Orthopedic Shoes Research Articles

Minimal shoes improve stability and mobility in persons with a history of falls

Postural and walking instabilities contribute to falls in older adults. Given that shoes affect human locomotor stability and that visual, cognitive and somatosensory systems deteriorate during aging, we aimed to: (1) compare the effects of footwear type on stability and mobility in persons with a history of falls, and (2) determine whether the effect of footwear type on stability is altered by the absence of visual input or by an additional cognitive load. Thirty participants performed standing and walking trials in three footwear conditions, i.e. conventional shoes, minimal shoes, and barefoot. The outcomes were: (1) postural stability (movement of the center of pressure during eyes open/closed), (2) walking stability (Margin of Stability during normal/dual-task walking), (3) mobility (the Timed Up and Go test and the Star Excursion Balance test), and (4) perceptions of the shoes (Monitor Orthopaedic Shoes questionnaire). Participants were more stable during standing and walking in minimal shoes than in conventional shoes, independent of visual or walking condition. Minimal shoes were more beneficial for mobility than conventional shoes and barefoot. This study supports the need for longitudinal studies investigating whether minimal footwear is more beneficial for fall prevention in older people than conventional footwear.

Evaluation of the effectiveness of a physical therapy complex program in patients after surgical treatment of ruptured Achilles tendon

The purpose of the work is to evaluate the effectiveness of a comprehensive program of physical therapy in patients after surgical reconstruction of the Achilles tendon.Materials and methods. Subjects population comprises 58 patients (aged 34–57 years), including 39 (67.24 %) males and 19 (32.76 %) females, who were up to the surgical restoration of the Achilles tendon. All patients were divided into two groups: the main group (MG, n = 29) and the control one (CG, n = 29). Research methods embraced a review of scientific literature presented on the Internet; experimental research of ascertaining and formative orientation; pedagogical observation; goniometry, plantodynamometry, modified Romberg test; methods of mathematical statistics.Results. After surgery, the angle of plantar flexion was better (P 0.05). The percentage values of the load distribution on the operated extremity had improved by the final measurement date (16 weeks), which reduced the difference in the load distribution on the extremities to 9.20 ± 3.09 % in MG patients and up to 14.60 ± 2.98 % in CG patients (Me (25 %; 75 %) ) ‒ 8 (6; 12) % and 16 (12; 18) %). The indicators of the final performance of Romberg test were significantly better in MG patients, making 11.4 ± 2.13 s, which is 2.5 seconds better than in CG patients (P < 0.01).Conclusions. Dynamic characteristics of plantar flexion were restored by the following means: adaptive physical exercises and corrective gymnastics, different walking exercises, exercises with fitball, exercises on an exercise bike and step platforms, hydrotherapeutic exercises, orthopedic shoes, physiotherapeutic methods, and massage. The proposed comprehensive program is effective and can be used for post-surgical physical therapy in patients diagnosed with Achilles tendon rupture.

Rehabilitation equipment

Technical means of rehabilitation (TMR) include special devices and mechanisms are intended to compensate or completely eliminate persistent disabilities in individuals with limited physical and mental capabilities and aimed at normalizing physical and work activity. They include special means for self-care and care, means for orientation in space, devices for communication and information exchange, materials for training and education, as well as devices for engaging in work activities. Rehabilitation equipment also includes all types of prostheses, orthopedic shoes and special clothing, eye prostheses and hearing aids, special sports equipment and sport outfit, as well as mobility aids (wheelchairs). They all have a single purpose, which is to facilitate the daily life of handicapped people and people with disabilities. Provision of this category of persons with technical means of rehabilitation is carriedout on the basis of individual programs. Federal Law of November 24, 1995 No. 181-FZ “On the Social Protection of Persons with Disabilities in the Russian Federation” guarantees free provision of technical rehabilitation means at the expense of the federal budget to the disabled people [6] in the Russian Federation.

