Heel Wedge Research Articles

Clinical and biomechanical characteristics of responders and non-responders to insoles in individuals with excessive foot pronation during walking

This study aimed to identify the clinical and biomechanical factors of subjects with excessive foot pronation who are not responsive (i.e., “non-responders”) to medially wedged insoles to increase knee adduction external moment. Ankle dorsiflexion range of motion, forefoot-shank alignment, passive hip stiffness, and midfoot passive resistance of 25 adults with excessive bilateral pronation were measured. Also, lower-limb angles and external moments were computed during walking with the participants using control (flat surface) and intervention insoles (arch support and 6° medial heel wedge). A comparison between “responders” (n = 34) and “non-responders” (n = 11) was conducted using discrete and continuous analyses. Compared with the responders, the non-responders had smaller forefoot varus (p = 0.014), larger midfoot passive internal torque peak (p = 0.005), and stiffness measured by the torsimeter (p = 0.022). During walking, non-responders had lower angle peaks for forefoot eversion (p = 0.001), external forefoot rotation (p = 0.037), rearfoot eversion (p = 0.022), knee adduction (p = 0.045), and external hip rotation (p = 0.022) and higher hip internal rotation angle peak (p = 0.026). Participants with small forefoot varus alignment, large midfoot passive internal torque, stiffness, small knee valgus, hip rotated internally, and foot-toed-in during walking did not modify the external knee adduction moment (“non-responders”). Clinicians are advised to interpret these findings with caution when considering the prescription of insoles. Further investigation is warranted to fully comprehend the response to insole interventions among individuals with specific pathologies, such as patellofemoral pain and knee osteoarthritis (OA).

Pes Planuslu Hastalarda Kişiye Özel Tasarlamış 3D Baskılı Tabanlıkların Fiziksel Aktivite Düzeyi, Denge ve Fiziksel Performans Üzerine Etkisi: Randomize, Plasebo Kontrollü, Çift-Kör Bir Çalışma

Objective: The aim of this study was to investigate the effects of individually designed insoles on physical activity level, balance and functional performance in patients with pes planus.
 Methods: 38 participants were divided into 2 groups as 3D printed (n=20) and placebo(n=18). In the 3D printed group, medial longitudinal arch support, medial wedge of the foot, medial heel wedge and transverse arch support were given to the insoles according to the needs of the participants. The placebo group received placebo insoles. Range of motion, muscle strength, static and dynamic balance, physical and physical activity levels were measured at baseline, and eight weeks later (clinicaltrials.gov ID: NCT05306886).
 Results: Muscle strengths of the plantar flexion and eversion increased after the use of insoles in the 3D printed and placebo groups (p0.05), but there were significant improvements in dynamic balance in both groups (p

Nonoperative Management of Achilles Tendon Ruptures

Abstract: Acute Achilles tendon ruptures are an increasingly common injury. Although operative fixation continues to be dominant in the United States, a growing body of literature supports nonoperative management. Although the specifics of functional rehabilitation vary, many studies support this management approach. Continued controversies include the type of castor orthosis used, acceptable gap size, need for ultrasound evaluation, time to initiation of weight bearing, time to initiation of motion, duration of orthosis, length of treatment, and use of heel wedges in shoes once the orthosis is discontinued. Level of Evidence: Level I.

Wearable sensor and machine learning estimate tendon load and walking speed during immobilizing boot ambulation

The purpose of this study is to develop a wearable paradigm to accurately monitor Achilles tendon loading and walking speed using wearable sensors that reduce subject burden. Ten healthy adults walked in an immobilizing boot under various heel wedge conditions (30°, 5°, 0°) and walking speeds. Three-dimensional motion capture, ground reaction force, and 6-axis inertial measurement unit (IMU) signals were collected. We used a Least Absolute Shrinkage and Selection Operator (LASSO) regression to predict peak Achilles tendon load and walking speed. The effects of altering sensor parameters were also explored. Walking speed models (mean absolute percentage error (MAPE): 8.81 ± 4.29%) outperformed tendon load models (MAPE: 34.93 ± 26.3%). Models trained with subject-specific data performed better than models trained without subject-specific data. Removing the gyroscope, decreasing the sampling frequency, and using combinations of sensors did not change the usability of the models, having inconsequential effects on model performance. We developed a simple monitoring paradigm that uses LASSO regression and wearable sensors to accurately predict (MAPE ≤ 12.6%) Achilles tendon loading and walking speed while ambulating in an immobilizing boot. This paradigm provides a clinically implementable strategy to longitudinally monitor patient loading and activity while recovering from Achilles tendon injuries.

