High-arched Feet Research Articles

Study of correlation between arches of foot and lower back pain in Eastern India

Background: Low back pain is one of the most common disorders of the musculoskeletal system, leading to impaired function and decreased quality of life in many patients. Foot arch alterations may lead to structural changes and/or affect its load distribution. It should be noted that even slight elevations of the foot’s medial longitudinal arch above the norm may lead to changes in load and pressure distribution. Hence, it becomes important to find the relationship between low back pain and altered foot arch indices leading to improper body balance. Aims and Objectives: The aims and objectives of the study are to find any correlation between lower back pain and an altered foot arch index in the Eastern Indian population. Materials and Methods: A total of 60 subjects aged 20–40 years with varying degrees of low back pain were selected. Low back pain scores of the subjects were found using modified oswestry low back pain disability questionnaire. Footprints in standing position using ink were taken on graph paper and the foot arch indices were calculated. Results: 54.16% of the male and 36.11% of female participants had low arched feet, 20.83% of male and 52.78% of female participants had normal arched feet, and 25% of male and 11.11% of female participants had high arched feet with varying degrees of low back pain. 77.42% of the participants with minimal disability due to low back pain were having normal arched feet, 71.43% of the participants with moderate disability due to low back pain were having low arched feet, and 100% of the participants with severe disability due to low back pain were having either high or low arched feet. Conclusion: This study showed that people having either low or high arched feet are at an increased risk of developing acute or chronic low back pain at some stage in their lives. Knowledge of this risk factor might even help people to choose appropriate occupations in the future.

Clinical markers of Charcot-Marie-Tooth disease (own experience)

Charcot-Marie-Tooth disease is also called hereditary motor and sensory neuropathy. It is a genetically determined disease that has different variants of inheritance whose substratum is neuromuscular disorders. It may begin during childhood or later in life. Scientists have identified and described more than thirty genetic mutations that form an individual unique passport of violations of the sequence of a group of organic compounds or nucleotides in nucleic acid molecules. There are autosomal dominant, autosomal recessive and X-linked types of genetic inheritance of Charcot-Marie-Tooth disease. This pathology was first described in 1886 and affects about 10 to 40 per 100,000 population. More than 15,000 cases of Charcot-Marie-Tooth disease have been registered in Ukraine. It should be noted that peripheral myelin protein 22 became the first described gene causing Charcot-Marie-Tooth disease. Autosomal dominant Charcot-Marie-Tooth type 1 is the most common form of the disease. When observing patients, a neurologist pays attention to gait disturbances (steppage gait), foot distortion (pes cavus), distal hypotrophy, decrease or absence of tendon and periosteal reflexes, weakness and loss of sensitivity in the distal parts of the limbs. Hypotrophic changes in the limbs are continuously progressive. As a result of muscle atrophy and foot deformity, high-arched feet and extension of the big toe (Friedreich’s foot) are formed. To date, no pathogenetically substantiated treatment exists for Charcot-Marie-Tooth disease, but a multi-vector approach to comprehensive rehabilitation measures creates the necessary conditions to effectively control the manifestations of the inevitable progression of this pathology.

Correlation between Foot Transverse Arch Index and Foot Posture Index in Identifying Foot Arches in Healthy Population

Background: Medial longitudinal arch of foot plays a crucial role on maintaining ankle during weight bearing activities. In previous studies arch index derived from foot print shows a negative correlation with the navicular height. There are no other studies have correlated mathematically derived foot print values with standing arch height measurements with an acceptable equation. This study correlates arch index and foot posture index to identify foot arches. Methods: subjects with high arch have taken for the study. The study type is observational study was done on sample size n=60,foot arch index and foot posture index was evaluated with the samples. Findings: a r- value of 0.333, there is a Negative correlation between Arch index and Foot posture index in low arched foot. There is no significant correlation, and the a r- value of 0.173, there is a low positive correlation between arch index and foot posture index in high arched foot. Interpretation: Among high arched foot and low arched foot, Foot Posture Index and Arch Index is correlated, according to Pearson's correlation, only high arched foot shows low positive correlation between Foot Posture Index and Arch Index. Flatfoot shows negative correlation.

