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Foot orthoses (FO) are a commonly prescribed intervention to alter foot function during walking although their effects have been primarily studied in the extrinsic muscles of the foot. Furthermore, enhancing sensory feedback under the foot sole has been recently shown to alter extrinsic muscle activity during gait; however, the effects of FOs with enhanced sensory feedback on plantar intrinsic foot muscles (PIFMs) remain unknown. Thus, the purpose of this study was to investigate the effect of FOs with and without sensory facilitation on PIFM activity during locomotion. Forty healthy adults completed a series of gait trials in non-textured and textured FOs when walking over hard and soft flooring. Outcome measures included bilateral joint kinematics and electromyography (EMG) of four PIFMs. Results of this study highlight the distinct onset and cessations of each PIFM throughout the stance phase of gait. PIFMs remained active during mid-stance when wearing FOs and textured FOs facilitated muscle activity across the stance phase of gait. Increasing cutaneous input from foot sole skin, via the addition of texture under the foot sole, appears to alter motor-neuron pool excitation of PIFMs. Future academics are encouraged to increase our understanding on which pathologies, diseases, and/or medical conditions would best benefit from textured FOs. [ABSTRACT FROM AUTHOR]

Background: Pavlik harness is the most widely used orthosis in the treatment of developmental dysplasia of the hip. The aim of this study was to evaluate the effect of the Pavlik harness on the development of "unaided sitting" and "independent walking" in infants with developmental dysplasia of the hip. Methods: This prospective study, conducted from 2017 to 2020, included infants undergoing Pavlik harness therapy. Inclusion criteria comprised gestational age > 37 weeks, treatment initiation before 6 months of age, and no prior treatment for developmental dysplasia of the hip. We assessed treatment initiation age, treatment duration, and the age of achieving unaided sitting and independent walking. Results: In the patient group, unaided sitting commenced at a mean age of 6.8 ± 1.6 (range: 4–11) months, while independent walking began at a mean age of 12.7 ± 1.8 (range: 9–18) months. By 15 months, 92% of the patients achieved independent walking. In the control group, unaided sitting occurred at a mean age of 6.1 ± 1.1 (range: 4–8) months, and independent walking at 11.8 ± 1.6 (range: 9–18) months. A significant positive correlation was observed between the duration of Pavlik harness usage and the age of unaided sitting (p < 0.001) and independent walking (p < 0.001). Conclusion: Our study indicates that Pavlik harness treatment for developmental dysplasia of the hip is generally safe and does not lead to clinically significant delays in unaided sitting and independent walking. However, some minor delays may occur due to extended orthosis use. Level of evidence: level III—prospective cohort study. [ABSTRACT FROM AUTHOR]

Purpose: Foot deformities are prevalent in children with cerebral palsy, but there is limited research on the progression of foot posture during growth. Our study aimed to evaluate the change in dynamic foot posture in children with cerebral palsy. Methods: Children with cerebral palsy, aged 17–40 months, were recruited to participate in this Institutional Review Board–approved prospective longitudinal study by having serial foot posture evaluations. The coronal plane index and foot segmental impulses were measured with dynamic pedobarography. Data were compared between children stratified by Gross Motor Function Classification System level and typically developing children using serial Welch's t -tests across time with Holm correction for multiple comparisons. Results: In total, 33 children (54 limbs) were included in the analysis (21 bilateral and 12 unilateral; Gross Motor Function Classification System: I-13, II-14, III-4, IV-2. Children completed 16.9 (± 4.4) evaluations (initial age 2.9 (± 0.7) and final age 18.6 (± 1.7) years)). Early valgus foot posture normalizes in children at Gross Motor Function Classification System levels I/II and persists in children at levels III/IV who do not have foot surgery. For most young children, foot posture development is variable. Conclusion: Foot posture in young children with cerebral palsy begins in valgus and tends to normalize in youth who walk without an assistive device. Conservative management of foot deformity is recommended in early childhood. Level of evidence: Level II, prognostic study. [ABSTRACT FROM AUTHOR]

To determine the effects of ankle-foot orthoses (AFO) on step-based physical activities in individuals with neurological, orthopaedic, or cardiovascular disorders. Electronic searches of databases such as Scopus, PubMed, Web of Science, Embase, ProQuest, Cochrane Library, and EBSCO were conducted. Two evaluators independently searched with keywords focusing on step-based physical activities, and either articulated or non-articulated AFO. Study quality was assessed using a modified Downs and Black quality scale. Eleven studies that met the inclusion criteria were selected, including four being classified as good, four as fair, and three as poor in quality. The majority of these trials found no significant effects of AFO on step activities. Only a few studies reported improvements in step counts and active times in step activity with a limited to moderate level of evidence. Subjective evaluations such as user satisfaction, and physical functionality during step activity, on the other hand, showed substantial changes with the use of AFO interventions, although there was no evidence of improvement in the quality of life. Although the AFO did not seem to have a substantial effect on step activity, it appeared to play a vital role in improving the patient satisfaction level of step activity. Ankle-foot orthoses (AFO) may not significantly affect the step activity of individuals with impaired ankle-foot complex. AFO may enhance patient-reported satisfaction, physical functioning, participation, and fatigue level during step activity. The patient's perception that the AFO is beneficial is in contrast to objective data showing no significant increase in real-world activity. [ABSTRACT FROM AUTHOR]

The traditional process of foot and ankle orthoses made of gypsum has the disadvantages of low air tightness, low production efficiency and poor comfort. In order to solve this problem, this paper uses reverse engineering combined with 3D printing technology to customize the design of the ankle foot orthosis, obtains the foot STL data, combines the reverse modeling software Geomagic studio and Rodin 4D to modify the key parts of the orthosis, uses Grasshopper to carry out lightweight design, reduces the printing cost and quality, verifies its mechanical properties through finite element analysis, uses polylactic acid to print the physical object by FDM 3D printing technology, and conducts wear tests. The results show that the maximum deviation of the model accuracy after reconstruction is 0.868 mm, and the standard deviation is 0.047 1 mm, and the model structure is accurate. Under the concentrated load of 30 N collision, the peak stress in the middle of the 2 mm thickness orthosis is 16.32 MPa, the maximum deformation is 1.49 mm, the peak stress on the right side of the lattice is 15.64 MPa, the maximum deformation is 0.78 mm, the peak stress is less than the tensile strength of PLA material, the maximum deformation is less than the thickness of the product itself by 2 mm, the mechanical strength performance meets the requirements of subsequent production design, and the physical wear test shows that the product comfort is good. [ABSTRACT FROM AUTHOR]

Lower limb orthoses are frequently used in children suffering from cerebral palsy (CP) alongside rehabilitation. The aim of this study was to analyze the effectiveness of ankle–foot orthosis (AFO) and knee–ankle–foot orthosis (KAFO) in walking, balance maintenance, spasticity, and quality of life improvement during rehabilitation in children affected by CP. The hypothesis was that the use of orthoses could improve the parameters compared to non-use. A systematic review was conducted in the main databases, including English language RCTs published about the use of AFO and KAFO in combination or not with rehabilitation methods in children affected by CP and studies mentioning walking, balance, muscle length, and quality of life as outcomes. From an initial number of 1484 results, a final number of 11 RCTs were included, comprising a total number of 442 participants and showing an overall high risk of bias in 10 studies and some concerns in one study. Six studies investigated the domain of walking, four studies investigated the domain of balance, and two studies investigated how KAFO and AFO orthoses could improve and prevent muscle contractures. Using highly heterogeneous study designs, different kinds of orthoses and different assessment tools were used. Further studies conducted with higher methodological quality are needed to establish whether AFO and KAFO are useful or not in combination with rehabilitation in improving the investigated domains. [ABSTRACT FROM AUTHOR]

