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Background: There is a paucity of evidence regarding the design of children's footwear in relation to musculoskeletal structure., Objectives: The aim was to gain consensus regarding where flexibility and support should be given on a school shoe for the 6- to 10-year-olds., Study Design: Delphi Questionnaire., Methods: Recruitment of 10 Allied Health Professionals yielded a consensus group. Those recruited had dedicated experience in paediatrics and foot health. Rounds of questions were delivered to investigate the basis of the opinions made by the group on the location of support and flexibility in a school shoe for the age range identified., Results: Six themes were generated. Four themes gained 100% consensus regarding footwear allowing normal foot movement, footwear allowing normal forefoot function, footwear providing a stable base and the foot being secure in the shoe. Fleiss' kappa calculations revealed 'poor agreement' for the remaining two themes regarding clinical intervention and the purpose of footwear design in the midfoot in both the upper and sole of the shoe., Conclusion: The qualitative data generated through discussion have highlighted areas where more understanding and research are required, particularly in understanding how, in the long term, shoe design can affect the developing foot., Clinical Relevance: Children's footwear advice is often delivered from experience and personal belief. This article questions current understanding and opinion from clinical experts in the field of paediatric footwear and highlights that there is a lack of knowledge and confidence into the effects of children's footwear. There is a strong requirement for further empirical research to be completed on children's footwear to allow clinicians to formulate relevant and appropriate footwear advice., (© The International Society for Prosthetics and Orthotics 2014.)

Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. While AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Interventions for the prevention of AIS progression include scoliosis-specific exercises, bracing, and surgery. The main aims of all types of interventions are to correct the deformity and prevent further deterioration of the curve and to restore trunk asymmetry and balance, while minimising morbidity and pain, allowing return to full function. Surgery is normally recommended for curvatures exceeding 40 to 50 degrees to stop curvature progression with a view to achieving better truncal balance and cosmesis. Short-term results of the surgical treatment of people with AIS demonstrate the ability of surgery to improve various outcome measures. However there is a clear paucity of information on long-term follow-up of surgical treatment of people with AIS., Objectives: To examine the impact of surgical versus non-surgical interventions in people with AIS who have severe curves of over 45 degrees, with a focus on trunk balance, progression of scoliosis, cosmetic issues, quality of life, disability, psychological issues, back pain, and adverse effects, at both the short term (a few months) and the long term (over 20 years)., Search Methods: We searched the Cochrane Back Review Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, four other databases, and three trials registers up to August 2014 with no language limitations. We also checked the reference lists of relevant articles and conducted an extensive handsearch of the grey literature., Selection Criteria: We searched for randomised controlled trials (RCTs) and prospective controlled trials comparing spinal fusion surgery with non-surgical interventions in people with AIS with a Cobb angle greater than 45 degrees. We were interested in all types of instrumented surgical interventions with fusion that aimed to provide curve correction and spine stabilisation., Data Collection and Analysis: We found no RCTs or prospective controlled trials that met our inclusion criteria., Main Results: We did not identify any evidence comparing surgical to non-surgical interventions for AIS with severe curves of over 45 degrees., Authors' Conclusions: We cannot draw any conclusions.

Background: Ankle foot orthoses are used to treat a wide variety of gait pathologies. Ankle foot orthosis-footwear combination tuning should be routine clinical practice when prescribing an ankle foot orthosis. Current research suggests that failure to tune ankle foot orthosis-footwear combinations can lead to immediate detrimental effect on function, and in the longer term, it may actually contribute to deterioration., Objectives: The purpose of this preliminary study was to identify the current level of knowledge clinicians have in the United Kingdom regarding ankle foot orthosis-footwear combination tuning and to investigate common clinical practice regarding ankle foot orthosis-footwear combination tuning among UK orthotists., Study Design: Cross-sectional survey., Methods: A prospective study employing a multi-item questionnaire was sent out to registered orthotists and uploaded on to the official website of British Association of Prosthetists and Orthotists to be accessed by their members., Results: A total of 41 completed questionnaires were received. The results demonstrate that only 50% of participants use ankle foot orthosis-footwear combination tuning as standard clinical practice. The most prevalent factors preventing participants from carrying out ankle foot orthosis-footwear combination tuning are a lack of access to three-dimensional gait analysis equipment (37%) and a lack of time available in their clinics (27%)., Clinical Relevance: Although, ankle foot orthosis-footwear combination tuning has been identified as an essential aspect of the prescription of ankle foot orthoses, the results of this study show a lack of understanding of the key principles behind ankle foot orthosis-footwear combination tuning., (© The International Society for Prosthetics and Orthotics 2014.)

Aim: The aim of this study was to evaluate the differences in ankle muscle strength using hand-held dynamometry and to assess difference in the isometric muscle force distribution between the people with diabetes and control participants., Methods: The maximal muscle strength of ankle plantarflexion, dorsiflexion, eversion, inversion, lesser toes flexors and extensors, hallux flexors, and extensors was assessed in 20 people with diabetes and 20 healthy participants using hand-held dynamometry. The maximal isometric ankle plantarflexion and dorsiflexion were imported to OpenSim software to calculate 12 individual muscle (8 plantarflexors and 4 dorsiflexors) forces acting on ankle joint., Results: A significant reduction in ankle strength for all measured actions and a significant decrease in muscle force for each of the 12 muscles during dorsi and plantar flexion were observed. Furthermore, the ratios of agonist to antagonist muscle force for 6 of the muscles were significantly different between the control group and the group with diabetes., Conclusions: It is likely that the muscles for which the agonist/antagonist muscle force ratio was significantly different for the healthy people and the people with diabetes could be more affected by diabetes., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives. To collect normative baseline data and identify any significant differences between hand and foot thermographic distribution patterns in a healthy adult population. Design. A single-centre, randomized, prospective study. Methods. Thermographic data was acquired using a FLIR camera for the data acquisition of both plantar and dorsal aspects of the feet, volar aspects of the hands, and anterior aspects of the lower limbs under controlled climate conditions. Results. There is general symmetry in skin temperature between the same regions in contralateral limbs, in terms of both magnitude and pattern. There was also minimal intersubject temperature variation with a consistent temperature pattern in toes and fingers. The thumb is the warmest digit with the temperature falling gradually between the 2nd and the 5th fingers. The big toe and the 5th toe are the warmest digits with the 2nd to the 4th toes being cooler. Conclusion. Measurement of skin temperature of the limbs using a thermal camera is feasible and reproducible. Temperature patterns in fingers and toes are consistent with similar temperatures in contralateral limbs in healthy subjects. This study provides the basis for further research to assess the clinical usefulness of thermography in the diagnosis of vascular insufficiency.

