Heel Cup Research Articles

Effects of Custom, Molded Foot Orthoses on Balance, Gait Speed, and Pain in Postmenopausal Osteoporotic Women: A Prospective Experimental Study

ABSTRACT Introduction Osteoporotic changes displace the center of pressure (COP) closer to the limits of stability, causing balance impairment and alteration of gait characteristics. Bone architecture destruction hinders the weight-bearing capacity of lower extremities, causing foot pain, redness, and swelling. Foot orthoses increase somatosensory input and shock absorption, thus improving balance, gait speed, and pain. Objectives The aim of this study was to evaluate and quantify the effects of custom-molded insoles on the balance, gait speed, and foot pain of postmenopausal osteoporotic women. Study Design This study is a parallel group randomized control trial. Methods A total of 44 postmenopausal osteoporotic women were recruited and randomized into two groups: experimental (EG) (n = 22) and control (CG) (n = 22). EG completed a 2-week intervention period with custom-molded insoles, whereas CG did not receive any intervention. Balance, gait speed, and foot pain were measured at baseline and after 2 weeks for both groups. Results The comparison of preintervention and postintervention outcomes for both groups highlighted that they were similar at baseline; however, EG showed significant improvement in all outcome measures after 2 weeks. Conclusions This study provides preliminary evidence that custom-molded insoles had a positive effect on the proprioceptive feedback of the lower limb, thus enhancing balance. The inclusion of a heel cup in the orthoses minimized the abnormal movement of the ankle that affected the mechanical stability of the lower limbs. Additionally, they increased the surface of contact, thus reducing the load per unit of surface, minimizing foot pain and discomfort. Clinical Relevance Osteoporotic falls and fractures have severe consequences and are a major public health concern; therefore, developing effective fall prevention strategies is crucial. Custom-molded insoles could help improve balance, gait speed, and pain, potentially reducing falls while also improving the quality of life for postmenopausal osteoporotic women.

Plantar pressure reduction in the heel region through self-adjusting insoles with a heel cup in standard and individualized rocker shoes

BackgroundEffectiveness of therapeutic footwear in reducing peak pressure in persons with diabetes and loss of protective sensation to prevent diabetic foot ulcers varies due to manual production and possible changing foot structure. A previous two-way approach to address this issue, featuring individualized 3D-printed rocker midsoles and self-adjusting insoles, proved effective in the forefoot but less in the heel. To address this, new insoles incorporating a heel cup are developed. MethodsIn-shoe pressure was measured, while persons with diabetes and loss of protective sensation with high peak pressure (≥ 200 kPa) in the heel walked on a treadmill with control and individualized rocker shoe paired with control and new insole. FindingsGeneralized estimating equations revealed significant decrease in peak pressure in the proximal heel with the new insole alone and combined with rocker shoe compared to rocker shoe alone. For the distal heel, significant decrease in peak pressure is shown with the combination of new insole and rocker shoe compared to control shoe. For the forefoot and toes (excluding hallux) significant decrease in peak pressure is shown using the rocker shoe alone or combined with the heel cup compared to control shoe. InterpretationThe new insole paired with rocker shoe is effective in reducing peak pressure in the distal heel. To have similar (or more) success in proximal heel, one could replace the rocker midsole with more compliant materials. The rocker shoe used separately or combined with a heel cup effectively reduces the peak pressure in the forefoot and other toes.

Shoe choice may affect fencing lunge attack performance.