Introduction: Patients with Charcot--Marie--Tooth disease (CMT) often suffer from walking-related pain (WRP), muscle weakness, foot deformities, and reduced ankle dorsiflexion (DF), which affects their ability to walk and daily activities. Functional surgery (FS) can restore foot deviations, affecting the loading ability during gait. We assessed the short-term effects of FS in patients with CMT on WRP, foot and ankle structure, and function, along with patients' perceived improvement. Methods: This is a prospective cohort study on CMT patients who had undergone FS and rehabilitation. We analyzed the changes after 1 month, focusing on WRP, DF, the center of pressure progression (COPP) during walking, and measures of walking ability. The non-parametric Wilcoxon test was used. Results: Ten patients were included. One month after FS, WRP reduced from 5.5 (IQR = 3.5) to 2 (IQR = 3.5), p = 0.063, with an effect size of 0.615. The highest decrease was found in patients with very high pre-surgical pain levels. DF almost reached 10° for both active and passive movements (p < 0.05), and COPP improved from 44 to 60% (p = 0.009) of foot length. Gait speed, lower limb functioning, and balance did not change. More than half of the sample felt improved or much improved after FS. Conclusion: FS can be effective in reducing WRP and restoring foot posture in CMT patients in the short-term, which allows them to wear shoes, and leads to a perceived improvement and satisfaction. Lack of improvement in functional skills may be due to muscle weakness typical of CMT. Studies with longer follow-ups may confirm these hypotheses. [ABSTRACT FROM AUTHOR]

Purpose: Different studies have shown that weightbearing is safe in stable transsyndesmotic, isolated lateral simple ankle fractures. Despite this evidence, AO guidelines still recommend immobilization with above-the-knee cast for 4–6 weeks for these fractures. The objective of this study was to compare the outcomes of mobilization and weightbearing to those of immobilization and non-weightbearing in patients with stable transsyndesmotic, lateral isolated simple ankle fractures. Methods: Fifty patients were randomly assigned to permissive weightbearing in a walking boot or non-weightbearing immobilization using a below-the-knee cast. Primary outcome was ankle functionality as scored by the Olerud-Molander Ankle Score (OMAS). Secondary outcomes were radiological displacement of fracture, range of motion (ROM), calf circumference, and RAND 36-item health survey. Patients were in follow-up for 24 months. Results: Ankle functionality after six and twelve weeks was significantly higher for the intervention group, with respectively 30 points (p = 0.001) and 10 points (p = 0.015) of difference. ROM improved significantly in the intervention group after six weeks. All fractures showed radiological progression of fracture healing. RAND 36-item showed differences in both physical (60.3 vs. 46.3, p = 0.017) and mental (78.5 vs. 58.2, p = 0.034) components in favor of the intervention group. In 16% of patients who initially showed stable fractures on radiographic imaging, joint dislocation was identified on weightbearing radiographs prior to randomization, leading to exclusion. Conclusion: Weightbearing and mobilization using a walking boot may be a safe treatment for patients with stable Weber B fractures. [ABSTRACT FROM AUTHOR]

Odontoid fractures are common cervical spine fractures; however, significant controversy exists regarding their treatment. Risk factors for failure of conservative therapy have been identified, although no predictive risk score has been developed to aid in decision-making. A retrospective review was conducted of all patients evaluated at a level 1 trauma center. Patients identified with type II odontoid fractures as classified by the D'Alonzo Classification system who were treated with external orthosis were included in analysis. Patients were considered to have failed conservative therapy if they were offered surgical intervention. A machine learning method (Risk-SLIM) was then utilized to create a risk stratification score based on risk factors to identify patients at high risk for requiring surgical intervention due to persistent instability. A total of 138 patients were identified as presenting with type II odontoid fractures that were treated conservatively; 38 patients were offered surgery for persistent instability. The Odontoid Fracture Predictive Model (OFPM) was created using a machine learning algorithm with a 5-fold cross validation area under the curve of 0.7389 (95% CI: 0.671 to 0.808). Predictive factors were found to include fracture displacement, displacement greater than 5 mm, comminution at the fracture base, and history of smoking. The probability of persistent instability was <5% with a score of 0 and 88% with a score of 5. The OFPM model is a unique, quick, and accurate tool to assist in clinical decision-making in patients with type II odontoid fractures. External validation is necessary to evaluate the validity of these findings. [ABSTRACT FROM AUTHOR]

Foot pronation, as one of the prevalent foot abnormalities, can influence the biomechanics of the lower limbs. The use of various foot orthoses, including insoles and braces, is very common in eliminating this problem. The results obtained regarding the effect of orthoses on pain and biomechanics of individuals with foot pronation are different. The present review study was conducted to evaluate the effects of foot orthoses and shoes on the biomechanics of the lower limbs and balance in individuals with foot pronation. The articles were searched in Persian and Latin languages during 2004-22 in the databases of PubMed, Web of Science (WOS), Scopus, Islamic Science Citation (ISC), and Google Scholar search engine. Moreover, the types of the searched studies were original research, review studies, and clinical trials. Using keywords of Foot pronation, Foot orthoses, Medical soles, and Motion-control shoes, 52 relevant articles were selected, and 22 articles regarding the effects of orthoses and shoes on foot pronation were finally analyzed. Eight articles also reported that reducing forces imposed on the joints, absorbing shock, preventing pronation-related running injuries, and improving muscle activity occurred when using orthosis. Furthermore, 4 articles reported improving sports performance in athletes, reducing the ground reaction forces, and changing the frequency of muscle activity. Finally, 2 articles showed that motion-control shoes prevented intensifying the injury due to increased fatigue and subsequently increased mechanical loading during running. The results of the present study demonstrated that foot orthoses and motion-control shoes could have positive effects on balance, improving the activities of the lower limbs and reducing foot pronation and force imposed on the foot and lower limb joints. [ABSTRACT FROM AUTHOR]

Foot injuries have been a problem among Thai farmers for a long time. The sowing process is one of the high-risk processes because farmers have to walk in the field to spray rice seed without footwear. Literature review showed that cuts from stepping on sharp material or snail shells were major sources of injury. Traditional footwear such as Ninja shoes or cloth socks have raised the questions regarding their ability in protection from such injuries. This study investigates using Neoprene diving boots to protect from foot injuries during the rice sowing process. The sample from this study were farmers from Sena District, Phra Nakhon Si Ayutthaya Province, Thailand. 29 farmer wearing Neoprene diving boots, 7 farmers wearing traditional Ninja shoes, and 19 farmers wearing cloth socks were asked to work in the sowing process and interviewed about any foot injuries that may have occurred. The statistical test showed there were no significant differences in characteristics among each group of farmers, except for work experience. The results show that there were no foot injuries in farmers wearing Neoprene diving boots, whereas 73% of farmers wearing Ninja shoes, and 14% of farmers wearing cloth socks still had foot injuries. Most injuries were alaceration that were caused by the golden apple snail. The satisfaction survey showed that farmers were satisfied and strongly satisfied with all of the aesthetics, utilization, and functionality factors. This study suggested that the Neoprene diving boots can be recommended for farmers to use as safeguarding against foot injuries in the rice sowing process. [ABSTRACT FROM AUTHOR]

