Effects Of Orthoses Research Articles

Effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running: A systematic review

The aim of this systematic review was to evaluate the literature pertaining to the effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running. A database search of Medline, CINAHL, Embase and SPORTDiscus without language restrictions revealed 504 citations for title and abstract review. Three articles were translated to English and a final 46 articles underwent a two-tiered quality assessment. First, all articles were scored for their reporting of electromyographic methodology using a set of standards adopted by the International Society of Electrophysiology and Kinesiology. Thirty-eight articles displayed adequate reporting of electromyographic methodology and qualified for detailed review including a second quality assessment using a modified version of the Quality Index. These included six studies investigating the effect of foot posture, 12 the effect of foot orthoses and 20 the effect of footwear on lower limb muscle activity during walking or running. Meta-analysis was not conducted due to heterogeneity between studies. Some evidence exists that: (i) pronated feet demonstrate greater electromyographic activation of invertor musculature and decreased activation of evertor musculature; (ii) foot orthoses increase activation of tibialis anterior and peroneus longus, and may alter low back muscle activity; and (iii) shoes with elevated heels alter lower limb and back muscle activation. Most studies reported statistically significant changes in electromyographic activation, although these findings were often not well supported when confidence intervals were calculated. Most important, however, is that there is a need for further research of more rigorous methodological quality, including greater consensus regarding standards for reporting of electromyographic parameters.

Effects of foot orthoses and valgus bracing on the knee adduction moment and medial joint load during gait

Effects of foot orthoses and valgus bracing on the knee adduction moment and medial joint load during gait

Short-term effects and long-term use of a hybrid orthosis for neuromuscular electrical stimulation of the upper extremity in patients after chronic stroke

To associate the short-term effects of the Handmaster orthosis on disabling symptoms of the affected upper extremity with long-term Handmaster orthosis use after stroke. Historic cohort study. Patients with chronic stroke. The Modified Ashworth Scale (0-5) for wrist (primary outcome) and elbow flexor hypertonia, visual analogue scale (0-10) for pain, oedema score (0-3), and passive range of wrist flexion and extension (pROM, degrees) were assessed prior to Handmaster orthosis prescription (T0), after 6 weeks try-out (T1) and a subsequent 4 weeks withhold period (T2). Long-term use was evaluated using a questionnaire. Non-parametric analyses and predictive values were used for statistical analyses. Of the 110 included patients 78.2% were long-term Handmaster orthosis users. Long-term users showed significant short-term (T0-T1) improvements on all impairment scores and a significant relapse of wrist and elbow Modified Ashworth Scale (T1-T2). Non-users showed significant short-term effects on elbow Modified Ashworth Scale and visual analogue scale only. Positive predictive values of short-term effects for long-term use varied between 75% and 100%, with 85% (95% confidence interval (CI) 0.72-0.93) for wrist Modified Ashworth Scale. Negative predictive values were low (11-27%). Short-term Handmaster orthosis effects were generally beneficial for hypertonia, pain, oedema, and pROM, especially in long-term users. Short-term beneficial effects were highly predictive for long-term use, but not for non-use.

Orthotic control of rear foot and lower limb motion during running in participants with chronic Achilles tendon injury

This study examined the kinematic effects of orthoses in participants with a history of chronic Achilles tendon injury. Twelve participants ran at self-selected speeds on a treadmill with and without customized orthoses. Joint and segment angles including leg abduction, calcaneal, eversion, ankle dorsiflexion, and knee flexion angles were calculated from three-dimensional data throughout stance. Five footfalls were obtained for each participant and condition. Statistical tests revealed an increase in maximum eversion with orthoses . In the individual participant analysis, this was evident in 9 of 12 participants. Trends towards increased eversion range of motion and decreased ankle dorsiflexion maximum and range of motion angles were also observed. Increased eversion was unexpected as all devices were designed to provide pronation control as deemed necessary by the podiatrist. Despite this, participants reported between 50 and 100% (average 92%) relief from symptoms with the use of orthoses. Further analysis of the angle–time curves and coordination between angular measures is recommended.

