Footwear Modifications Research Articles

Footwear Modification in Patients with Peripheral Neuropathy by Use of Three-dimensional Force Plate

Abstract Background: Peripheral neuropathy is the most common chronic complication of both type 1 and type 2 diabetes, with an estimated lifetime prevalence exceeding 50%. Loss of cutaneous sensory information from the foot sole is reported to be a critical factor contributing to walking instability, poor balance and falls, in people with diabetic peripheral neuropathy (DPN). Although there is a very little evidence in the literature on the effectiveness of microcellular rubber insoles, they may offer a new rehabilitative approach, which promotes self-management by the user, to improve balance and walking, and reduce the risk of falling, in adults with diabetes and this study aims to find out the effectiveness of microcellular rubber insoles in peripheral neuropathy. Materials and Methods: This was a prospective observational study. A total of 30 patients with DPN, fulfilling the inclusion criteria, were selected for the study. All of the participants were clinically tested for the presence of neuropathy and evaluated by the force platform, after which they were advised to wear micro cellular rubber insole footwear (which was made in institutional set up as per patient’s foot size) for a period of 4 weeks. At the end of the stipulated period, the participants were again evaluated on the same parameters in the force platform. Results: After 4 weeks of intervention, there was a significant improvement in the postural stability as evidenced by a decrease in the mean of anterior–posterior sway (7.1225 ± 0.7102/5.7972 ± 0.6901) (P < 0.0001). Mean mediolateral sway also shows an improvement (4.9570 ± 0.5106/3.9639 ± 0.5749) (P < 0.0001). Similarly, improvements shown in mean sway area (368.4048 ± 58.9558/313.8788 ± 57.5957) (P = 0.0040) and sway velocity (23.2842 ± 2.1151/21.8840 ± 1.8419) (P < 0.0001). The step length, however, did not show any statistically significant improvement (0.6474 ± 0.0524/0.6333 ± 0.0597) (P = 0.2820). There was a significant reduction in the vertical component of the ground reaction force post-use of the insole (737.4333 ± 73.1577/659.3667 ± 82.7937) (P < 0.0001) with a reduction of 13% mean value. Conclusion: This study demonstrates that neuropathy deteriorates postural balance and gait; the present evidence provides insight indicating that footwear interventions do significantly alter static balance performance in the neuropathy population. Footwear interventions seem to have the capacity to alter underlying strategies controlling static and dynamic movement patterns through a combination of mechanical and sensorimotor mechanisms, for which in-depth investigation of neurophysiologic responses to footwear interventions is necessary to help confirm any sensorimotor adaptations.

The Heel Complex: Anatomy, Imaging, Pathologic Conditions, and Treatment.

The differential diagnosis for heel pain is broad but primarily involves abnormalities of the Achilles tendon, calcaneus, and plantar fascia. Achilles tendon disorders include tendinosis, tendinitis, and partial or complete tears. Tendinosis refers to tendon degeneration, while tendinitis is inflammation after acute overload. Untreated tendinosis can progress to partial or complete tears. Tendon disorders can be accompanied by paratenonitis or inflammation of the loose sheath enclosing the tendon. Initial management involves rehabilitation and image-guided procedures. Operative management is reserved for tendon tears and includes direct repair, tendon transfer, and graft reconstruction. The calcaneus is the most commonly fractured tarsal bone. The majority of fractures are intra-articular; extra-articular fractures, stress or insufficiency fractures, medial process avulsion, and neuropathic avulsion can also occur. Posterosuperior calcaneal exostosis or Haglund deformity, retrocalcaneal bursitis, and insertional Achilles tendinosis form the characteristic triad of Haglund syndrome. It is initially managed with orthotics and physiotherapy. Operative management aims to correct osseous or soft-tissue derangements. The plantar fascia is a strong fibrous tissue that invests the sole of the foot and contributes to midfoot stability. Inflammation or plantar fasciitis is the most common cause of heel pain and can be related to overuse or mechanical causes. Acute rupture is less common but can occur in preexisting plantar fasciitis. Conservative treatment includes footwear modification, calf stretches, and percutaneous procedures. The main operative treatment is plantar fasciotomy. Plantar fibromatosis is a benign fibroblastic proliferation within the fascia that can be locally aggressive and is prone to recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