This study assessed the basic fundamental movements of mixed martial arts (MMA) athletes using the functional movement screen (FMS) assessment and determined if an intervention program was successful at improving results. Participants were placed into 1 of the 2 groups: intervention and control groups. The intervention group was required to complete a corrective exercise program 4 times per week, and all participants were asked to continue their usual MMA training routine. A mid-intervention FMS test was included to examine if successful results were noticed sooner than the 8-week period. Results highlighted differences in FMS test scores between the control group and intervention group (p = 0.006). Post hoc testing revealed a significant increase in the FMS score of the intervention group between weeks 0 and 8 (p = 0.00) and weeks 0 and 4 (p = 0.00) and no significant increase between weeks 4 and 8 (p = 1.00). A χ analysis revealed that the intervention group participants were more likely to have an FMS score >14 than participants in the control group at week 4 (χ = 7.29, p < 0.01) and week 8 (χ = 5.2, p ≤ 0.05). Finally, a greater number of participants in the intervention group were free from asymmetry at week 4 and week 8 compared with the initial test period. The results of the study suggested that a 4-week intervention program was sufficient at improving FMS scores. Most if not all, the movements covered on the FMS relate to many aspects of MMA training. The knowledge that the FMS can identify movement dysfunctions and, furthermore, the fact that the issues can be improved through a standardized intervention program could be advantageous to MMA coaches, thus, providing the opportunity to adapt and implement new additions to training programs.

Background: Uncomfortable shoes have been attributed to poor fit and the cause of foot pathologies. Assessing and evaluating comfort and fit have proven challenging due to the subjective nature. The aim of this paper is to investigate the relationship between footwear characteristics and perceived comfort., Methods: Twenty-seven females assessed three different styles of ballet pump shoe for comfort using a comfort scale whilst walking along a 20 m walkway. The physical characteristics of the shoes and the progression of centre of pressure during walking were assessed., Results: There were significant physical differences between each style, square shoe being the shortest, widest and stiffest and round shoe having the least volume at the toe box. Centre of pressure progression angle was centralised to the longitudinal axis of the foot when wearing each of the three shoes compared to barefoot. Length, width and cantilever bending stiffness had no impact on perceived comfort., Conclusion: Wearing snug fitting flexible soled round ballet flat pump is perceived to be the most comfortable of the shoe shapes tested producing a faster more efficient gait. Further investigations are required to assess impact/fit and upper material on perceived comfort to aid consumers with painful feet in purchasing shoes., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The purpose of this study is to demonstrate a new MRI compatible loading device capable of reconstructing realistic loading scenarios of the human foot for research in the field of foot biomechanics. This device has two different configurations: one used to compress the forefoot and one to bend the metatarsophalangeal joints. Required plantar pressure distribution under the metatarsal heads can be achieved by modifying the distribution of the dorsally applied forces. To validate the device, subject-specific plantar pressures were measured and then reconstructed using the device. For quiet stance the peak pressure reconstruction error was 3% while for mid-stance phase of gait it was 8%. The device was also used to measure the passive bending stiffness of the metatarsophalangeal joints of one subject with low intra-subject variability. A series of preliminary MRI scans confirmed that the loading device can be used to produce static weight-bearing images of the foot (voxel size: 0.23 mm × 0.23 mm × 1.00 mm). The results indicate that the device presented here can accurately reconstruct subject specific plantar pressure distributions and measure the foot's metatarsophalangeal passive stiffness. Possible future applications include the validation of finite element models, the investigation of the relationship between plantar pressure and internal stresses/strains and the study of the foot's inter-segmental passive stiffness., (Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.)

Aim: The present study aims at investigating the correlation between the mechanical properties of the heel-pad of people with type-2 diabetes and the clinical parameters used to monitor their health and ulceration risk., Methods: A new device for the in-vivo testing of plantar soft tissues was built and pilot-tested. This device consists of an ultrasound probe connected in series with a dynamometer. Loading is applied manually using a ball-screw actuator. A total of 35 volunteers with type-2 diabetes were recruited and the thickness, stiffness of their heel-pads as well as the energy absorbed during loading were assessed. The participants with diabetes also underwent blood tests and measurements of Ankle Brachial Index and Vibration Perception Threshold., Results: Pearson correlation analysis revealed strong correlations between triglycerides and heel-pad stiffness (r=0.675, N=27, p<0.001) and between triglycerides and energy (r=-0.598, N=27, p=0.002). A correlation of medium strength was found between Fasting Blood Sugar (FBS) and stiffness (r=0.408, N=29, p=0.043)., Conclusions: People with type-2 diabetes and high levels of triglycerides and FBS are more likely to have stiffer heel-pads. Increased stiffness could limit the tissues' ability to evenly distribute loads making them more vulnerable to trauma and ulceration., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Functional hallux limitus (FHL) is diagnosed with a static test known as the Hubscher Manoeuvre, the validity of which has been previously questioned., Objectives: To investigate the validity of this Manoeuvre and whether introducing severity of pronation as a second concurrent test would increase this validity., Method: 30 participants with a hallux dorsiflexion <12° were divided into 2 equal groups, depending on their severity of pronation according to the Foot Posture Index. A single video camera, placed perpendicular to the plane of motion of the 1st MPJ, captured its movement, from which the angle of maximum dorsiflexion of this joint was measured., Results: 10 males and 20 females, aged 18-56 years (mean 28 yrs, SD ± 12.1 yrs) participated. There was no significant relationship between non-weight bearing and dynamic maximum dorsiflexion (p=0.160), and between weight bearing and dynamic maximum dorsiflexion (p=0.865). A significant relationship between 1st MPJ dynamic maximum dorsiflexion and severity of pronation (p=0.004) was found., Conclusions: None of the participants exhibited a complete lack of hallux dorsiflexion. A positive Hubscher Manoeuvre test, on its own, is not a good indicator of limited 1st MPJ dorsiflexion during dynamic motion. However, as pronation increases, 1st MPJ maximum dorsiflexion during gait decreases., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The complexity of human gait patterns has become a topic of major interest in motor control and biomechanics. Range of motion is still the preferred method to quantify movement impairment, however, within these traditional linear measures, the inter-segmental coordination and movement variability is normally ignored. A dynamical systems approach using vector coding and circular statistics provides non-linear techniques to quantify coordination and variability. This study provides comprehensive vector coding and circular statistics calculations. Additionally, pelvis-lumbar coordination and coordination variability data obtained from ten healthy young male participants during five walking trials using an optoelectronic system is provided. This novel data can form the baseline information for future studies in this area of research. Finally, a new illustration to present coordination and coordination variability information of gait kinematics, combining the output from the modified vector coding technique with traditional time-series segmental angle data is presented. This technique, when applied to single patients can be beneficial to assess the effect of an intervention on the patient-specific inter-segmental coordination pattern with implications to the clinical setting., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Aim: To conduct a systematic review which examined the effectiveness of footwear and other removable off-loading devices as interventions for the treatment of diabetic foot ulcers or the alteration of biomechanical factors associated with ulcer healing and to discuss the quality and interpret the findings of research to date., Methods: The CINAHL, Medline and Cochrane Register of Controlled Trials databases were searched with seventeen articles identified for review., Results: Majority of the identified studies were randomised control trials which compared the ulcer healing rates of different footwear and other removable off-loading device interventions. Three categories of interventions were identified; 1) removable cast walkers (RCWs), 2) half or heel relief shoes and 3) therapeutic shoes. Most studies compared at least one intervention to a total contact cast (TCC). Factors which influenced study findings such as TCC application method, compliance, activity levels, and the footwear worn on the contralateral limb are discussed with recommendations provided for future studies., Conclusion: Due to the lack of randomised controlled studies conducted in this area it is not currently possible to make strong conclusions on the interventions effectiveness. However, it appears the currently available therapeutic shoes were the least effective intervention followed by half or heel relief shoes. RCWs were found to be the most effective of the removable devices.