Analysis of type and frequency dynamics of rehabilitation assistive devices in children with cerebral palsy

Background. Currently, cerebral palsy is the most common neuromuscular disease in the pediatric population. Spastic forms of cerebral palsy are characterized by secondary musculoskeletal complications. They are corrected by the use of assistive devices and, especially, orthoses, along with surgical treatment, botulinum toxin, and others.&#x0D; Aim. The aim of this study was to assess the type and frequency dynamics of rehabilitation assistive devices in children with spastic forms of cerebral palsy, depending on the level of the gross motor function of the patient.&#x0D; Materials and methods. A prospective analysis was conducted by questioning 214 parents of children with spastic forms of cerebral palsy who were treated for the period from 2017 to 2019. The patients were divided into five groups according to the gross motor function classification (GMFCS). The statistical processing was performed using the application package Statistica 10 and Microsoft Excel.&#x0D; Results. Statistically significant differences in variances (p 0.05) were obtained between the number of rehabilitation assistive devices used in the anamnesis in the year before the questionnaire (period I) and assistive devices used in the last six months before the questionnaire (period II). Repeatedly, patients used orthopedic shoes the most often, and the trunk-hip-knee-ankle-foot orthoses the most rarely. We found five main causes groups of assistive device use failure for children with cerebral palsy.&#x0D; Conclusion. Statistically significant differences in variances were obtained between the frequency of rehabilitation assistive devices used in the anamnesis and during the last six months before the questionnaire was obtained. It has been confirmed that patients used orthopedic shoes most regularly; of all functional orthoses, hip adductor orthosis was used most often repeatedly, whereas the trunk-hip-knee-foot orthoses were the least common. Factors such as a negative attitude of the child towards the orthosis, uncomfortable in life, the presence of construction errors of the product, the absence of appropriate appointments in the individual rehabilitation and habilitation programs for the patient, have led to the most frequent rejection of the reuse of the technical device for rehabilitation. At the same time, positive or negative dynamics on the condition of the patient affected the regularity of the use of a technical device for rehabilitation in only one in six patients.

족부질환 장애 개선을 위한 정형 신발 제품의 디자인 특성

족부질환 장애 개선을 위한 정형 신발 제품의 디자인 특성

Orthopedic Boot-Tree 3D Design by means of the Integral Curves of Solutions of Differential Equations

For the preparation of orthopedic shoes, it is necessary to design boot-trees, where pathological abnormalities of club feet are taken into account as much as possible. For the normal functioning of the club foot, we have to develop such an internal shape of special-purpose footwear, which is comfortable for the patient. This paper describes the methods and issues of the 3D design for constructing the geometric shapes of the main cross sections of the orthopedic boot-tree. In the research process, the authors’ team of this article relied mainly on the patient database, containing the anthropometric, strain-gauge, and pedographic data on club and pathological feet. To construct the shapes of the main cross sections of the orthopedic boot-tree, we have used the integral curves to the suitable second-order differential equations. By means of a computer program, we executed turning and connection of sections of the obtained curves, on the basis of which we have the shapes of transverse-vertical cross sections of the orthopedic boot-tree. This paper also describes the main longitudinal-vertical section and the print of the orthopedic boot-tree in 3D format. By using a program of 3D design (Delcam), a skeleton of the orthopedic boot-tree was constructed in the spatial format.