The purpose of this study was to investigate the differences in attack time and lower limb biomechanics when performing fencing lunge with fencing shoes (FS) and commonly used court shoes (CS). Additionally, the study aimed to evaluate whether fencing shoes with a heel cup (FSH) could reduce lower limb impact. Thirteen female collegiate fencers who had participated in national-level competitions were recruited for this study. Participants performed the lunge on a human-shaped target while wearing FS, FSH, or CS in a randomized order. Biomechanical data were collected using a 3D motion analysis system synchronized with a force plate. A signal light, and an accelerometer were attached to the target's head to initiate lunge movement and detect hit moment for calculating attack time. Attack time was significantly shorter when wearing FS (0.92 ± 0.05s) and FSH (0.93 ± 0.07s) compared to CS (0.96 ± 0.06s). The maximum angular velocity of ankle plantarflexion in rear foot push-off phase was significantly slower when wearing FS and FSH than when wearing CS. The maximum knee posterior shear force, maximum knee flexion moment, and maximum ankle medial shear force during the front foot step phase were significantly greater when wearing FS than when wearing CS. These forces were significantly reduced or nearly significantly reduced when wearing FSH, and there were no significant differences compared to wearing CS. The maximum ankle medial shear force during the push-off phase in rear foot was the greatest when wearing FS but decreased significantly when using FSH. However, this force was still greater than when wearing CS. Wearing FS resulted in a higher loading rate (LR) on the front foot. This LR was reduced when a heel cup was used but still remained higher than when wearing CS. There were no significant differences in the forward extension of body, maximum ground reaction force, or center of pressure displacement during front foot step and rear foot push-off phases among the three shoe conditions. Wearing FS can enhance lunge performance, and the use of a heel cup can effectively reduce lower limb impact.

Footwear, Orthoses, and Insoles and Their Effects on Balance in Older Adults: A Scoping Review.

Footwear, orthoses, and insoles have been shown to influence balance in older adults; however, it remains unclear which features, singular or in combination, are considered optimal. The aim of this scoping review was to identify and synthesise the current evidence regarding how footwear, orthoses, and insoles influence balance in older adults. Four electronic databases (MEDLINE, CINAHL, Embase, and AMED) were searched from inception to October 2023. Key terms such as "shoe*," "orthoses," "postural balance" and "older people" were employed in the search strategy. Studies meeting the following criteria were included: (i) participants had a minimum age ≥60 years, and were free of any neurological, musculoskeletal, and cardiovascular diseases; (ii) an active intervention consisting of footwear, foot orthoses, or insoles was evaluated; and (iii) at least one objective outcome measure of balance was reported. A total of 56 studies from 17 different countries were included. Three study designs were utilised (cross-sectional study, n = 44; randomised parallel group, n = 6; cohort study n = 6). The duration of studies varied considerably, with 41 studies evaluating immediate effects, 14 evaluating effects from 3 days to 12 weeks, and 1 study having a duration of 6 months. Seventeen different interventions were evaluated, including/consisting of textured insoles (n = 12), heel elevation (n = 8), non-specific standardised footwear and changes in sole thickness or hardness (n = 7 each), sole geometry or rocker soles, contoured or custom insoles and high collar height (n = 6 each), insole thickness or hardness and vibrating insoles (n = 5 each), outsole tread (n = 4), minimalist footwear and slippers (n = 3 each), balance-enhancing shoes, footwear fit, socks, and ankle-foot orthoses (n = 2 each), and eversion insoles, heel cups, and unstable footwear (n = 1 each). Twenty-three different outcomes were assessed, and postural sway was the most common (n = 20), followed by temporo-spatial gait parameters (n = 17). There was uncertainty regarding intervention effectiveness. Overall, features such as secure fixation, a textured insole, a medium-to-hard density midsole and a higher ankle collar, in isolation, were able to positively impact balance. Conversely, footwear with an elevated heel height and the use of socks and slippers impaired balance. There is a substantial body of literature exploring the effects of footwear, orthoses, and insoles on balance in older adults. However, considerable uncertainty exists regarding the efficacy of these interventions due to variability in methodological approaches. Further high-quality research is necessary to determine whether a singular intervention or a combination of interventions is most effective for enhancing balance in older adults.

Effects of individually optimized rocker midsoles and self-adjusting insoles on plantar pressure in persons with diabetes mellitus and loss of protective sensation