Background: In rheumatoid arthritis (RA) forefoot pathology is often related to increased peak plantar pressures under the metatarsal heads., Objectives: This study sought to assess peak plantar pressures in newly diagnosed RA patients compared to non-rheumatic subjects., Method: Plantar pressure in a group of 10 pain free RA patients diagnosed within two years before the starting date of the study and 10 healthy volunteers matched for gender, age and weight were assessed. Each group consisted of seven females and three males aged between 30 and 55 years., Results: The results showed no significant difference (ρ=0.420) at the hallux, however there was a statistical difference in all the other regions (ρ=0.000 and p=0.011 for 1st MPJ and 2nd-4th MPJ respectively and p=0.007 for 5th MPJ). The RA group had higher pressure underneath the 1st and 2nd-4th MPJ regions and lower pressures underneath the 5th MPJ., Conclusion: Although it is for a small group of patients, the results from this pilot study show that even at an early stage of RA, forefoot pressures are shifted toward the medial MPJs., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Aim: The aim of this study was to compare ankle brachial indices (APBI) with pedal waveforms utilizing the continuous wave Doppler in a population with diabetes mellitus., Methods: A prospective study design was employed to investigate the ABPI in a cohort of 49 people with type 2 diabetes mellitus. ABPI assessment was completed using a portable handheld Doppler and ankle pressures of <0.9 were taken as suggestive of peripheral arterial disease (PAD). Arterial spectral waveforms in each foot were also recorded and compared to the ABPI readings., Results: Inconsistencies were identified between ABPIs and waveform interpretations in the study population. Approximately 35% of subjects had inconsistencies between their ABPI result and waveform interpretation in their right or left foot., Conclusions: Both ABPIs and Doppler waveforms should be used in the assessment of people with diabetes in order to screen for PAD. This would ensure an accurate assessment of PAD and would allow initiation of appropriate secondary risk factor control measures., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Modern footwear has been associated with the development of foot pain and pathology in the ageing adult. Yet this foot health issue does not seem to alter the footwear purchases made by younger women. In total, 162 teenage girls were questioned regarding shoes purchased over a 6-month period. The results indicated that footwear choices are activity specific and participants chose the style and design of shoes related to the image they wanted to portray. Association of footwear choice to foot function and health was not found to influence choice of footwear.

Background: Although assessment of passive maximum foot dorsiflexion angle is performed routinely, there is a paucity of information regarding adolescents' foot and foot segment motion during this procedure. There are currently no trials investigating the kinematics of the adolescent foot during passive foot dorsiflexion., Methods: A six-camera optoelectronic motion capture system was used to collect kinematic data using the Oxford Foot Model. Eight female amateur gymnasts 11 to 16 years old (mean age, 13.2 years; mean height, 1.5 m) participated in the study. A dorsiflexing force was applied to the forefoot until reaching maximum resistance with the foot placed in the neutral, pronated, and supinated positions in random order. The maximum foot dorsiflexion angle and the range of movement of the forefoot to hindfoot, tibia to forefoot, and tibia to hindfoot angles were computed., Results: Mean ± SD maximum foot dorsiflexion angles were 36.3° ± 7.2° for pronated, 36.9° ± 4.0° for neutral, and 33.0° ± 4.9° for supinated postures. One-way repeated-measures analysis of variance results were nonsignificant among the 3 groups (P = .70), as were the forefoot to tibia angle and hindfoot to tibia angle variations (P = .091 and P = .188, respectively). Forefoot to hindfoot angle increased with the application of force, indicating that in adolescents, the forefoot does not lock at any particular posture as portrayed by the traditional Rootian paradigm., Conclusions: Participants had very flexible foot dorsiflexion, unlike those in another study assessing adolescent athletes. This finding, together with nonsignificant statistical results, implies that foot dorsiflexion measurement may be performed at any foot posture without notably affecting results.

Background: Unstable shoes, which have recently become popular, claim to provide additional physiological and biomechanical advantages to people who wear them. Alterations in postural stability have been shown when using the shoe after training. However, the immediate effect on muscle activity when walking in unstable shoes for the first time has not been investigated., Objective: To evaluate muscle activity and temporal parameters of gait when wearing Masai Barefoot Technology shoes(®) for the first time compared to the subject's own regular trainer shoes., Study Design: A pilot repeated-measures quasi control trial., Method: Electromyographic measurements of lower leg muscles (soleus, medial gastrocnemius, lateral gastrocnemius, tibialis anterior, peroneus longus, rectus femoris, biceps femoris and gluteus medius) were measured in 15 healthy participants using Masai Barefoot Technology shoes and trainer shoes over a 10-m walkway. Muscle activity of the third and sixth steps was used to study the difference in behaviour of the muscles under the two shoe conditions. Temporal parameters were captured with footswitches to highlight heel strike, heel lift and toe off. Paired samples t-test was completed to compare mean muscle activity for Masai Barefoot Technology and trainer shoes., Results: Indicated that the use of Masai Barefoot Technology shoes increased the intensity of the magnitude of muscle activity. While this increase in the activity was not significant across the subjects, there were inter-individual differences in muscle activity. This variance between the participants demonstrates that some subjects do alter muscle behaviour while wearing such shoes., Conclusion: A more rigorous and specific assessment is required when advising patients to purchase the Masai Barefoot Technology shoe. Not all subjects respond positively to using unstable shoes, and the point in time when muscle behaviour can change is variable., Clinical Relevance: Use of Masai Barefoot Technology shoe in patient management should be monitored closely as the individual muscle changes and the point in time when changes occur vary between subjects, and evaluation of how a subject responds is not yet clear.

Background: The assessment of the maximum ankle dorsiflexion angle is an important clinical examination procedure. Evidence shows that the traditional goniometer is highly unreliable, and various designs of goniometers to measure the maximum ankle dorsiflexion angle rely on the application of a known force to obtain reliable results. Hence, an innovative ankle dorsiflexion measurement device was designed to make this measurement more reliable by holding the foot in a selected posture without the application of a known moment., Objectives: To report on the comprehensive validity and reliability testing carried out on the new device., Methods: Following validity testing, four different trials to test reliability of the ankle dorsiflexion measurement device were performed. These trials included inter-rater and intra-rater testings with a controlled moment, intra-rater reliability testing with knees flexed and extended without a controlled moment, intra-rater testing with a patient population, and inter-rater reliability testing between four raters of varying experience without controlling moment. All raters were blinded., Study Design: A series of trials to test intra-rater and inter-rater reliabilities., Results: Intra-rater reliability intraclass correlation coefficient was 0.98 and inter-rater reliability intraclass correlation coefficient (2,1) was 0.953 with a controlled moment. With uncontrolled moment, very high reliability for intra-tester was also achieved (intraclass correlation coefficient = 0.94 with knees extended and intraclass correlation coefficient = 0.95 with knees flexed). For the trial investigating test-retest reliability with actual patients, intraclass correlation coefficient of 0.99 was obtained. In the trial investigating four different raters with uncontrolled moment, intraclass correlation coefficient of 0.91 was achieved., Conclusions: The new ankle dorsiflexion measurement device is a valid and reliable device for measuring ankle dorsiflexion in both healthy subjects and patients, with both controlled and uncontrolled moments, even by multiple raters of varying experience when the foot is dorsiflexed to its end of range of motion., Clinical Relevance: An ankle dorsiflexion measuring device has been designed to increase the reliability of ankle dorsiflexion measurement and replace the traditional goniometer. While the majority of similar devices rely on application of a known moment to perform this measurement, it has been shown that this is not required with the new ankle dorsiflexion measurement device and, rather, foot posture should be taken into consideration as this affects the maximum ankle dorsiflexion angle.