The attitude of doctors of various specialties to the problem of flatfoot

Purpose: to assess the subjective perception of flatfoots prevalence in children, its age dynamics and the main approaches to the diagnosis and treatment by doctors of various pediatric specialties with different medical experience and working in medical facilities at various levels by anonymous questionnaire.&#x0D; Materials and methods. Questionnaire data from 80 orthopedists (50 outpatient doctors, 30 doctors from a specialized scientific research institute and orthopedic departments of city hospitals (research institutes / hospitals) and 30 neurologists (polyclinic).&#x0D; Results: our study demonstrated that outpatient orthopedists diagnose the flatfoot on average in half of the cases. The orthopedists diagnose flatfoot only by means of visual examination in 46.1% of cases (neurologists in 85.7% of cases). According to our data, 58.9 % of outpatient doctors recommend wearing special orthopedic shoes (46.1 % only if the foot alone is affected) and 95.1 % of specialists recommend wearing individual orthopedic insoles (53.6 % if there are complaints). While 88.2 % of the orthopedic surgeons from specialized research institutes and hospitals do not recommend wearing orthopedic shoes; 26.7 % of experts recommend wearing individual orthopedic insoles only in the presence of complaints. On the other hand, the neurologists recommend wearing orthopedic shoes 5.3 times more often than the orthopedists do.&#x0D; Conclusion: our study demonstrates that the specialty of the doctor (orthopedist, neurologist) and the type of health care facilities in which the specialist works have the greatest impact on his subjective perception of the prevalence and age dynamics of flatfoot in children, tactics of diagnostics and treatment. The outpatient orthopedists diagnose flatfoot 4.2 times more often than the orthopedic surgeons from the specialized research institute and hospitals. Also, the outpatient orthopedists prescribe wearing orthopedic shoes 4.9 times more often (insoles 3.6 times more often) in comparison with the orthopedic surgeons of the specialized research institute and orthopedic hospitals. Summarizing the above mentioned, we would like to note that due to the fact that the current assessment of the age limits of the arch height feet is ambiguous, there is a need to introduce a unified system for assessing the foots shape and posture with defining the concepts of average height and typically developing foot.

A comparison of two designs of postoperative shoe for hallux valgus surgery: A biomechanical study in a cadaveric model

BackgroundHallux Valgus Surgery success depends not only on the operative technique, but also on the care of the foot during the postoperative period. Orthopedic shoes have been developed to decrease the weight load on the first ray, an excess of which might lead to a loss of fixation or pseudoarthrosis.The goal of this study was to determine how the load distribution changed as the forced applied to the foot increased, with and without an orthopedic shoe. Also, we compared to different shoe models. MethodsPressure sensors were placed under the first metatarsal head and the heel of twenty specimens of fresh cadaveric adult feet. Two orthopedic shoes were chosen, a double padded (MS) and a reverse camber shoe (RCS). 10 kg loads were progressively applied, up to 60 kg. We first compared three instances: no shoe, MS and RCS. A secondary analysis comparing barefoot versus shoes was performed. A mean comparison was performed (ANOVA/T-student). ResultsThe mean pressure of the heed and the first metatarsal showed that there were significant differences between groups (P < .005). The secondary analysis (no shoe vs orthopedic shoes) showed that the pressure without shoe was significantly higher than with any orthopedic shoe (P < .005). There were no statistically significant differences between models of shoes (P = .402). ConclusionAfter a surgical procedure for hallux valgus fixation, postoperative shoes should be indicated to decrease the pressure on the first metatarsal head and heel in order to avoid an overload of the postoperative area. Level of evidenceCadaveric study. Level V.

Assessment of COP characteristics and force-time changes during walking in the third trimester of pregnancy