Relationship Between Positive Clinical Outcomes of Foot Orthotic Treatment and Changes in Rearfoot Kinematics

Previous two-dimensional kinematic studies that assessed the effect of foot orthoses on rearfoot motion have yielded mixed results regarding whether control of rearfoot motion is related to symptom relief. We sought to determine the effect of foot orthoses on rearfoot motion and to correlate these changes with the degree of symptom improvement in 22 individuals with excessive rearfoot pronation (17 women and 5 men; mean +/- SD age, 44.3 +/- 16.7 years; mean +/- SD weight, 74.9 +/- 15.9 kg). Two-dimensional motion-analysis software was used to assess frontal plane rearfoot motion with and without foot orthoses. The mean +/- SD Foot Posture Index of the left foot was 8.83 +/- 3.54 and of the right foot was 9.22 +/- 3.64). The pain and function subscales of the Foot Health Status Questionnaire were then used to determine the degree of symptom relief associated with the orthoses at baseline and 4 weeks later. Orthoses had a small but statistically significant effect on rearfoot motion, although no significant correlations were found between differences in rearfoot motion with and without foot orthoses and the improvements demonstrated in the Foot Health Status Questionnaire subscales of pain and function. The effect of orthoses on frontal plane rearfoot motion is considered small and probably insufficient to account for the extent of symptom reduction found in this study. Other parameters of orthotic function, such as kinetic and neuromechanical variables, should be further investigated.

Effect of Orthoses on Postural Stability in Asymptomatic Subjects With Rearfoot Malalignment During a 6-Week Acclimation Period

Mattacola CG, Dwyer MK, Miller AK, Uhl TL, McCrory JL, Malone TR. Effect of orthoses on postural stability in asymptomatic subjects with rearfoot malalignment during a 6-week acclimation period. Objective To determine the effect of custom-fitted orthoses on postural sway over a 6-week acclimation period. Design Repeated-measures analysis of variance on postural sway measures with factors being group (control, malaligned), time (initial, 2wk, 4wk, 6wk postintervention), and condition (with orthoses, without orthoses). For single-limb stance, side (right, left) was analyzed to determine bilateral differences. Setting Biodynamics laboratory. Participants Twenty-one subjects, 11 asymptomatic with rearfoot malalignment and 10 asymptomatic with normal rearfoot alignment. Interventions Orthoses were prescribed and worn for 6 weeks. Balance testing was performed on 4 different dates with each subject tested in both orthotic conditions. Postural control was measured with three 10-second eyes-closed trials for single-limb stance, one 20-second eyes-closed bilateral stance with the platform moving, and one 20-second eyes-open bilateral stance with the platform and surroundings moving. Main Outcome Measures Sway velocity (in deg/s) for single-limb stance and equilibrium score for bilateral stance. Results Postural sway measures were significantly decreased during single-limb testing with orthoses versus without orthoses, regardless of group. The orthotic intervention significantly improved bilateral stance equilibrium score in the malaligned group at weeks 2, 4, and 6 when compared with measures at the initial week. Equilibrium score of the malaligned group with orthoses at initial week was significantly lower (worse) than the control group with orthoses at initial week; however, these results were not repeated during measurements taken at weeks 2, 4, or 6. Conclusions The application of orthoses decreased sway velocity for single-limb stance, improving postural stability regardless of group when visual feedback was removed. During bilateral stance, postural stability was initially worse for the malaligned group with and without orthoses when compared with the control group; however, improvements were seen by week 2 and continued throughout the remainder of testing. Clinically, the application of orthoses appears to improve postural control in people with rearfoot malalignment, particularly when vision is removed.

The effect of longitudinal compliance on amputee gait kinetics and knee kinematics