Introduction: Ankle-foot orthosis (AFO) and functional electrical stimulation (FES) are commonly used interventions for patients with foot drop caused by a central neurological origin. The aimof this systematic review is to analyze the available evidence on the improvement of gait endurance in people with foot drop caused by a central neurological origin when comparing effectiveness of AFO and FES. The secondary aim is to evaluate the available evidence for the difference between the use of FES and AFO on perception of walking function. Methods: A literature search was conducted using MEDLINE/PubMed, Cochrane, JBI, CINAHL, Nursing and Allied Health, Ovid Emcare, PsycInfo, Scopus, and Web of Science. All articles published through July 2020 were included in this review. Randomized control trials or crossover trials addressing the comparison of AFO to FES in people with foot drop of central neurological origin on gait endurance and perception of improvement in walking function were assessed. PEDro scale was used to assess methodological quality. Two independent reviewers screened titles, abstracts, and full articles, and a third reviewer resolved any disagreements. Results: Twenty-five records were screened with 16 full-text articles assessed for eligibility using the PEDro score. Eleven final studies (PEDro scores range from 5 to 7) were included in qualitative analysis. Only two of the nine studies that evaluated gait endurance reported significant improvement in gait endurance in favor of FES. Seven of the eight studies evaluated the participant preference of device for various walking functions, which showed significance in favor of the use of FES. Conclusions: Our review reveals inconclusive evidence to support the use of FES compared with AFO for improving gait endurance. However, qualitative analysis of device preference for walking by participants reveals that FES was the preferred device in this population compared with AFO. Clinical Relevance: For patients with foot drop of central nervous system pathology, FES or AFO can be used to improve gait endurance. However, FES may be the preferred device by participants for their walking function. [ABSTRACT FROM AUTHOR]

Introduction: This retrospective chart review aims to find evidence supporting a difference in complications rates and progression of Charcot deformity between two orthotic interventions: the CROW and the custom calf lacer ankle foot orthosis. The existing evidence base to support the use of orthoses in the prevention and treatment of diabetic foot ulcers secondary to Charcot arthropathy is extremely limited. Methods: Subjects were diagnosed with diabetes mellitus and Charcot arthropathy and referred for orthotic treatment. A billing audit of subjects treated between September 1, 2018, and May 1, 2020, was generated using L codes L2330 and L4631. Subjects were excluded if they received a midfoot or higher amputation before application of the offloading device. In total, 87 charts were retrospectively reviewed, and 47 subjects were included. Results: No significant difference was found in complication rate between the two groups. The first year of orthotic intervention had the highest number of complications for both devices. In addition, most calf lacer subjects wore the orthosis for 2 to 3 years, whereas most CROW subjects wore the orthosis for 2 years. Conclusions: These findings suggest that both orthotic interventions available to treat diabetic foot ulcers secondary to Charcot arthropathy have similar complication rates. More research is needed to determine the clinical benefits of prescribing one intervention over the other. Clinical Relevance: Although clinical empirical evidence suggests lower complication rates with the use of calf lacer AFOs, this study found no statistical difference in the overall number of complications observed with the two orthotic interventions. [ABSTRACT FROM AUTHOR]

Objective: To characterize the environmental factors of children and adolescents with Cerebral Palsy (CP) in the state of Minas Gerais (MG), Brazil. Methods: This is a cross-sectional study involving 164 caregivers of children/adolescents with CP, aged 1-14 years. The Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) were used to classify the participants’ functioning, and environmental factors were evaluated by an on-line questionnaire that examined products and technologies, physical environment, services, and systems. A descriptive analysis was performed using percentage and frequency. Results: Most participants had bilateral CP (66.9%) and 45% of them were spastic. Levels II and V of the GMFCS and MACS were the most frequent. About half (49.4%) used anticonvulsants, 27.4% underwent botulinum toxin application, and 29% went through orthopedic surgery in the lower limbs. Among the participants, 71.3% used orthoses in the lower limbs, and 51.8% used the public health care system. Most had access to physiotherapy (91.5%), but found difficulties to access interventions with other professionals, such as psychologists (28%) and nutritionists (37.8%). The school was the most frequently adapted environment (78%), and had the highest level of structural adaptation (42.7%). Conclusions: The results of this study suggest that the barriers to access health services and barriers to the physical environment may impact participation and social inclusion. [ABSTRACT FROM AUTHOR]

This article presents the process of development, testing, and use of wrist–hand orthosis in the hand therapy of a teen patient with congenital paresis disease. A regular 3D-printed anatomically adjusted orthosis is modified with a set of sensors, to work as motion and interaction controller in virtual reality (VR). As the patient with this condition cannot operate VR controllers due to wrist and hand defects, the corrective orthosis was converted to a VR controller, by introducing custom-made electronics and commercially available motion trackers, linking them to the orthosis. A VR game scenario, with typical input from the VR controllers replaced by input from the custom-made controllers is then designed. The VR game scenario is prepared with involvement of physiotherapists, to incorporate the most important exercises for patients with the same condition. The scenario is tested with a group of human patients and assessed by an expert physiotherapist, for determining its efficiency, as well as to determine a set of necessary improvements for future development of the orthosis. [ABSTRACT FROM AUTHOR]

This article introduces a novel concept where advanced technologies have been leveraged to produce a modular walking orthosis (MOWA) within a completely digital process chain. All processes of this new supply chain are described step-by-step. The prescription and treatment of lower leg orthoses for individuals with paralysis or muscle weakness, particularly cerebral palsy (CP), are complex. A single case study indicates successful treatment with this new orthosis (MOWA). From the authors' perspective, this innovative fitting concept is promising and will contribute to creating more efficient care within a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Background: The Lokomat ® is a device utilized for gait training in post-stroke patients. Through a systematic review, the objective was to determine whether robot-assisted gait training with the Lokomat ® is more effective in enhancing lower extremity rehabilitation in patients with stroke in comparison to conventional physical therapy (CPT). Methods: In this study, a systematic search was conducted in various databases, including CINAHL, MEDLINE, PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Physiotherapy Evidence Database (PEDro), as well as bibliographies of previous meta-analyses, to identify all randomized controlled trials that investigated the use of Lokomat ® devices in adult stroke patients. The study aimed to derive pooled estimates of standardized mean differences for six outcomes, namely, Fugl-Meyer Assessment lower-extremity subscale (FMA-LE), Berg Balance Scale (BBS), gait speed, functional ambulation category scale (FAC), timed up and go (TUG), and functional independence measure (FIM), through random effects meta-analyses. Results: The review analyzed 21 studies with a total of 709 participants and found that the use of Lokomat ® in stroke patients resulted in favorable outcomes for the recovery of balance as measured by the BBS (mean difference = 2.71, 95% CI 1.39 to 4.03; p < 0.0001). However, the FAC showed that Lokomat ® was less effective than the CPT group (mean difference = -0.28, 95% CI -0.45 to 0.11, P = 0.001). There were no significant differences in FMA-LE (mean difference = 1.27, 95% CI -0.88 to 3.42, P = 0.25), gait speed (mean difference = 0.02, 95% CI -0.03 to 0.07, P = 0.44), TUG (mean difference = -0.12, 95% CI -0.71 to 0.46, P = 0.68), or FIM (mean difference = 2.12, 95% CI -2.92 to 7.16, P = 0.41) between the Lokomat ® and CPT groups for stroke patients. Conclusion: Our results indicate that, with the exception of more notable improvements in balance, robot-assisted gait training utilizing the Lokomat ® was not superior toCPT based on the current literature. Considering its ability to reduce therapists' work intensity and burden, the way in which Lokomat ® is applied should be strengthened, or future randomized controlled trial studies should use more sensitive assessment criteria. [ABSTRACT FROM AUTHOR]

This cross-sectional study, conducted at a tertiary care hospital's rehabilitation clinic, aimed to validate Short Physical Performance Battery (SPPB) results obtained through plantar pressure analysis using commercial smart insoles (SPPB-SI) and to compare these results to manually acquired results by an experienced examiner (SPPB-M). This study included 40 independent-walking inpatients and outpatients aged 50 or older. SPPB-SI and SPPB-M were administered concurrently, with the smart insoles providing plantar pressure data that were converted into time–pressure curves. Two interpreters assessed the curves, determining component completion times for the SPPB-SI scores. Among the 40 participants (mean age: 72.98, SD: 9.27), the mean total SPPB-SI score was 7.72 ± 2.50, and the mean total SPPB-M score was 7.95 ± 2.63. The time recordings and measured scores of each SPPB-SI component exhibited high reliability with inter- and intra-interpreter correlation coefficients of 0.9 and 0.8 or higher, respectively. The intraclass correlation coefficient between the total SPPB-SI and SPPB-M scores was 0.831 (p < 0.001), and that between the component scores of the two measurements ranged from 0.837 to 0.901 (p < 0.001). Consistent correlations with geriatric functional parameters were observed for both SPPB-SI and SPPB-M. This study underscores the potential of commercial smart insoles as reliable tools for conducting SPPB assessments. [ABSTRACT FROM AUTHOR]