Purpose: The primary aim of this study was to analyse the COP characteristics and force-time changes during walking between weeks 27 and 36 of pregnancy. The secondary objective was to verify the influence of the specific orthopaedic shoes that were given to the experimental group. The experimental group wore patented J Hanák R biomechanical footwear and insoles, which are designed to help with redistribution of forces acting on foot, to support both longitudinal and transverse arches of the foot and to strengthen the foot muscles during movement.Methods: Seventy-three pregnant women participated in this study. This group was random divided into the experimental group (35 pregnant women) wearing specific orthopaedic shoes and the control group (38 pregnant women). The motor task consisted of five gait trials where two foot prints for each leg were always recorded. The participants started barefoot walking 3 m ahead of the pressure platform and finished the trial 1 m after the end of the platform in order to preserve acceleration and deceleration in gait. Participants walked at their own preferred velocity. All pedobarometric parameters were registered by Emed walkway - trademark of novel gmbh in Munich, Germany. Data processing was divided to two scrips. The first script processed data to these variables (COP characteristics): Centre of pressure index (COPI), centre of pressure excursion index (COPEI), distance (D) of COP, maximum velocity (MaV) and mean velocity (MeV) of COP. The second script processed data for ten pre-defined areas of the foot: hindfoot, midfoot, MH1-5 – metatarsal heads, big toe, second toe, toes 3, 4 and 5 with these applied variables (force-time characteristics): Force-time integral (FTI) and contact time (CT).Results: For the experimental group, in comparison between 27th week and the 36th week of gestation, we can find lower COPI for both feet, significantly only for the left foot (p=0.04). Also, significant difference in COPEI (p=0.03, p=0.03) for both feet was found. In comparison pre and post measurement we found higher values of parameters COPI and COPEI and that indicates more lateral weight shifting during the last trimester. We can distinctly register extension of D, especially for the left foot (p=0.04). Changes in velocity of COP indicate that MaV was increased for both feet (p=0.00, p=0.00) and MeV was significantly increased only for the right foot (p=0.00) in the 36 week of pregnancy. For the control group, we found no significant changes in COPI, COPEI or COP. MaV and MeV of COP were significantly increased for both feet in the 36 week of pregnancy (p=0.02, p=0.00, p=0.01, p=0.00). Higher values of MaV and MeV indicate that pregnant women accelerated their walking in the 36 week of pregnancy. Further, force-time characteristics in most cases did not reveal statistically significant changes in the last trimester.Conclusion: Over the last three months of pregnancy, significant observable changes can be found, especially through COP parameters of the experimental and the control group. We found out that the specific orthopaedic shoes given to the experimental group influenced the trajectory of COP, which could have positive health aspects. Further, certain conflicting results of our study in comparison with other similar studies only confirm that individual biomechanic and physiological developments in pregnancy affect the kinematic and kinetic aspects of walking differently.Key Words: Center of pressure, pregnancy, gait, feet

Utilization of rapid prototyping technology for the fabrication of an orthopedic shoe inserts for foot pain reprieve using thermo-softening viscoelastic polymers: A novel experimental approach

This research work has been completed by concentrating on the structure of inserts for foot orthosis fabricated by utilizing rapid prototyping technology. Thermoplastic elastomer and thermoplastic polyurethane are the most commonly used materials that are being used in customized three-dimensional printed orthotic insoles, which are comfortable and prevent the user in many foot disorders. Thermo-softening viscoelastic polymers, explicitly Filaflex and Ninjaflex, have been printed by utilizing Flash Forge three-dimensional printers to evaluate the mechanical properties of specimens with alterations of the percentage rate fill-up design replicas. The results are compared on the basis of hardness test, flexural/bending test, and tensile test using Durometer and Universal Testing Machine (UTM). It has also been observed that the most significant effecting factor is infill density.

Orthopedic services as a tool of medical rehabilitation of patients with foot drop syndrome

To study the features of the rehabilitation of patients with foot drop syndrome and to develop recommendations for the appointment of technical means of rehabilitation (TMR) for this pathology. Retrospective analysis of the survey data of 375 patients in need of lower limb orthosis was carried out. General clinical and biomechanical methods were used to study the disturbances of statodynamic function of the musculoskeletal system. The results confirm that patients with foot drop syndrome have disturbances of support, stability, symmetry and rhythmicity of walking and, as a result, a significant deterioration in the quality of life. It has been established that the patients is not fully provided with orthoses and orthopedic shoes appointed to compensate for impaired function. Practitioners and rehabilitation specialists have difficulties in substantiating the needs and recommendations of TMR for a particular patient. The presented medical and technical requirements for product designs, the methodology for determining the need for them and recommendations for the appointment of TMR will contribute to the successful rehabilitation of patients with foot drop syndrome.

Description of orthotic properties and effect evaluation of ankle-foot orthoses in non-spastic calf muscle weakness.