Effectiveness of Lateral Heel Wedge in Patient Suffering from Knee Osteoarthritis

Effectiveness of Lateral Heel Wedge in Patient Suffering from Knee Osteoarthritis

Does medial calcaneal wedge improve static balance and load distribution in young adults with pronated foot?

Foot orthoses changing the momentum in the subtalar joint are often recommended, especially in activities loading the foot, to bring the pronated foot posture closer to neutral. To examine the immediate effect of medial heel wedge on static balance and load distribution in patients with increased pronation in the foot. Experimental study design. Forty people with right dominant lower extremity participated in the study. For static balance assessment, we assessed ellipse surface, sway length, x-y mean, AP index, and Romberg ratio on 1 foot and measured load distribution as right-left foot and fore-hind foot with and without wedge. There was a difference between the parameters of the ellipse surface and the Romberg ratio on the left side in the measurements performed with and without wedge for static balance on the left side ( P < 0.05) while there was no difference in the remaining values ( P > 0.05). In the load distribution, the change in the right anteroposterior foot was significant, increasing the load on the forefoot with the wedge ( P < 0.05) while we observed no difference in the left fore-hind foot load distribution and right-left foot load distribution ( P > 0.05). Our study showed that for static balance, medial wedge can improve balance on the left side by decreasing sway, and for load distribution, the medial wedge changed the load distribution from back to front on the right side. These small differences in young healthy individuals are a preliminary indication that further studies are needed.

The effect of bilateral heel wedge on lower extremity kinematics during walking for children with hypermobility

The effect of bilateral heel wedge on lower extremity kinematics during walking for children with hypermobility

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&lt;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.

Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position.

Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position.

Evaluation of the Effect of Different Height Heel Wedges on Postural Stability and Plantar Pressure in Women with Genu Recurvatum

Evaluation of the Effect of Different Height Heel Wedges on Postural Stability and Plantar Pressure in Women with Genu Recurvatum

Achilles Tendon Loading During Walking Differs Between Commonly Used Immobilizing Boots

Category: Sports; Basic Sciences/Biologics Introduction/Purpose: Achilles tendon ruptures have increased 10-fold in the past three decades, leading to long-term functional deficits in nearly two-thirds of patients. To counter this, rehabilitation protocols have been developed to strike a balance between protecting the healing tendon from re-rupture while allowing patients to return to activities of daily living as early as possible. However, Achilles tendon loading is neither prescribed nor quantified during immobilization and there is no standardized method of immobilization. Therefore, the purpose of this study was to quantify the amount of tendon loading experienced while walking in 3 different kinds immobilizing boot with respect to prescribed ankle angle and walking speed. Methods: Two healthy-young adults (2M; Age: 29.6 +- 2.3 y/o; BMI: 30 +- 7) walked over flat ground while wearing 3 different immobilizing boots and athletic shoes after providing written informed consent in this IRB approved study. We calculated Achilles tendon loading while subjects walked in 3 boots that positioned the ankle in 30 degrees of plantar flexion (Figure A, Air Cam Walker, United Ortho; AirSelect Walker, Aircast, VACOped, OPED). In all three boots, an instrumented insole (Loadsol, Novel) was placed under the foot to quantify load experienced by the tendon. We calculated the Achilles tendon loading profiles during gait for each immobilizing boot and compared them against the normal shod condition. We also provided the surgical repair threshold of 0.5 bodyweights to visualize the potential efficacy of each immobilizing boot for early rehabilitation when the tendon is early in the healing phase. Results: As expected, tendon loading was highest in the shod condition with no ankle bracing and lowest in the fully plantarflexed adjustable boot (Figure B). On average, the immobilizing boots reduced tendon loading decreased by 68% compared to unsupported walking in shoes but there were differences among the boots. The 3 different immobilizing boots provided differing levels of support. The 2 walking boots that use heel wedges to support the ankle in plantar flexion provided the least support, reducing loading by an average of 60-68%. The more rigid boot that constrained ankle angle using a posterior strut reduced tendon loading by 77% compared to gait in a normal walking shoe. Based on biomechanical studies of Achilles tendon repair strength in cadaveric experiments, only the rigid boot with the posterior strut reduced tendon loading biomechanics to levels that could be resisted by the surgical repair (Figure B). Conclusion: In this study, we used an instrumented insole to quantify Achilles tendon loading in a variety of immobilizing boots used by rupture patients. Our initial findings show that tendon loading is varies greatly between boot types and patients, highlighting the importance of understanding how these loads change in patients. Our future work centers around identifying the tendon loading profiles that promote tendon healing and optimize patient outcomes. These loading profiles will then provide the quantitative data needed to personalize loading for patients and guide rehabilitation to improve outcomes.