Trampolines are recognized as a valuable tool in exercise and rehabilitation due to their unique properties like elasticity, rebound force, low-impact exercise, and enhancement of posture, balance, and cardiopulmonary function. To quantitatively assess the effects of trampoline exercises, it is essential to estimate factors such as stiffness, elements influencing jump dynamics, and user safety. Previous studies assessing trampoline characteristics had limitations in performing repetitive experiments at various locations on the trampoline. Therefore, this research introduces a robotic system equipped with foot-shaped jigs to evaluate trampoline stiffness and quantitatively measure exercise effects. This system, through automated, repetitive movements at various locations on the trampoline, accurately measures the elastic coefficient and vertical forces. The robot maneuvers based on the coordinates of the trampoline, as determined by its torque and position sensors. The force sensor measures data related to the force exerted, along with the vertical force data at X, Y, and Z coordinates. The model's accuracy was evaluated using linear regression based on Hooke's Law, with Mean Absolute Error (MAE), Root Mean Square Error (RMSE), and Correlation Coefficient Squared (R-squared) metrics. In the analysis including only the distance between X and the foot-shaped jigs, the average MAE, RMSE, and R-squared values were 17.9702, 21.7226, and 0.9840, respectively. Notably, expanding the model to include distances in X, Y, and between the foot-shaped jigs resulted in a decrease in MAE to 15.7347, RMSE to 18.8226, and an increase in R-squared to 0.9854. The integrated model, including distances in X, Y, and between the foot-shaped jigs, showed improved predictive capability with lower MAE and RMSE and higher R-squared, indicating its effectiveness in more accurately predicting trampoline dynamics, vital in fitness and rehabilitation fields. [ABSTRACT FROM AUTHOR]

Background: To analyze the factors affecting the loss of correction effect in patients with congenital scoliosis after one stage posterior hemivertebra resection, orthosis, fusion and internal fixation. Methods: Thirty-nine patients with congenital scoliosis (CS) who underwent one-stage posterior hemivertebra resection, orthosis, fusion and internal fixation were retrospectively included in Hebei Children's Hospital General demographic information of patients was collected. Preoperative and postoperative imaging indicators were compared, Including cobb Angle of the main curvature of the spine, segmental Cobb Angle, compensatory cephalic curve, compensatory curve on the caudal side, segmental kyphosis, coronal balance, sagittal balance, thoracic kyphosis, lumbar lordosis, and apical vertebra translation. Correlation analysis is used to evaluate the factors affecting the loss of judgment and correction effect, and the correlation indicators are included in the multi-factor Logistics regression. Results: In terms of radiographic indicators in the coronal plane, compared to preoperative values, significant improvements were observed in postoperative Cobb Angle of main curve (8.00°±4.62° vs. 33.30°±9.86°), Segmental Cobb angle (11.87°±6.55° vs. 31.29°±10.03°), Compensatory cephalic curve (6.22°±6.33° vs. 14.75°±12.50°), Compensatory curve on the caudal side (5.58°±3.43° vs. 12.61°±8.72°), coronal balance (10.95 mm ± 8.65 mm vs. 13.52 mm ± 11.03 mm), and apical vertebra translation (5.96 mm ± 5.07 mm vs. 16.55 mm ± 8.39 mm) (all P < 0.05). In the sagittal plane, significant improvements were observed in Segmental kyposis Angle (7.60°±9.36° vs. 21.89°±14.62°, P < 0.05) as compared to preoperative values. At the last follow-up, Segmental kyphosis Angle (6.09°±9.75° vs. 21.89°±14.62°, P < 0.05), Thoracic kyphosis (26.57°±7.68° vs. 24.06°±10.49°, P < 0.05) and Lumbar lordosis (32.12°±13.15° vs. 27.84°±16.68°, P < 0.05) had statistical significance compared with the preoperative department. The correlation analysis showed that the correction effect of the main curve Cobb angle was correlated with fixed segment length (rs=-0.318, P = 0.048), postoperative segment Cobb angle (rs=-0.600, P < 0.001), preoperative apical vertebra translation (rs = 0.440, P = 0.005), and spinal cord malformation (rs=-0.437, P = 0.005). The correction effect of segmental kyphosis was correlated with age (rs = 0.388, P = 0.037). The results of the multivariate logistic regression analysis revealed that postoperative segmental Cobb angle > 10° (OR = 0.011, 95%CI:0.001–0.234, P = 0.004), associated spinal cord anomalies (OR = 24.369, 95%CI:1.057-561.793, P = 0.046), and preoperative apical translation > 10 mm (OR = 0.012, 95%CI:0.000-0.438, P = 0.016) were influential factors in the progression of the main curve Cobb angle. Conclusion: The one-stage posterior hemivertebra resection and short-segment corrective fusion with internal fixation are effective means to treat congenital scoliosis. However, attention should be paid to the loss of correction and curve progression during follow-up. Patients with spinal cord malformation and a large preoperative apical vertebra translation have a greater risk of losing the correction after surgery. [ABSTRACT FROM AUTHOR]

Background: Although nonsurgical treatment of thumb carpometacarpal (CMC-1) osteoarthritis (OA) provides short-term improvement, the durability of these effects beyond 1 year is unknown. In this study, we investigated patient-reported pain and limitations in activities of daily living (ADL) at >5 years following nonsurgical treatment (i.e., exercise therapy and use of an orthosis) for CMC-1 OA. We hypothesized that pain and limitations in ADL would not worsen after 12 months. Secondary outcomes were satisfaction with treatment results and health-related quality of life at >5 years of follow-up and the rate of conversion to surgery. Methods: This was a multicenter, prospective cohort study using 2 overlapping samples. The change in the Michigan Hand Outcomes Questionnaire (MHQ) subscales of pain and ADL between 12 months and >5 years was the primary outcome as measured in the first sample (n = 170), which consisted of patients who did not undergo conversion to surgery. Additional measurement time points included baseline and 3 months. We evaluated conversion to surgery in a second sample, which included all patients who responded to the invitation for this follow-up study (n = 217). Results: At a median follow-up of 6.6 years (range, 5.1 to 8.7 years), the score on the MHQ pain subscale did not differ significantly from that at 12 months. The score on the MHQ ADL improved by 4.4 points (95% confidence interval [CI],1.5 to 7.2) compared with 12 months, but this was not clinically relevant. At >5 years, 5% of the patients rated their satisfaction as "poor," 14% as "moderate," 26% as "fair," 39% as "good," and 16% as "excellent." The median EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) index score was 0.852 (range, 0.135 to 1). The rate of conversion to surgery was 22% (95% CI,16.4% to 27.7%) at a median follow-up of 7 years (range, 5.5 to 9.0 years). Conclusions: We found positive outcomes at >5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or of limitations in ADL after 12 months. Our findings support nonsurgical treatment as the first treatment choice and suggest that treatment effects are sustainable. Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

