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We conducted a meta-analysis to investigate the effectiveness of ankle-foot orthosis (AFO) use in improving gait biomechanical parameters such as walking speed, mobility, and kinematics in patients with stroke with gait disturbance. We searched the MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, Embase, and Scopus databases and retrieved studies published until June 2021. Experimental and prospective studies were included that evaluated biomechanics or kinematic parameters with or without AFO in patients with stroke. We analyzed gait biomechanical parameters, including walking speed, mobility, balance, and kinematic variables, in studies involving patients with and without AFO use. The criteria of the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the methodological quality of the studies, and the level of evidence was evaluated using the Research Pyramid model. Funnel plot analysis and Egger's test were performed to confirm publication bias. A total of 19 studies including 434 participants that reported on the immediate or short-term effectiveness of AFO use were included in the analysis. Significant improvements in walking speed (standardized mean difference [SMD], 0.50; 95% CI 0.34-0.66; P < 0.00001; I 2 , 0%), cadence (SMD, 0.42; 95% CI 0.22-0.62; P < 0.0001; I 2 , 0%), step length (SMD, 0.41; 95% CI 0.18-0.63; P = 0.0003; I 2 , 2%), stride length (SMD, 0.43; 95% CI 0.15-0.71; P = 0.003; I 2 , 7%), Timed up-and-go test (SMD, - 0.30; 95% CI - 0.54 to - 0.07; P = 0.01; I 2 , 0%), functional ambulation category (FAC) score (SMD, 1.61; 95% CI 1.19-2.02; P < 0.00001; I 2 , 0%), ankle sagittal plane angle at initial contact (SMD, 0.66; 95% CI 0.34-0.98; P < 0.0001; I 2 , 0%), and knee sagittal plane angle at toe-off (SMD, 0.39; 95% CI 0.04-0.73; P = 0.03; I 2 , 46%) were observed when the patients wore AFOs. Stride time, body sway, and hip sagittal plane angle at toe-off were not significantly improved (p = 0.74, p = 0.07, p = 0.07, respectively). Among these results, the FAC score showed the most significant improvement, and stride time showed the lowest improvement. AFO improves walking speed, cadence, step length, and stride length, particularly in patients with stroke. AFO is considered beneficial in enhancing gait stability and ambulatory ability., (© 2021. The Author(s).)

We studied the use of powered ankle-foot orthoses (PAFOs) and walking stability of the wearers, focusing on the ankle joint, which is known to play a critical role in gait stability. Recognizing that the subtalar joint is an important modulator of walking stability, we conducted the walking experiment on a treadmill by applying varying assistance techniques to the 2-degree-of-freedom (DOF) PAFO, which has the subtalar joint as the rotating axis, and the commonly used 1-DOF PAFO. The participants were 8 healthy men (mean±SD: height, 174.8±7.1 cm; weight, 69.8±6.5 kg; and age, 29.1±4.8 years) with no history of gait abnormality. Center of pressure (COP) was measured with an in-shoe pressure sensor, and stability was estimated on the basis of the angular acceleration measured with the inertial measurement unit attached to the trunk. The experimental results of the 2-DOF PAFO, with or without assistance, showed a significantly higher stability than those of the 1-DOF PAFO (up to 23.78%, p<0.0326). With the 1-DOF PAFO, the stability deteriorated with the increase in the degree of assistance provided. With the 2-DOF PAFO, this tendency was not observed. Thus, the importance of the subtalar joint was proven using PAFOs. The mean position analysis of the COP during the stance phase confirmed that the COP highly correlated with stability (Pearson correlation coefficient: -0.6607). Thus, we conclude that only the 2-DOF PAFO can maintain walking stability, regardless of the assistance characteristics, by preserving the COP in the medial position through eversion. Awareness regarding the role of the subtalar joint is necessary during the manufacture or use of PAFOs, as lack of awareness could lead to the degradation of the wearer's gait stability, regardless of effective assistance, and deteriorate the fundamental functionality of PAFO., Competing Interests: The authors have declared that no competing interests exist.

