be beneficial for individuals with knee OA since it helped in reduction of the knee frontal plane ROM during stair descending. Importantly, the effect of LWI use or any other treatment must be investigated for each different activity, and the results found in one activity must not be generalised across other activities. [ABSTRACT FROM AUTHOR]

Background: Foot orthoses (FOs) are one of the most common interventions to restore normal foot mechanics in flatfoot individuals. New technologies have made it possible to deliver customized FOs with complex designs for potentially better functionalities. However, translating the individuals' biomechanical needs into the design of customized FOs is not yet fully understood.Research Question: Our objective was to identify whether the deformation of customized FOs is related to foot kinematics and plantar pressure during walking.Methods: The kinematics of multi-segment foot and FOs contour were recorded together with plantar pressure in 17 flatfoot individuals while walking with customized FOs. The deformation of FOs surface was predicted from its contour kinematics using an artificial neural network. Plantar pressure map and deformation were divided into five anatomically based regions defined by the corresponding foot segments. Forward stepwise linear mixed models were built for each of the four gait phases to determine the feet-FOs interaction.Results: It was observed that some associations existed between foot kinematics and pressure with regional FOs deformation. From heel-strike to foot-flat, longitudinal arch angle was associated with FOs deformation in forefoot. From foot-flat to midstance, rearfoot eversion accounted for variation in the deformation of medial FOs regions, and forefoot abduction for the lateral regions. From midstance to heel-off, rearfoot eversion, longitudinal arch angle, and plantar pressure played significant role in deformation. Finally, from heel-off to toe-off, forefoot adduction affected the deformation of forefoot and midfoot.Significance: This study provides guidelines for designing customized FOs. Flatfoot individuals with excessive rearfoot eversion or very flexible medial arches require more support on medial FOs regions, while the ones with excessive forefoot abduction need the support on lateral regions. However, a compromise should be made between the level of support and the level of increase in plantar pressure to avoid stress on foot structures. [ABSTRACT FROM AUTHOR]

Background: Although the effects of medial wedge insoles on lower limb biomechanics have been investigated, information about the effects of different magnitudes of medial posting is still lacking.Research Question: What are the dose-response effects of medial wedge insoles with postings varying between 0 °, 3 °, 6 °, and 9 ° of inclination on the lower limb biomechanics during walking and running in individuals with pronated feet?Methods: Sixteen participants with an FPI ≥ 6 were recruited. Four arch-supported insole conditions with varying degrees of medial heel wedge were tested (0°, 3°, 6°, and 9°). A 3D motion analysis system with force plates was used to obtain the kinetics and kinematics of walking and running at self-selected speeds. To compare the ankle, knee, and hip angles and moments among conditions, a time series analysis was performed using Statistical Parametric Mapping (SPM).Results: A reduction in ankle eversion angle was observed during walking for all insoles. For running, the 6° and 9° insoles decreased the ankle eversion angle during early stance and increased this angle during the propulsive phase. A decrease in ankle eversion moment was observed in walking and running for 6° and 9° insoles. An increase in knee adduction moment occurred in walking and running for all insoles. For hip, the 6° and 9° insoles showed, during walking, a decrease in hip adduction angle and an increase in hip adduction and external rotation moments. For most variables, statistical differences were found for a greater period across the stance phase as the medial wedge increased, except for ankle eversion moment and hip external rotation moment during walking.Significance: The biomechanical effects over the time series for many of the parameters increased with the addition of insole inclination, showing a dose-response effect of medial wedge insoles on the lower limb biomechanics during walking and running in adults with excessive foot pronation. [ABSTRACT FROM AUTHOR]