Horizontal Heterophoria Modifications by Means of Thin Proprioceptive Stimulations Applied on the Foot Sole: A Randomised Study

Some authors have demonstrated that proprioceptive stimuli applied on the feet soles can interfere on the ocular muscles. However, these studies do not clarify possible functional differences between the dominant eye and the non-dominant eye. The purpose of this randomised study is to establish if the positioning of an Internal Heel Wedge (IHW) and an External Heel Wedge (EHW) can modify horizontal heterophoria, determine dissimilar behaviours between the dominant eye and the non-dominant eye. Forty-two healthy subjects, with a right dominant eye, were tested. The 1.5 mm-thick proprioceptive stimuli were shaped out of a cork half-moon. The experimental group was divided into two groups: IHW group and EHW group. Both groups performed the “Baseline” (without mechanical stimulation) and “After 15’” (following a fitting period of 15 minutes on a treadmill with mechanical stimulation) trials. The control group performed the same trials without any podalic stimulation. Meaningful changes were observed on the horizontal heterophoria of the non-dominating eye with an IHW. Non-statistically significant variations were observed with an EHW and in the Control group. A thin heel wedge applied on the foot sole was able to generate functional changes in the non-dominant eye and could help health professionals develop increasingly personalised rehabilitation programmes.

Pressure Properties of Three Different Types of Prefabricated Insoles Related to Plantar Pressure in Asymptomatic Men.

In clinical fields, many types of insoles are used to not only realign movement patterns, but also treat pressure-related foot diseases. However, the characteristics of and plantar pressure in each type of insole are still unclear. Therefore, the aim of this study was to validate the plantar pressure-relieving effect of three representative types of insoles (metatarsal padding insole [MPI], lateral heel wedge insole [LHI], and arch support insole [ASI]) in asymptomatic men. A total of 35 feet of 35 asymptomatic men with a mean age of 23.4 ± 2.0 years were included. Pedobarographic data were evaluated by dividing the foot into eight designated regions to compare the three types of insoles. Peak plantar pressure (PPP) and pressure time integral (PTI) were assessed using the Pedar-X system. A repeated measures analysis of variance was used for statistical analyses. In the hallux region, there was no statistically significant difference. MPI showed highest pressure in the 2nd-5th toe and midfoot region, but lowest in the central and lateral forefoot regions. Meanwhile, ASI showed highest pressure in the medial forefoot region but lowest in the lateral heel region. Lastly, pressure in the lateral heel region was highest in LHI. Overall, results of PTI were similar to those of PPP. This study demonstrated that the three types of insole each could reduce and redistribute pressure of specific part of the foot to help select an appropriate insole for each purpose.

Is there a dose-response of medial wedge insoles on lower limb biomechanics in people with pronated feet during walking and running?

Although the effects of medial wedge insoles on lower limb biomechanics have been investigated, information about the effects of different magnitudes of medial posting is still lacking. What are the dose-response effects of medial wedge insoles with postings varying between 0 °, 3 °, 6 °, and 9 ° of inclination on the lower limb biomechanics during walking and running in individuals with pronated feet? Sixteen participants with an FPI ≥ 6 were recruited. Four arch-supported insole conditions with varying degrees of medial heel wedge were tested (0°, 3°, 6°, and 9°). A 3D motion analysis system with force plates was used to obtain the kinetics and kinematics of walking and running at self-selected speeds. To compare the ankle, knee, and hip angles and moments among conditions, a time series analysis was performed using Statistical Parametric Mapping (SPM). A reduction in ankle eversion angle was observed during walking for all insoles. For running, the 6° and 9° insoles decreased the ankle eversion angle during early stance and increased this angle during the propulsive phase. A decrease in ankle eversion moment was observed in walking and running for 6° and 9° insoles. An increase in knee adduction moment occurred in walking and running for all insoles. For hip, the 6° and 9° insoles showed, during walking, a decrease in hip adduction angle and an increase in hip adduction and external rotation moments. For most variables, statistical differences were found for a greater period across the stance phase as the medial wedge increased, except for ankle eversion moment and hip external rotation moment during walking. The biomechanical effects over the time series for many of the parameters increased with the addition of insole inclination, showing a dose-response effect of medial wedge insoles on the lower limb biomechanics during walking and running in adults with excessive foot pronation.

Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture.