The primary objective of the Dual-mode Dynamic Wrist Driven Orthosis (D-WDO) is to facilitate wrist-hand therapy exercises for patients with varying levels of residual muscle function. This dual-mode D-WDO system comprises two main components: the orthosis structure and the soft pneumatic actuator (SPA). All system components were designed and produced using Computer Aided Design (CAD) software and the Fused Deposition Modeling (FDM) 3D printing technique. The D-WDO’s structure is constructed from PLA (Polylactic Acid), while the SPA is made from TPU (Thermoplastic Polyurethane) filament. The D-WDO can be operated in passive or active mode by attaching or detaching the SPA from the structure. This D-WDO system is particularly suitable for patients with a minimum MMT level between 2 and 3, as it provides assistance for wrist movement and supports repetitive wrist motion to enhance wrist muscle function. However, it is important to note that the operation and performance of the dual-mode D-WDO system may vary depending on the chosen system configuration. The active D-WDO’s performance demonstrates its ability to achieve the necessary wrist flexion angle for a functional wrist joint, especially in the context of daily activities. [ABSTRACT FROM AUTHOR]

Around the world, customized ankle-foot-orthosis (AFO) for patients with central nervous system damage are continuously being developed. Existing customized AFOs are manufactured by considering the size of the user's feet and calves using 3D scanning and printing technologies. In this study, we propose a customized AFO that reflects the shape of the user's feet and ankles by setting anatomically based landmarks and trim lines. Design standards are established through landmarks and trim lines, and AFOs are designed. To confirm the safety of the designed AFO, specimens using ABS and PLA were fabricated, and tensile tests were conducted. At this time, each material's density difference was considered to address the economic aspect during subsequent production. The mechanical properties were obtained through the tests and applied to the AFO model through finite element analysis to confirm the behavior of dorsiflexion and plantar flexion. Finally, ABS-AFO and PLA-AFO prototypes were produced, and after production, actual subjects wore them to confirm the difference from the existing. [ABSTRACT FROM AUTHOR]

Background: Foot orthoses and footwear interventions are advocated for the management of lower limb musculoskeletal conditions including the hip, but much of the research is focused on knee disorders. The aim of this systematic review was to synthesise the literature that investigates the use of foot orthoses or footwear in people with hip‐related pain. Methods: MEDLINE, EMBASE, CINAHL, AMED and SPORTDiscus were searched from inception to March 2023. Randomised controlled trials (RCT), cohort and pre‐post studies reporting on footwear and foot orthoses interventions, in participants with hip‐related pain, were eligible for inclusion. Outcomes included pain, physical function, and quality of life (QoL). Effect sizes were calculated where sufficient data were available. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Rob‐2) and the Joanna Briggs Institute Checklist. The overall quality of evidence was rated according to the Grading of Recommendations, Assessment, Development, and Evaluations framework. Results: Of the seven included studies (n = 266 participants), there was one RCT, one cohort and five single‐group pre‐post designs. Interventions included customised and non‐customised arch supports, heel lifts, and footwear modifications, used in the following hip conditions: trochanteric pain, non‐specific hip pain, hip osteoarthritis, and leg length dysfunction following total hip arthroplasty. Meta‐analysis was possible for outcomes in two studies, demonstrating moderate improvement in pain following foot orthoses use. Overall certainty of evidence ranged from very low to low. Conclusion: Single‐group pre‐post study designs describe positive relationships between foot orthoses and footwear use and improvements in hip pain, function, and QoL. However, these results were not supported by the only available RCT. Given this is a relatively inexpensive and non‐invasive treatment approach, further rigorous studies are warranted. [ABSTRACT FROM AUTHOR]

Estimating the contact forces and moments (CFMs) between exoskeletons' feet and the ground is a prerequisite for calculating exoskeletons' joint moments. However, comfortable, portable, and high-precision force sensors for CFM detection are difficult to design and manufacture. In addition, there are many unknown CFM components (six force components and six moment components in the double-support phase). These reasons make it challenging to estimate CFMs precisely. In this paper, we propose a novel method for estimating these CFMs based on a proposed dynamic decoupled coordinate system (DDCS) and the minimum energy hypothesis. By decomposing these CFMs into a DDCS, the number of unknowns can be significantly reduced from twelve to two. Meanwhile, the minimum energy hypothesis provides a relatively reliable target for optimizing the remaining two unknown variables. We verify the accuracy of this method using a public data set about human walking. The validation shows that the proposed method is capable of estimating CFMs. This study provides a practical way to estimate the CFMs under the soles, which contributes to reducing the research and development costs of exoskeletons by avoiding the need for expensive plantar sensors. The sensor-free approach also reduces the dependence on high-precision, portable, and comfortable CFM detection sensors, which are usually difficult to design. [ABSTRACT FROM AUTHOR]

Background: Pes planovalgus, or flexible flatfoot, deformity is a common problem in pediatric orthopedic patients. There is no consensus on using the technique of arthroereisis in the treatment of symptomatic pes planovalgus. The aim of our study was to prospectively assess the functional outcomes following symptomatic pes planovalgus treatment with the use of the Spherus talar screw. Methods: Twenty-seven patients (11 females, 16 males), at a mean age of 10.5 years (7–14 years) were included in the prospective study. We assessed the level of physical activity (including sports) based on the University of California, Los Angeles (UCLA) activity scale, a 10-point level-of-activity VAS scale, and the Grimby physical activity scale. Pain was assessed based on a VAS pain scale; foot function was assessed with the revised Foot Function Index (FFI-R); and ankle joint mobility was measured. Results: The mean follow-up period was 18 months (14–26 months). There was a significant improvement in VAS-measured physical activity scores from 5.47 to 7 at follow-up, p = 0.048. There was a significant improvement in UCLA activity scale scores from 4.78 to 6.05 at follow-up, p = 0.045. Pain levels decreased from a mean VAS score of 4.73 prior to surgery to a mean score of 2.73 at follow-up, p = 0.047. The functional FFI-R scores showed a significant improvement from 140 points prior to surgery to 97.75 points at follow-up, p = 0.017. Comparison of the preoperative and follow-up values of the range of plantar flexion, adduction, and abduction in the operated limb also showed no significant changes in those individual parameters. The mean values of dorsiflexion, plantar flexion, adduction, and abduction at the ankle joint at follow-up, compared individually between the operated and non-operated foot showed no statistically significant differences. Conclusions: The use of a talar screw in the treatment of symptomatic pes planovalgus helps reduce pain and improve functional outcomes after treatment. Foot function assessments showed diminished pain, improved levels of physical and sport activity, and no effect on the range of motion after surgery in comparison with preoperative data. Arthroereisis with a talar screw is a valid surgical technique for the treatment of symptomatic pes planovalgus. [ABSTRACT FROM AUTHOR]

Subjects with Parkinson's Disease (PD) display different motor and non-motor symptoms. Different therapies have been shown to be effective, such as plantar foot stimulation, which has proved to be effective for motor symptoms. Different stimulation methods were proposed and tested through specific devices, or insoles. Our aim was to assess the effect of a newly designed custom-made insole called PRO-STEP compared with a flat sham insole on subjects with PD. Subjects were randomized 1:1 into two arms and were asked to wear PRO-STEP or sham insoles for at least 6 h per day for 10 weeks. Participants were evaluated at four timepoints. Forty-two subjects were randomly assigned to the PRO-STEP (EG) or sham group (SG). The comparison of the EG and SG without and with insoles (T0–T1) did not show significant differences in the TUG time and in the 10MWT gait parameters. At T1, T2, and T3 TUG time, BBS, SF12-MC, and SF12-PC did not show significant differences. The satisfaction level with the PRO-STEP or sham insoles was high in both groups. PD patients were satisfied with PRO-STEP insoles; however, plantar foot stimulation is not effective from a functional perspective. Future studies should consider possible modifications to the proposed stimulation to improve its effectiveness in patients with PD. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the lower extremity loading during activities of daily living (ADLs) using the Continuous Scale of Physical Functional Performance (CS-PFP 10) test and wireless sensor insoles in healthy volunteers. Methods: In this study, 42 participants were recruited, consisting of 21 healthy older adults (mean age 69.6 ± 4.6 years) and 21 younger healthy adults (mean age 23.6 ± 1.8 years). The performance of the subjects during ADLs was assessed using the CS-PFP 10 test, which comprised 10 tasks. The lower extremity loading was measured using wireless sensor insoles (OpenGo, Moticon, Munich, Germany) during the CS-PFP 10 test, which enabled the measurement of ground reaction forces, including the mean and maximum total forces during the stance phase, expressed in units of body weight (BW). Results: The total CS-PFP 10 score was significantly lower in older participants compared to the younger group (mean total score of 57.1 ± 9.0 compared to 78.2 ± 5.4, respectively). No significant differences in the mean total forces were found between older and young participants. The highest maximum total forces were observed during the tasks 'endurance walk' (young: 1.97 ± 0.34 BW, old: 1.70 ± 0.43 BW) and 'climbing stairs' (young: 1.65 ± 0.36 BW, old: 1.52 ± 0.28 BW). Only in the endurance walk, older participants showed a significantly higher maximum total force (p < 0.001). Conclusion: The use of wireless sensor insoles in a laboratory setting can effectively measure the load on the lower extremities during ADLs. These findings could offer valuable insights for developing tailored recommendations for patients with partial weight-bearing restrictions. [ABSTRACT FROM AUTHOR]