IntroductionRocker shoes and insoles reduce peak pressure (PP) in persons with diabetes (DM) and loss of protective sensation (LOPS). However, they are handmade, leading to inconsistent effectiveness. If foot structure changes over time, high PP-locations also change. To address this, individualized algorithm based 3D-printed rockers and self-adjusting pressure-reducing insoles are applied. MethodsPP across seven foot regions was analyzed in 21 persons with DM and LOPS. Regions with PP < 200 kPa were considered not at risk (RnoR); regions with PP ≥ 200 kPa at risk (RaR). The aim was to offload RaR, while remaining PP < 200 kPa in RnoR. ResultsIndividualized rockers and self-adjusting insoles combined successfully reduce PP < 200 kPa (on average 24 % - 48 %) in all feet with toes, central and lateral forefoot identified as RaR. Same intervention reduces PP in 68 % of the feet with medial forefoot identified as RaR. With the heel as RaR, no intervention reduces PP successfully in all feet. ConclusionsIndividualized 3D-printed rockers combined with self-adjusting insoles reduce PP (< 200 kPa) in toes, central and lateral forefoot, but not in heels. Alternative insoles with medial arch support, heel cup and compliant midsole materials might enhance success rate across entire foot.

Effects of a range of 6 prefabricated orthotic insole designs on plantar pressure in a healthy population: A randomized, open-label crossover investigation.

Prefabricated orthotic insoles are widely commercially available for self-selection to treat foot and lower-body musculoskeletal pain, without requiring advice from health care professionals. Although they are generally designed to mimic traditional design features of custom-made orthotics used in clinical practice, the effects of prefabricated insoles on plantar pressure distribution are poorly understood. This investigation aimed to evaluate and directly compare the effects of a range of 6 different commercially available prefabricated orthotic insole designs on plantar pressure in healthy individuals. This was a single-center, randomized, open-label, crossover investigation. In-shoe dynamic pressure (F-scan) was investigated in 24 healthy subjects with normal foot posture, wearing standard shoes alone and in combination with 6 different orthotic insoles, consecutively, measured on a single day. The biomechanical impact of each insole was determined by the statistical significance of changes from baseline measurements (standard shoe alone). Insoles with heel cups and medial arch geometries consistently increased contact area at medial arch and whole-foot regions and reduced both plantar peak pressure (PP) and pressure time integral at medial arch and heel regions. This investigation has aided in further understanding the mode of action of prefabricated insoles in a healthy population. The insoles in this study redistributed plantar pressure at key regions of the foot, based on design features common to prefabricated insoles. Prefabricated orthotic insoles represent an easily accessible means of reducing lower-body musculoskeletal stress for those who spend prolonged periods of time on their feet.

Does a corticosteroid injection plus exercise or exercise alone add to the effect of patient advice and a heel cup for patients with plantar fasciopathy? A randomised clinical trial

ObjectiveTo compare the effectiveness of patient advice plus heel cup alone (PA) versus PA and lower limb exercise (PAX) versus PAX plus corticosteroid injection (PAXI) to improve self-reported pain in...

Effects of Customized 3D-Printed Insoles in Patients with Foot-Related Musculoskeletal Ailments—A Survey-Based Study

The prevalence of individuals with flat feet and high arches is very high (between 15% to 37%), which can often lead to other orthopedic complications. Three-dimensional-printed insoles are being studied and validated for their effects in correcting these highly prevalent foot disorders. Highly customizable parameters while printing the insole allows for precise correction of foot biomechanics. In this study, 200 patients suffering from various foot-related problems and joint pain were given 3d-printed insoles (designed using plantar pressure systems and clinical practitioner’s assessment) to use in their footwear. Tested activities included standing, walking, running, sports, and gym workout. Customization of insoles included custom density, heel cup, heel rise, medial arch height, and lateral wedge. Based on the patient history, additional podiatry elements were provided for patients with diabetes. Each insole was designed as per the insole profile of the shoe with a comfortable fit. These insoles were found to be effective in alleviating pain for more than 90% of the patients and provided a longer life cycle with effective orthotic correction (for &gt;16 months of daily use). This paper presents the post-use effects (6–18 months) of custom 3D-printed insoles.

The Use of Laser Therapy in the Management of Chronic Plantar Heel Pain

Purpose: To compare the efficacy of laser therapy versus conventional treatment (stretching exercises and silicone heel cups) for the short-term management of CPHP. Methods: A case-control study was carried including 18 participants with 26 symptomatic limbs with CPHP. Each participant received one of two treatments; laser therapy or conventional treatment Progress was monitored using two pain scales; VAS pain scale and the Foot Function Index where participants were asked to rate their pain at the start of the study (Time 0) and after 3 weeks (Time 1). Results: Both treatment options showed a significant reduction in pain scores (p&lt;0.05) however, when comparing both treatment options, a significant difference (p&lt;0.05) in mean pain score was found with the laser therapy being more effective treatment option for the short-term management of CPHP. Conclusion: Laser therapy, when compared to conventional treatment, is a better short-term treatment option for the management of CPHP. Further research in this area is warranted to ensure best patient care, to further clarify long-term efficacy and optimal treatment parameters of Laser Therapy.