A rare case of adult-onset spastic paraparesis associated with Klinefelter syndrome

ReportThe rare association of Klinefelter syndrome and the clinical presentation of a late onset chronic progressive spastic paresis.Clinical Presentation and GeneticsAn infertile, 61-year-old man, presented with late adult onset of gait problems, deep muscle pain, and bladder problems. He presented for the first time, years after onset with a spastic paraparesis with high arched feet. His parents had already died, but the patient described high arched feet with his mother. There is no further certain information about the parents. After thorough investigation, an additional X chromosome was found, whereafter the diagnosis of Klinefelter syndrome could be made. Other acquired and genetic causes for spastic paraparesis or hereditary motor neuropathy are excluded.ConclusionThis rare case, together with three other literature reports by Sasaki (Intern Med 58(3):437–440, 2019), Sajra (Med Arh 61(1):52–53, 2007) and Matsubara et al., (J Neurol Neurosurg Psychiatry 57(5):640–642, 1994). suggests that Klinefelter syndrome can be associated with spastic paraparesis, besides the other various neuropsychiatric symptoms that are more commonly described.

Investigating the Effects of High-arch and Flat Foot Deformities on Postural Control: A Systematic Review and Meta-analysis

Introduction: High-arch and flat foot deformities can negatively impact an individual’s performance in different situations. They may also balance as well as disturb postural control, which is essential for performing optimal routine and port activities, in addition to preventing injuries. This is a comparative meta-analysis of postural control in people with high-arch and flat foot deformities with normal feet.
 Materials and Methods: This is a systematic review of articles published from 2004 to 2021 in Medline/PubMed, Embase/Scopus, LILACS, CINAHL, CENTRAL (cochrane central register of controlled trials), Web of Science, PEDro, and Google Scholar databases.
 Results: The results revealed that the total balance score in people with high-arch and flat foot deformities was lower (P=0.001), compared to normal people. However, no significant difference was observed in the total balance of people with high-arch and flat foot deformities (P>0.05). Additionally, flat-foot people showed a weaker balance in the postural control test on a force plate, when compared to individuals with high-arch feet (P=0.001). Nevertheless, the results of dynamic balance were the same for all groups (P>0.05).
 Conclusion: Our findings indicate that people with high-arch and flat foot deformities suffer from weaker postural control when compared to their normal peers. Moreover, flat-foot people showed lower scores on postural control tests on force plates, compared to subjects with higharch feet, even though they had no significant differences for static and dynamic tests. There was no difference in the results of dynamic balance among the 3 groups.

The Importance of Rebalancing Foot Biomechanics by Computerized Podoscopic Assessment - Study in Charcot Marie Tooth Syndroms

Abstract Charcot–Marie–Tooth disease (CMT) is one of the hereditary motor and sensory neuropathies, a group of varied inherited disorders of the peripheral nervous system characterized by progressive loss of muscle tissue and touch sensation across various parts of the body. Currently incurable, this disease is the most commonly inherited neurological disorder, and affects about one in 2,500 people. A CMT diagnosis involves clinical evaluation of muscle function and atrophy, testing of sensory responses, and electromyography and nerve conduction studies. Often, the most important goal for patients with CMT is to maintain movement, muscle strength, and flexibility. Therefore, an interprofessional team approach with occupational therapy, physical therapy, orthotics, podiatrist, and orthopedic surgeon is recommended. Physical therapy should be involved in designing an exercise program that fits a person’s personal strengths and flexibility, but also in a god evaluation podoscopic assessment. Due to the lack of good sensory reception in the feet, CMT patients need to see a physical therapist in order to stabilize their feet or correct progressive problems by rebalancing the biomechanics of the foot. The procedure involves a computerized assessment, the realization of the plant footprint in the foam and the creation of plantatory therapeutics on the mold. These plantar orthoses help control foot drop and ankle instability and often provide a better sense of balance for patient. Appropriate footwear is also very important for CMT case, but often with difficulty finding well-fitting shoes because of their high arched feet and hammer toes. The patient will use these plantatory proponents in the right shoes in order to: increase of planting support surface, reduction of varus, slowing down the retraction tendency of plant aponeurosis