Study Design: Non-randomized within-subject experimental study., Objective: To determine whether the addition of the 1 cm heel lift to the footwear improves the walking ability of the persons with Cauda Equina Syndrome (CES)., Setting: Department of Physical Medicine and Rehabilitation, Christian Medical College, India., Methods: Fourteen people with bilateral plantar flexor weakness following traumatic CES (mean age 43.7 years) were recruited for the study. Their walking speed, stride length, cadence, and time taken to complete Timed Up and Go (TUG) were measured using footwear with back straps. Then, the 1 cm heel lift was attached to the sole of the footwear. After sufficient practice, all the parameters were reassessed to find out the effectiveness of the heel lift., Results: With the 1 cm heel lift, the participants walked 0.13 m/s (95% CI, 0.08-0.17) faster than their regular footwear. They were able to complete the TUG test 2.6 s (95% CI, 1.4-3.7) earlier than before. There was an increase of 5.2 in. in stride length (95% CI, 2.9-9) and an eight steps increase in cadence (95% CI, 4.9-11.3) observed after the heel lift., Conclusions: This pilot study has demonstrated that addition of 1 cm heel may be effective in improving the walking performance of persons with Cauda Equina Syndrome. Future studies should investigate the kinetic and kinematic changes of this modification using a randomized controlled trial study design.

Since ancient Egypt, orthosis was generally made from wood and then later replaced with metal and leather which are either heavy, bulky, or thick decreasing comfort among the wearers. After the age of revolution, the manufacturing of products using plastics and carbon composites started to spread due to its low cost and form-fitting feature whereas carbon composite were due to its high strength/stiffness to weight ratio. Both plastic and carbon composite has been widely applied into medical devices such as the orthosis and prosthesis. However, carbon composite is also quite expensive, making it the less likely material to be used as an Ankle-Foot Orthosis (AFO) material whereas plastics has low strength. Kenaf composite has a high potential in replacing all the current materials due to its flexibility in controlling the strength to weight ratio properties, cost-effectiveness, abundance of raw materials, and biocompatibility. The aim of this review paper is to discuss on the possibility of using kenaf composite as an alternative material to fabricate orthotics and prosthetics. The discussion will be on the development of orthosis since ancient Egypt until current era, the existing AFO materials, the problems caused by these materials, and the possibility of using a Kenaf fiber composite as a replacement of the current materials. The results show that Kenaf composite has the potential to be used for fabricating an AFO due to its tensile strength which is almost similar to polypropylene's (PP) tensile strength, and the cheap raw material compared to other type of materials., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

BACKGROUND Unbalanced standing and gait asymmetry are common in individuals with musculoskeletal disorders. Achieving symmetrical posture and gait is an important goal of rehabilitation. This study investigated the biomechanical differences in the lower extremities observed immediately after an insole was used and without the use of different one-sided insoles. MATERIAL AND METHODS Thirty young, healthy adult males received 3 different insole interventions: experimental group A had a customized 3-dimensional (3D)-printed single-sided lateral wedge insole (CLWI) inserted on the left side, and experimental group B had on the left side, a traditional single insert. The control had unilateral flat insoles; no insole inserted into the socks. Motion mechanics and gait parameters were collected at the 2-time points, after insertion of the insole and after 20 minutes of walking with the insole. RESULTS Asymmetric posture and gait appeared immediately after using the 2 insoles (lower joint moment, P<0.05). Compared with the control group, the abnormal posture and gait of experimental group B after wearing the traditional insole for 20 minutes were not obvious (P>0.05). However, the asymmetrical posture and gait remained in experimental group A after wearing the CLWI for 20 minutes (P<0.05). The center of pressure (COP) trajectory of the left foot of experimental group A was significantly higher than that of experimental group B and the control group at the 2-time points (P<0.05). CONCLUSIONS The asymmetry of posture and gait can be observed in a short time using a customized 3D-printed single-sided lateral wedge insole. This experiment provides guidance for the application of customized 3D-printed single-sided lateral wedge insoles for gait rehabilitation.

BACKGROUND 3D-printed insoles are widely used. This study was conducted to test a customized three-dimensional (3D)-printed heel support insole based on arch lift and to investigate whether the pressure distribution on the sole was improved while maintaining foot function. MATERIAL AND METHODS The design was based on a 3D plantar contour scanning modeling technique. Thirty healthy male participants walked along a 10-m track under 3 self-controlled interventions. A customized 3D-printed heel support insole based on arch lift was inserted into the socks for the experimental condition A. For condition B, a customized 3D-printed heel-supporting insole was inserted into the socks, and a standardized pre-made heel-supporting insole was inserted into the socks as a control (condition C). We used the Footscan® pressure plate to measure the plantar parameters in the forefoot contact and foot flange phases in each condition. RESULTS Compared with condition B and the control condition, the peak pressure under the heel was significantly lower in condition A (P<0.05), and the peak pressure in the midfoot region was not significantly increased (P>0.05). CONCLUSIONS The biomechanical properties of the customized 3D-printed heel support are better than those of the traditional heel support insole, especially when there is a need for an additional increase in heel height. Patients do not decrease midfoot motion function while using this customized insole.