Background: Changes in gait due to an ankle foot orthosis (AFO) have been shown to be impacted by the sagittal plane alignment of the AFO, but there is variability in practice and lack of consensus as to how this alignment should be measured. The neutral angle is a measure of AFO alignment that has the potential to be used by various specialties that prescribe, provide, and analyze AFOs. Currently, a lack of validated measurement methods prevents the neutral angle from being used in various clinical settings. Two experimental neutral angle measurement methods are proposed to address this shortcoming: a portable low-cost method for use during AFO fabrication and fitting, and a laboratory-based method for use during dynamic three-dimensional gait analysis (3DGA).Research Question: What is the concurrent validity of the two experimental neutral angle measurement methods against the gold standard?Methods: The gold standard neutral angle measurement (NAGOLD) was prospectively collected during a static 3DGA trial for 19 pediatric AFOs from 10 individuals. While NAGOLD was being collected, the neutral angle was simultaneously measured using digital differential inclinometers (NAINCL). Within the same 3DGA session, the neutral angle was also measured during the swing phase of gait (NASWING). The NAINCL and NASWING measurements were compared to NAGOLD using repeated measures ANOVA, ICC, and bootstrapped errors-in-variables regressions.Results: Repeated measures ANOVA indicated no differences between measurement methods (p = 0.43) and ICC analysis indicated good absolute agreement (ICC(A-1) = 0.85). Mean absolute deviations between the NAINCL and NASWING with NAGOLD measurements were 2.4 ° and 1.9 °, with standard deviations of 2.9 ° and 2.7 °, respectively. Maximum observed differences were less than 7 °. The NAINCL and NASWING methods explained 74 % and 81 % of the variance in NAGOLD, respectively.Significance: The concurrent validity of two new neutral angle measurement methods provides alternative means to assess AFO alignment in the clinic. [ABSTRACT FROM AUTHOR]

Background: Although foot orthoses are often used in the management of lower limb musculoskeletal conditions, their effects on muscle activation is unclear, especially in more proximal segments of the lower limb.Research Question: Primary aim: Is there an immediate effect of foot orthoses on gluteal muscle activity during overground walking in healthy young adults? Secondary aim: Is there an immediate effect of foot orthoses on the activity of hamstring, quadriceps and calf muscles?Methods: In eighteen healthy young adults, muscle activity was recorded using fine wire electrodes for gluteus minimus (GMin; anterior, posterior) and gluteus medius (GMed; anterior, middle, posterior); and surface electrodes for gluteus maximus (GMax), hamstring, quadriceps and calf muscles. Participants completed six walking trials for two conditions; shoe and shoe with prefabricated foot orthoses. Muscle activity was normalised to the peak activity of the shoe condition and analysed using one-dimensional statistical non-parametric mapping to identify differences across the gait cycle.Results: Activity of GMed (anterior, middle, posterior) and GMin (posterior) was reduced in early stance phase when the orthosis was worn in the shoe (p < 0.05). GMin (anterior) activity was significantly reduced during swing (p < 0.05). Muscle activity was also significantly reduced during the orthoses condition for the lateral hamstrings and calf muscles (p < 0.05).Significance: Using foot orthoses may provide a strategy to reduce demand on GMin, GMed, lateral hamstring and calf muscles while walking. [ABSTRACT FROM AUTHOR]

Background: The posterior tibialis tendon dysfunction (PTTD) is typically associated with progressive flatfoot deformity, which could be alleviated with foot orthosis. However, the evaluation of tibialis posterior (TP) weakness on lower limb mechanics of flatfoot adults with foot orthoses is scarce and requires further investigation.Research Question: This study aimed to examine the effects of TP weakness on lower limb mechanics in flatfoot adults with foot orthosis through gait analysis and musculoskeletal modelling.Methods: Fifteen young adults with flatfoot were recruited from University to perform a gait experiment with and without foot orthoses. Data collected from the motion capture system were used to drive the musculoskeletal modelling for the estimation of the joint force and extrinsic muscle forces of the lower limb. A parametric analysis was conducted by adjusting the TP muscle strength from 40 % to 100 %. Two-way repeated measures ANOVA was used to compare the peak extrinsic foot muscle forces and joint forces among different levels of TP weakness and insole conditions.Results: TP weakness significantly increased ankle joint force superoinferiorly (F = 125.9, p < 0.001) and decreased anteroposteriorly (F = 125.9, p < 0.001), in addition to a significant increase in the muscle forces of flexor hallucis longus (p < 0.001) and flexor digitorum longus (p < 0.001). Besides, the foot orthosis significantly reduced most peak muscle forces whilst significantly reduced the second peak knee force and peak ankle force compared to the control condition (F = 8.79-30.9, p < 0.05).Significance: The increased extrinsic foot muscle forces (flexor hallucis longus and flexor digitorum longus) and ankle joint forces in the TP weakness condition indicated that TP weakness may induce compensatory muscle activation and attenuated joint load. The abnormal muscle and joint mechanics in flatfoot adults with TP weakness might be restored by the orthosis. [ABSTRACT FROM AUTHOR]