A Cross Sectional Analysis of Arch Height and Pressure Distribution in a Normalized Population of More than 1000 Subjects

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: There are normal variations in the shape of an individual’s foot. However, recent investigations involving large, heterogenous populations are scarce, complicating attempts to create a uniform definition of clinical foot arch height. The purpose of this study was to determine the distribution of plantar foot pressures from the general population. Methods: 1015 randomly sampled individuals (2030 feet) had a bipedal standing profile obtained utilizing a high sensitivity pressure mat. Data collected included: total foot length (cm), peak pressure (kPa), peak contact pressure (kPa), and total contact area (cm2). Demographic information and data regarding individual comorbidities previously to be linked to pathologic arch height conditions were collected. A flatfoot was defined as Midfoot total area>Mean+1SD while a high arch was defined as Midfoot total area< Mean-1SD. Results: Our logarithmic transformation the data was representative of a normally distributed dataset and our demographic data closely reflective of the demographics United States population. Data for the right foot vs left foot were: 8.18% and 6.50% of participants had a flatfoot, 78.82% and 79.51% had normal arches, and 13.00% and 13.99% had high arches, respectively. The prevalence of normal bilateral arches was 70.54%, bilateral flat feet was 3.55%, and bilateral high-arched feet was 8.67%. Conclusion: Our data demonstrate a normalized distribution of plantar pressures and arch heights that were sampled from a population larger and more representative of the general populous than previously described. Given that our data may more accurately reflect the spectrum of normal adult foot. With these baseline characteristics defined, future research into arch height associated pathologies may proceed with a more standardized assessment when defining study populations.

An Analysis of Foot Morphology Using a Self-Designed Foot Scanner in Preparing Custom-Made Footwear: An Anatomical Approach

Foot morphology and morphometry knowledge is vital in several domains. 60% of the population has foot pain due to ill-fitting footwear. There is no standard device or parameters to evaluate the arches of the foot, and most of the research to assess the arches of the foot. Aim of the study: The study aimed to develop a hodoscope (foot scanner) device to evaluate the arches of the foot. The study's objective was to prepare custom–made footwear based on foot morphology. The study included 849 (405 males and 444 females) participants aged between 25 and 45. Podoscope was used to evaluate the arches of the foot. Based on the evaluation, 62 participants were provided with custom-made footwear based on the morphometry of the foot. The statistical analyses were performed using SPSS software. Wilcoxon Signed Ranks Test was used to analyze the pain scale based on positive ranks, with a statistically significant p-value (< 0.001). Results: 44.19% of men and 47.97% of women had a normal arch foot. 33.08% of men and 28.82% of women had a flat arch, and 22.71% of men and 23.19% of women had a high arch foot. The present study identified foot problems (forefoot, midfoot and hindfoot) using a self-designed podoscope and attempted to design custom–made footwear based on foot morphometry. The quality of the footwear was acceptable and cost-effective. Custom-made footwear based on foot morphology will benefit individuals with foot problems. KEYWORDS: Foot Morphology, Self-Designed Foot Scanner, Custom-Made Footwear, Podoscope.

Using a spherical inverted pendulum and statokinesigram for modeling and evaluating quiet standing posture

This paper proposes a new approach to model and analyze erect posture, based on a spherical inverted pendulum which is used to mimic the body posture. The pendulum oscillates in two directions, [Formula: see text] and [Formula: see text], from which the mathematical model was derived and two torque components in oscillation directions were introduced. They are estimated using stabilometric data acquired by a foot pressure mapping system. The model was quantitatively investigated using data from 19 participants, who were first were classified into three groups, according to the foot arch-index. Stabilometric data were then collected and fed into the model to estimate the torque’s components. The components were statistically processed, and the results revealed that the components in direction [Formula: see text] are able to reject intrinsic perturbation. The frequency spectrum of the components in direction [Formula: see text] was processed using fast Fourier transform, and the results showed the feasibility of the component in segregating foot deformities. In addition, high-arched foot cases tended to be more stable than other cases because the exerted torque is less. The torque profiles estimated by our model were compared with the profiles derived from a classical inverted pendulum. In most cases, our results showed a significant change ( t-test p < 0.05).