The Soft Prefabricated Orthopedic Insole Decreases Plantar Pressure during Uphill Walking with Heavy Load Carriage.

This study aimed to investigate the effect of varying the hardness of prefabricated orthopedic insoles on plantar pressure and muscle fatigue during uphill walking with a heavy backpack. Fifteen healthy male recreational athletes (age: 20.4 ± 1.0 years, height: 176.9 ± 5.7 cm, weight: 76.5 ± 9.0 kg) wore prefabricated orthopedic insoles with foot arch support; a heel cup with medium (MI), hard (HI), and soft (SI) relative hardnesses; and flat insoles (FI). They performed treadmill walking on uphill gradients with 25 kg backpacks. The plantar pressure and surface electromyographic activity were recorded separately, in 30 s and 6 min uphill treadmill walking trials, respectively. The HI, MI, and SI significantly decreased peak plantar pressure in the lateral heel compared to FI. The MI and SI significantly decreased the peak plantar pressure in the fifth metatarsal compared to FI. The MI significantly reduced the pressure-time integral in the lateral heel compared to FI. The HI significantly increased the peak plantar pressure and pressure-time integral in the toes compared to other insoles, and decreased the contact area in the metatarsal compared to SI. In conclusion, a prefabricated orthopedic insole made of soft material at the fore- and rearfoot, with midfoot arch support and a heel cup, may augment the advantages of plantar pressure distribution during uphill weighted walking.

Investigation of Impact Absorption Function of Carbon Plantar Plate for Low Arch Foot

At present, it cannot be said that the impact absorption function of the truss structure of the foot arch during static standing has been elucidated.In this study, the spring constant and the viscous damping coefficient are calculated and examined in order to compare the shock absorption characteristics of the low-arch foot seen in flat feet and the characteristics of the normal-arch foot.In addition, in order to supplement the spring constant and viscous damping coefficient for one case of low arch foot, we investigated using a carbon plantar plate. Six types of carbon plantar plates were compared, with heels and without heels, with 2 layers, 3 layers, and 4 layers.As a result, the low arch foot showed a low spring constant and a high viscous damping coefficient. In the comparison of 6 types of carbon plantar plates, the one with heel showed high spring constant and viscous damping coefficient. The value closest to the normal arch was the 3-layer carbon plantar plate without heel.It was thought that the low-arch foot had a reduced spring function that absorbs impact. The carbon plantar plate with heel cup clearly shows high values of spring constant and viscous damping coefficient, which means that hard to sink the heel.The reason for this is presumed to be the influence of the soft tissue of the heel is likely to collapse due to the heel couter.The carbon plantar plate used this time was not able to compensate for the impact class function of the normal arch foot, so further examination was necessary. However, this research has a small number of subjects, so it is necessary to increase the number of subjects and investigate again. As a future task, we will consider increasing the number of subjects.

Effects of supportive and minimalist footwear on standing balance and walking stability in older women