Background: There is a common perception that poorly fitting footwear will negatively impact a child's foot, however, there is limited evidence to support this.Aim: To determine the effect of shoe size on foot motion, perceived footwear comfort and fit during walking, maximal vertical jump height and maximal standing broad jump distance in children aged 8-12 years.Methods: Fourteen participants completed 3D walking gait analysis and jumping tasks in three different sizes of school shoes (one size bigger, fitted for size, one size smaller). In-shoe motion of the hindfoot, midfoot and 1st metatarsophalangeal joint (1st MTPJ) were calculated using a multi-segment kinematic foot model. Physical performance measures were calculated via maximal vertical jump and maximal standing broad jump. Perceived footwear comfort and fit (heel, toes and overall) was assessed using a 100 mm visual analog scale (VAS). Differences were compared between shoe sizes using repeated measures ANOVA, post-hoc tests and effect sizes (Cohen's d).Results: Compared to the fitted footwear, the smaller sizing restricted hindfoot eversion (-2.5°, p = 0.021, d = 0.82), 1st MTPJ dorsiflexion (-3.9°, p = 0.012, d = 0.54), and compared to the bigger footwear, smaller sizing restricted sagittal plane midfoot range-of-motion during walking (-2.5°, p = 0.047, d = 0.59). The fitted footwear was rated as more comfortable overall with the smaller size rated as too tight in both the heel (mean difference 11.5 mm, p = 0.042, d = 0.58) and toes (mean difference 12.1 mm, p = 0.022, d = 0.59), compared to the fitted size. Vertical and standing broad jump distance were not impacted by footwear size (p = 0.218-0.836).Significance: Footwear that is too small restricts foot motion during walking in children aged 8-12 years. Jump performance was not affected. Children were able to recognise shoes that were not correctly matched to their foot length, reinforcing that comfort is an important part of the fitting process. [ABSTRACT FROM AUTHOR]

Background: Ankle-foot orthoses (AFOs) have been shown to improve gait and static balance in individuals with lower extremity weakness and instability. However, the effects of AFOs on dynamic balance reactions including reactive stepping responses are not well known. Therefore, the purpose of this study was to determine the effects of an AFO on reactive stepping responses in healthy young adults.Research Question: Does an AFO alter reactive stepping responses in healthy young adults?Methods: Twenty healthy young adults completed 10 reactive stepping trials using a lean-and-release system for each of three AFO conditions: 1) no AFO, 2) AFO on left leg and 3) AFO on right leg. Trials were recorded using 3D motion capture and force plates. Stepping limb preference and temporal, spatial, and kinematic variables were measured. Differences between conditions were determined by a one-way ANOVA with a Tukey post-hoc.Results: With no AFO, participants demonstrated a preference for stepping with the right leg, 7.0 ± 3.9 of 10 trials. With an AFO on the right leg, this preference decreased to 5.7 ± 4.4 (p = 0.03). With an AFO on the left leg, this preference increased to 8.1 ± 3.3 (p = 0.03). Reaction times were not significantly different between conditions, but participants took a significantly shorter reactive step with the leg wearing the AFO. Peak ankle, knee, and hip joint angles were significantly less with the AFO on the stepping limb compared to the stance limb.Significance: This study shows that AFO use can influence reactive stepping limb preference and stepping limb kinematics in healthy young adults. These results can inform future research on AFO users with gait impairments. These finding may also be helpful in developing interventions to address the specific effects of an AFO on reactive stepping responses. [ABSTRACT FROM AUTHOR]