Purpose: Plantar fasciitis (PF) is characterized by the degeneration of the plantar fascia, leading to heel pain. We aimed to investigate the effectiveness of extracorporeal shock wave therapy (ESWT) and custom foot orthotics (CFO)., Method: The study was planned as a prospective randomized controlled study. In total, 83 patients were evaluated. The patients were divided into two groups: patients treated with ESWT (group I, n=40) and patients treated with CFO (group II, n=43). Visual analogue scale (VAS) was used to evaluate pain in the morning, evening, at rest and while walking. Foot Function Index (FFI) was used to evaluate foot functions, and Foot Health Status Questionnaire (FHSQ) was used to evaluate foot health., Results: Both group I and group II achieved significant improvements in our evaluation parameters (morning and evening pain) at 4, 12 and 24 weeks compared with their baseline values (P<0.001), and significant improvement observed in the group II continued at 48 weeks (P<0.05); however, there was no significant difference in some parameters in the group I after treatment compared with their baseline values (P>0.05)., Conclusion: Both treatment ESWT and CFO can use interchangebably. Neither method was superior in treating plantar fasciitis.

Background: The etiology of non-specific low back pain (LBP) is complex and not well understood. LBP is common and causes a remarkable health burden worldwide. Leg-length discrepancy (LLD) is potentially a risk factor for development of LBP, although this relationship has been questioned. Yet only one randomized controlled study (RCT) has been performed. The objective of our study was to evaluate the effect of insoles with leg-length discrepancy (LLD) correction compared to insoles without LLD correction among meat cutters in a RCT-design., Methods: The study population consisted 387 meat cutters who were over 35 years old and had been working 10 years or more. The LLD measurement was done by a laser ultrasound technique. All workers with an LLD of at least 5 mm and an LBP intensity of at least 2 on a 10-cm Visual Analog Scale were eligible. The LLD of all the participants in the intervention group was corrected 70%, which means that if the LLD was for example 10 mm the correction was 7 mm. The insoles were used at work for eight hours per day. The control group had insoles without LLD correction. The primary outcome was between-group difference in LBP intensity. Secondary outcomes included sciatic pain intensity, disability (Roland Morris), RAND-36, the Oswestry Disability Index, physician visits and days on sick leave over the first year. We used a repeated measures regression analysis with adjustments for age, gender and BMI. The hurdle model was used for days on sick leave., Results: In all, 169 workers were invited and 114 (67%) responded. Of them, 42 were eligible and were randomized to the intervention (n = 20) or control group (n = 22). The workers in the intervention group had a higher improvement in LBP intensity (- 2.6; 95% confidence intervals - 3.7 - - 1.4), intensity of sciatic pain (- 2.3; - 3.4 - - 1.07) and RAND-36 physical functioning (9.6; 1.6-17.6) and a lesser likelihood of sick leaves (OR -3.7; - 7.2 - -0.2)., Conclusions: Correction of LLD with insoles was an effective intervention among workers with LBP and a standing job., Trial Registration: ISRCTN11898558 . Registration date 11. Feb 2011. BioMed Central Ltd.