To describe the orthotic properties and evaluate the effects of ankle-foot orthoses for calf muscle weakness in persons with non-spastic neuromuscular disorders compared with shoes-only. Cross-sectional study. Thirty-four persons who used ankle-foot orthoses for non-spastic calf muscle weakness. The following orthotic properties were measured: ankle-foot orthosis type, mass, and ankle and footplate stiffness. For walking with shoes-only and with the ankle-foot orthoses, walking speed, energy cost and gait biomechanics were assessed. Four types of ankle-foot orthosis were identified: shaft-reinforced orthopaedic shoes (n = 6), ventral ankle-foot orthoses (n = 10), dorsal leaf ankle-foot orthoses (n = 12) and dorsiflexion-stop ankle-foot orthoses (n = 6). These types differed significantly with regards to mass, ankle-and footplate stiffness. Compared with shoes-only, all ankle-foot orthoses/orthopaedic shoes groups combined increased walking speed by 0.18 m/s (95% confidence interval (95% CI) 0.13-0.23), reduced energy cost by 0.70 J/kg/m (95% CI 0.48-0.94) and limited ankle dorsiflexion by -3.0° (95% CI 1.3-4.7). Higher ankle-foot orthoses ankle stiffness correlated with greater reductions in walking energy cost and maximal ankle dorsiflexion angle. Ankle-foot orthoses for persons with non-spastic calf muscle weakness vary greatly in properties and effects on gait. The large variation in effectiveness may be due to differences in ankle stiffness, although this requires further prospective evaluation.

The Lucie Odes

The Lucie Odes Heather Treseler (bio) The Lucie Odes For Lucie Nell Beaudet (1960–2018) I. I’d known you six years before you told mehow your first husband pimped you out—used the cash to buy a fried-chicken franchise along a rural highway in Alabama. How youslept under the counter where you cashieredwings and thighs. How you rinsed, out back, and spread baby powder across a bath towelto soak up the tumid August sweat, keep offskittering roaches. For the rest of your life you had nothing to do with chicken. Mixed,in memory, with the smell of strange men’ssemen. How you dreaded what came despite rough-shod precaution. How you stole fromthe till, dollar at a time, until you had enoughfor a bus to the clinic. I picture you there alone, benumbed, draped and gauzed in a steel theater,vowing never to seek what had been siphoned.How, after, he hunted you with a shotgun, [End Page 109] not to get you back but to put the narrow shapeof you under his dirty boot, under carmine soil.He called you darling paydirt, his working girl, and promised broken knees; a bullet in eachpalm; a tongue ribboned; and your eyes gored—in primitive backwoods punishment and burial. [End Page 110] II. Twenty-seven bucks got you as far as St. Louis,once the gambol of young Thomas Stearns Eliot,an indoor creature, his double hernia delicately trussed as he daydreamed his mahogany futurestaring into the glass of Prufrock’s Furniture,plotting revenge against the failure of his flesh. You heard, on the radio, that Eliot was the greatpoet from St. Louis, so you bought his Quartets,recited the liturgical lines as you washed floors nightly at the medical school. There, you metDr. Fischer, famed neuroanatomist, fugitiveof Kristallnacht, who insisted on cleaning his own lab to Wagner’s Flying Dutchman. He sawyour mop and asked your name. Within a week,you’d offered to work for free if he would train you in pathology, and to his surprise you lovedperfusing tissue, fixing slides, teasing diseaseinto blooms of legible color. You did not flinch at gutted cadavers or dank shit of euthanizedchimps. Neither of you spoke of a past, of menmechanized in murder who killed off a sister, or the dark knives in a drunk mother’s slurrykitchen. Both of you, schooled in subterfuge,took temporary refuge in never looking back. [End Page 111] III. Unlikely from the start: our friendshipin a night course where I felt a fraud,teaching adults as old as my mother. You with the cornflower-blue eyes, silkblouses, Chanel blush, and cat-eye glasses,classing up the class. My ugly orthopedic shoes and brace. Both of us learning to actfrom half-wrecked bodies: my accidenta small occasion beside your catastrophe, paralysis, metal chair. In your essays,I learned of the reckless man who sped,flipped his car, the chassis’s shear of your thoracic spine, a tailpipe’s tattoo of yourlong leg. How Dr. Fischer visited, daily,as you recovered. I learned, too, of your penchant for opera and Creole cooking,Melville and Eliot. And of your technicaljob, the spellbind that is mitosis: daughter cells twinned in chromosomes, circumstance.Ballet of mirror neurons. After the last class,I walked to your car while snow squalled low over the sullied city, Prufrock’s retreats. Soon,I was sidekick and kid sister. Two solitudesopened to the field and furrow in each other. [End Page 112] IV. What you knew: how to anesthetize a smallanimal without it seeing the glint of needle.Sculpt perfect blue lunettes and dark kohl over the eyes; launder black lace; rise earlyand stay up late; quell heartbreak, hangover.Coax a cork or cactus bloom. Plump a soufflé, dodge a Bible thumper. That year, my petitereckoning: a man-child to whom I’d beenbetrothed called it off late one night, in a fit of rage, as I lay down to sleep. For weeks,I dozed upright in a shabby sublet wherethe lights...