Biomechanics of transverse axis of medial longitudinal arch of children's foot based on 3D scanning.

To explore the application value of 3D scanning to obtain the parameters of transverse axis of medial longitudinal arch of foot in the biomechanical evaluation of transverse axis of medial longitudinal arch of foot in children. The feet of children with flat foot, normal foot and high arched foot were scanned with the Foot Secret 3D scanner in the sitting and standing positions. The scanning data were imported into CATIA v5 software for measurement, to obtain four parameters of transverse axis of medial longitudinal arch from transverse arch angle, external transverse arch angle, curvature and transverse arch cross-sectional area. There were statistically significant difference in transverse arch angle, external transverse arch angle and cross-sectional area between sitting and standing positions (p < 0.05). There were statistically significant differences in transverse arch angle, external transverse arch angle, curvature and transverse arch cross-sectional area among children with flat foot, normal foot and high arch foot (p < 0.05). The four parameters of transverse arch angle, external transverse arch angle, maximum curvature and cross-sectional area obtained by three-dimensional scanning can detect the changes of transverse axis of children's foot arch in different body positions with different foot types, which can be effectively used for the biomechanical evaluation of transverse axis of children's foot arch.

The effectiveness of heel raises in managing Haglund deformity pain in figure skaters – a pilot study

Haglund’s deformity (HD) is an abnormal protrusion on the posterosuperior aspect of the calcaneus and a common foot deformity in skaters. Pain due to HD can hinder the skater’s balance and performance on ice. One of the non-surgical management of HD pain is to insert a heel raise into footwear. However, the use of heel raises may impact the biomechanics of skating and increase injury risk in the lower limb. The primary aim of this pilot study was to investigate whether the use of heel raises reduced pain caused by HD in figure skaters effectively. Eight experienced figure skaters performed 10 minutes of on-ice skating under two conditions 1) with heel raises and 2) without heel raises. To reduce bias, the order of the conditions was randomly assigned. Each skater provided their pain perception due to their HD according to a 10 cm visual analogue scale. Other variables such as foot posture, skate foot fit and HD size were also compared. The pilot results concluded that figure skaters with high arched foot types were more prone to more severe HD. Custom fit skates should be done weight bearing to allow for better accommodation of HD, and heel raise use did not significantly reduce HD pain. This pilot study provides initial evidence that challenges the current management of HD pain in figure skaters.

Acute, Transient, Brain Lesions on Magnetic Resonance Imaging in X-linked Charcot-Marie-Tooth type 1 (P13-4.002)

<h3>Objective:</h3> NA <h3>Background:</h3> CMTX1 is an X-linked dominant form of hereditary sensorimotor polyneuropathy. It is caused by mutations in the gap junction protein beta 1(GJB1) gene on chromosome Xq13.1, which encodes connexin 32 protein. CNS can be affected and lead to transient or persistent CNS symptoms including dysarthria, dysphagia, hemiparesis or quadriparesis, ataxia, aphasia, and encephalopathy. <h3>Design/Methods:</h3> <h3>Case Report:</h3> A 22-year-old man presented with acute onset left facial droop, dysarthria and left upper extremity weakness. Two weeks prior he experienced a one-day episode of gastroenteritis. Neurological examination showed weakness in the left lower face, distal muscle weakness in toe extension, ankle dorsiflexion and hand intrinsic muscles, absent lower extremity reflexes, diminished vibration and temperature senses in length-dependent pattern, high-arched feet and hammertoes. Family history of early onset polyneuropathy, never genetically tested. Brain MRI showed marked and symmetric restricted diffusion lesions involving bilateral fronto-parietal white matter, corpus callosum and posterior limb of internal capsule without contrast enhancement. CSF analysis was unremarkable. The patient was given pulse steroid therapy for possible demyelinating disease, his symptoms completely resolved within 48 hours. Two prior similar symptoms, one was diagnosed as acute disseminated encephalomyelitis (ADEM) and treated with steroids. Brain MRI of these two episodes showed similar restricted diffusion abnormalities. Repeat brain MRI seven months after the second episode showed complete resolution of restricted diffusion lesions. Leukodystrophy genetic panel was negative. Genetic testing showed hemizygous pathogenic mutation c.491G&gt;A in GJB1 gene, associated with X-linked Charcot-Marie-Tooth disease - CMTX1. <h3>Results:</h3> NA <h3>Conclusions:</h3> Young patients with history of polyneuropathy presenting with acute CNS symptoms with bilateral white matter and corpus callosum lesions, CMTX1 should be included in the differential diagnosis. Upon confirmation of CMTX1 diagnosis, patient reassurance is important as well as education regarding potential provoking factors that lead to CNS involvement. <b>Disclosure:</b> Dr. Altarazi has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Sankaraneni has nothing to disclose.