The mechanical properties of the interface between the human body and the ground play an important role in attenuating the foot strike impact during locomotion. Understanding the properties of such an impact-attenuating system and the mathematical models governing its behavior has major implications in determining the load on the musculoskeletal system during locomotion. This interface consists of the plantar soft tissue and the sole complex of the shoe that together act like a sophisticated suspension system with generic viscoelastic properties. The interface has generally been modeled as a system of spring and damper, in which the reaction force deformation is expressed by a mathematical equation that represents the reaction force as a nonlinear function of the deformation and deformation rate of the interface. This overview intends to provide an insight into the different mathematical models that have been used to describe such relationship and into further understanding the role of the reaction model parameters in determining the behavior of the interface under compression. Various models included within this review ranged from the models representing the plantar soft tissue behavior during barefoot walking to those that consider the sole complex force-deformation behavior during shod foot running. The barefoot models are categorized under in vitro/in situ and in vivo, whereas the models representing the sole complex behavior are investigated before discussing the shod foot models. The mathematical models varied from those in which the reaction force was a nonlinear function of interface deformation to those that considered the deformation rate of the interface as a contributing factor to the interface reaction force. Ultimately, the implication of the reaction models in determining the load on the musculoskeletal system is discussed.

Background: Ill-fitting footwear can be detrimental to foot health with the forefoot being an area for most discomfort. Studies on footwear have primarily examined sports or orthopaedic prescription shoes and little is known about the effects that everyday flat shoes have on the forefoot. The aim of this study was to investigate the effect of toe box shape in a popular slip-on pump on dorsal and plantar pressures with particular interest around the forefoot in a healthy female population., Method: A convenience sample of 27 female participants with no known foot pathologies was recruited. After assessment of foot size, plantar foot pressure and interdigital pressures were recorded for each of the 3 different toe box styles; round, square and pointed. Participants walked at a self-selected speed over a 10 m walkway whilst wearing each of the 3 styles of shoe and also whilst barefoot. Processed and analysed data extracted included peak pressure, time to peak pressure, contact time and pressure time integral. ANOVA and Freidman analysis was used to test for statistical significance., Results: Shoes with a round toe showed least pressure around the medial aspect of the toes whilst the pointed shoe had least pressure on the lateral toes. Contact times for the plantar regions were not altered in any shoe condition yet contact around the medial aspect of the toes was highest in the pointed shoe., Conclusion: This study highlights that the shape of the toe box in footwear can significantly influence the amount of pressure applied to the forefoot. Furthermore, the contours of the shoe also have an impact on the contact time and pressure time integral around the forefoot and also the peak plantar pressure in the toe region. The changes observed could be significant in the development of pathology in certain footwear toe box shapes. Consideration should be given to footwear design around the toe box to improve fit and reduce pressure. Further work is required to investigate the effect of toe box shape and volume on a pathological population with pressure related lesions.

Aim: Footwear interventions are used within clinical practice in an effort to reduce ulcerations however the effectiveness of these interventions is unclear. The aim of this paper was to conduct a systematic review which examined the effectiveness of footwear as an intervention for prevention of diabetic foot ulcers or the reduction of biomechanical risk factors for ulceration and to discuss the quality and interpret the findings of research to date., Methods: The CINAHL, Medline and Cochrane Register of Controlled Trials databases were searched with 12 articles identified for review., Results: The majority of these studies were cross sectional and examined the effect of different footwear conditions on plantar pressure measurements. Factors which influenced study findings such as participant selection, measurement and analysis techniques, footwear design and compliance are discussed and recommendations for future studies are provided., Conclusions: No research to date has examined the effectiveness of footwear in preventing ulceration. Conflicting findings are reported on the effective of footwear interventions to prevent reulceration. While the use of rocker sole footwear and custom orthoses in plantar pressure reduction are supported in cross sectional studies, longitudinal studies are required to confirm their benefit., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Study Design: Systematic review of interventions., Objective: To evaluate the efficacy of scoliosis-specific exercise (SSE) in adolescent patients with adolescent idiopathic scoliosis (AIS)., Summary of Background Data: AIS is a 3-dimensional deformity of the spine. Although AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. The use of SSEs to reduce progression of AIS and postpone or avoid other more invasive treatments is controversial., Search Methods: The following databases (up to March 30, 2011) were searched with no language limitations: CENTRAL (The Cochrane Library 2011, issue 2), MEDLINE (from January 1966), EMBASE (from January 1980), CINHAL (from January 1982), SPORTDiscus (from January 1975), PsycINFO (from January 1887), and PEDro (from January 1929). We screened reference lists of articles and conducted an extensive hand search of gray literature., Selection Criteria: randomized controlled trials and prospective cohort studies with a control group comparing exercises with no treatment, other treatment, surgery, and different types of exercises., Data Collection and Analysis: Two review authors independently selected studies, assessed risk of bias and extracted data., Results: Two studies (154 participants) were included. There is low-quality evidence from 1 randomized controlled study that exercises as an adjunctive to other conservative treatments to increase the efficacy of these treatments (thoracic curve reduced: mean difference 9.00, [95% confidence interval, 5.47-12.53]; lumbar curve reduced: mean difference 8.00, [95% confidence interval, 5.08-10.92]). There is very low-quality evidence from a prospective controlled cohort study that SSEs structured within an exercise program can reduce brace prescription (risk ratio, 0.24; [95% confidence interval, 0.06-1.04]) as compared with "usual physiotherapy" [many different kinds of general exercises according to the preferences of the single therapists within different facilities])., Conclusion: There is a lack of high-quality evidence to recommend the use of SSE for AIS. One very low-quality study suggested that these exercises may be more effective than electrostimulation, traction, and postural training to avoid scoliosis progression, but better quality research needs to be conducted before the use of SSE can be recommended in clinical practice., Level of Evidence: 2.