Background: Charcot-Marie-Tooth disease (CMT) results in distal muscle weakness that leads to gait difficulties in both the stance and swing phases, thus limiting function in the community. A primary purpose of ankle foot orthoses (AFOs) is to improve gait function; however, little is known about what AFOs are prescribed and how they benefit children with CMT.Research Question: To determine the impact of previously prescribed AFOs on gait in children with CMT using comprehensive gait analysis techniques.Methods: We examined strength, passive range of motion and gait (kinematics, kinetics and temporal-spatial) for barefoot and AFO walking on 15 children with a diagnosis of CMT. Participants used their prescribed AFOs, the design of which varied depending on the patient. Comparisons between barefoot and AFO walking were completed for selected ankle, knee and hip kinematics and kinetics and temporal-spatial parameters. Subgroups were also evaluated based upon specific ankle kinematics relevant to AFO prescription.Results: AFOs resulted in increased walking velocity (0.91, SD 0.31 to 1.13, SD 0.23 m/sec, p = 0.001) and improved ankle kinematics (dorsiflexion in mid-swing: -11, SD 10 to 0, SD 5 degrees, p = 0.0001) and kinetics (peak plantar flexor moment in stance: 0.71, SD 0.30 to 0.85, SD 0.29 Nm/kg, p = 0.001). In patients with increased equinus in swing, AFOs resulted in improved ankle kinematics. In patients with increased dorsiflexion in terminal stance, AFOs did not provide the support that was needed to improve gait function.Significance: AFOs enhance gait function in children with CMT by improving walking velocity and selected ankle kinematics and kinetics. It is important that the AFO design be aligned with the patient's specific joint level impairment and associated gait dysfunction. Comprehensive gait analysis techniques can measure differences between barefoot and AFO function and help to clarify the most appropriate AFO prescription for an individual child. [ABSTRACT FROM AUTHOR]

Background: Sensorimotor foot orthoses is an alternative concept, which in addition to mechanical effects, are designed to change muscle activation by altering sensory input to the plantar surface of the foot. However, there is little evidence of how these affect the kinematics of the foot during gait.Research Question: The aim of the study was to explore the immediate effect of calcaneal medial heel bars and retrocapital bars on foot kinematics during the stance phase of gait.Methods: Kinematic data were collected from 32 healthy individuals using an eight camera motion capture system and a six-degrees-of-freedom multi-segment foot model in three different orthotic conditions; calcaneal medial heel bar, retrocapital bar, and no orthosis. Vector field statistical analysis was performed to explore the effect of the orthotic conditions over the kinematic time series curves during stance phase. Peak median and interquartile ranges were also reported during the different phases of stance.Results: The calcaneal medial bar significantly decreased rearfoot eversion for the majority of the stance phase and compensatory increased midfoot eversion during the entire stance phase compared to the no orthosis condition. The retrocapital bar rotated the foot externally significantly abducting the rearfoot for the entire stance phase and the midfoot for the majority of stance phase.Significance: The calcaneal medial heel bar and retrocapital bar significantly altered the foot kinematics in a way that may benefit patients with abnormal pronation and intoeing gait. [ABSTRACT FROM AUTHOR]