Objectives: Idiopathic Congenital Talipes Equino Varus (CTEV), commonly referred to as Clubfoot, is a complex musculoskeletal deformity affecting infants. The Ponseti technique, a gold standard approach, has emerged as an effective treatment. This study aims to evaluate the clinical and sonographic outcomes of percutaneous Achilles tendon tenotomy in children with idiopathic clubfoot who underwent the Ponseti procedure. Methods: A prospective study was conducted at the JIPMER Department of Orthopaedics, involving 41 feet with residual equinus deformity following Ponseti treatment. Infants with idiopathic clubfoot were included. Clinical and sonographic evaluations were performed, percutaneous Achilles tendon tenotomy was performed. Parameters were measured, Data were statistically analyzed using Kolmogorov-Smirnov tests, paired t-tests, ANOVA, and correlation analysis. Results: 29 infants (41 feet), primarily boys (89.7%) were studied. Following percutaneous tenotomy, clinical improvement was observed, with a mean increase in dorsiflexion of 20-25 degrees. Sonographic parameters showed significant improvement in tibio calcaneal distance, talocalcaneal divergence, and metaphyseal-talocalcaneal angle posttenotomy (p<0.05). Positive correlations were found between clinical and sonographic improvements. Conclusion: Clinical improvement of hindfoot deformity following percutaneous Achilles tendon tenotomy in idiopathic clubfeet correlates with the sonological improvement of talo calcaneal, tibio calcaneal angles and tibio calcaneal distance. [ABSTRACT FROM AUTHOR]

Background: The flexible flatfoot is characterized by a flattening of the foot arch due to excessive bodyweight. The use of shoe insoles or taping methods has been identified as effective in realigning the navicular or calcaneus bones and addressing supination in pronated feet. Objects: This study aimed to analyze the difference between the arch taping attachment method, introduced in a previous study, and a novel taping method designed to provide support to the inner aspect of the heel bone in cases of flexible flatfoot. Methods: A navicular drop test was performed to discriminate flexible flatfoot. To analyze the differences in pressure distribution during walking for each taping method, the subjects underwent testing in the barefoot state with no attachments. The procedure included a sequence of arch taping and heel taping. Subsequent analysis of pressure distribution during walking utilized the GaitRite® system (GAITRite Gold, CIR Systems Inc.). Results: Arch taping and calcaneus taping significantly reduced the integrated pressure over time and peak pressure on the medial side of the midfoot for both feet compared to the barefoot state. Conclusion: The findings of this study suggest that supporting the inside of the heel through calcaneus taping, without direct stimulation to the longitudinal arch and navicular bone, is an effective intervention for flexible flatfoot.

Objectives: Among the foot orthoses prescribed to improve postural control in chronic ankle instability, foot orthoses designed to affect both types of mechanical and functional instability have a limited research background. In the present study, a type of foot orthosis named the custom mold with a raised ridge around the perimeter was designed, and manufactured, and its effect on the dynamic posture control of the subjects was investigated. Methods: This study was a quasi-experimental type in which 30 active young people with chronic ankle instability were selected from sports clubs and divided into two groups. One of these groups used custom mold foot orthoses (CFO) and the other group used custom mold with a raised ridge around the perimeter foot orthoses (CRFO). Dynamic postural control of the participants was evaluated before and after one month with the star excursion balance test (SEBT). A repeated measured statistical test was used to evaluate the obtained data. Results: Both types of foot orthoses increased the reaching distance of the SEBT, but the result of CRFO was significant in this field, so that after one month in medial (P=0.045), posteromedial (P=0.002), and anteromedial (P˂0.001) directions, significant differences were observed between the two groups. Discussion: The CRFO can put the subtalar joint in optimal conditions and change the amount of input resulting from the stimulation of the mechanoreceptors in the plantar area of the foot, thus increasing the improvement of dynamic postural control; however, more studies are needed to prove this claim. Coresponding author: Mahmood Bahramizadeh, E-mail: ma.bahramizadeh@uswr.ac.ir You can also search for this author in: PubMed, Google Scholar

Nour Alsaafin,1,2 Nabil Saad,1 Shima A Mohammad Zadeh,1,2 Fatma A Hegazy1,2 1Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; 2Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab EmiratesCorrespondence: Fatma A Hegazy, Department of Physiotherapy, College of Health Sciences, University of Sharjah, University City Rd, University City, Sharjah, United Arab Emirates, Tel +971 50 480 0753, Fax +971 6 505 7502, Email fhegazy@sharjah.ac.aeBackground: Although the inverted technique was shown to be more effective compared to other orthotic designs for the treatment of flatfeet, the biomechanical mechanisms underlying the therapeutic effect of the inverted angle orthoses is still unclear. Therefore, the aim of this study was to examine the effect of different inverted angles of foot orthoses on walking kinematics in females with flexible flatfeet.Methods: Thirty-one female adults with flexible flatfeet aged 18– 35 years old participated in this study. Kinematic data of the hip, knee, and ankle were collected via BTS motion-capture system during walking under three test conditions in random order: with shoes only; with 15° inverted orthoses; and with 25° inverted orthoses.Results: Compared to the shoes only condition, both the 15° and 25° inverted orthotic conditions significantly decreased the maximum ankle plantarflexion angle during loading response, maximum ankle dorsiflexion angle during mid-stance, maximum ankle external rotation angle, and maximum ankle internal rotation angle. The maximum ankle plantarflexion angle at toe-off showed a significant decrease with the 25° inverted angle orthosis compared to both the 15° inverted angle and shoes only conditions. No significant differences were found in the knee kinematic variables, maximum hip extension angle, and maximum hip adduction angle between test conditions.Conclusion: Using inverted orthoses at 15° and 25° inverted angles resulted in significant changes in ankle joint kinematics during walking in female adults with flexible flatfeet. A 25° inverted angle orthosis significantly decreased ankle plantarflexion during push-off, potentially impacting gait mechanics. This suggests that a smaller inverted angle may be more effective for managing flexible flatfeet in female adults.Keywords: flatfoot, foot orthoses, gait analysis, walking

