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Objectives: Ankle-Foot orthoses are used to minimize the impact of weakness in ankle dorsiflexion muscles. The study on different orthotic types defines the optimal design, which effectively improves the users’ mobility. This study investigated the potential benefits and risks of a Dictus-band (flexible orthotic), compared with a thermoplastic (fixed) ankle-foot orthosis on the mobility of individuals with Multiple Sclerosis (MS). Methods: Fifteen subjects with MS and dorsiflexion ankle weakness volunteered in this randomized crossover study. The study participants received either a Dictus-band or a thermoplastic ankle-foot orthosis worn on the weaker leg, compared to barefoot as the control condition. Postural stability during standing, forward reach test, timed up and go test, and walking speed in the 10-meter walking test were compared between the study conditions. Results: There were no significant differences in the postural stability and forward reach tests between study conditions (P>0.5). When the research participants used a Dictus-band, compared to the fixed ankle-foot orthosis, the time required to complete the timed up and go was significantly reduced [P0.5). No adverse or safety events were sustained in this research. Discussion: The present study data provided initial evidence for the lack of detrimental effects of using the Dictus-band in subjects with MS and ankle dorsiflexion deficiencies.

Introduction: Patellofemoral pain syndrome (PFPS) is a common problem that particularly affects active young people. In these patients, dynamic knee valgus causes hip and knee kinematic changes. Therefore, the reduction of dynamic valgus angle is one of the rehabilitation strategies in people with PFPS. The objective of this study was to evaluate the immediate effect of a medial wedge insole and knee orthosis on the knee pain and knee movement during walking and squat on involved side in people with PFPS.Materials and Methods: 15 volunteers with PFPS participated in this crossover clinical study. All participants signed the consent form and then were evaluated in four random conditions (without orthosis, medial wedge, medial wedge in combination with knee brace, and knee brace). The kinematics and kinetics of the lower limb were studied during walking and single-leg squat. Data analysis was performed using repeated measures statistical analysis of variance (ANOVA).Results: The knee brace, knee brace with medial wedge, and medial wedge significantly reduced the pain of affected leg after single-leg squat (P = 0.001). The walking speed (P = 0.067) and dynamic knee valgus angle (P = 0.490) did not significantly change in four different modalities of intervention. The peak moment of the knee in frontal plane was significantly increased in three conditions [medial wedge (P = 0.001), knee brace (P = 0.008), and knee brace in combination with medial wedge (P = 0.033)] compared with the control condition.Conclusion: Use of medial wedge and neoprene knee brace can decrease pain and improve the biomechanical performance of people with PFPS. The use of these interventions can cause positive biomechanical effects on the lower limb.

Introduction: Osteoarthritis is one of the most common musculoskeletal disorders. Analyzing the energy expenditure in people who suffer from musculoskeletal disorders provides objective evidence to measure individual’s disability and the effect of therapeutic interventions. Present study investigated the effect of various severities of knee osteoarthritis on mechanical energy of lower extremities. Materials and Methods: 48 women aged between 40-70 years were purposefully divided into mild, moderate and sever osteoarthritis and healthy control group according to simple X-ray features of their knee joints. The participants walked at their convenient self-selected speed to collect five clean trials. The data were recorded using a motion analysis system and a 3-dimentional model of lower extremity segments was developed from motion capture data using visual 3-D software. Mechanical energy of lower extremity was calculated using this model. Results: The study groups were significantly different in age (P ≤ 0.001) and walking speed (P ≤ 0.001). One-way analysis of variances (ANOVA) and post-hoc Tukey test revealed that there was significant difference between the study groups regarding mechanical energy. However, univariate general linear models with adjustments to age and to walking speed were developed; in addition, a bivariate general linear model was adjusted to age and walking speed. All the models confirmed that the differences were not imposed by the severity of knee osteoarthritis. Conclusion: It seems that increase in mechanical energy of lower extremity in subjects with knee osteoarthritis intensifies with the progression of the disease; this is not a direct effect of the level of joint deterioration but is an indirect effect of older age and lower walking speed in subjects suffering from more advanced knee osteoarthritis.

Introduction: Foot insoles are widely used to reduce excessive pressure exerted on the plantar surface of the foot and prevent diabetic foot ulceration. The objective of this study was to investigate the effects of the metatarsal pad on pressure on the forefoot area. Materials and Methods: This randomized crossover clinical trial was conducted on 18 volunteers (5 women and 13 men) with diabetic peripheral neuropathy. Plantar pressure was recorded while participants walked over a plantar pressure platform in three random conditions of barefoot, with a placebo intervention, and with a metatarsal pad. The processed variables were statistically analyzed using repeated measure one-way ANOVA. Results: The metatarsal pad caused a significant reduction in mean pressure on the forefoot compared to the barefoot and placebo conditions (P < 0.001). The metatarsal pad also significantly reduced the time-pressure integral in the forefoot compared to the barefoot and placebo conditions (P < 0.001). There was no significant difference in the time-pressure integral of the total plantar surface between the three conditions. Conclusion: The metatarsal pad transfers the forefoot load to the midfoot area, thereby, reducing the pressure exerted on the forefoot. This finding implies that using a metatarsal pad can be an effective intervention to prevent diabetic foot ulceration.