The aim of this study was to quantify the effects of foot orthoses (FOs) with and without a lateral bar on muscle activity of participants with cavus feet. Fifteen participants were recruited from the Université du Québec à Trois-Rivières students and podiatry clinic. The muscle activity of the tibialis anterior, fibularis longus, gastrocnemius lateralis and medialis, vastus medialis and lateralis, biceps femoris and gluteus medius were recorded during fast walking under two experimental conditions (FOs with and without a lateral bar) and a control condition (shoes). Experimentations were completed after a one-month adaptation period to each experimental condition. The root mean square of the electromyography (EMG) data was analyzed. To compare the effects between conditions, a curve analysis was performed using one-dimensional statistical parametric mapping. The main result of this study was an increased gastrocnemius lateralis muscle activity (maximum mean difference: +28%) during the propulsion phase of gait (44-46%) when participants wore FOs compared to the control condition. This result will help researchers and clinicians better understand the FOs' EMG effects of individuals with cavus feet. As FOs are mainly prescribed for symptomatic patients, future studies should assess their effects on individuals suffering of a pathology, such as Achilles tendinopathy., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Foot orthoses are routinely used to treat plantar fasciopathy in clinical practice. However, minimal evidence exists as to the effect of both truly custom designed foot orthoses, as well as that of the shoe the foot orthoses are placed into. This study investigated the effect of wearing custom foot orthoses and new athletic footwear on first-step pain, average 24-h pain and plantar fascia thickness in people with unilateral plantar fasciopathy over 12 weeks., Methods: A parallel, three-arm randomised controlled trial with blinding of participants and assessors. 60 participants diagnosed with unilateral plantar fasciopathy were randomised to either custom foot orthoses and new shoes (orthoses group), a sham insole with a new shoes (shoe group) or a sham insole placed in the participant's regular shoes (control group). Primary outcome was first-step pain. Secondary outcomes were average 24-h pain and plantar fascia thickness measured on ultrasound. Outcomes were assessed at baseline, 4 week and 12 week trial time-points., Results: At 4 weeks, the orthoses group reported less first-step pain (p = 0.002) compared to the control group. At 12 weeks, the orthoses group reported less first-step pain compared to both the shoe (p = < 0.001) and sham (p = 0.01) groups. Both the orthoses (p = < 0.001) and shoe (p = 0.006) groups reported less average 24-h pain compared to the control group at 4 and 12 weeks. The orthoses group demonstrated reduced plantar fascia thickness on ultrasound compared to both the shoe (p = 0.032) and control groups (p = 0.011)., Conclusions: Custom foot orthoses in new shoes improve first-step pain and reduce plantar fascia thickness over a period of 12 weeks compared to new shoes alone or a sham intervention., Trial Registration: Australian New Zealand Clinical Trials Registry ( ACTRN 12613000446763 ). Submitted on the 10th of April 2013 and registered on the 18th of April 2013.

Background: In the Ponseti treatment of idiopathic clubfoot, children are generally provided with a standard foot abduction orthosis (FAO). A significant proportion of these patients experience irresolvable problems with the FAO leading to therapeutic non-compliance and eventual relapse. Accordingly, these patients were equipped with a unilateral lower leg orthosis (LLO) developed in our institution. The goal of this retrospective study was to determine compliance with and the efficacy of the LLO as an alternative treatment measure. The minimum follow-up was 5 years., Results: A total of 45 patients (75 ft) were retrospectively registered and included in the study. Compliance with the bracing protocol was 91% with the LLO and 46% with the FAO. The most common problems with the FAO were sleep disturbance (50%) and cutaneous problems (45%). Nine percent of patients experienced sleep disturbance, and no cutaneous problems occurred with the LLO. Thirteen percent of patients being treated with an FAO until the age of four (23 patients; 40 ft) underwent surgery because of relapse, defined by rigid recurrence of any of the components of a clubfoot. Fourteen percent of patients being treated with an LLO (22 patients; 35 ft), mostly following initial treatment with an FAO, experienced recurrence., Conclusion: Changing from FAO to LLO at any point during treatment did not result in an increased rate of surgery and caused few problems.

Objective: To compare the randomized controlled trial evidence for therapeutic effects on walking of functional electrical stimulation and ankle foot orthoses for foot drop caused by central nervous system conditions., Data Sources: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination, Scopus and clinicaltrials.gov., Study Selection: One reviewer screened titles/abstracts. Two independent reviewers then screened the full articles., Data Extraction: One reviewer extracted data, another screened for accuracy. Risk of bias was assessed by 2 independent reviewers using the Cochrane Risk of Bias Tool., Data Synthesis: Eight papers were eligible; 7 involving participants with stroke and 1 involving participants with cerebral palsy. Two papes reporting different measures from the same trial were grouped, resulting in 7 synthesized randomized controlled trials (n= 464). Meta-analysis of walking speed at final assessment (p = 0.46), for stroke participants (p = 0.54) and after 4-6 weeks' use (p = 0.49) showed equal improvement for both devices., Conclusion: Functional electrical stimulation and ankle foot orthoses have an equally positive therapeutic effect on walking speed in non-progressive central nervous system diagnoses. The current randomized controlled trial evidence base does not show whether this improvement translates into the user's own environment or reveal the mechanisms that achieve that change. Future studies should focus on measuring activity, muscle activity and gait kinematics. They should also report specific device details, capture sustained therapeutic effects and involve a variety of central nervous system diagnoses.