Purpose: To determine the effect of manipulating foot longitudinal arch motion with different-stiffness foot orthoses on running economy (RE) in runners with flat-arched feet and if changes in arch deformation and recoil were associated with changes in RE. Methods: Twenty-three recreational distance runners performed 5-minute submaximal treadmill runs at 12 km·h−1, in the following 3 conditions in a randomized order: (1) footwear only, (2) flexible orthoses (reduced arch thickness), and (3) standard orthoses. The RE (submaximal steady-state oxygen consumption [VO2submax]) and sagittal arch range of motion were compared among conditions using a repeated-measures analysis of variance and effect sizes (Cohen d). Pearson correlation coefficients were used to determine the association between the change in the sagittal arch range of motion and VO2submax. Results: Compared with standard orthoses, the mean VO2submax was significantly lower in both the flexible orthoses (−0.8 mL·kg−1·min−1, P <.001, d = 0.35) and footwear-only conditions (−1.2 mL·kg−1·min−1, P <.001, d = 0.49). The change in VO2submax between the flexible orthoses and footwear-only conditions was significantly positively correlated with the change in sagittal arch range of motion (r =.591, P =.005). Conclusion: Conventional foot orthoses were associated with poorer RE compared with flexible orthoses and footwear alone. Changes in arch deformation were positively correlated to changes in oxygen consumption, indicating that foot orthoses that limit arch deformation and recoil degrade RE. Foot orthoses that facilitate energy storage and release in the foot longitudinal arch may be advisable for athletes prescribed these devices for clinical purposes to maintain optimal running performance. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) affecting the knee or hip is highly prevalent in the general population and has associated high disease burden. Early identification of modifiable risk factors that prevent, limit, or resolve disease symptoms is critical. Foot pain may represent a potentially modifiable factor however little is known about the prevalence of foot pain in people with knee or hip OA nor whether foot pain is associated with clinical characteristics. The main aim of this study was therefore to determine the prevalence of foot pain in people with knee or hip OA attending an education and supervised exercise-based intervention in Denmark (GLA:D®) and determine if baseline demographic or clinical characteristics are associated with foot pain. Methods: Analysis was conducted on baseline data of 26,003 people with symptomatic knee or hip OA completing a pain mannequin as part of the Good Life with osteoArthritis in Denmark (GLA:D®) primary care programme. Odds Ratios (OR) and 95% confidence intervals (CI) were calculated to estimate the strength of association between baseline clinical characteristics (including pain severity in worst knee/hip joint, number of painful knee/hip joints, pain medication use and physical activity level) and the presence of baseline foot pain. Results: Twelve percent of participants (n = 3,049) reported foot pain. In those people with index knee OA (n = 19,391), knee pain severity (OR 1.01 CI 1.00, 1.01), number of painful knee/hip joints (OR 1.67 CI 1.58, 1.79), and use of pain medication (OR 1.23 CI 1.12, 1.36) were statistically associated with foot pain. Excluding use of pain medication, similar associations were seen in those with index hip OA. Conclusion: Twelve percent of people with knee or hip OA participating in GLA:D® had foot pain. Those with worse knee/hip pain, and greater number of painful joints were more likely to report foot pain. This study is the first to demonstrate a significant relationship between clinical characteristics and foot pain in people with knee or hip OA participating in education and supervised exercise. Future investigation should consider the role that foot pain may play on knee and hip related outcomes following therapeutic intervention. [ABSTRACT FROM AUTHOR]

Background: Foot and lower limb health complications are common among patients undergoing dialysis; but a summary of prevention and management evidence is not available. The aim of this scoping review was to summarise study characteristics and the nature of results regarding strategies to prevent and manage peripheral arterial disease (PAD), foot ulceration, amputation, associated infection and associated hospital admission in adults undergoing dialysis. Methods: MEDLINE, Embase, CINAHL and AMED databases were searched for longitudinal experimental and observational studies. Eligible studies included adults undergoing dialysis (≥10 dialysis patients, with separate results or ≥ 75% of the cohort). Any interventions relating to PAD, foot ulceration, amputation, associated infection, and associated hospital admission were included. Results: The review included 212 studies, of which 199 were observational (94%) and 13 were experimental (6%). Sixteen studies (8%) addressed the prevention of foot and lower limb health complications, 43 (20%) addressed management, and 153 (72%) addressed both. The main intervention type in each study was surgery (n = 159, 75%), care from one or more health professionals (n = 13, 6%), screening by a health professional (n = 10, 5%), medication (n = 9, 4%) and rehabilitation (n = 5, 2%). No studies were identified where exercise, offloading or education were the main intervention. Results for PAD were reported in 137 (65%) studies, foot ulceration in 54 (25%), amputation in 171 (81%), infection in 7 (3%), and admission in 26 studies (12%). Results for more than one foot or lower limb outcome were reported in 141 studies (67%), with each study reporting on average two outcomes. Results varied and spanned positive, negative, and neutral outcomes following intervention. Conclusions: Identified studies frequently aimed to both prevent and manage foot and lower limb health complications. A variety of interventions were identified and studies often reported results for more than one foot or lower limb health outcome. Findings from this review can be used to guide future research, with a goal to support improved patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Isolated gastrocnemius tightness (IGT) is a prevalent condition linked to various foot pathologies. In a previous quantitative gait analysis study, we identified an increase in knee flexion during the midstance phase in IGT patients compared with controls. Although stretching and eccentric exercises (the Stanish protocol) are commonly used for IGT management, their impact on gait parameters remains poorly understood. This study aimed to assess the influence of a Stanish protocol on gait parameters in bilateral IGT subjects. Methods: We enrolled 10 asymptomatic bilateral IGT subjects and 10 controls. Quantitative gait analysis and dynamic baropodometry were carried out on each subject. A Stanish protocol was applied for 4 weeks (five sessions/week) by the IGT group, followed by a similar gait analysis. The ankle and knee range of motion and foot pressure distribution were assessed during the midstance phase of the gait. Results: An increase in knee flexion was initially present in the IGT group compared with controls (8.9 +/− 4.6 vs. 3.4 +/− 2.3 degrees, p < 0.001). There was no difference in the ankle range of motion and foot pressures between the groups at that time. Significant reductions in knee flexion during gait were observed in the IGT subjects after the Stanish protocol (8.9 +/− 4.6 to 3.7 +/− 2.3 degrees, p < 0.001) with a normalization of this parameter (3.4 +/− 2.3 in controls vs. 3.7 +/− 2.3 degrees in IGT, p = 0.72). There was no change in ankle range of motion and foot pressure after the Stanish protocol. Conclusions: Our findings support the effectiveness of the Stanish protocol in reducing knee flexion and normalizing gait in IGT subjects. This protocol not only offers a noninvasive approach for IGT-related issues management but could also enable prophylactic care in asymptomatic cases. [ABSTRACT FROM AUTHOR]

Featured Application: This research offers insights into the performance and durability of 3D-printed foot orthoses made from various thermoplastic polyurethane filaments with different shore A hardness levels. The research involved conducting tests on insoles using specialized equipment to simulate cyclic flexion stress in the metatarsophalangeal area, as well as evaluating their performance in real-world conditions. A new filament, varioShore, based on foaming technology, was also investigated for this type of application. This research examines the flexural fatigue response of 3D-printed foot orthoses produced from various thermoplastic polyurethane (TPU) filaments, including Filaflex 60A, Filaflex 70A, Filaflex 82A, PolyFlex 90A, and varioShore. To subject the insoles to repeated flexion in the metatarsophalangeal area, specialized equipment was developed. A real-world testing scenario was applied to the Filaflex 82A insole, demonstrating that it can sustain over 1,400,000 steps over several months of normal walking (a cadence of approximately 120 steps per minute). Consequently, the experimental conditions were adjusted to double this pace to obtain pertinent results within a shorter testing timeframe. The insoles were subjected to 250 cycles per minute at constant clamping pressures of 176 kPa in the forefoot region. The objective of the evaluation was to determine if 700,000 testing cycles, equivalent to more than two and a half months of daily walking, would induce any damages in the internal structure (infill failure) or external condition (delamination, cracks) of the insoles. Except for compression marks, particularly notable on the foamed material (varioShore TPU) within the clamping zones of the testing device, none of the tested insoles exhibited any signs of external damage after 700,000 cycles. Moreover, the deformations observed in the insoles were non-permanent and nearly entirely disappeared within a few days of rest. The only insole that displayed deterioration of the infill structure was a TPU 82A insole that had been previously worn and then left on a shelf for approximately one year in uncontrolled conditions before being tested at repeated flexion on the apparatus. Additionally, a fifteen-minute walking test was carried out to assess the comfort of each insole, and it was found that the varioShore model, which had a 20% infill density and was 3D-printed at a temperature of 220 °C, stood out as the most comfortable among the tested insoles. [ABSTRACT FROM AUTHOR]