Background: Posterior tibial tendon dysfunction (PTTD) is characterized by degeneration of this tendon leading to a flattening of the medial longitudinal arch of the foot. Foot orthoses (FOs) can be used as a treatment option, but their biomechanical effects on individuals with PTTD are not yet fully understood.Research Question: The aim of this study was to investigate the effects of three types of FOs on gait biomechanics in individuals with PTTD.Methods: Fourteen individuals were recruited with painful stage 1 or 2 PTTD based on Johnson and Strom's classification. Quantitative gait analysis of the affected limb was performed in four conditions: shoes only (Shoe), prefabricated FO (PFO), neutral custom FO (CFO) and custom varus FO (CVFO) with a 5° medial wedge and a 4 mm medial heel skive. A curve analysis, using 1D statistical parametric mapping, was undertaken to assess differences in lower limb joint motion, joint moments and muscle activity over the stance phase of gait across conditions.Results: Decreased hindfoot eversion angles, decreased ankle inversion moments and increased ankle eversion moments were observed with custom FOs compared to the Shoe and PFO conditions (p < 0.001). CFOs and CVFOs induced an increased knee abduction moment compared to Shoe (p < 0.001). No changes in hip kinematics and kinetics or in EMG activity of tested muscles were observed between conditions.Significance: Custom orthoses may be more suitable than PFOs to decrease the pathological biomechanical outcomes observed in PTTD. Decreased ankle inversion moments during the stance phase could explain why custom orthoses are effective at reducing pain in PTTD patients. However, clinicians should be careful when prescribing custom orthoses for PTTD since unwanted collateral biomechanical effects can be observed at the knee. [ABSTRACT FROM AUTHOR]

Background: Foot pain experienced by long-distance runners could be relieved by functional insoles which aim at evenly distributing the plantar pressure.Research Question: We hypothesised that an individually moulded insole with medial arch support would reduce the impact and loading under the heel and metatarsal regions.Methods: Twelve male recreational runners ran on a treadmill at 10 km/h for 1 hour with flat insoles and medial arch supported insoles. A pressure insole system (Novel Pedar, Germany) was used to obtain the peak pressure, peak force, time normalised pressure-time integrals, and the percentage of the total force-time integrals under 10 regions.Results: Medial arch supported insoles reduced the peak force under the heel (medial: -15.3%, p = 0.001; lateral: -19.2%, p = 0.037) during the initial run, and reduced peak pressure under the heel (medial: -13.3%, p = 0.005; lateral: -9.9%, p = 0.006), and peak force under the medial heel (-17.8%, p = 0.006) after the run. The percentage of the total force-time integrals under the heel was reduced (medial: -23.8%, p = 0.004; lateral: -13.6%, p = 0.022) after the run. No significant difference was found under the metatarsal regions. There is shift of load from the metatarsal regions to the medial mid-foot as indicated by the change of the percentage of total force-time integrals.Significance: Medial arch supported insoles were effective in reducing the impact and loading under the heel region in prolonged running on a treadmill.Level Of Evidence: Controlled laboratory study, Level V. [ABSTRACT FROM AUTHOR]

Background: Foot orthoses (FOs) have been widely prescribed to alter various lower limb disorders. FOs' geometrical design and material properties have been shown to influence their impact on foot biomechanics. New technologies such as 3D printing provide the potential to produce custom shapes and add functionalities to FOs by adding extra-components.Research Question: The purpose of this study was to determine the effect of 3D printed FOs stiffness and newly design postings on foot kinematics and plantar pressures in healthy people.Methods: Two pairs of ¾ length prefabricated 3D printed FOs were administered to 15 healthy participants with normal foot posture. FOs were of different stiffness and were designed so that extra-components, innovative flat postings, could be inserted at the rearfoot. In-shoe multi-segment foot kinematics as well as plantar pressures were recorded while participants walked on a treadmill. One-way ANOVAs using statistical non-parametric mapping were performed to estimate the effect of FOs stiffness and then the addition of postings during the stance phase of walking.Results: Increasing FOs stiffness altered frontal and transverse plane foot kinematics, especially by further reducing rearfoot eversion and increasing the rearfoot abduction. Postings had notable effect on rearfoot frontal plane kinematics, by enhancing FOs effect. Looking at plantar pressures, wearing FOs was associated with a shift of the loads from the rearfoot to the midfoot region. Higher peak pressures under the rearfoot and midfoot (up to +31.7 %) were also observed when increasing the stiffness of the FOs.Significance: 3D printing techniques offer a wide range of possibilities in terms of material properties and design, providing clinicians the opportunity to administer FOs that could be modulated according to pathologies as well as during the treatment by adding extra-components. Further studies including people presenting musculoskeletal disorders are required. [ABSTRACT FROM AUTHOR]