A STUDY ON PREVALENCE OF IDIOPATHIC FLATFOOT IN ADOLESCENTS OF NORTH EAST INDIA

Introduction: “Pes planus” commonly known as “atfoot” is characterised by sagging of medial longitudinal arch with secondary hind foot valgus, forefoot abduction and supination relative to hind foot. Idiopathic type of atfoot is physiological and there is a lack of clear consensus about the maximum limit of age for its persistence. Assessment of medial longitudinal arch can be done either on clinical grounds or based on radiological evidences. Foot prints can be easily obtained with simple ink print method. They are simple, fast, inexpensive and non-invasive way to assess the arches of foot. The present study was conducted over a Materials and methods: period one year under Department of Orthopaedics, Assam Medical College &amp; Hospital. In this community based cross sectional study, 800 school going children of age group 10 to 15 years were included. Bilateral footprints of all children were taken using simple ink print method. Results and Observations: The Staheli's PAI value ≥ +2SD from the mean was regarded as threshold index for atfoot in either feet. The cut off in left foot was PAI value ≥1.29 and for right foot it was ≥1.18 to dene atfoot. Number of children with normal foot was 704 (88%) compared to 72 children (9%) with atfoot. 3% of children had high arched foot. There is a signicant c Discussion and conclusion: orrelation in terms of persistence of atfoot in adolescents with obesity, faulty shoe wearing practices and children belonging to higher socio-economic groups. Though exible atfoot is self correctable but proper cut off age by which it resolves is still a matter of debate

Clinical characteristics analysis of 22 062 patients of foot and ankle deformity from QIN Sihe Orthopaedic Surgery Database between May 25, 1978 and December 31, 2020

Based on the clinical data of patients with foot and ankle deformities in the QIN Sihe Orthopaedic Surgery Database, to analyze the characteristics and treatment strategies of foot and ankle deformities, and provide a basis for clinical decision-making. A total of 22 062 patients with foot and ankle deformities who received orthopedic surgery between May 25, 1978 and December 31, 2020 were searched in the QIN Sihe Orthopedic Surgery Database. The gender, age at operation, regional distribution, etiology, type of deformity, operation method, postoperative fixation method, and other information were collected. Among the 22 062 patients, there were 13 046 males (59.13%) and 9 016 females (40.87%); the age at operation ranged from 1 to 77 years, with a median of 17 years, and 20 026 cases (90.77%) were aged 5 to 40 years. The patients came from 32 provinces, municipalities, and autonomous regions across the China and 5 countries including India and the United States, et al. The etiology and diseases type covered 154 kinds (of which sequelae of poliomyelitis, cerebral palsy, spina bifida and tethered spinal cord, congenital equinovarus foot, post-traumatic foot and ankle deformity, and Charcot-Marie-Tooth disease accounted for the highest proportion). The types of deformities included varus foot, equinus foot, valgus foot, talipes calcaneus, equinocavus, high arched foot, claw toe, and flail foot. Surgical methods included tendon lengthening, soft tissue release, tendon transposition, osteotomy orthopedics, and ankle arthrodesis. The 36 620 operations were performed, including 11 561 cases of hip, knee, and lower leg operations to correct the foot and ankle deformities. Postoperative fixation methods included Ilizarov external fixator in 2 709 cases (12.28%), combined external fixator in 3 966 cases (17.98%), and plaster or brace fixation in 15 387 cases (69.74%). Male patients with foot and ankle deformities account for a large proportion, and the population distribution is mainly adolescents, with a wide distribution of regions, causes and diseases, and talipes equinovarus and varus foot are the main types of deformities. Foot and ankle deformities are often combined with deformities of other parts of the lower limb, which requires a holistic treatment concept. The application of foot soft tissue and bone surgery combined with Ilizarov external fixator and combined external fixators provides a guarantee for the correction of complex foot and ankle deformities.