Background: Hemiplegic Celebral Palsy (CP) children commonly use AFO orthoses as walking aids. It is known that AFOs may have a detrimental effect on gait. To enhance mechanical properties of AFOs we developed an innovative, custom-made, carbon, ankle-foot orthosis (Ca.M.O) which offers the opportunity to tune its response to the patient's gait characteristics and/or functional maturity., Objective: To assess the efficacy of Ca.M.O. in improving gait in a group of hemiplegic CP children and to compare its performances with those of commonly prescribed AFO., Methods: A clinical and instrumental gait analysis was performed on a group of 15 spastic hemiplegic children (WINTERS-GAGE type I-II) walking barefoot, with commonly prescribed AFOs and with Ca.M.O.Temporal, kinematic and kinetic data were collected with an 8 cameras optoelectronic system and 2 force plates., Results: Studied variables were comparable walking with Ca.M.O. and with the commonly prescribed AFO and are significantly different (p < 0.01) with respect to barefoot condition., Conclusions: Both types of orthoses normalize the kinematics of the first and second ankle rocker. The main advantage of Ca.M.O. is its modularity that allows to tune its effect on gait in relationship with the progress or involution of the child's functional development.

In the past 100 years, running shoes experienced dramatic changes. The question then arises whether or not running shoes (or sport shoes in general) influence the frequency of running injuries at all. This paper addresses five aspects related to running injuries and shoe selection, including (1) the changes in running injuries over the past 40 years, (2) the relationship between sport shoes, sport inserts and running injuries, (3) previously researched mechanisms of injury related to footwear and two new paradigms for injury prevention including (4) the 'preferred movement path' and (5) the 'comfort filter'. Specifically, the data regarding the relationship between impact characteristics and ankle pronation to the risk of developing a running-related injury is reviewed. Based on the lack of conclusive evidence for these two variables, which were once thought to be the prime predictors of running injuries, two new paradigms are suggested to elucidate the association between footwear and injury. These two paradigms, 'the preferred movement path' and 'the comfort filter', suggest that a runner intuitively selects a comfortable product using their own comfort filter that allows them to remain in the preferred movement path. This may automatically reduce the injury risk and may explain why there does not seem to be a secular trend in running injury rates., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: Knee osteoarthritis (OA) progression has been linked to increased peak external knee adduction moments (KAMs). Although some trials have attempted to reduce pain and improve function in OA by reducing KAMs with a wedged footwear insole intervention, KAM reduction has not been specifically controlled for in trial designs, potentially explaining the mixed results seen in the literature. Therefore, the primary purpose of this trial is to identify the effects of reduced KAMs on knee OA pain and function., Methods/design: Forty-six patients with radiographically confirmed diagnosis medial knee OA will be recruited for this 3 month randomized controlled trial. Recruitment will be from Alberta and surrounding areas. Eligibility criteria include being between the ages of 40 and 85 years, have knee OA primarily localized to the medial tibiofemoral compartment, based on the American College of Rheumatology diagnostic criteria and be classified as having a Kellgren-Lawrence grade of 1 to 3. Patients will visit the laboratory at baseline for testing that includes dual x-ray absorptiometry, biomechanical testing, and surveys (KOOS, PASE activity scale, UCLA activity scale, comfort visual analog scale). At baseline, patients will be randomized to either a wedged insole group to reduce KAMs, or a waitlist control group where no intervention is provided. The survey tests will be repeated at 3 months, and response to wedged insoles over 3 months will be evaluated., Discussion: This study represents the first step in systematically evaluating the effects of reduced KAMs on knee OA management by using a patient-specific wedged insole prescription procedure rather than providing the same insole to all patients. The results of this trial will provide indications as to whether reduced KAMs are an effective strategy for knee OA management, and whether a personalized approach to footwear insole prescription is warranted., Trial Registration: NCT02067208.