Background: There are a wide variety of ankle foot orthoses used in clinical practice which are characterised by their design, the material used and the stiffness of that material. Changing any of these three components will alter the effect of the ankle foot orthosis on gait., Objectives: The purpose of this article is to provide an overview on the available research on ankle foot orthosis-footwear combination tuning on the gait characteristics of children with cerebral palsy through a structured review., Study Design: Literature review., Methods: A thorough search of previous studies published in English was conducted within all major databases using relevant phrases without any limits for the dates. These searches were then supplemented by tracking all key references from the appropriate articles identified including hand searching of published books where relevant., Results: To date, there are 947 papers in the literature pertaining to the study of ankle foot orthosis. Of these, 153 investigated the use of ankle foot orthosis for children with cerebral palsy. All the studies included in this review were of a within-subjects design and the evidence levels were generally low., Conclusions: The overall results suggested that ankle foot orthosis-footwear combination tuning has the potential to improve the kinematics and kinetics of gait in children with cerebral palsy. However, the review highlights a lack of well-designed and adequately powered studies. Clinical relevance While the research described in this article indicates an improvement in the gait of children with cerebral palsy following tuning of their ankle foot orthosis-footwear combination, there is still a paucity of research with quantitative data on the effects of kinematics and kinetics of ankle foot orthosis-footwear combination tuning, comparing untuned ankle foot orthosis-footwear combinations with tuned ankle foot orthosis-footwear combination. Furthermore, current research does not identify the effect of tuning on energy efficiency.

Aims: The aim of the study was to assess foot morphology and document foot deformities and joint mobility in a cohort of subjects living with type-2 diabetes mellitus in Malta in a Primary Care setting., Methods: A retrospective observational study was conducted on 243 subjects who participated in a local pilot diabetes foot screening project. Assessments included hammer/claw toes, hallux valgus, hallux limitus, prominent metatarsal heads, bony prominences, Charcot deformity, plantar callus, foot type and ankle and hallux mobility. The clinical assessments used during this screening program were based on validated and previously published tools., Results: Upon clinical examination 38% of the sample was found to have developed some form of corns or callosities in their feet. Hallux valgus deformity was present in 49.4% of the sample, whilst 39% of the sample had hammer toes. Prominent metatarsal heads (24%), other bony prominences (44%) and limited joint mobility were also reported. Furthermore, 56% of the sample presented with unsuitable footwear and upon clinical biomechanical examination a further 28% of the sample required prescription orthosis., Conclusions/interpretation: A significant proportion of participants living with type-2 diabetes presented with foot deformities which are known to be predictive of foot ulceration in this high risk population. This research conducted in a primary care setting highlights the importance of increased vigilance coupled with strengthening of existing screening structures and introducing clinical guidelines with regards to biomechanical assessment of the feet in a primary care setting in order to reduce the incidence of diabetes foot complications., (Copyright © 2012 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Midsole force-deformation pattern has important implications in determining the kinematics and kinetics of foot during locomotion. Furthermore, the midsole stiffness and viscosity determine the midsole's force-deformation behaviour. Despite the importance of stiffness and damping components of the midsole reaction, which determines the shoe-specific ground reaction forces during locomotion, there is still a lack of methodology to quantify them separately. The purpose of this study was to develop a method of extracting the shoe-specific midsole stiffness and damping components during uniaxial compression testing. For this purpose, the force-deformation behaviour of the sole was modelled as a system consisting of a nonlinear spring and a nonlinear damper. Based on the fact that the stiffness and damping component of the midsole reaction force acts in favour during loading, and work against each other during unloading, the stiffness and damping components were separated. Utilising a curve-fitting technique, a parametric curve represented by the stiffness and damping components of the midsole reaction force model was fitted to each components of force-deformation data to extract the parameters. Statistical tests indicated that the proposed method is reliable for extracting the midsole reaction model parameters with the stiffness and damping components producing favorable results (R² 0.998 ± 0.000 and 0.984 ± 0.018/root mean squared error of 5.550 ± 0.954 and 3.286 ± 2.504, respectively).

Aims: The main objective of this research was to identify the prevalence of diabetes-related lower-extremity complications in a cohort of Maltese patients living with type 2 diabetes., Methods: A retrospective study was conducted on a cohort of 243 patients living with type 2 diabetes mellitus in two Maltese Health Centre catchment areas. A convenience sampling was adopted to recruit subjects from a local pilot diabetes foot screening program. The clinical assessments used during this screening program were based on validated and previously published tools such as: neuropathy disability score, vibration perception threshold, Semmes-Weinstein monofilaments, vascular status and foot deformities were evaluated., Results: The results from this study demonstrate that risk factors for foot deterioration and ulceration are common in Maltese population living with type 2 diabetes. Whilst, metabolic outcomes such as hypertension and dyslipidaemia were present in most subjects, peripheral vascular disease, peripheral sensory neuropathy and foot deformities were also common. Twenty-six per cent of the sample had to be referred for further vascular assessment following this screening program due to their critical vascular status., Conclusions/interpretation: A significant proportion of Maltese participants living with type 2 diabetes presented with vascular insufficiency, abnormal neural function and deformities in the feet. Metabolic outcomes such as high blood pressure and high levels of cholesterol were also highly prevalent. Strengthening of existing screening structures is imperative in order to reduce the burden of this disease in Malta., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: To determine if there are changes in temporal gait parameters with a focus on pelvis when comparing overground and treadmill ambulation, and to assess the effect of sex., Design: An observational study employing motion analysis techniques to evaluate pelvic movement during gait., Setting: University biomechanics laboratory., Participants: Men (n=8; 22.5±3.0 y) and women (n=6; 23.8±4.1 y)., Interventions: Not applicable., Main Outcome Measures: Cadence, stride time, stance phase percent, and pelvic tilt, obliquity, and rotation parameters throughout the gait cycle were assessed during overground and treadmill walking. Kinematic data were recorded using a passive full body marker based motion analysis system. While an independent sample t test was used to determine if differences in walking speed were evident between sexes, a 2-way, repeated-measures analysis of variance was performed to examine the effect of walking mode and sex on each dependent variable., Results: Significant differences (P<.05) between overground and treadmill walking for the temporal parameters analyzed were evident for both sexes. A lower pelvic obliquity motion for treadmill walking when compared with overground walking was evident for both sexes, and the pelvic rotation movement pattern showed the greatest difference between walking modes. The majority of the significant differences between sexes were of a magnitude greater than the differences between overground and treadmill walking., Conclusions: The differences in temporal and angular kinematics identified in the present study should be considered when treadmills are used in a rehabilitation program., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Arthritic toe pathologies frequently lead to the development of painful apical pressure skin lesions that can compromise gait and affect quality of life. Historically conservative treatments involve the use of a toe prop with the intended aim of reducing plantar pressure from the apex of the digit. However, the effect of toe prop treatment on plantar digital pressure has not been investigated., Method: Twenty two subjects were recruited with lesser digital deformities and associated apical skin lesions. Individual pressure sensors were placed on the apices of the lesser toes and pressure was recorded under three toe prop conditions (leather, gel and silicone mould). A modified comfort index was utilised to assess the comfort of each condition., Results: Significant difference (p < 0.05) in mean peak pressure was observed at the apex of the 2nd toe when using the gel (p < 0.001) and silicone (p < 0.001) toe prop compared to no toe prop. There was also a significant difference in the mean pressure time integral at the apex of the 2nd toe when using gel (p < 0.001) and silicone (p < 0.004) toe props. There was no significant correlation between comfort and the recorded peak pressures. However, there was an indication that the silicone toe prop was more comfortable., Conclusion: As compared to the leather and silicone mould toe props, gel toe props were found to be the most effective for reducing peak pressure and pressure time integral on the apex of the second digit in patients with claw or hammer toe deformity.

Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine . While AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. The use of scoliosis-specific exercises (SSE) to reduce progression of AIS and postpone or avoid other more invasive treatments is controversial., Objectives: To evaluate the efficacy of SSE in adolescent patients with AIS., Search Methods: The following databases (up to 30 March 2011) were searched with no language limitations: CENTRAL (The Cochrane Library 2011, issue 2), MEDLINE (from January 1966), EMBASE (from January 1980), CINHAL (from January 1982), SportDiscus (from January 1975), PsycInfo (from January 1887), PEDro (from January 1929). We screened reference lists of articles and also conducted an extensive handsearch of grey literature., Selection Criteria: Randomised controlled trials and prospective cohort studies with a control group comparing exercises with no treatment, other treatment, surgery, and different types of exercises., Data Collection and Analysis: Two review authors independently selected studies, assessed risk of bias and extracted data., Main Results: Two studies (154 participants) were included. There is low quality evidence from one randomised controlled study that exercises as an adjunctive to other conservative treatments increase the efficacy of these treatments (thoracic curve reduced: mean difference (MD) 9.00, (95% confidence interval (CI) 5.47 to 12.53); lumbar curve reduced:MD 8.00, (95% CI 5.08 to 10.92)). There is very low quality evidence from a prospective controlled cohort study that scoliosis-specific exercises structured within an exercise programme can reduce brace prescription (risk ratio (RR) 0.24, (95% CI 0.06 to1.04) as compared to usual physiotherapy (many different kinds of general exercises according to the preferences of the single therapists within different facilities)., Authors' Conclusions: There is a lack of high quality evidence to recommend the use of SSE for AIS. One very low quality study suggested that these exercises may be more effective than electrostimulation, traction and postural training to avoid scoliosis progression, but better quality research needs to be conducted before the use of SSE can be recommended in clinical practice.

The Achilles tendon has been shown to be comprised of segmental components of tendon arising from the tricpes surae muscle group. Motion of the foot joints in low and high arched feet may induce a change in behaviour of the triceps surae muscle group due to altered strain on the tendon. Surface electromyogram of the medial and lateral gastrocnemius and the soleus muscle from 12 subjects (with 6 low arched and 6 high arched feet) (1:1) was recorded whilst walking at a self selected speed along a 10m walkway. The results showed a high variability in muscle activity between groups with patterns emerging within groups. Soleus was more active in 50% of the low arch feet at forefoot loading and there was a crescendo of activity towards heel lift in 58% of all subjects. This observed variability between groups and foot types emphasises the need for further work on individual anatomical variation and foot function to help in the understanding and management of Achilles tendon pathologies and triceps surae dysfunction., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Plantar pressure assessment is routinely used in a clinical setting for diagnosing foot problems and prescribing orthoses or footwear. Despite this, the measurement procedures and protocols that might have an effect on the results are not standardised., Objective: The purpose of this study was to evaluate, if variations in the data collection protocol such as the use of a walkway and stepping preference influence the measured plantar pressure parameters., Method: 21 participants who were recruited from a convenience sample and consented to participate were tested under a number of different conditions through which the effect of these variations was tested. A paired T-test was used to determine whether a significant difference in the data corresponding to each subject for different testing conditions existed., Results: Although there were significant differences between the plantar pressure measurement with the choice of the foot, there were no significant difference in the majority of plantar pressure parameters whilst using or not using the walkway., Conclusion: The results suggest that in a clinical and research setting extrinsic factors such as stepping preference needs to be considered to eliminate the effect of variability in plantar pressure data., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Trials investigating ankle joint measurement normally apply a known moment. Maximum ankle angle is affected by foot posture and stretching characteristics of the calf muscles., Objectives: To investigate whether consistent maximum ankle angles could be achieved without applying a constant moment to all subjects, and whether short, repetitive stretching of the calf muscle tendon unit would produce a difference in the maximum ankle angle., Method: Passive dorsiflexion in 14 healthy participants was captured using an optoelectronic motion analysis system, with the foot placed in 3 postures., Results: The maximum ankle angles for both the neutral and supinated positions did not differ significantly. In general, the majority of subjects (92.8%) showed no increase in the maximum ankle dorsiflexion angle following repetitive brief passive stretching. Only one subject exhibited a significant increase in maximum ankle angle at the neutral position., Conclusion: Since the range of motion of the ankle joint is clearly determined by other physical factors, the maximum ankle dorsiflexion angle can be assessed at both neutral and supinated positions without moment being controlled., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Plantar pressure measurements are regularly utilised while assessing patients with in-shoe systems allowing for discrete assessment. In the present study a new portable system capable of continuous monitoring of plantar pressure is assessed for its repeatability when compared to another commercially available and widely used system., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

For many patients, the motivation in seeking treatment is the improvement of their appearance rather than to correct an underlying skeletal deformity, so cosmetic concerns and the psychosocial impacts of adolescent idiopathic scoliosis are important factors in the clinical decision-making process. In the current environment of evidence based medicine there is a growing need to quantify back surface shape and general body asymmetry with the objective of producing an agreed scoring to be used in developing treatment plans and assessing outcomes but to date many clinics continue to rely on qualitative or expensive methods to describe cosmetic deformity. In November 2010, Microsoft® Corporation launched the low cost Kinect™ camera with 18 million units sold (as at January 2012) throughout the world. The device incorporates proprietary light coding technology that reconstructs the three dimensional location of an estimated 50,000 projected points illuminating objects within its field of view in approximately 1/30th of a second. The aim of the research was to investigate the capabilities of a low cost, reliable and inherently safe apparatus based on Kinect depth sensing and video technology to simultaneously acquire back surface shape and the locations of bony landmarks with the goal of providing data to describe cosmetic defect. Work has been completed using both the apparatus and a commercially available optical motion capture system (Vicon Motion Systems, Oxford, U.K.) to acquire data from a test object representing an unaffected human torso. Results were obtained to compare tri-dimensional bony landmark reconstruction accuracy and combined with analyses of point cloud data to describe back shape. Early indications are that the proposed apparatus has potential to be a clinically useful tool.

Background: Peripheral vascular disease (PVD) is strongly associated with type 2 diabetes. PVD assessment and diagnosis are often neglected in primary care office visits, and ankle/brachial pressure index (ABPI) examinations are seldom performed for PVD detection. The purpose of this study was to evaluate the occurrence of PVD in a primary care setting using ABPI in patients with type 2 diabetes in Malta., Method: A retrospective study was conducted on a cohort of 243 patients with type 2 diabetes to address various issues. As part of this large study, data from ABPI measurements collected using a portable hand-held Doppler with ankle pressures of <0.8 suggestive of PVD were extracted., Results: Twenty-six per cent of the sample had to be referred for further vascular assessment following this screening programme due to their critical vascular status. Furthermore, at the time of examination, approximately 7% of the patients had an ABPI of less than 0.8 in both left and right extremities., Conclusion: A significant proportion of Maltese patients with type 2 diabetes who visit primary care present with vascular insufficiency. The use of ABPI should be considered as an added measurement in order to facilitate early detection and treatment and reduce the burden of PVD in this high-risk population.