An exploration of footwear preferences, attitudes and beliefs in people with knee osteoarthritis: A qualitative study

BackgroundAlthough footwear can improve pain and function in individuals with knee osteoarthritis (OA), perspectives about footwear in this population have not been explored. ObjectivesThis qualitative study explored preferences, attitudes and beliefs about footwear in adults with knee OA. MethodsTwenty individuals with a clinical diagnosis of knee OA (aged 45–79 years, 65% women) participated in semi-structured interviews about factors which influence footwear selection, the effect of footwear on knee symptoms, and footwear modifications. Data were analysed thematically. ResultsFour themes, with sub-themes, were identified: i) there are specific footwear characteristics people look for, with comfort as their top priority; ii) shoe appearance is important; iii) footwear can aggravate or ease symptoms; and iv) people with knee OA find footwear in a variety of ways. Participants related built-in arch support, a cushioned insole and low/no heel, without addition of foot orthoses, to comfort, and were willing to pay more for comfort and quality. Appearance was also a consideration, and participants indicated they would tolerate short periods of symptom aggravation for aesthetic shoes. Participants felt that footwear choice affected their knee symptoms and risk of slipping/twisting. Participants reported that their footwear choices were determined through trial-and-error, and sometimes on advice from health professionals or shoe store salespersons. ConclusionsThere are specific footwear features important to individuals with knee OA. Knowledge of these features can be used by health professionals to inform footwear discussions with knee OA patients and serve as considerations when developing footwear targeted for this population.

Effects of foot orthoses and footwear interventions on impairments and quality of life in people with hip pain: A systematic review.

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

Effectiveness of Dextrose Prolotherapy in Chronic Plantar Fasciitis: A Cross-Sectional Study


 Introduction: Plantar fasciitis is a very common musculoskeletal condition encountered in the outpatient department of orthopedics. It's the most common cause of heel pain. Patients have pain on weight-bearing, which limits their activities. Usually, plantar fasciitis is diagnosed on the basis of history and clinical examination; however, X-ray and USG can be helpful in atypical presentations. Mostly, plantar fasciitis is managed conservatively, which includes stretching exercises, footwear modification, ultrasonics, and injections. Prolotherapy is a very cost-effective, and OPD-based procedure that has shown promising results in many tendinopathies. There are no other risks involved in this procedure, and patients can start light activities immediately after the injection.
 Objective: To evaluate the efficacy of dextrose prolotherapy in the treatment of chronic resistant plantar fasciitis (PF).
 Methodology: This prospective, cross-sectional study, was conducted from July 2021 to December 2021 at Birat Medical College and Teaching Hospital after taking permission from the Institutional Review Committee (IRC). Patient selection was done using inclusion and exclusion criteria. A total of 66 patients were included in the study, who received two prolotherapy injections in a gap of two weeks and were followed up after 12 weeks. Patient’s clinical (Visual Analogue Score for pain at rest and activities), functional (Foot Function Index), and ultrasonograhic (plantar fascia thickness) findings were noted pre- and post-test and were evaluated.
 Results: There were 66 adult patients included in the study, out of which 39 patients (59.1%) were female and 27 patients (40.1%) were male. Their age ranged from 26 to 68 years, with a mean age of 43.91 and a standard deviation (SD) of 10.225. The mean BMI was 25.758 with an SD 2.69 (range: 19.6-33.2). The clinical score (VAS-R and VAS-A), functional score (FFI), and ultrasonographic findings (PF thickness) yielded significant outcomes following prolotherapy.
 Conclusion: Prolotherapy is a safe, economical, and effective treatment module for plantar fasciitis that has shown significant improvement in pain, functional outcomes, and patient satisfaction.

First Metatarsophalangeal Joint Pain in Athletes: Diagnosis, Management, and Return to Play Considerations.

The first metatarsal-phalangeal joint plays a key role for athletes of various disciplines. When an athlete presents for evaluation of pain at this joint, there are several causes that should be considered. The purpose of this article is to review common injuries including turf toe, sand toe, extensor and flexor hallucis longus tendinopathy, sesamoiditis, and metatarsalgia and provide current evidence-based recommendations for diagnosis, management, and return to play considerations. Conditions not specific to athletes like gout and hallux rigidus also are discussed. Mechanism of injury, physical examination, and imaging such as weight-bearing radiographs and point-of-care ultrasound can help with diagnosis. Treatment of many of these injuries begins with nonsurgical management strategies including footwear or activity modification, physical therapy, and select interventions.