Correlation analysis between body mass index and foot length in Chinese adolescents: a regional study

This study aims to analyse the relationship between body mass index and foot length in Chinese adolescents and to provide theoretical guidance for preventing a flat foot in Chinese adolescents. This study recruited 1477 students aged 14–23 years. The participants’ height, weight, and body mass index were measured, as well as baseline data, including age, gender and foot length. Differences in foot length (bilateral) and flat foot distribution were statistically significant except for the normal foot and high arch foot distribution based on different body mass index groups. Linear correlation analysis demonstrated that body height, weight and body mass index were positively correlated with bilateral foot length regardless of gender. Body mass index acted as a risk factor for flat foot (bilateral) through disordered multi-classification logistic regression analysis. Body mass index was positively correlated with left and right foot length regardless of gender and acted as a risk factor for a flat foot in Chinese adolescents. Practitioner summary: Significant differences exist in the anthropometric data of various races and ethnic groups. The study was investigated in the form of a cross-sectional study. BMI was positively correlated with bilateral foot length and acted as a risk factor for a flat foot in Chinese adolescents.

The association between foot posture, single leg balance and running biomechanics of the foot

ObjectivesA mal-aligned foot posture (high-arched and flat feet) and poor single leg balance ability have been separately associated with foot injuries during running. Therefore, clinicians assess these routinely. However, the extent to which foot posture and single-leg balance ability affect actual foot biomechanics during running is not known. This study aims to investigate the association of foot posture, single-leg balance ability, and foot biomechanics during running. MethodThis is a cross sectional study of sixty-nine participants who had their foot postures and single-leg balance ability assessed. The Foot Posture Index and Balance Error Scoring System were used. Their foot kinetics was measured as they ran on an instrumented treadmill and foot kinematics was processed using a 3D motion capture system. Multiple-regression was used to analyse the variance of foot biomechanics explained by foot posture and single-leg balance ability. ResultsFoot posture and single-leg balance ability were found to account significantly for the variance in rearfoot eversion (24%) and forefoot dorsiflexion (7%). Two regression equations were derived, where rearfoot eversion and forefoot dorsiflexion during running may be predicted. ConclusionFoot posture and single-leg balance ability can predict rearfoot eversion and forefoot dorsiflexion only during running. Based on the regression equations, individuals with the same foot posture but different single-leg balance ability may exhibit different foot kinematics. However, the angular differences are small. The equations may be useful for clinicians working in places where running gait analysis equipment are not readily accessible. Further studies with larger sample sizes are required to validate these equations. In addition, further studies are necessary to investigate the effect of these two variables under different running conditions e.g. with footwear and with orthoses.

Elite Tennis Players Experiencing High-Arched Supination and Cuboids Dropped Foot Syndromes in Daily Normal Gait.

Many studies have focused on the plantar pressure characteristics of specific movements and footwork in tennis. However, little research has been conducted for exploring the foot characteristics among tennis professionals’ daily habitual paces. This study aims to examine the pressure profiles associated with foot posture and balance abilities of elite tennis players during normal gait to understand how foot loading patterns result from habitual paces that may be derived from intensive tennis training and competition. A cross-sectional comparative study is conducted on 95 male college elite tennis players (mean age: 20.2 ± 1.2 years) and 100 male recreational tennis players (mean age: 19.8 ± 0.9 years). Bipedal plantar pressure distributions (PPDs) associated with arch index (AI) and centers of gravity balance are explored through the plantar pressure device. The foot posture is estimated to determine the rearfoot postural alignment. During the midstance phase of walking with a normal gait, the bipedal AI values of the elite group are significantly lower, indicating that they have high-arched feet. Additionally, the elite group experienced higher PPDs at the lateral regions of their longitudinal arches and heels and relatively lower PPDs at the medial portions of both feet. Rearfoot postural alignment resonance analysis of the PPDs suggests that the elite group experienced foot supination associated with cuboid dropped. Moreover, the right foot bears heavier centers of gravity balance in the present study. The elite tennis players in the study are categorized as having high-arched supination with cuboids dropped when performing daily habitual paces. This finding warrants further investigation into the correlation between possible injuries and daily habitual paces that may result from tennis’ intensive training and competition.