Background: Novel designs of lateral wedge insoles with arch support can alter walking biomechanics as a conservative treatment option for knee osteoarthritis. However, variations in foot posture may influence individual responses to insole intervention and these effects are not yet known.Research Question: How does foot posture influence biomechanical responses to novel designs of lateral wedge insoles with arch support?Methods: This exploratory biomechanical investigation categorized forty healthy volunteers (age 23-34) into pronated (n = 16), neutral (n = 15), and supinated (n = 9) foot posture groups based on the Foot Posture Index. Three-dimensional gait analysis was conducted during walking with six orthotic insole conditions: flat control, lateral wedge, uniform-stiffness arch support, variable-stiffness arch support, and lateral wedge + each arch support. Frontal plane knee and ankle/subtalar joint kinetic and kinematic outcomes were compared among insole conditions and foot posture groups using a repeated measures analysis of variance.Results: The lateral wedge alone and lateral wedge + variable-stiffness arch support were the only insole conditions effective at reducing the knee adduction moment. However, the lateral wedge + variable-stiffness arch support had a smaller increase in peak ankle/subtalar eversion moment than the lateral wedge alone. Supinated feet had smaller ankle/subtalar eversion excursion and moment impulse than neutral and pronated feet, across all insole conditions.Significance: Supinated feet have less mobile ankle/subtalar joints than neutral and pronated feet and, as a result, may be less likely to respond to biomechanical intervention from orthotic insoles. Supported lateral wedge insoles incorporating an arch support design that is variable-stiffness may be better than uniform-stiffness since reductions in the knee adduction moment can be achieved while minimizing increases in the ankle/subtalar eversion moment. [ABSTRACT FROM AUTHOR]

Background: A hinged ankle-foot orthosis is prescribed for children with spastic unilateral cerebral palsy to improve gait function by correcting spastic equinus. However, little is known about how orthotic management relates to muscle activity during walking in this population.Research Question: Does muscle activity in medial gastrocnemius and tibialis anterior change in children with spastic unilateral cerebral palsy when walking with hinged ankle-foot orthoses featuring two different footplate designs?Methods: In this prospective, repeated-measures trial, electromyographic activity in medial gastrocnemius and tibialis anterior was recorded from 17 children (mean age: 8.4 years ± 1.3 years) with spastic unilateral cerebral palsy walking barefoot and with two designs of hinged ankle-foot orthosis. The orthotic devices consisted of custom-made hinged ankle-foot orthoses with unmodified, flatter footplates and rectified, contoured footplates. Primary outcome measures were total muscle activity, quantified as the area under a linear envelope, and relative change in profiles of muscle activity, depicted by curves of mean difference with 95% confidence bands.Results: No statistical difference was found in total activity of either muscle for the ankle-foot orthosis with an unmodified footplate but a significant reduction in muscle activity of tibialis anterior was seen for the ankle-foot orthosis with a contoured footplate relative to barefoot walking. Profiles of change in muscle activity were significantly altered for both shank muscles between all walking conditions. The most pronounced differences were decreased activity in medial gastrocnemius during early stance phase and lower activity in tibialis anterior during swing phase with orthotic devices.Significance: Orthotic management with hinged ankle-foot orthoses may mitigate spastic activation of medial gastrocnemius in children with spastic unilateral cerebral palsy but also appears to functionally inactivate tibialis anterior during gait. The hinged ankle-foot orthosis with an unmodified footplate corresponded with better performance by facilitating more functional muscle activity while impeding spastic response. [ABSTRACT FROM AUTHOR]