amplitudes of m. rectus femoris and m. tibialis anterior decreased (p = 0.02 and 0.04, respectively) in the AFO condition, while the amplitude of the medial hamstrings increased (p = 0.03). The amplitude of m. gastrocnemius medialis did not show any changes and there were no changes in any of the separate phases of the gait cycle. No significant effects of AFOs on co-activation of the thigh or shank were found over the gait cycle. Analysis of the separate phases of the gait cycle showed a significant increase of the co-activation of the shank (11%) during loading. 6. Discussion The increase in stride length with 11 cm, is comparable to the amount of increase found in previous studies as a result of wearing fixed AFOs, ranging from 11 to 13 cm [2,7]. Changes in walking speed and cadence were not significant. This could be due to different individual adaptations to walking with AFOs, some of the children showed an increase in speed, whereas others decreased their cadence. The higher coactivation in thigh and shank muscles compared to the control group are in agreement with the literature and suggest an inefficient gait pattern and abnormal muscle activation [8–12]. Walking with an AFO showed no differences in co-activation of the shank and thigh in the CP children. Analysis of the separate phases of the gait cycle showed a significant increase of co-activation of the shank during loading. This indicates that fixed AFOs have little influence on co-activation. The AFOs had small effects on the EMG amplitude during the whole gait cycle. Our results suggest that fixed AFOs do not moderate the abnormal muscle activation patterns observed in children with SCP in the short-term. Longitudinal studies are required to investigate the long-term effects of orthoses on muscle activation. All the children wore prescribed AFOs, but no details for the prescription or the biomechanical alignment procedure were available. It is possible that AFO/footwear combinations modified after biomechanical alignment could result in greater improvements in gait and lower levels of co-activation [13].

Nonsurgical Management of Acute and Chronic Low Back Pain

A variety of nonsurgical treatment alternatives exists for acute and chronic low back pain. Patients should receive appropriate education about the favorable natural history of low back pain, basic body mechanics, and methods (eg, exercises, activity modification, behavioral modification) that can reduce symptoms. Nonprescription medication is efficacious for mild to moderate pain. Nonsteroidal anti-inflammatory drugs, alone or in combination with muscle relaxants, relieve pain and improve overall symptoms of acute low back pain. Exercise therapy has limited value for acute low back pain, but strong evidence supports exercise therapy in the management of chronic low back pain. Moderately strong evidence supports the use of manipulation in acute back pain. Evidence is weak for the use of epidural corticosteroid injections in patients with acute low back pain, strong for short-term relief of chronic low back pain, and limited for long-term relief of chronic low back pain. The use of facet injections in the management of acute low back pain is not supported by evidence, nor is the effectiveness of orthoses, traction, magnets, or acupuncture. Trigger point injections are not indicated for nonspecific acute or chronic low back pain, and sacroiliac joint injections are not indicated in the routine management of low back pain. Conflicting evidence exists regarding the use of transcutaneous electrical nerve stimulation.

Comparison of foot orthoses made by podiatrists, pedorthists and orthotists regarding plantar pressure reduction in The Netherlands

BackgroundThere is a need for evidence of clinical effectiveness of foot orthosis therapy. This study evaluated the effect of foot orthoses made by ten podiatrists, ten pedorthists and eleven orthotists on plantar pressure and walking convenience for three patients with metatarsalgia. Aims were to assess differences and variability between and within the disciplines. The relationship between the importance of pressure reduction and the effect on peak pressure was also evaluated.MethodsEach therapist examined all three patients and was asked to rate the 'importance of pressure reduction' through a visual analogue scale. The orthoses were evaluated twice in two sessions while the patient walked on a treadmill. Plantar pressures were recorded with an in-sole measuring system. Patients scored walking convenience per orthosis. The effects of the orthoses on peak pressure reduction were calculated for the whole plantar surface of the forefoot and six regions: big toe and metatarsal one to five.ResultsWithin each discipline there was an extensive variation in construction of the orthoses and achieved peak pressure reductions. Pedorthists and orthotists achieved greater maximal peak pressure reductions calculated over the whole forefoot than podiatrists: 960, 1020 and 750 kPa, respectively (p < .001). This was also true for the effect in the regions with the highest baseline peak pressures and walking convenience rated by patients A and B. There was a weak relationship between the 'importance of pressure reduction' and the achieved pressure reduction for orthotists, but no relationship for podiatrists and pedorthotists.ConclusionThe large variation for various aspects of foot orthoses therapy raises questions about a consistent use of concepts for pressures management within the professional groups.