Rehabilitation Challenges in Orthotic Offloading with Dual Disability Involving Bilateral Lower Limbs with Right Transtibial Amputation for Charcot Joint, Left Neuropathic Foot of Hereditary Motor and Sensory Neuropathy Aetiology

Orthotic management of offloading neuropathic foot in hereditary motor and sensory neuropathy (HMSN) is challenging due to motor, sensory and functional deficits which may interfere with weight distribution over the foot. The challenge further becomes difficult with the involvement of the contralateral lower limb with below-knee amputation. This study is regarding challenges in offloading, weight transmission and distribution during the stance phase of gait in the case of a 35-year-old female with a left neuropathic foot due to HMSN with concomitant right transtibial amputation. The energy expenditure and cosmetic issues for the right lower limb and aiming for maximum functional conservation of the left foot, were considered by taking into account the heel pad thickness measured by musculoskeletal ultrasound, dynamic plantar pressure measured by footplate pressure measurement, the integrity of the ankle joint mobility and stability by clinical assessment, the electrophysiological status of the neuropathic foot by nerve conduction study and the weight-bearing capability of the right below-knee stump. The following management measures are planned for effective offloading with therapeutic footwear modification with silicone gel cushion heel and insole and rocker bottom outsole as an alternative to conventional weight-relieving calliper in a government tertiary care set-up, thereby conserving the foot function and morphology. This will help in planning a structured rehabilitation programme which will be beneficial in preventing future foot changes including trophic ulceration and subsequent amputation. Case follow-up after patient education and assessment of disease progression in each visit is being done. A better outcome in terms of quality of life and level of independent ambulation with concomitant bio-functionality of the left neuropathic foot was accomplished with community ambulation.

Effects of footwear modification along with physiotherapy on activity of daily living (ADLS) in patients with medial knee osteoarthritis

Background: the management of osteoarthritis (OA) of the knee with biomechanical therapies claimed that application of orthotic devices is another crucial component of a rehabilitation program. Several footwear modifications are used to lessen medial knee loading (MKL), which helps to reduce pain and other symptoms. Objective: to compare the effects of lateral heel wedge insole alone and in combination with medial arch support on ADLs in patient with medial knee OA. Methodology: A randomized clinical trial was conducted on n=60 patients with medial knee OA were randomly allocated in to group A, received lateral heel wedge insole (LHWI) along with medial arch support (MAS) and group B only adjusted with LHWI. Nonprobability convenient sampling technique was used to collect the data on the knee injury and osteoarthritis outcomes score (KOOS) was used as outcome measures. The outcome measures were assessed at the baseline, and after 8 and 16 weeks. Results: The results of independent t-test showed that group A which received LHWI along with MAS showed more significant improvement (p<0.05) in pain, ADLs, sports activity on KOOS questionnaire at each level of assessment than group B which only received the LHWI. But KOOS quality of life scores only showed significant improvement after 8 weeks of intervention in group A while after 16th weeks no significant difference (p=0.09) was observed. Conclusion: the lateral wedge insoles with medial arch support combined with conventional physical therapy protocol is more effective to improve activities of daily living (ADLS) in patients having medial knee osteoarthritis. Keywords: Footwear, osteoarthritis, lateral heel wedge insoles, KOOS, ADLs.