Introduction: In a normal clinical environment, foot function and treatment efficacy is evaluated using static foot posture assessment. Whilst there are several methods of static assessment, the longitudinal arch angle (LAA) has been validated as a repeatable and reliable static measure that represents foot posture during midstance whilst walking and running. The main aim of this study was to assess if static LAA is representative of dynamic LAA with the use of orthoses., Method: 17 male subjects with a mean age of 33.4 (SD 12.3) years, mean height of 169.88 (SD 9.2) mm and a mean weight of 72.71 (SD 11.36)kg, who provided an informed consent were included in the study. Orthotic prescription was produced using measurements from a weightbearing goniometer. An optoelectronic movement analysis system was employed to record and analyse the LAA in barefoot, shoe and shoe with orthoses conditions. This data was collected in a static standing condition and then repeated whilst walking., Results: No significant differences were observed between right static and right dynamic barefoot condition t=1.329 (p=0.05). Same results were observed for right static and right dynamic orthotic condition t=-.233 (p=0.05). Similarly, no significant differences were recorded for left static and left dynamic barefoot condition and orthotic condition t=.303 (p=0.05) and t=.049 (p=0.05) respectively. However, differences were observed within the shoe only condition., Conclusion: LAA is been shown to be a good static measure for dynamic foot function and can reliably be implemented in a normal clinical environment to evaluate and assess the efficacy of the prescribed foot orthoses., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Most previous research on golf swing mechanics has focused on the driver club. The aim of this study was to identify the kinematic factors that contribute to greater hitting distance when using the 5 iron club. Three-dimensional marker coordinate data were collected (250 Hz) to calculate joint kinematics at eight key swing events, while a swing analyser measured club swing and ball launch characteristics. Thirty male participants were assigned to one of two groups, based on their ball launch speed (high: 52.9 ± 2.1 m · s(-1); low: 39.9 ± 5.2 m · s(-1)). Statistical analyses were used to identify variables that differed significantly between the two groups. Results showed significant differences were evident between the two groups for club face impact point and a number of joint angles and angular velocities, with greater shoulder flexion and less left shoulder internal rotation in the backswing, greater extension angular velocity in both shoulders at early downswing, greater left shoulder adduction angular velocity at ball contact, greater hip joint movement and X Factor angle during the downswing, and greater left elbow extension early in the downswing appearing to contribute to greater hitting distance with the 5 iron club.

Orthoses have been broadly used by clinicians to treat mechanical misalignments, such as abnormal foot pronation. As such, the influences of orthoses on lower-limb kinematics have been studied numerous times, with many articles reporting nonsystematic results; the aim of this review, therefore, was to examine the recognized effects of foot orthoses on lower-limb kinematics. The findings from this review suggest that foot orthoses seem to have certain generic and common effects on the lower limb when designed to control rearfoot pronation. We also discuss the possible reasons behind the lack of consistent results between studies. Based on the findings, a list of recommendations is presented for future research on foot orthoses to facilitate comparisons between studies and enable the scientific and clinical communities to better comprehend the effects that these variables might have on the kinematics and, possibly, the treatment outcomes.

Posterior tibial tendon dysfunction is a progressive deformity that can result in the development of a pathologic flatfoot deformity. Numerous publications have studied the effects of clinical interventions at specific stages of progression of posterior tibial tendon dysfunction, but there is still uncertainty regarding the clinical identification of the condition. It is clear that more information regarding the etiology, progression, and risk factors of posterior tibial tendon dysfunction is required. Clear evidence exists that suggests that the quality of life for patients with posterior tibial tendon dysfunction is significantly affected. Furthermore, evidence suggests that early conservative intervention can significantly improve quality of life regarding disability, function, and pain. This would suggest that significant cost burden reductions could be made by improving awareness of the condition, which would improve early diagnosis. Early conservative intervention may help reduce the number of patients requiring surgery. This review focuses on the etiologic factors, epidemiologic features, and pathogenesis of posterior tibial tendon dysfunction. It aims to analyze, discuss, and debate the current understanding of this condition using the available literature. In addition, there is a discussion of the evidence base surrounding disease characteristics associated with the different clinical stages of posterior tibial tendon dysfunction.

Ankle dorsiflexion measurement is important for clinical and research use. With so much evidence on the unreliability of goniometric measurements, a systematic review was performed to investigate various alternative techniques for measuring ankle dorsiflexion in the nonneurologic patient. All of the major databases were queried electronically to identify studies that used any method of ankle dorsiflexion measurement in the nonneurologic subject. Keywords included ankle dorsiflexion NOT cerebral palsy NOT stroke, the latter to exclude neurologic conditions. In 755 studies that used some form of ankle joint dorsiflexion measurement, ten different techniques were identified that included various apparatuses designed specifically for this purpose. Reliability testing of these techniques involved test-retest trials with small student populations as subjects, which returned high intraclass correlation coefficient scores. However, their methodological quality would have benefitted from the use of an actual patient population and comparison with a reference standard. When validating ankle dorsiflexion measurement techniques, actual patient populations should be used, otherwise papers would score poorly on methodological quality assessment. Standardizing patient position, foot posture, amount of moment applied, and reference landmarks will ensure that various trial results can be compared directly.

Radiographic angles are used to assess the severity of hallux valgus deformity, in preoperative planning, assessing postoperative outcomes, and in comparing results between interventions. The manual method to measure these angles has been shown to be prone to errors and to be time consuming. Computer programs are now available to assist in angular measurements. This study was undertaken to compare the reliability and time taken between the 2 methods. A total of 30 radiographs were used from a population of patients with hallux valgus deformity. The radiographs were digitized for computer-assisted measurements. The technical error of measurement (TEM) was calculated for intra- and interobserver data to assess the error in angular measurement with both methods. The technical error of measurement was lower with the computer-assisted method, suggesting that this method is more reliable. Furthermore, the time taken was also reduced with this method., (Copyright © 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: First metatarsophalangeal (MTP) joint pain is a common foot complaint which is often considered to be a consequence of altered mechanics. Foot orthoses are often prescribed to reduce 1st MTP joint pain with the aim of altering dorsiflexion at propulsion. This study explores changes in 1st MTP joint pain and kinematics following the use of foot orthoses., Methods: The effect of modified, pre-fabricated foot orthoses (X-line®) were evaluated in thirty-two patients with 1st MTP joint pain of mechanical origin. The primary outcome was pain measured at baseline and 24 weeks using the pain subscale of the foot function index (FFI). In a small sub-group of patients (n = 9), the relationship between pain and kinematic variables was explored with and without their orthoses, using an electromagnetic motion tracking (EMT) system., Results: A significant reduction in pain was observed between baseline (median = 48 mm) and the 24 week endpoint (median = 14.50 mm, z = -4.88, p < 0.001). In the sub-group analysis, we found no relationship between pain reduction and 1st MTP joint motion, and no significant differences were found between the 1st MTP joint maximum dorsiflexion or ankle/subtalar complex maximum eversion, with and without the orthoses., Conclusions: This observational study demonstrated a significant decrease in 1st MTP joint pain associated with the use of foot orthoses. Change in pain was not shown to be associated with 1st MTP joint dorsiflexion nor with altered ankle/subtalar complex eversion. Further research into the effect of foot orthoses on foot function is indicated.