Klinische Ganganalyse

Clinical gait analysis comprises a well defined repertoire of various methods for valid and reliable assessment. The rapid development of corresponding hardware and software has substantially decreased the efforts necessary for data processing and has promoted the clinical applicability of the procedures. The clinical question defines the amount of methodological input. Clinical gait analysis may provide diagnostic insight into the pathobiomechanics and the pathophysiology of complex gait disorders for which a profound understanding of the underlying causes is a prerequisite for adequate treatment. The methods may help in the screening of gait function following reconstructive surgery as a measure of quality control, the assessment of the severity of a gait disturbance, the evaluation of a rehabilitation process, or the quantification of the effect of orthoses, insoles or specific shoe ware. Simple procedures of gait analysis may suffice to obtain information on gait function which can not be derived by mere clinical observation and which can be incorporated into a clinical concept.

Effecten van een orthopedisch hulpmiddel aan anterior zijde van de enkel/voet op de houdingsstabiliteit bij patiënten met een hemiplegie

Anterior ankle-foot orthosis effects on postural stability in hemiplegic patients [Archives of Physical Medicine and Rehabilitation 1999;80(12):1587-92]

A Clinical Investigation to Determine the Effectiveness of Biomechanical Foot Orthoses as Initial Treatment for Patellofemoral Pain Syndrome

A Clinical Investigation to Determine the Effectiveness of Biomechanical Foot Orthoses as Initial Treatment for Patellofemoral Pain Syndrome

The influence of orthotic devices and vastus medialis strength and timing on patellofemoral loads during running

Objective. To use a musculoskeletal model and simulation of running to examine: (1) the influence of two commonly prescribed treatments for patellofemoral pain (vastus medialis oblique strengthening and orthoses) and (2) the functional significance of timing differences between vastus medialis oblique and vastus lateralis on lateral patellofemoral joint loads. Design. A three-dimensional musculoskeletal model of the lower extremity was used to simulate running at 4 m/s. Background. Repetitive and excessive joint loading is often associated with overuse injuries that require clinical treatments to reduce pain and restore function. Affecting one in four runners, patellofemoral pain is one of the most common injuries in running. Although conservative treatments have been reported to successfully treat patellofemoral pain, the effectiveness is often based on subjective or empirical data, which have generated disagreement on the most effective treatment. Methods. Nine subject specific running simulations were generated and experiments were performed by applying the treatments and timing differences to the nominal simulations. Results. Both treatments significantly reduced the average patellofemoral joint load and the vastus medialis strengthening also significantly reduced the peak patellofemoral joint load. In addition, when the vastus medialis oblique timing was delayed and advanced relative to the vastus lateralis timing, a significant increase and decrease in the joint load was observed, respectively, during the loading response. Conclusions. Increasing vastus medialis oblique strength yielded more consistent results across subjects than the orthosis in reducing patellofemoral joint loads during running. The effect of orthoses was highly variable and sensitive to the individual subject's running mechanics. Vastus medialis oblique activation timing is an important determinant of lateral patellofemoral joint loading during the impact phase. Relevance These findings indicate that a reduction in patellofemoral pain may be achieved through techniques that selectively increase the vastus medialis oblique strength. Therefore, future studies should be directed towards identifying such techniques. Additionally, the functional significance of timing differences between the vastus medialis oblique and vastus lateralis is an important consideration in patellofemoral pain treatment and orthoses may be beneficial for some patients depending on their running mechanics.

Anterior ankle-foot orthosis effects on postural stability in hemiplegic patients

Objectives: To evaluate the effects of an anterior ankle-foot orthosis (AFO) on static and dynamic postural stability in hemiplegic patients. Design: A cross sectional assessment of hemiplegic subjects with and without an AFO. Setting: Outpatient department of a rehabilitation hospital. Patients: A convenience sample of 24 subjects who had been prescribed an anterior AFO. Outcome Measures: Postural sway index and postural symmetry (body weight distribution through the affected leg) when standing were measured as static postural stability. Maximal balance range in anterior-posterior and lateral directions and the affected leg's weight bearing after weight shift to affected side were measured as dynamic postural stability. Results: When wearing the anterior AFO, there was no significant difference and small effect size ( r < 0.3) in postural sway index ( p = .35), postural symmetry ( p = .21), and maximal balance range in anterior-posterior direction ( p = .46). There was a significant improvement and large effect size ( r > 0.5) in lateral weight shifting ( p < .01) and weight bearing through the affected leg after weight shifted to the affected side ( p < .01). Conclusions: The significant effects of the anterior AFO in long-term hemiplegic patients were on lateral weight shifting and weight bearing through affected leg after weight shifted to the affected side. Postural sway, postural symmetry, and anterior-posterior weight shifting were not significantly affected.