MORTON’S NEUROMA

Introduction: In 1876 American surgeon Thomas George Morton first detailed compressive neuropathy of the interdigital nerve of the forefoot. Mortons neuropathy occurs mostly. The condition is generated secondary to repeated pressure or irritation that leads to thickening of the nerve, located in the second or third intermetatarsal space. It is suggested that the use of pointed heel shoes could be a triggering factor for the development of this pathology due to the increased pressure on the forefoot. Objective: to describe the current information related to Mortons neuroma etiology, epidemiology, presentation, diagnosis, management and treatment. Methodology: a total of 39 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 29 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Morton, neuroma, neuritis, neuralgia, interdigital. Results: it is more frequently present in the female sex, presenting a female:male ratio of 4:1 in some bibliographies and 5:1 in others. The average age at the time of surgery is 50 years old. In 21% of the cases the neuroma is bilateral, in 66% of the cases it is related to the third space, 2% to the fourth and 32% to the second. A study showed that the average diameter of Mortons neuroma was 4.1 mm in the asymptomatic staff versus 5.3 mm in the symptomatic group. Conclusions: This condition is certainly not a neuroma as it is a degenerative rather than neoplastic condition due to fibrosis of the digital nerve. The diagnosis is primarily clinical, where there may be altered sensation and a dorsal bulge. Examinations, investigations and non-surgical treatment are the same as those used in a primary neuroma. The use of orthoses and footwear modifications is indicated for conservative treatment. For surgical treatment, dorsal and plantar approaches are used, each with their advantages and disadvantages. The dorsal incision should be extended proximally to observe the residual limb, however sometimes exposure becomes difficult. The plantar approach provides better exposure for the nerve to be easily identified and resected, however the presence of painful scarring is notable. Other complications that may occur are atrophy, recurrence and chronic pain. KEY WORDS: Morton, neuroma, neuritis, neuritis, neuralgia, interdigital.

The effect of upper panel stiffness on biomechanical performance in athletic footwear

Athletic footwear can improve performance through targeted design features to improve biomechanical mechanisms of performance. The alteration of athletic shoe uppers can impact athletic performance and biomechanics in both males and females; moreover, the impact may differ between males and females due to anatomical differences between sexes. Therefore, assessment of sex-specific impacts of footwear modification on athletic performance is essential when determining how to modify footwear. The purpose of this research was to determine the impact of upper panel stiffness on biomechanical performance during agility tasks and determine if the optimal upper stiffness depends on the sex of the athlete. It was hypothesized that stiffening the upper panel, quantified through uniaxial tension testing, would result in decreased contact time and increased force production during jumping and change of direction tasks. Forty participants (20 males, 20 females) were recruited and completed eight lateral skater jumps, eight counter movement jumps, three triangle drop step drills and six anterior-posterior drills in three footwear conditions that varied in upper panel stiffness. 3D motion capture and embedded force plates were used to measure biomechanical outcomes that were compared between stiffness conditions using a linear mixed effect model. Upper panel stiffness significantly affected contact time during the lateral skater jump with the stiffest shoe resulting in the shortest contact time compared to the two other conditions (p = .02–.046, η2 = 0.18). No sex-related interactions were found for any outcome variable. Taken together, upper panel stiffness is important to consider when developing both male and female footwear.

Outcome Analysis Comparing Muscle and Fasciocutaneous Free Flaps for Heel Reconstruction: Meta-Analysis and Case Series.

Background Choosing the components of free flap (fasciocutaneous or muscle) is one of the crucial but controversial decisions in heel reconstruction. This meta-analysis aims to provide an up-to-date comparison of fasciocutaneous flaps (FCFs) and muscle flaps (MFs) for heel reconstruction and to ascertain if one flap has an advantage over the other. Methods Following the Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines, a systematic literature review was performed identifying studies on heel reconstruction with FCF and MF. Primary outcomes were survival, time of ambulation, sensation, ulceration, gait, need for specialized footwear, revision procedures, and shear. Meta-analyses and Trial Sequential Analysis (TSA) were performed to estimate the pooled risk ratios (RRs) and standardized mean difference (SMD) with fixed effects and random effects models, respectively. Results Of 757 publications identified, 20 were reviewed including 255 patients with 263 free flaps. The meta-analysis showed no statistically significant difference between MF and FCF in terms of survival (RR, 1; 95% confidence interval [CI], 0.83, 1.21), gait abnormality (RR, 0.55; 95% CI, 0.19, 1.59), ulcerations (RR, 0.65; 95% CI, 0.27, 1.54), footwear modification (RR, 0.52; 95% CI, 0.26, 1.09), and revision procedures (RR, 1.67; 95% CI, 0.84, 3.32). FCF had superior perception of deep pressure (RR, 1.99; 95% CI, 1.32, 3.00), light touch, and pain (RR, 5.17; 95% CI, 2.02, 13.22) compared with MF. Time to full weight-bearing (SMD, -3.03; 95% CI, -4.25, -1.80) was longer for MF compared with FCF. TSA showed inconclusive results for comparison of the survival of flaps, gait assessment, and rates of ulceration. Conclusion Patients reconstructed with FCF had superior sensory recovery and early weight bearing on their reconstructed heels, hence faster return to daily activities compared with MFs. In terms of other outcomes such as footwear modification and revision procedure, both flaps had no statistically significant difference. The results were inconclusive regarding the survival of flaps, gait assessment, and rates of ulceration. Future studies are required to investigate the role of shear on the stability of the reconstructed heels.