Background:Following percutaneous repair of acute Achilles tendon (AT) ruptures, early postoperative weightbearing is advocated; however, it is debatable how aggressive rehabilitation should be. We compared the clinical and functional outcomes in 2 groups of patients who followed either our “traditional” or a “slowed down” rehabilitation after percutaneous surgical repair.Methods:Sixty patients were prospectively recruited to a slowed down (29 patients) or a traditional (31 patients) rehabilitation program. Both groups were allowed immediate weightbearing postoperatively; a removable brace with 5 heel wedges was applied at 2 weeks. In the slowed-down group, 1 wedge was removed after 4 weeks. Gradual removal of the boot took place after 4 wedges were kept for 4 weeks. In the traditional group, 1 wedge was removed every 2 weeks, with removal of the boot after 2 wedges had been kept for 2 weeks. The AT Resting Angle (ATRA) evaluated tendon elongation. Patient reported functional outcomes were assessed using the AT Rupture Score (ATRS). Calf circumference difference and the isometric plantarflexion strength of the gastro-soleus complex were evaluated.Results:At the 12-month follow-up, both ATRA and ATRS were more favorable in the slowed-down group. The isometric strength and the calf circumference were more similar to the contralateral leg in the slowed-down group than in the traditional one.Conclusion:Following percutaneous repair of acute Achilles tendon patients undergoing slowed down rehabilitation performed better than the traditional one. These conclusions must be considered within the limitations of the present study.Level of Evidence:Level II, prospective comparative study.

The Effects of a Medial Heel Wedge on the Weight-Bearing Response of Hindfoot Valgus and the Total Weight-Bearing Responses of the Navicular and Talus Bones

OBJECTIVES Medial heel wedges are commonly prescribed to manage the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones. Previous studies have reported that a medial heel wedge is effective in the management of musculoskeletal injuries. However, it remains unclear the effect of a medial heel wedge on the weight-bearing responses of footarch bones in vivo. To clarify the effects of a medial heel wedge on the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones is necessary to understand how best to treat musculoskeletal injuries clinically. The purpose of our study was to clarify the effects of a medial heel wedge on the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones.METHODS Twenty-five healthy males were analyzed. We obtained MRI scanning of the right foot under non-loading (NL) and full weight-bearing (FW) conditions. Participants wore two insole types, a flat insole and a medial heel wedge. To evaluate the weight-bearing response in hindfoot valgus, the hindfoot alignment view (HAV) was measured. We also measured navicular and talus bone positions and calculated the total positional changes of the navicular and talus bones (ΔTPCN, ΔTPCT) from the vertical and medial displacements using the Pythagorean theorem.RESULTS Significant interactions were observed with the HAV. Under both NL and FW conditions, the HAV was smaller on the medial heel wedge than on the flat insole. In addition, the ΔTPCN was significantly smaller on the medial heel wedge than on the flat insole. However, no significant differences were observed for ΔTPCT.CONCLUSIONS Our results suggest that use of a medial heel wedge decreases hindfoot valgus values under both NL and FW conditions and stabilizes the total weight-bearing response of the navicular bone.

Influence of trimming, hoof angle and shoeing on breakover duration in sound horses examined with hoof-mounted inertial sensors.

Aim of the current in vivo, observational study was to investigate the effect of trimming, heel elevation and different types of shoeing on breakover duration (BreakD) with a novel, hoof-mounted inertial measurement unit (IMU) sensor system. Ten sound, crossbred horses were examined barefoot before and after trimming fitted with an IMU sensor at the dorsal hoof wall. Additionally, application of 5° heel wedges, plain steel shoes, rolled-toe shoes and palmarly-placed quarter-clip shoes was tested. Horses were guided in a straight line on firm ground. Obtained data were speed corrected prior to calculations testing the influence of different manipulations for their significance on BreakD. Trimming had no significant influence on BreakD. Heel elevation caused a significant decrease of BreakD in walk and trot. Shoeing with a plain steel shoe resulted in a significant increase in BreakD in walk. This could be rescinded by creating a rolled toe or placing the shoe palmarly. Obtained results emphasize the use of heel wedges or rolled-toe and palmarly-placed shoes to ease breakover in the context of therapeutic shoeing. Hoof-mounted IMU sensors with high resolution seem to be a practical and valuable approach to accurately examine BreakD and factors influencing this parameter.

Assessment of the Shank-to-Vertical Angle While Changing Heel Heights Using a Single Inertial Measurement Unit in Individuals with Incomplete Spinal Cord Injury Wearing an Ankle-Foot-Orthosis.