BackgroundFootwear has been shown to influence balance and is an important consideration in relation to the prevention of falls. However, it remains unclear as to what type of footwear is most beneficial for balance in older people: sturdy, supportive footwear, or minimalist footwear to maximise plantar sensory input. The objectives of this study were therefore to compare standing balance and walking stability in older women wearing these two footwear styles, and to investigate participants’ perceptions in relation to comfort, ease of use and fit.MethodsOlder women (n = 20) aged 66 to 82 years (mean 73.4, SD 3.9) performed a series of laboratory tests of standing balance (eyes open and closed on floor and foam rubber mat, near tandem standing) and walking stability (treadmill, level and irregular surface) using a wearable sensor motion analysis system. Participants were tested wearing supportive footwear (incorporating design features to improve balance) and minimalist footwear. Perceptions of the footwear were documented using structured questionnaires.ResultsThere were no statistically significant differences in balance performance between the supportive and minimalist footwear. Participants perceived the supportive footwear to be significantly more attractive to self and others, easier to put on and off but heavier compared to the minimalist footwear. Overall comfort was similar between the footwear conditions, although the supportive footwear was reported to be significantly more comfortable in the heel, arch height, heel cup, heel width and forefoot width regions. Eighteen participants (90%) reported that they felt more stable in the supportive footwear and 17 (85%) reported that they would consider wearing them to reduce their risk of falling.ConclusionBalance performance and walking stability were similar in supportive footwear designed to reduce the risk of falling and minimalist footwear, although participants preferred the supportive footwear in relation to aesthetics, ease of use, comfort and perceived stability. Prospective studies are now required to ascertain the longer-term advantages and disadvantages of these footwear styles on comfort and stability in older people.Trial registrationAustralian New Zealand Clinical Trials Registry. ACTRN12622001257752p, 20/9/2022 (prospectively registered).

Sever's Disease in Mandiana (North-East Guinea): A Case Report and Review of the Literature

Introduction: Sever's disease or calcaneal osteochondrosis of the posterior apophysis affects adolescent athletes between 8 and 15 years of age, boys are more affected in about 60% of cases and the involvement is uni or bilateral, described in 1912 by the surgeon James Warren Sever. Objective: To present the first case of Sever's disease in Mandiana, supported by a review of the literature. Clinical Case: This was an 11-year-old adolescent, living in Mandiana, a soccer player (right lateral), playing with his right foot, who consulted for a right posteroinferior talalgia, progressive, of mechanical appearance, triggered by walking and physical activity, calmed by rest or by taking non- steroidal anti-inflammatory drugs (NSAID). No notion of taking fluoroquinolone-based medication, no signs suggestive of an infectious focus, particularly auto-rhino-laryngology (ENT) and dental, or tumors. The painful swelling (VAS 9/10) on palpation of the medial and lateral heel cup with degree 2 flat foot, the densification and fragmentation of the posterior calcaneal process on the right foot profile radiograph allowed the diagnosis of Sever's disease. The treatment was based on oral ibuprofen 400 mg three times a day for three weeks, diclofenac gel to rub the ankle, and the cessation of physical and sports activity for three months which gave a favorable outcome by the regression of pain (VAS at 1/10) and the normal resumption of walking. Conclusion: Sever's disease is a common condition in growing children, its diagnosis is clinical, radiology is used for differential diagnosis, and rest is essential in its management.

The Implications of Sports Biomechanics Studies on the Research and Development of Running Shoes: A Systematic Review.

Although various sports footwear demonstrated marked changes in running biomechanical variables, few studies have yielded definitive findings on the underlying mechanisms of shoe constructions affecting running-related performance and injuries. Therefore, this study focused on examining the effect of basic shoe constructions on running biomechanics and assessing the current state of sports shoe production in terms of injury and efficiency. Relevant literature was searched on five databases using Boolean logic operation and then screened by eligibility criteria. A total of 1260 related articles were retrieved in this review, and 41 articles that met the requirements were finally included, mainly covering the influence of midsole, longitudinal bending stiffness, heel-toe drop, shoe mass, heel flare, and heel stabilizer on running-related performance and injuries. The results of this review study were: (1) The functional positioning of running shoe design and the target groups tend to influence running performance and injury risk; (2) Thickness of 15–20 mm, hardness of Asker C50-C55 of the midsole, the design of the medial or lateral heel flares of 15°, the curved carbon plate, and the 3D printed heel cup may be beneficial to optimize performance and reduce running-related injuries; (3) The update of research and development concepts in sports biomechanics may further contribute to the development of running shoes; (4) Footwear design and optimization should also consider the influences of runners’ strike patterns.

Biomechanical Effects of Plastic Heel Cup on Plantar Fasciitis Patients Evaluated by Ultrasound Shear Wave Elastography.