Effects of Physical Therapy Combined with Footwear Modifications on Cadence, Stride Lengthand Speed in Patients with Knee Osteoarthritis. (A Randomized Clinical Trial)

Effects of Physical Therapy Combined with Footwear Modifications on Cadence, Stride Lengthand Speed in Patients with Knee Osteoarthritis. (A Randomized Clinical Trial)

Radiographic Correction of Bunionette Deformity using Minimally Invasive Fifth Metarsal and Akinette Osteotomy

Category: Midfoot/Forefoot; Lesser Toes; Other Introduction/Purpose: Bunionette Deformity is defined as a painful lateral prominence of the fifth metatarsal head. Conservative treatment entails footwear and activity modification. Symptoms can be exacerbated in the athletic population and activities with specific footwear such as cycling, winter sports and water sports. In refractory cases, patients may pursue operative intervention. Historically, open surgical correction carried risks of wound complications, prolonged recovery time, and nonunion risk. Minimally invasive techniques have gained popularity due to the decreased risk of wound complications, preservation of blood supply and healing potential, and faster operative and recovery times. The purpose of the current study is to examine radiographic and clinical outcomes of minimally invasive bunionette correction with a sliding distal 5th metatarsal osteotomy and lateral closing wedge proximal phalanx (Akinette) osteotomy. Methods: A retrospective review examined 36 feet in 28 patients who underwent minimally invasive bunionette correction from 01/2021 to 12/2021. The study patients were treated at a single center by 3 participating providers trained in minimally invasive techniques. All patients underwent a distal 5th metatarsal osteotomy and Akinette osteotomy of the proximal phalanx. Length of follow up ranged from 3 to 12 months. Radigraphic measurements including 4,5 intermetatarsal angle (IMA), 5th metatarsophalangeal angle, and osteotomy displacement (mm) were compared pre and postoperatively. Patients were asked to complete postoperative satisfaction survey and lesser toe American Orthopaedic Foot & Ankle Society (AOFAS) score. Results: Preliminary analysis shows a radiographic 4,5 IMA correction of 4.9 degrees to 3.4 degrees. Fifth metatarsophalangeal angle was corrected from 20.3 degrees preoperatively to 5.3 degrees postoperatively. Average medial displacement of the metatarsal osteotomy was 2.64 mm. There was one nonunion of the 5th metatarsal in a revision case that had previously been treated at an outside facility with open techniques, which was treated with bone grafting. Two other patients underwent revision surgery for complications from concomitant procedures that were performed (1 lapidus nonunion and 1 lapidus wound dehiscence). There were no wound or neurovascular complications involving the 5th ray. Conclusion: Our data shows that minimally invasive bunionette correction with sliding 5th metatarsal and Akinette osteotomy leads to reliable radiographic correction and clinical improvement. This operation has favorable safety profile with low incidence of complications and a high union rate.

Prevention of Lower Extremity Musculoskeletal Injuries in Tactical and First Responder Populations: A Systematic Review and Meta-Analysis of Randomized Trials From 1955 to 2020.

