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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.