The plastic heel cup has been adopted to treat plantar heel problems for years. However, its mechanisms and biomechanical effects are yet to be fully understood. The purpose of this study was to investigate the effects of the plastic heel cup on the microchamber and macrochamber layers of the heel pad by comparing the stiffness (in terms of the shear wave speed) and thickness of these two layers with and without a plastic heel cup during static standing. Fifteen patients with unilateral plantar fasciitis were recruited. The shear wave speed and thickness of the microchamber and microchamber layers of each symptomatic heel pad during standing measured by ultrasound shear wave elastography were compared between conditions with and without a plastic heel cup. It was found that a plastic heel cup reduced the shear wave speed of the microchamber layer to 55.5% and increased its thickness to 137.5% compared with the condition without a plastic heel cup. For the microchamber layer, the shear wave speed was reduced to 89.7%, and thickness was increased to 113.6% compared with the condition without a plastic heel cup. The findings demonstrate that a plastic heel cup can help to reduce the stiffness and increase the thickness for both layers of the heel pad during standing, suggesting that the mechanism of a plastic heel cup, and its resulting biomechanical effect, is to reduce the internal stress of the heel pad by increasing its thickness through confinement.

Different Design Feature Combinations of Flatfoot Orthosis on Plantar Fascia Strain and Plantar Pressure: A Muscle-Driven Finite Element Analysis With Taguchi Method.

Customized foot orthosis is commonly used to modify foot posture and relieve foot pain for adult acquired flexible flatfoot. However, systematic investigation of the influence of foot orthotic design parameter combination on the internal foot mechanics remains scarce. This study aimed to investigate the biomechanical effects of different combinations of foot orthoses design features through a muscle-driven flatfoot finite element model. A flatfoot-orthosis finite element model was constructed by considering the three-dimensional geometry of plantar fascia. The plantar fascia model accounted for the interaction with the bulk soft tissue. The Taguchi approach was adopted to analyze the significance of four design factors combination (arch support height, medial posting inclination, heel cup height, and material stiffness). Predicted plantar pressure and plantar fascia strains in different design combinations at the midstance instant were reported. The results indicated that the foot orthosis with higher arch support (45.7%) and medial inclination angle (25.5%) effectively reduced peak plantar pressure. For the proximal plantar fascia strain, arch support (41.8%) and material stiffness (37%) were strong influencing factors. Specifically, higher arch support and softer material decreased the peak plantar fascia strain. The plantar pressure and plantar fascia loading were sensitive to the arch support feature. The proposed statistics-based finite element flatfoot model could assist the insole optimization and evaluation for individuals with flatfoot.

Proximal Medial Gastrocnemius Release: Surgical Technique.