Sinnott, AM, Krajewski, KT, LaGoy, AD, Beckner, ME, Proessl, F, Canino, MC, Nindl, BC, Turner, RL, Lovalekar, MT, Connaboy, C, and Flanagan, SD. Prevention of lower extremity musculoskeletal injuries in tactical and first responder populations: A systematic review and meta-analysis of randomized trials from 1955 to 2020. J Strength Cond Res 37(1): 239-252, 2023-Lower extremity musculoskeletal injuries (LEMSIs) impose a significant burden on tactical and first responder populations. To determine the effectiveness of LEMSI prevention strategies, we performed a systematic review and meta-analysis of randomized controlled trials published in English from 1955 to 2020 (PROSPERO: CRD42018081799). MEDLINE, EMBASE, Cochrane, CINAHL, ProQuest, and DTIC databases were searched for trials that assigned military service members, police, firefighters, or paramedics to LEMSI prevention interventions with a minimum surveillance period of 12 weeks. Evidence was synthesized as odds ratios (OR) for LEMSI occurrence between individuals assigned to interventions and those assigned to standard activities. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0. Random-effects meta-analyses were conducted for (a) physical training and (b) footwear modifications to reduce LEMSI and (c) footwear modifications to reduce stress fractures specifically. Certainty in the body of evidence was determined with the GRADE approach. Of 28,499 records, 18 trials comprised of more than 11,000 subjects were synthesized. Interventions included physical training (8, N = 6,838), footwear modifications (8, N = 3,792), nutritional supplementation (1, N = 324), and training modifications (1, N = 350). Overall risk of bias was generally moderate ( N = 7 of 18) or high ( N = 9 of 18). Physical training (OR = 0.87, 95% CI [0.71, 1.08], p = 0.22, I 2 = 58.4%) and footwear modification (OR = 1.13, 95% CI [0.85, 1.49], p = 0.42, I 2 = 0.0%) did not reduce LEMSI or stress fractures (OR = 0.76, 95% CI [0.45, 1.28], p = 0.30, I 2 = 70.7%). Our results indicate that there is weak evidence to support current LEMSI prevention strategies. Future efforts will benefit from longer surveillance periods, assessment of women and nonmilitary populations, improved methodological rigor, and a greater breadth of approaches.

Gait Biomechanics for Fall Prevention among Older Adults

In our currently ageing society, fall prevention is important for better healthy life expectancy and sustainable healthcare systems. While active outdoor walking is recommended as adequate exercise for the senior population, falls due to tripping and slipping exist as the primary causes of severe injuries. Minimum foot clearance (MFC) is the lowest vertical height of the foot during the mid-swing phase and indicates the risk of tripping. In contrast, coefficient of friction (COF) factors determine the occurrence of falls from slipping. Optimisation of the MFC and the COF for every step cycle prevents tripping and slipping, respectively. Even after the initiation of hazardous balance loss (i.e., tripping and slipping), falls can still be prevented as long as the requirements for balance are restored. Biomechanically, dynamic balance is defined by the bodily centre of mass and by the base of support: spatially—margin of stability and temporally—available response time. Fall prevention strategies should, therefore, target controlling the MFC, the COF and dynamic balance. Practical intervention strategies include footwear modification (i.e., shoe-insole geometry and slip-resistant outsoles), exercise (i.e., ankle dorsiflexors and core stabilisers) and technological rehabilitation (i.e., electrical stimulators and active exoskeletons). Biomechanical concepts can be practically applied to various everyday settings for fall prevention among the older population.

Acceptability of a nurse-led non-pharmacological complex intervention for knee pain: Nurse and patient views and experiences

The overall purpose of this research programme is to develop and test the feasibility of a complex intervention for knee pain delivered by a nurse, and comprising both non-pharmacological and pharmacological interventions. In this first phase, we examined the acceptability of the non-pharmacological component of the intervention; issues faced in delivery, and resolved possible challenges to delivery. Eighteen adults with chronic knee pain were recruited from the community. The intervention comprised holistic assessment, education, exercise, weight-loss advice (where appropriate) and advice on adjunctive treatments such as hot/cold treatments, footwear modification and walking aids. After nurse training, the intervention was delivered in four sessions spread over five weeks. Participants had one to one semi-structured interview at the end of the intervention. The nurse was interviewed after the last visit of the last participant. These were audio recorded and transcribed verbatim. Themes were identified by one author through framework analysis of the transcripts, and cross-checked by another. Most participants found the advice from the nurse easy to follow and were satisfied with the package, though some felt that too much information was provided too soon. The intervention changed their perception of managing knee pain, learning that it can be improved with self-management. However, participants thought that the most challenging part of the intervention was fitting the exercise regime into their daily routine. The nurse found discussion of goal setting to be challenging. The nurse-led package of care is acceptable within a research setting. The results are promising and will be applied in a feasibility randomised-controlled trial.