Previous research showed that an Inertial Measurement Unit (IMU) on the anterior side of the shank can accurately measure the Shank-to-Vertical Angle (SVA), which is a clinically-used parameter to guide tuning of ankle-foot orthoses (AFOs). However, in this context it is specifically important that differences in the SVA are detected during the tuning process, i.e., when adjusting heel height. This study investigated the validity of the SVA as measured by an IMU and its responsiveness to changes in AFO-footwear combination (AFO-FC) heel height in persons with incomplete spinal cord injury (iSCI). Additionally, the effect of heel height on knee flexion-extension angle and internal moment was evaluated. Twelve persons with an iSCI walked with their own AFO-FC in three different conditions: (1) without a heel wedge (refHH), (2) with 5 mm heel wedge (lowHH) and (3) with 10 mm heel wedge (highHH). Walking was recorded by a single IMU on the anterior side of the shank and a 3D gait analysis (3DGA) simultaneously. To estimate validity, a paired t-test and intraclass correlation coefficient (ICC) between the SVAIMU and SVA3DGA were calculated for the refHH. A repeated measures ANOVA was performed to evaluate the differences between the heel heights. A good validity with a mean difference smaller than 1 and an ICC above 0.9 was found for the SVA during midstance phase and at midstance. Significant differences between the heel heights were found for changes in SVAIMU (p = 0.036) and knee moment (p = 0.020) during the midstance phase and in SVAIMU (p = 0.042) and SVA3DGA (p = 0.006) at midstance. Post-hoc analysis revealed a significant difference between the ref and high heel height condition for the SVAIMU (p = 0.005) and knee moment (p = 0.006) during the midstance phase and for the SVAIMU (p = 0.010) and SVA3DGA (p = 0.006) at the instant of midstance. The SVA measured with an IMU is valid and responsive to changing heel heights and equivalent to the gold standard 3DGA. The knee joint angle and knee joint moment showed concomitant changes compared to SVA as a result of changing heel height.

Effects of sand, asphalt and 3-degree hind toe or heel elevation on horse kinematics.

Although the effects of both the surfaces and plantar angles on equine locomotion have been widely discussed, limited scientific data are available. Our objectives were to determine the effects of two surfaces (asphalt and sand) and of 3-degree hind toe or heel elevation on horse kinematics in an experimental study. Six saddle horses were shod with a reference shoeing (REF), characterized by a fore aluminium (REF F) and hind steel racehorse (REF H) shoeing. Two dimensional kinematic videos compared horse's kinematic parameters when walking and trotting on asphalt and sand. On asphalt, REF was also compared with REF F and a modified REF H with additional 3-degree hind-toe or -heel wedges. On asphalt versus sand, horses had, at the trot, a shorter stride duration and forelimb maximal retraction, and at walk and trot, a greater fetlock, carpus, elbow and tarsus extension, a greater fore and hind limbs maximal protraction and a shorter hind limbs maximal retraction. Increasing the plantar angle decreased the tarsus and hind fetlock extension, in contrast to fore-limb, on asphalt during the stance phase. These findings could be useful to adapt rehabilitation programs related to fore and hind limb pathologies, at slow gaits.

The influence of design variations in footwear medial-lateral support on the running biomechanics of older female runners

Reports of greater incidence of knee pain and injury in older female runners compared with their younger counterparts may be associated with differences in lower limb biomechanics that influence knee joint loading. The aim of this study was to investigate footwear interventions aimed at influencing lower limb biomechanics in older female runners (&gt;45 years). Strategies for reducing peak rearfoot eversion and the external knee adductor moment were investigated, since both measures have been associated with knee joint injury. Twenty female runners (mean age 50.7 ± 5.6 years) performed 10 running trials in four footwear conditions: neutral running shoe (Control); neutral shoe with 4° medial heel wedge insole (Medial Wedge); neutral shoe with 4° lateral heel wedge insole (Lateral Wedge); and neutral shoe with combined insole with 5° lateral wedge and medial arch support (Combined Insole). Peak rearfoot eversion and knee external adductor moment were compared for the four conditions using RMANOVA and post-hoc Tukey tests ( p &lt; 0.05). Compared with the Control, peak rearfoot eversion was lower for the Combined Insole condition, with this value being lower than for all other insole conditions ( p &lt; 0.05). Compared with the Control, the peak knee external adductor moment was lower for the Lateral Wedge and the Combined Insole conditions ( p &lt; 0.05). These results support the use of a combined insole with lateral wedge and medial arch support for the reduction of peak rearfoot eversion and peak knee external adductor moment, variables that have been associated with increased risk of knee injury. If aiming to reduce knee external adductor moment alone, then the lateral wedge technology employed in this study provides an effective method for older female runners.