PMGR is performed with the patient in the prone position. A thigh tourniquet is not utilized. We prefer to use spinal anesthesia, but local anesthesia could be applied along with sedation. A posteromedial incision is made on or just below the posterior knee crease. The crural fascia is divided, and the proximal insertion of the medial gastrocnemius is identified. Performing the "hook maneuver" with a curved dissector is helpful at this step. Only the white fibers are sectioned in order to allow for a lengthening of the muscular fibers that is completed with forceful ankle dorsiflexion. After proper hemostasis has been achieved, the subcutaneous layer and skin are closed, leaving the fascia open. Nonoperative treatment should be the first option, including analgesics, insoles, heel cups, calf-stretching, injections, and extracorporeal shock wave therapy8. Some authors have also suggested that application of a walking cast for 3 to 6 weeks should be attempted9,10. Once all of these treatment options have failed, operative treatment is appropriate. Historically, open plantar fasciotomy was offered to patients with recalcitrant plantar fasciitis, and this treatment continues to be a surgical option. Other procedure, like the Strayer, Vulpius, or Baumann techniques, involve the calf system and are called "gastrocnemius recession." However, these techniques act in the more distal aspect of the calf system compared with PMGR. PMGR offers patients with recalcitrant plantar fasciitis rapid recovery and good results. This procedure obviates the complications associated with plantar fasciotomy, in which the medial aspect of the proximal plantar fascia is divided to relieve the overload. A plantar fasciotomy (either open or endoscopic11) risks lateral column overload12 or a painful flatfoot if >50% of the fascia is divided. A long recovery period following plantar fasciotomy has also been described7. On the other hand, other procedures have been utilized to lengthen the Achilles-calcaneus-plantar system to an even greater extent. Techniques like the Silfverskiöld (i.e., medial and lateral proximal gastrocnemius release) or Strayer (i.e., division of the distal aspect of the gastrocnemius fascia) technique present a higher rate of complications (up to 38%), specifically nerve injuries13,14. We consider these procedures (classified as gastrocnemius recession procedures) more properly indicated for patients with neurological diseases or with an equinus contracture. The medial gastrocnemius is the more powerful of the 2 bellies. Releasing the medial head alone offers a robust decrease in tension and is safer than approaching the lateral head of the gastrocnemius15. At the same time, this technique provides a quick recovery for the patient. PMGR can also help those patients with other clinical signs related to gastrocnemius tightness, such as calf cramps and pain or repeated muscle injuries. Moreover, it can be effective in patients with second-rocker metatarsalgia or midportion Achilles tendinitis1,16. PMGR has a reported rate of satisfaction of >80%. Most patients undergoing this procedure experience substantial pain relief within the first 2 to 3 months6,17. PMGR is an outpatient procedure with a short operative time and a rapid return to recreational and labor activities. The complication rate is low, and the most common complications are calf hematomas and delayed wound healing. The present article demonstrates a reduction in pain and good functional results. An improvement in the perception of health-related quality of life, especially in the physical and pain domains of the Short Form-36 questionnaire, was also observed. The prone position allows for direct access to the proximal medial head of the gastrocnemius. Preferably, perform PMGR without a tourniquet in order to assure proper hemostasis. Keep the ankle joint free at the end of operating table because ankle dorsiflexion is a helpful maneuver at some stages in this procedure. Digital (index finger) dissection should be performed among the medial head of the gastrocnemius, the hamstrings, and the posterior aspect of the proximal tibia. The hook maneuver, performed with use of a blunt dissector, is helpful to identify all of the white fibers. Only white fibers should be divided. The surgeon must also make sure to cut the more anterior part of the aponeurosis that is hidden by red fibers. After cutting the white fibers, forceful ankle dorsiflexion is required to obtain full lengthening of the muscle. Proper hemostasis should be achieved to prevent formation of a calf hematoma. Advise the patient to do calf-stretches as soon as pain permits in order to prevent a contracting muscle scar. PMGR = proximal medial gastrocnemius releaseESWT = extracorporeal shock wave therapySD = standard deviation.

Efficacy of peloidotherapy in unilateral plantar fasciitis: A pilot study.

Objectives The aim of this study was to investigate the efficacy of peloidotherapy on pain, functional status, and quality of life (QoL) in patients with unilateral plantar fasciitis (PF). Patients and methods This prospective, observational pilot study included a total of 80 patients (13 males, 67 females; mean age: 47.7±9.9 years; range, 28 to 68 years) with a diagnosis of unilateral PF between April 2018 and October 2018. The patients were divided into two equal groups. The study group (n=40) received peloidotherapy (five days per week for two weeks, total of 10 sessions) + Achilles tendon and plantar fascia stretching exercises (self-stretching for two weeks twice per day for 30 sec, 10 repeats) + heel cup treatment. The control group (n=40) received Achilles tendon and plantar fascia stretching exercises + heel cup treatment. The patients were evaluated before and after treatment using the Visual Analog Scale-pain (VAS-pain), Foot and Ankle Outcome Scores (FAOS), and Heel Tenderness Index (HTI). Results The study group showed statistically significant improvements for all parameters after treatment compared to baseline (p<0.05). Control group showed statistically significant improvements in the VAS-pain, HTI, and FAOS-QoL subscales after treatment compared to baseline (p<0.05). The study group had a better improvement in the VAS-pain, FAOS-pain, and FAOS-work daily life subscales than the control group (p<0.05). Conclusion These results indicate that peloidotherapy may be effective in reducing pain and improving functional status and QoL for patients with unilateral PF.

Immediate comfort perception of 3D-printed foot orthoses in individuals with unilateral heel pain.