Efficacy of Hallux Valgus Deformity Correction Exercise Program in Young Females

<p><strong>Background:</strong> Hallux valgus deformity mostly seen in females because of high heels and tight/narrow shoes. Previous studies have focused on surgical treatment, orthosis, footwear modifications and tapping, but this not correct valgus deformity and causes certain complications. No studies are conducted showing proper exercise program effective in decreasing the valgus angle. The purpose of this study was to determine the efficacy of hallux valgus deformity correction exercise program in young females. <strong>Objectives:</strong> To determine the efficacy of hallux valgus deformity correction exercise program in young females. Methods: 24 female subjects with mild and moderate hallux valgus angle were divided, in group A (experimental) treated with deformity correction exercises, mobilization, stretching and group B (control) with toe spread out and short foot exercises. A goniometer was used to determine the valgus angle of great toe. Visual analogue scale for the pain and functional limitations was evaluated by using Foot and Ankle Disability Index. <strong>Results:</strong> On comparing both groups, there was no statistically significant difference seen in pre interventional values. In post interventional values, there was significant difference seen with p value for pain at rest (<0.0001) and on activity (<0.0001), goniometric range of motion of great toe of right (<0.0002) and left side (<0.0003), foot and ankle disability index score (<0.0238). <strong>Conclusion:</strong> The conducted study shows that deformity correction exercises, stretching and mobilization had more beneficial effects than toe spread out and short foot exercises for correcting the deformity.</p>

Conservative treatment of hallux rigidus: narrative review of scientific evidence

This study proposes an update on conservative treatment of hallux rigidus based on scientific evidence. This is a narrative review of 19 articles that analyzed conservative treatment of hallux rigidus in its different modalities. Conservative treatment is effective in approximately half of the patients with hallux rigidus, and footwear modifications, use of insoles, and hyaluronic acid injections are the most effective treatments, according to evidence-based medicine. Level of Evidence III; Therapeutic Studies; Systematic Review of Level III Studies.

Proposed treatment algorithm for hallux rigidus

This study performs a literature review on the treatment of hallux rigidus and proposes a treatment algorithm.This literature systematic review expanded a similar study conducted in 2014 by the authors and analyzed the levels of recommendation according to scientific evidence.Most articles found in the search present scarce evidence (level IV or case series), we only found 8 articles with an at least moderate level of recommendation (B); of these, only one article had a level of evidence I.Conservative treatment is effective with the implementation of footwear modifications, use of insoles, and infiltrations with hyaluronic acid. Cheilectomy, either isolated or combined with Moberg osteotomy, shows good outcomes in stage III, or moderate, although its outcomes worsen after 5 years. Metatarsophalangeal joint (MTPJ) arthrodesis is still the gold standard in stage IV, or advanced. In recent years, the technique of interposition arthroplasty has re-emerged, especially with the use of a synthetic cartilage implant (Cartiva®), with outcomes at least similar to those of MTPJ arthrodesis in comparative studies. Level of Evidence III; Therapeutic Studies; Systematic Review of Level III Studies.

Effect of Foot Orthoses and Shoes in Parkinson’s Disease Patients: A PRISMA Systematic Review

Reduced plantar foot sensation, postural instability, and gait difficulties are characteristic of Parkinson´s disease patients. A systematic review was carried out to determine the effect of the different types of insoles and shoes in these patients. Several databases were used to search for relevant articles reporting Parkinson´s disease patients undergoing treatment with any type of insole and footwear. All titles and abstracts were reviewed independently by two reviewers and the available data were extracted. The study eligibility criteria were any type of experimental study that included Parkinson’s disease patients treated with any type of insole or footwear. Eight studies were selected. Interventions used were textured insoles, footwear modifications, and habitual footwear. Three different outcomes were evaluated in each study: gait parameters, balance, and plantar sensation. According to the data available from this systematic review, the most important conclusion is that more controlled studies are needed in this research field. There are indications to suggest that textured insoles have positive effects on gait parameters, balance, and plantar sensation in Parkinson’s disease patients.