Orthopedic services as a tool of medical rehabilitation of patients with foot drop syndrome

To study the features of the rehabilitation of patients with foot drop syndrome and to develop recommendations for the appointment of technical means of rehabilitation (TMR) for this pathology. Retrospective analysis of the survey data of 375 patients in need of lower limb orthosis was carried out. General clinical and biomechanical methods were used to study the disturbances of statodynamic function of the musculoskeletal system. The results confirm that patients with foot drop syndrome have disturbances of support, stability, symmetry and rhythmicity of walking and, as a result, a significant deterioration in the quality of life. It has been established that the patients is not fully provided with orthoses and orthopedic shoes appointed to compensate for impaired function. Practitioners and rehabilitation specialists have difficulties in substantiating the needs and recommendations of TMR for a particular patient. The presented medical and technical requirements for product designs, the methodology for determining the need for them and recommendations for the appointment of TMR will contribute to the successful rehabilitation of patients with foot drop syndrome.

State of the art design protocol for custom made footwear for people with diabetes and peripheral neuropathy.

Supported by evidence‐based guidelines, custom‐made footwear is often prescribed to people with diabetes who are at risk for ulceration. However, these guidelines do not specify the footwear design features, despite available scientific evidence for these features. We aimed to develop a design protocol to support custom‐made footwear prescription for people with diabetes and peripheral neuropathy. The population of interest was people with diabetes who are at moderate‐to‐high risk of developing a foot ulcer, for whom custom‐made footwear (shoes and/or insoles) can be prescribed. A group of experts from rehabilitation medicine, orthopaedic shoe technology (pedorthics) and diabetic foot research, reviewed the scientific literature and met during 12 face‐to‐face meetings to develop a footwear design algorithm and evidence‐based pressure‐relief algorithm as parts of the protocol. Consensus was reached where evidence was not available. Fourteen domains of foot pathology in combination with loss of protective sensation were specified for the footwear design algorithm and for each domain shoe‐specific and insole (orthosis)‐specific features were defined. Most insole‐related features and some shoe‐related features were evidence based, whereas most shoe‐related features were consensus based. The pressure‐relief algorithm was evidence based using recent footwear trial data and specifically targeted patients with a healed plantar foot ulcer. These footwear design and pressure‐relief algorithms are the first of their kind and should facilitate more uniform decision making in the prescription and manufacturing of adequate shoes for moderate‐to‐high‐risk patients, reducing variation in footwear provision and improving clinical outcome in the prevention of diabetic foot ulcers.