The Association between Symmetrical or Asymmetrical High-Arched Feet and Muscle Fatigue in Young Women

The foot arches are responsible for proper foot loading, optimal force distribution, and transmission throughout the soft tissues. Since the foot arch is an elastic structure, able to adapt to forces transmitted by the foot, it was reported that low arch is related to excessive foot pronation, while high arched foot is more rigid and inflexible. Therefore, it is also probable, that foot arch alterations may change the force transmission via myofascial chains. The objective of this study was to evaluate the effect of symmetrical and asymmetrical excessive feet arching on muscle fatigue in the distal body parts such as the lower limbs, trunk, and head. Seventy-seven women (25.15 ± 5.97 years old, 62 ± 10 kg, 167 ± 4 cm) were assigned to three groups according to the foot arch index (Group 1—both feet with normal arch, Group 2—one foot with normal arch and the other high-arched, Group 3—both feet with high-arch). The bioelectrical activity of the right and left hamstrings muscles, erector spine, masseter, and temporalis muscle was recorded by sEMG during the isometric contraction lasting for 60 s. The stable intensity of the muscle isometric contraction was kept for all the time during the measurement. Mean frequency difference (%), slope (Hz), and intercept (Hz) values were calculated for muscle fatigue evaluation. No differences were observed in fatigue variables for all evaluated muscles between the right and left side in women with symmetrical foot arches, but in the group with asymmetric foot arches, the higher muscle fatigue on the normal-arched side compared to the high-arched side was noted. Significantly greater values of the semitendinosus—semimembranosus muscle frequency difference was observed on the normal-arched side compared to the high-arched side (p = 0.04; ES = 0.52; −29.5 ± 9.1% vs. −24.9 ± 8.4%). In the group with asymmetric foot arches, a significantly higher value of lumbar erector spinae muscle frequency slope (p = 0.01; ES = 1.32; −0.20 ± 0.04 Hz vs. −0.14 ± 0.05 Hz) and frequency difference (p = 0.04; ES = 0.92; −7.8 ± 3.1% vs. −4.8 ± 3.4%) were observed on the high-arched foot side compared to the side with normal foot arching. The thoracic erector spine muscle frequency slope was significantly larger in women with asymmetrical arches than in those with both feet high-arched (right side: p = 0.01; ES = 1.25; −0.20 ± 0.08 Hz vs. −0.10 ± 0.08 Hz); (left side: p = 0.005; ES = 1,17; −0.19 ± 0.04 Hz vs. −0.13 ± 0.06 Hz) and compared to those with normal feet arches (right side: p = 0.02; ES = 0.58; −0.20 ± 0.08 Hz vs. −0.15 ± 0.09 Hz); (left side: p = 0.005; ES = 0.87; −0.19 ± 0.04 Hz vs. −0.14 ± 0.07 Hz). In the group with asymmetric foot arches, the frequency difference was significantly higher compared to those with both feet high-arched (right side: p = 0.01; ES = 0.87; −15.4 ± 6.8% vs. 10.4 ± 4.3%); (left side: p = 0.01; ES = 0.96; 16.1 ± 6.5% vs. 11.1 ± 3.4%). In the group with asymmetric foot arches, a significantly higher value of the masseter muscle frequency difference was observed on the high-arched side compared to the normal-arched side (p = 0.01; ES = 0.95; 6.91 ± 4.1% vs. 3.62 ± 2.8%). A little increase in the longitudinal arch of the foot, even though such is often not considered as pathological, may cause visible changes in muscle function, demonstrated as elevated signs of muscles fatigue. This study suggests that the consequences of foot high-arching may be present in distal body parts. Any alterations of the foot arch should be considered as a potential foot defect, and due to preventing muscle overloading, some corrective exercises or/and corrective insoles for shoes should be used. It can potentially reduce both foot overload and distant structures overload, which may diminish musculoskeletal system pain and dysfunctions.