In-shoe pressure measurements with a viscoelastic heel orthosis

Objective: To detect the mechanical effect of a viscoelastic heel orthosis. Design: Two-factor analysis of variance with interactions between the orthosis and the subjects. The number of subjects was determined by presuming the effect of the orthosis to be twice as large as the error-free standard deviation (SD) of the interactions, the step-to-step SD four times as large as the error-free SD of the interactions, type 1 error probability equal to .05, and type 2 error probability equal to .20. Setting: A gait laboratory in a university hospital. Subjects: Twenty-two consecutive patients with treated heel pain. Main Outcome Measures: Peak pressure (PP), pressure-time integral (PTI), and foot-to-sensor contact time (CoT) measured for five steps at 24 discrete sensors of predetermined positions in the foot with treated heel pain. Results: The orthosis reduced PPs, PTIs, and CoT ( p < .05) in the median midfoot and lateral midfoot; reduced PPs and PTIs ( p < .05) in the posterior heel and medial midfoot; increased PP and PTI ( p < .05) in the anterior part of the first metatarsal head; and increased PTI ( p < .05) in the lateral part of the hallux. The ratios of the estimated step-to-step SDs to the estimated error-free SDs of the interactions of PPs, PTIs, and CoT were less than four at all the sensors. Conclusion: Proper design and estimation of the variations ensured that there was sufficient power to detect the effect of an a priori specified size as statistically significant: the orthosis reduced the mechanical loads in the posterior heel and the midfoot and increased the mechanical loads in the anterior part of the first metatarsal head and the lateral part of the hallux during walking.

Moment about the lower leg during gait of children with down syndrome (DS) and the effect of foot orthoses

Moment about the lower leg during gait of children with down syndrome (DS) and the effect of foot orthoses

Orthotic Stabilization of Thoracolumbar Injuries

Spinal orthoses have been traditionally used in the management of thoracolumbar injuries treated with or without surgical stabilization. However, the orthotic treatment modality in the management of spinal fractures remains subjective since few objective data are available on the effectiveness of orthoses in stabilizing injured segments. This study used a finite element model of the spine to evaluate the effectiveness of a hyperextension orthosis in controlling the progression of deformities at the injury site under gravitational and flexion loads. Two types of injuries were simulated: a single-level injury at T12-L1 and a two-level injury at T11-T12-L1 segments. An injury of increasing severity was simulated by progressively reducing the bending stiffness of the affected segments relative to the normal values in flexion-extension mode. The interaction of a three-point hyperextension orthosis with the spine was simulated using experimentally measured stiffness properties of the orthosis. The authors' results suggest that in single-level injuries that cause up to 50% loss of segmental stiffness, the orthosis can restore normal resistance to deformity at the injured segments, under gravitational as well as large flexion loads. In loss of stiffness between 50% and 85% of normal, such as severe two-column disruptions, the orthosis can restore resistance to deformity under restricted patient activity level in the brace (low-flexion moment). Beyond 85% loss of segmental stiffness, such as three-column injuries, the orthosis alone appears to be ineffective in preventing progression of deformity.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of orthoses on selected physiologic parameters in cycling

Effects of orthoses on selected physiologic parameters in cycling

Effects of ankle-foot orthoses on the gait of children.

Gait analysis was performed on five normal children walking barefoot with bilateral double-upright ankle-foot orthoses (AFOs) and with plastic AFOs. When orthoses were worn, walking speed and cadence were reduced and quadriceps EMG timing was prolonged. Changes in lower extremity motions and torques were observed. The metal-and-leather AFOs impaired normal walking, more than the plastic orthoses. This study provides baseline information for evaluation of new orthotic designs and materials for children. In clinical practice, this information may be useful in selection of orthotic materials for some patients.