Features of specialized care for patients with diabetic osteoarthropathy

Objective: to evaluate the results of specialized treatment of uncomplicated and complicated trophic ulcer (TU) and osteomyelitis (OM) of diabetic osteoarthropathy (DOAP).Materials and methods. The results of treatment in 114 patients (127 feet) with DOAP were analyzed: There were 52 (45.6 %) men, 62 (54.4 %) women. The type 1 diabetes mellitus (DM) was diagnosed in 36 (31.6 %) patients (average age 43.0 years old); type 2 diabetes – in 78 (68.4 %) people (average age – 58.0 years old). The acute and subacute stages of DOAP were detected in 55.9 % of cases, chronic – in 44.1 % of cases. The defeat of the middle part of the foot prevailed in 66.9 % of cases. Patients are ranked by the University of Texas classification. DOAP without TU – 71 (55.9 %) cases, with TU – 56 (44.1 %) observations. Stage BIII (OM) – 22 (17.3 %) cases: 8 (6.2 %) – in the subacute stage of DOAP, 14 (11.2 %) – in the chronic stage of DOAP. The examination protocol for DOAP included clinical data (+ sounding of the adjacent bone in TU), thermometry, radiography, and magnetic resonance imaging (MRI) of the feet, as well as laboratory data. A diagnostic algorithm has been developed for the optimal choice of tactical decisions in case of DOAP (TU–/OM–) and DOAP (TU+/OM+).Results. 80 patients were treated on an outpatient basis under the supervision of a podiatrist. Patients with acute or subacute DOAP (TU−/OM−) received conservative treatment in the form of unloading the limb using an individual discharge bandage until the transition to the chronic stage. In the chronic stage of DOAP (TU–/OM–) recommended the manufacture of complex orthopedic shoes for an individual block. In addition to the correction of hyperglycemia, patients with DOAP (TU+) (AI, AII, BI) used local treatment in accordance with the stage of the wound process. 34 patients (BII, BIII) were treated in a hospital. 27 patients of these underwent surgical procedures, osteonecrectomy, 7 patients underwent arthrodesis. All patients with DOAP (TU–/OM–) (n = 71) limb saved. With DOAP (TU+/OM+) (n = 56): 8 (14.3 %) people – the result is unknown, 7 (12.5 %) patients – retention of TU, 35 (62.5 %) patients – complete epithelization, 2 (3.6 %) cases – small amputations, 4 (7.2 %) – high amputations.Conclusion. Differentiated specialized treatment of uncomplicated and complicated by trophic ulcers or osteomyelitis DOAP in its various clinical stages made it possible to avoid high amputation in 96.6 % of cases.

Orthopädische Schuhtechnik

AbstractOrthopedic footwear care is a means that orthopedists and traumatologists in the German-speaking regions have at their disposal due to the long-standing tradition in the crafts sector. The prescription for orthopedic care is based on the patient’s functional deficit: e. g. foot deformities, degenerative joint diseases of the foot, knee and hip, trauma, metabolic, neurological and rheumatic diseases, tumors, inflammatory transformation, skin and nail diseases, pressure calluses, static alteration and leg length differences. Orthopedic footwear supplies are an essential component of conservative and postoperative orthopedic and traumatic therapy. Orthopedic shoe modifications include orthopedic insoles, alterations on ready-to-wear shoes, foot orthoses or prosthetic foot orthoses, custom orthopedic footwear, standard orthopedic footwear (training shoes, semi-orthopedic shoes, protective footwear) and orthopedic specialty footwear.

Minimal footwear improves stability and physical function in middle-aged and older people compared to conventional shoes

BackgroundEffects of minimal shoes on stability and physical function in older people are under-researched. No studies have systematically explored effects of a range of minimal footwear features on these factors in older people. MethodsA within-participant repeated-measures design was used. Participants were subjected to thirteen footwear conditions: (i) barefoot, (ii) a conventional shoe, (iii) a control minimal shoe, (iv-xiii) minimal shoes differing from the control minimal shoe by one design feature. The outcomes were: (i) postural stability expressed with movement of the center of pressure (CoP) during standing (ii) dynamic stability expressed with the CoP movement during walking, (iv) physical function assessed with the Timed Up and Go test (TUG), and (iv) perceptions of footwear assessed with the Monitor Orthopaedic Shoes questionnaire. Linear Mixed Models were applied for statistical analyses. FindingsTwenty-two people participated in the study. Compared to the conventional shoe, participants: (i) were more stable during standing and walking in the majority of minimal shoes, and (ii) completed the TUG test faster when wearing the minimal shoe with wider sole. Compared to the control minimal shoe, participants: (i) completed the TUG test faster when wearing the minimal shoe with wider sole; and (ii) perceived features such as a split toe and a higher ankle collar as less fashionable and wearable. InterpretationWearing minimal shoes might be more beneficial for stability and physical function in older adults than wearing conventional shoes. The results will be highly valuable for the design of minimal footwear for older adults.