Background: The efficacy of foot orthoses in reducing patellofemoral pain (PFP) is well documented; however, the mechanisms by which foot orthoses modulate pain and function are poorly understood.Research Question: This within-subject study investigated the immediate effects of foot orthoses on lower limb kinematics and angular impulses during level walking and stair ambulation in individuals with persistent PFP.Methods: Forty-two participants with persistent PFP (≥3 months duration) underwent quantitative gait analysis during level walking, stair ascent and stair descent while using: (i) standard running sandals (control); and (ii) standard running sandals fitted with prefabricated foot orthoses. Hip, knee, and ankle joint kinematics and angular impulses were calculated and statistically analyzed using paired t-tests (p < 0.05).Results: Relative to the control condition, foot orthoses use was associated with small but significant decreases in maximum ankle inversion angles during walking (mean difference [95% confidence interval]: -1.00° [-1.48 to -0.53]), stair ascent (-1.06° [-1.66 to -0.45]) and stair decent (-0.94° [-1.40 to -0.49]). Foot orthoses were also associated with decreased ankle eversion impulse during walking (-9.8Nms/kg [-12.7 to -6.8]), and decreased ankle dorsiflexion and eversion impulse during stair ascent (-67.6Nms/kg [-100.7 to -34.6] and -17.5Nms/kg [-23.6 to -11.4], respectively) and descent (-50.4Nms/kg [-77.2 to -23.6] and -11.6Nms/kg [-15.6 to -7.5], respectively). Ankle internal rotation impulse decreased when participants ascended stairs with foot orthoses (-3.3Nms/kg [-5.4 to -1.3]). Limited changes were observed at the knee and hip.Significance: In individuals with persistent PFP, small immediate changes in kinematics and angular impulses - primarily at the ankle - were observed when foot orthoses were worn during walking or stair ambulation. The clinical implications of these small changes, as well as the longer-term effects of foot orthoses on lower limb biomechanics, are yet to be determined. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis is a disease of the joint causing decreased function and pain. Currently, treatments range from medication to surgery, with the use of different insoles and footwear recommended. These methods are effective by either correcting the position of the knee or providing shock absorption. However, there is little understanding of the effective characteristics of these devices.Research Question: This paper aims to investigate this question and provide future areas of research to help better define treatment guidelines. Foot orthoses are an example of non-pharmacological conservative treatments mentioned in National Institute for Health and Care Excellence (NICE) guidelines to treat knee osteoarthritis (OA). These include lateral wedge insoles (LWI), developed with the intention of load reduction of the knee. Different footwear has also been shown to affect pain, biomechanical and functional outcomes in knee OA patients.Methods: To address what features of LWIs and footwear make them effective in the treatment of knee OA, scientific databases were used to search for papers on this topic and then selected to be included based on pre-defined criteria. Data were extracted and analysed from these studies to provide a basis for possible areas for future development of these foot orthoses, and research required to improve clinical treatment guidelines. Databases used were PubMed, Scopus and Web of Science.Results and Significance: Thirty-four out of 226 papers were included after application of inclusion and exclusion criteria. Regarding LWIs, the characteristics showing the most beneficial effect on either biomechanical, functional or pain outcomes were customisation, full-length, 5° elevation, shock absorption and arch support. For footwear, barefoot mimicking soles produced the most favourable biomechanics. Results also showed that insoles work in correcting the position of the knee, but it may or may not affect patients' pain and function. [ABSTRACT FROM AUTHOR]