We investigated the effects of hindfoot and forefoot eversion on the knee's positional and rotational displacement, plantar pressure, and foot discomfort in a standing posture, beyond the traditional focus on external knee adduction moments (EKAM) in lateral wedge insoles. Twenty-six healthy participants underwent hindfoot eversion from 0 to 10 degrees in 2-degree increments, and forefoot eversion from 0 degrees to the hindfoot eversion angle in 2-degree increments in a standing posture. At each eversion angle, the knee's medial displacement, EKAM's moment arm decrease, plantar pressure changes, and foot discomfort were obtained and compared across varying angles. Both hindfoot-only and entire-foot eversion led to significant medial knee displacement and the EKAM's moment arm decrease, with more pronounced effects in entire-foot eversion. At each hindfoot eversion angle, increasing forefoot eversion resulted in significant medial knee displacement and EKAM's moment arm decrease. Lower leg rotations were not significantly affected in hindfoot-only eversion but displayed significant medial tilting and internal rotation in entire-foot eversion at specific combinations. Varying eversion angles significantly influenced the forefoot pressure, with heel pressure remaining unaffected. Notably, the lateral forefoot pressure increased significantly as the forefoot eversion angle increased, particularly at higher hindfoot eversion angles. Foot discomfort increased significantly with higher eversion angles, particularly in entire-foot eversion, and also increased significantly as the forefoot eversion angle increased at higher hindfoot eversion angles. Insole configurations incorporating 6–10 degrees of hindfoot eversion and 40–60% forefoot eversion of the hindfoot angle may offer optimized biomechanical support for knee osteoarthritis patients. [ABSTRACT FROM AUTHOR]

Purpose: Tibial bone stress injuries are a common overuse injury among runners andmilitary cadets. Current treatment involves wearing an orthopedic walking boot for 3 to 12 wk, which limits ankle motion and leads to lower limb muscle atrophy. A dynamic ankle orthosis (DAO) was designed to provide a distractive force that offloads in-shoe vertical force and retains sagittal anklemotion during walking. It remains unclear how tibial compressive force is altered by the DAO. This study compared tibial compressive force and ankle motion during walking between the DAO and an orthopedic walking boot. Methods: Twenty young adults walked on an instrumented treadmill at 1.0 m·s-1 in two brace conditions: DAO and walking boot. Three-dimensional kinematic, ground reaction forces, and in-shoe vertical force data were collected to calculate peak tibial compressive force. Paired t-tests and Cohen's d effect sizes were used to assess mean differences between conditions. Results: Peak tibial compressive force (P = 0.023; d = 0.5) and Achilles tendon force (P = 0.017; d = 0.5) were moderately lower in the DAO compared with the walking boot. Sagittal ankle excursion was 54.9% greater in the DAO compared with the walking boot (P = 0.05; d = 3.1). Conclusions: The findings fromthis study indicated that the DAOmoderately reduced tibial compressive force and Achilles tendon force and allowedmore sagittal ankle excursion during treadmill walking compared with an orthopedic walking boot. [ABSTRACT FROM AUTHOR]

BACKGROUND: Accurate prediction of recovery is essential to determine whether a knee-ankle-foot orthosis (KAFO) is required in the subacute phase of stroke. However, there are currently no reliable methods to predict such recovery. OBJECTIVE: This study aimed to determine whether muscle strength of the affected lower limb (affected side LL strength) in stroke patients in the subacute phase who cannot walk without a KAFO can be used to predict the continuous need for a KAFO, using a hand-held dynamometer. METHODS: We enrolled patients with severe hemiplegia (n = 51) who were unable to walk without a KAFO for 10 days after stroke onset. They were divided into two groups depending on the continuous need for a KAFO at 1 month after onset; the KAFO and non-KAFO groups. Logistic regression analysis was used to investigate whether the affected side LL strength was a predictor of the continuous need for a KAFO at 1 month after onset. In addition, significant predictors were analyzed using receiver operating characteristic (ROC) curves. RESULTS: The KAFO and non-KAFO groups included 23 (45.10%) and 28 (54.90%) patients, respectively. The affected side LL strength and pusher syndrome severity were identified as predictors of the continuous need for a KAFO. The predictor with the highest predictive ability was the affected side LL strength, with an area under the ROC curve of 0.80 (95% CI, 0.68–0.93). CONCLUSIONS: Affected side LL strength may be a highly accurate predictor of the need for a KAFO in the subacute phase of stroke. [ABSTRACT FROM AUTHOR]

There is some uncertainty regarding how foot orthoses (FO) affect the biomechanics of the lower extremities during running in non-injured individuals. This study aims to describe the behavior of the angular velocity of the foot in the stride cycle measured with a low-sampling-rate IMU device commonly used by podiatrists. Specific objectives were to determine if there are differences in angular velocity between the right and left foot and to determine the effect of foot orthoses (FO) on the 3D angular velocity of the foot during running. The sample was composed of 40 male adults (age: 43.0 ± 13.8 years, weight: 72.0 ± 5.5 kg, and height: 175.5 ± 7.0 cm), who were healthy and without any locomotor system alterations at the time of the test. All subjects use FO on a regular basis. The results show that there are significant differences in the transverse plane between feet, with greater differences in the right foot. Significant differences between FO and non-FO conditions were observed in the frontal and transverse planes on the left foot and in the sagittal and transverse planes on the right foot. FO decreases the velocity of the foot in dorsi-plantar flexion and abduction and increases the velocity in inversion. The kinematic changes in foot velocity occur between 30% and 60% of the complete cycle, and the FO reduces the velocity in abduction and dorsi–plantar flexion and increases the velocity in inversion–eversion, which facilitates the transition to the oscillating leg and with it the displacement of the center of mass. Quantifying possible asymmetries and assessing the effect of foot orthoses may aid in improving running mechanics and preventing injuries in individuals. [ABSTRACT FROM AUTHOR]

Objective: To design appropriate orthosis for hallux valgus, a difficult foot condition that affects a quarter of the body's bones, we need to clarify the numerical biomechanical features, which have not been established in previous biomechanical studies. Therefore, we constructed a finite element model of the bunion foot to investigate the orthopaedic force compensation mechanism. Methods: A patient with moderate hallux valgus was recruited. CT imaging data in DICOM format were extracted for three‐dimensional foot model reconstruction. In conjunction with the need for rapid design of bunion orthosis, a metatarsal force application sizing method based on an orthogonal test design was investigated. The orthogonal test design was used to obtain the hallux valgus angle (HVA) and the inter metatarsal angle (IMA) data for different force combinations. Based on the extreme difference analysis and analysis of variance of the test results, the influence of different force combinations on the bunion angle was quickly determined. Results: The results showed that the stress concentration occurred mainly in the first metatarsal bone. The distribution trend was in the medial and lateral middle of the bone and gradually decreased to the dorsal base of the bone body. The greatest stress occurs in the cartilage between the phalanges and metatarsals. In 25 groups of simulation experiments, HVA was reduced from 27.7° to 13°, and IMA was reduced from 12.5° to 7.3°. Conclusion: Applying detailed orthopaedic force collocation to the first metatarsal column can effectively restore the mechanics and kinematics of hallux valgus, and provide a reference for the treatment of bunion valgus and the design of orthopaedic devices. [ABSTRACT FROM AUTHOR]