Background:Custom-made foot orthoses (FOs) play an integral part in managing foot disorders. Traditional FO fabrication is time-consuming and labor intensive. Three-dimensional (3D) printed FOs save time and cost compared with the traditional manufacturing process. To date, the differences in dimensions and comfort perception of these orthoses have not been compared in a pathological population.Objective:Compare the dimensions between 3D-printed and traditionally made FOs and comfort perception between 3D-printed, traditionally made, and no FOs in individuals with flatfeet and unilateral heel pain.Study design:Within-subject single-blinded randomized crossover study design.Methods:Thirteen participants had custom-made FOs using 3D-printing and traditional processes. Orthotic lengths, widths, arch heights, and heel cup heights were compared. Participants performed walking trials under three conditions: (1) no orthoses, (2) 3D-printed orthoses, and (3) traditionally made orthoses. Comfort perception was recorded. Orthotic dimensions were compared using paired t tests, and comfort perception were compared using one-way multiple analysis of variance and Bonferroni post hoc tests.Results:Three-dimensional–printed orthoses were wider, have higher arch heights, and heel cup heights compared with traditionally made FOs (medium to large effect sizes). There was a difference in comfort perception between the three orthotic conditions, F(12,62) = 1.99, P = 0.04; Wilk Λ = 0.521, ηp2 = 0.279. Post hoc tests show that there is no difference in comfort perception between the 3D-printed and traditionally made FOs. Both FOs were significantly more comfortable than no orthoses.Conclusions:Three-dimensional printing seems to be a viable alternative orthotic fabrication option. Future studies should compare the biomechanical effects of 3D-printed and traditionally made FOs.

Comfort perception of 3D printed orthotics in individuals with symptomatic pes planus

Introduction: Custom-made foot orthoses are an integral part of managing of foot disorders in individuals with symptomatic pes planus (flat feet). Traditional orthotic fabrication is time-consuming and labour intensive. Technological advancement means that the orthotic design process can be automated, and manufacture could include the use of 3D printing. Purported benefits include reduced design and manufacturing time, ability to replicate subsequent orthotic devices, a reduction in waste production and improved fit and comfort. This study compared the structural dimensions of 3D printed and traditionally-made foot orthoses, and comfort perception in individuals with symptomatic pes planus. Methods: Thirteen flat-footed individuals with unilateral heel pain participated in this study. Participants’ feet were measured using a foot scanner and plaster casting. Foot scans and plaster casts were sent to a single orthotic laboratory which produced a 3D printed and a traditional foot orthotic device. Orthotic length, width, arch height and heel cup height were measured using callipers. Following fitment, participants performed three walking trials 1) no orthoses, 2) 3D printed orthoses and 3) traditionally-made orthoses. Comfort perception was recorded with a comfort survey on a scale of -50 (most uncomfortable) to +50 (most comfortable), with ‘zero’ being neither comfortable nor uncomfortable. Paired t-tests examined differences in orthotic dimensions and one-way ANOVA was used to analyse comfort perception. Statistical significance was accepted at p<0.05. Results: Traditionally-made orthoses were narrower (p<0.001), had lower arch heights at the sustentaculum tali (p=0.005) and navicular (p=0.003), and lower heel cup height (p<0.001) compared to 3D printed orthoses. There was no difference in orthoses length (p=0.286). A significant difference in comfort perception in overall experience (F(2,36) = 4.81, p =0.014), heel cushioning (F(2,36) = 6.20, p =0.005), forefoot cushioning (F(2,36) = 6.30, p =0.004), medio-lateral control (F(2,36) = 8.17, p =0.001), arch support (F2,36 = 11.16, p <0.001) and heel cup fit (F(2,36) = 12.45, p <0.001) was observed. Post hoc tests with Bonferroni correction revealed that 3D printed orthoses and traditionally made orthoses were both rated more comfortable than no orthoses. There was no difference in ratings between 3D printed orthoses and traditionally-made foot orthoses. Discussion: Traditionally-made orthoses are narrower, have lower arch heights, and have lower heel cup heights compared to 3D printed orthoses. These differences do not affect the comfort perception in wearers with symptomatic pes planus. 3D printing appears to be a viable alternative orthotic fabrication option but future studies comparing the biomechanical impact of 3D printed orthoses is needed. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.