Background: Foot orthoses are a recommended treatment for patellofemoral (PF) pain and a number of lower limb osteoarthritic (OA) conditions. However, their mechanism of effect is poorly understood.Research Question: To compare the immediate effects of foot orthoses and flat inserts on lower limb biomechanics, knee pain and confidence in individuals with PFOA.Methods: Twenty-one participants (14 females; mean ± SD age 58 ± 8 years) with PFOA underwent three-dimensional motion analysis during level-walking, stair ascent, and stair descent under three footwear conditions: (i) their own shoes; (ii) prefabricated foot orthoses; and (iii) flat shoe inserts. Participants reported their average levels of knee pain and confidence after each task. Data were analysed with repeated-measures analysis of variance (ANOVA), effect sizes (partial eta squared), and Bonferroni post-hoc tests.Results: During level-walking, there was a significant main effect of foot orthoses on peak ankle dorsiflexion angle (F2 = 0.773, p < 0.001, ƞ2 = 0.773) and peak ankle external dorsiflexion moment (F2 = 0.356, p = 0.046, ƞ2 = 0.356). Foot orthoses decreased the peak ankle dorsiflexion angle compared to the flat insert and shoe conditions, and decreased the peak ankle external dorsiflexion moment relative to flat inserts. During stair descent, there was a significant main effect of foot orthoses on peak ankle external dorsiflexion moment (F2 = 0.823, p = 0.006, ƞ2 = 0.738), with a trend towards lower peak dorsiflexion moment for foot orthoses compared to the flat insert and shoe conditions. No significant main effects were observed during stair ascent. No other lower limb biomechanical changes were observed across all three conditions. Knee pain and confidence scores were not significantly different across the three conditions.Significance: Prefabricated foot orthoses altered sagittal plane biomechanics of the ankle during level-walking and stair descent in individuals with PFOA. Further research is required to determine whether these changes are clinically beneficial. [ABSTRACT FROM AUTHOR]

Background: Abnormal peak plantar pressure in neuropathic diabetic foot during walking activities is well managed through the use of appropriate design and material selection for the fabrication of custom made insoles (CMI). The redistribution of plantar pressure is possible by selecting an appropriate material for the fabrication of CMI. The walking activities may alter the plantar pressure distribution; which may differ while using CMI with different materials.Objective: The objective of the study was to evaluate the effectiveness of CMI's materials on plantar pressure distribution during different walking activities, in diabetic feet with neuropathy.Methods: The study was conducted on sixteen diabetic neuropathic subjects. The subjects were provided with two types of CMI; CMI-A (Plastazote® and microcellular rubber) and CMI-B (Multifoam, Plastazote® and microcellular rubber). Maximum peak plantar pressure and plantar pressure distribution were determined by Pedar-X® sensor insole during level walking, ramp walking and stair walking.Results: The CMI-B lessened the maximum peak plantar pressure from the forefoot throughout the walking activities compared to CMI-A. The contact area was observed as lower using CMI-A compared to CMI-B, while performing walking activities.Conclusion: CMI-B, with multifoam as an additional top layer, provided more effective peak plantar pressure reduction at forefoot and it had better plantar pressure distribution compared to CMI-A during level walking and ramp ascending in diabetic foot with neuropathy. [ABSTRACT FROM AUTHOR]

Background: Excessive foot pronation during running in individuals with foot varus alignment may be reduced by medially wedged insoles.Research Question: This study investigated the effects of a medially wedged insole at the forefoot and at the rearfoot on the lower limbs angles and internal moments of runners with excessive foot pronation and foot varus alignment.Methods: Kinematic and kinetic data of 19 runners (11 females and 8 males) were collected while they ran wearing flat (control condition) and medially wedged insoles (insole condition). Both insoles had arch support. We used principal component analysis for data reduction and dependent t-test to compare differences between conditions.Results: The insole condition reduced ankle eversion (p = 0.003; effect size = 0.63); reduced knee range of motion in the transverse plane (p = 0.012; effect size = 0.55); increased knee range of motion in the frontal plane in early stance and had earlier knee adduction peak (p = 0.018; effect size = 0.52); reduced hip range of motion in the transverse plane (p = 0.031; effect size = 0.48); reduced hip adduction (p = 0.024; effect size = 0.50); reduced ankle inversion moment (p = 0.012; effect size = 0.55); and increased the difference between the knee internal rotation moment in early stance and midstance (p = 0.012; effect size = 0.55).Significance: Insoles with 7˚ medial wedges at the forefoot and rearfoot are able to modify motion and moments patterns that are related to lower limb injuries in runners with increased foot pronation and foot varus alignment with some non-desired effects on the knee motion in the frontal plane. [ABSTRACT FROM AUTHOR]