Stride kinematic changes in laminitic horses treated with three different types of hoof orthopedic devices

Considering the hypothesis that laminitic horses display changes in the kinematics of their forelimbs and clog type orthopedic devices can be beneficial in such cases, the objectives of this study were to compare the stride pattern of healthy horses versus that of horses with chronic laminitis and to assess the kinematic effects of three types of clog shoes on the stride of laminitic horses. Six healthy and six laminitic mares were subjected to a kinematic evaluation at a walk. The horses with laminitis were evaluated before and after the use of three different models of clog type orthopedic shoes on the hooves of both their forelimbs. The treatment types that were administered were the application of no shoes, wooden shoes, leather and ethylene-vinyl acetate (EVA) shoes, and wooden and EVA shoes. The horses with laminitis have a stride length that is reduced by 11% (P = 0.03), and in the swing phase, by 18% (P = 0.004), and the relative stance phase of each limb is prolonged by 6% (P = 0.02) when compared with the healthy group. However, values associated with the stride duration, stance phase duration, breakover duration, speed, and frequency were not significantly different among the laminitic groups. Further, no statistical differences were found in the comparison of the outcomes among the treatments administered to the horses with laminitis, except in their stride length, which was longer in the horses shod with wooden clogs when compared with in the unshod laminitic horses (P = 0.04). It was concluded that horses with stable chronic laminitis display changes in the kinematics of their forelimbs while walking. Immediate and remarkable beneficial effects were not observed with the use of all the types of orthoses; however, the wooden clog resulted in a significant improvement in the length of the stride. Further studies are needed to verify the prolonged effects of clog shoe-type ortheses in the different phases of equine laminitis.

Objective Signs of Foot Deformities in Children with Spastic Form of Cerebral Paralysis: Justification of Individual Approach to Footwear Support

Relevance. Foot deformities are the most common locomotor pathology in children with infantile cerebral paralysis. At the same time many children suffering from this pathology wear standard shoes that do not take into account the individual foot anatomy. Purpose of the study — to justify the expedience of individual approach to orthopaedic support for children with infantile cerebral paralysis. Materials and methods. The authors examined 220 feet in 110 patients aging from 3 to 18 years: 62 patients with spastic form of infantile cerebral paralysis and 48 children who were examined during periodic screening at general education institutions (control group). Clinical examination methods, computerized plantography and podometry by flatbed foot scanning (ventrally, posteriorly, medially) in standing position were used in the present study. Results. Statistically significant variances (p*0.005) were obtained for 8 indicators of foot deformity in three planes in children with infantile cerebral paralysis as compared to the norm, as well as differences between the groups of patients with varying degree of disorders in gross motor functions. The authors established pathological foot deformities in children with infantile cerebral paralysis; statistically significant variances in types and degrees of these disorders for patient groups with different levels of gross motor functions disorders; distinctiveness of foot deformities within each of the groups. Conclusion. Objectively instrumental method was used to identify the main components of foot deformities in patients with infantile cerebral paralysis with preservation and realization of walking capability: loss of height of longitudinal arches, midfoot pronation and hindfoot valgus, hallux valgus. Increased elevation of longitudinal arches (cavus foot), midfoot supination and hindfoot varus are rarer components of deformities occurring more often in patients with severer forms of the pathology. Strong variation in the spread of foot anatomy parameters observed within different groups of motor dysfunctions indicates the expediency of individual approach to footwear recommendations: standard, less or more complex orthopaedic shoes. Implementation of obtained data into the clinical practice requires additional series of biomechanical trials aimed at elaboration of criteria for recommendations and efficiency evaluation of various footwear types that take into account not only specifics of foot anatomy but also its statodynamic function as well as the level of gross motor functions of a particular patient.