Application of the \u201ctelescopic rod\u201d in a combined surgical technique for the treatment of congenital pseudarthrosis of the tibia in children

BackgroundThe current surgical treatment of choice is the combination surgical technique, involving tibial intramedullary fixation to maintain the mechanical axis and mechanical stability of tibial pseudarthrosis. In traditional combined surgery, the Williams rod is often used. Long-term intramedullary fixation of the foot and ankle will affect the ankle joint function of children. The intramedullary rod is relatively shorter due to the growth of the distal tibia. In addition, there are some complications such as epiphyseal bone bridge and high-arched foot. The use of a telescopic intramedullary rod may avoid these complications.PurposesTo investigate the initial effect of the “telescopic rod” in a combined surgical technique for the treatment of congenital pseudarthrosis of the tibia in children.MethodsA retrospective study including 15 patients with Crawford type IV CPT who were treated using a combined surgical technique and the telescopic rod from January 2017 to May 2018. The average age at the time of surgery was 43.3 months (16–126 months). Of the 15 patients, 7 had proximal tibia dysplasia and 12 exhibited neurofibromatosis type 1. The combined surgical technique using the telescopic rod included the excision of pseudarthrosis, intramedullary rod insertion, installation of Ilizarov’s fixator, tibia-fibular cross union, and wrapping autogenic iliac bone graft. The incidence of refracture, ankle valgus, tibial valgus, and limb length discrepancy (LLD) in patients were investigated.ResultsAll patients achieved primary union with an average follow-up time of 37.3 months (26–42 months). The mean primary union time was 4.5 months (4.0–5.6 months). Nine cases showed LLD (60%), with an average limb length of 1.1 cm (0.5–2.0 cm). Ankle valgus, proximal tibial valgus, telescopic rod displacement, and epiphyseal plate tethering occurred in 1 case (6.6%) (18°), 3 cases (20%) (10°, 5°, and 6°, respectively), 6 cases (40%), and 2 cases (13%), respectively. There were no refractures during the follow-up periods.ConclusionAlthough there are complications such as intramedullary rod displacement while using the telescopic rod in a combined surgery, the primary healing rate of congenital pseudarthrosis of the tibia in children is high.

Benefits of 3D Printed and Customized Anatomical Footwear Insoles for Plantar Pressure Distribution.

During walking, the foot is in direct contact with the insole of the footwear, and it affects the biomechanics of the whole human body. The aim of this study was to compare the plantar pressure distribution while walking in the same footwear in three different situations: with an original footwear insole, with an ethylene-vinyl acetate customized insole, and with a 3D printed anatomical insole to find out the optimal insoles for people with a normal, flat, and high arched foot according to the plantar pressure relief. Fifty-one adults were grouped into three groups (normal foot, flat foot, and high arched foot geometry). The feet of the randomly selected subjects from each group were scanned, and the insoles were designed on the basis of the foot model. These models were then used for the 3D printing. The plantar pressure distribution was observed when walking in all three different insole types for each of the three subjects with the different foot types. The peak pressure values in the forefoot, midfoot, and rearfoot and contact area were compared. The results of the study show that customized insoles influence the plantar pressure distribution mainly in people with a flat foot or with a high arched foot deformity. This influence is dependent on the type of the customized insoles, mainly in people with a high arched foot. People with a flat foot deformity have a similar plantar pressure relief in the thermoplastic insoles as those in the 3D printed insoles, and both these customized insoles can be used as a supplementary therapeutic instrument. Our study showed that the biggest attention, with regards to customizing insoles, is required by people with a high arched foot deformity, and we recommend that these people use fully customized insoles which can be guaranteed with 3D printing techniques.