Study Design: Cochrane systematic review., Objective: To evaluate the efficacy of bracing in adolescent patients with adolescent idiopathic scoliosis (AIS)., Summary of Background Data: AIS is a 3-dimensional deformity of the spine. Although AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Braces are traditionally recommended to stop curvature progression in some countries and criticized in others. They generally need to be worn full time, with treatment extending over years., Methods: The following databases (up to July 2008) were searched with no language limitations: the Cochrane Central Register of Controlled Trials, MEDLINE (from January 1966), EMBASE (from January 1980), and CINHAL (from January 1982), and reference lists of the articles. An extensive handsearch of the gray literature was also conducted. Randomized controlled trials (RCTs) and prospective cohort studies were searched for comparing braces with no treatment, other treatment, surgery, and different types of braces. Two review authors independently assessed trial quality and extracted data., Results: We included 2 studies. There was very low quality evidence from 1 prospective cohort study with 286 girls that a brace curbed curve progression at the end of growth (success rate, 74% [95% confidence interval {CI}: 52%-84%]), better than observation (success rate, 34% [95% CI: 16%-49%]) and electrical stimulation (success rate, 33% [95% CI: 12%-60%]). There is low-quality evidence from 1 RCT with 43 girls that a rigid brace is more successful than an elastic one (SpineCor) at curbing curve progression when measured in Cobb degrees, but there were no significant differences between the 2 groups in the subjective perception of daily difficulties associated with wearing the brace., Conclusion: There is very low quality evidence in favor of using braces, making generalization very difficult. Further research could change the actual results and our confidence in them; in the meantime, patients' choices should be informed by multidisciplinary discussion. Future research should focus on short- and long-term patient-centered outcomes, in addition to measures such as Cobb angles. RCTs and prospective cohort studies should follow both the Scoliosis Research Society and Society on Scoliosis Orthopedic and Rehabilitation Treatment criteria for bracing studies.

Background: Appropriate conservative treatment is considered essential to address symptoms associated with tibialis posterior tendon dysfunction (TPTD) and prevent its potential long-term disabling consequences. The main aim of this review, undertaken in 2007, was to evaluate the evidence from studies for the effects of conservative treatment modalities in the management of TPTD. This evidence could then be used as a basis for the development of a clinical guideline for the management of the condition., Methodology: Studies were selected according to specific criteria and evaluated for methodological quality. As preliminary literature searches had identified no randomised controlled trials at the time of the review, studies of lower hierarchy were included., Results: Five uncontrolled observational studies evaluating the outcomes of various orthotic treatments alone or in combination with other therapies were included in the review. Different study designs, methodological quality, population characteristics, interventions and outcome measures were found., Discussion: Limited and poor quality evidence was found in this review regarding the conservative treatment of TPTD. Thus a cause-effect relationship between intervention and outcome could not be established nor an optimal conservative treatment regime for the condition. Further better quality research is warranted in this area to inform practice, particularly as there is no consensus in the literature regarding treatment of this condition., (Copyright (c) 2009 Elsevier Ltd. All rights reserved.)

Background: Radiographic angles are commonly used in patients with hallux valgus deformity to assess the severity, plan surgery, assess outcome and compare results. Many different manual methods have been used, but are prone to error. More recently computer-assisted methods using software have become available., Objective: To review the different methods that have been used to measure radiographic angles in hallux valgus., Method: A general literature search using relevant key words was undertaken using databases such as Medline, Embase, Cinahl and Cochrane Library. REVIEW FINDINGS AND DISCUSSION: The manual methods used are prone to errors. The reliability can be improved by using standardised radiographic technique and measurement technique using specific reference points. Computer-assisted methods using software, might improve reliability of measurements. Further studies are needed to assess if these methods are easy to use, and to compare different software's that are available. Specifically designed software for the foot might further improve the reliability of radiographic measurements in hallux valgus., (Copyright (c) 2009 Elsevier Ltd. All rights reserved.)

This study compared three different foot-pressure measurement methods to investigate whether these measurement methods could or should be used interchangeably. In-shoe pressure measurements using F-Scan system, shod and unshod pressure measurements using the MatScan system were taken for each of the 21 healthy subjects while performing walking trials using a two-step gait initiation protocol. Each foot was separated in three regions: forefoot (40%), midfoot (30%) and rearfoot (30%) for further analysis. The parameters researched include average peak pressure, average peak force, timing and centre of pressure displacement. The in-shoe condition produced the highest values for the average peak force. However, the shod condition showed a trend for the highest average peak pressure. The F-Scan system consistently demonstrated slower timing values for all parameters, except one. Centre of pressure anterior/posterior trajectory was considerably shorter for the in-shoe gait condition. Consequently, the data cannot be extrapolated from one collection method to another. It is therefore recommended that a standardised collection method is utilised when pressure analysis is undertaken and that they are not used interchangeably., (Copyright 2009 Elsevier B.V. All rights reserved.)

Background: Early and appropriate conservative treatment is considered essential to prevent progression of tibialis posterior tendon dysfunction (TPTD), with its potential long term disabling consequences and the need for surgical intervention. However, there is no consensus in the literature regarding the treatment of the disorder. This investigation aimed at developing a local clinical guideline for the conservative management of TPTD by a consensus development group., Methodology: An action research methodology utilising the RAND modified Delphi approach was employed involving seven multidisciplinary consensus group participants. The guideline developed from this process was then sent for national evaluation via postal questionnaire., Results: Although a difference in opinion regarding certain aspects of the conservative management of TPTD was initially present, a local consensus was achieved following extensive discussion. 86% of survey respondents from other localities found the guideline useful but their comments, which were sometimes at odds with each other, revealed a lack of national consensus regarding the management of the condition., Conclusion: This research project has provided empirical evidence that a local clinical guideline can be developed by a consensus group for the management of TPTD. However, the lack of national consensus regarding TPTD treatment found in this research study and as reflected in the published literature, would limit the transferability of this guideline to other localities. While, the guideline reported in this study could be used to inform the development of other national and international guidelines, different areas of expertise that emerged between professions highlighted the importance of employing a multidisciplinary group in the development of guidelines for the management of musculoskeletal conditions of the foot and ankle.

This article explores relevant full-text literature to reveal the effects of heel height on gait and posture and the kinetics and kinematics of the foot, ankle, knee, hip, and spine. Furthermore, special attention will be given to the implications of increased heel height for clinicians treating locomotor disorders and provide information to aid clinical decision making. Full-text articles accessed from databases including AMED, ASSIA, Blackwell Synergy, BNI, Voyager, CINAHL, ScienceDirect, and Taylor Francis inform the review.