Shoe Modifications Research Articles

The efficacy of shoes modification and orthotics in hallux valgus deformity: a comprehensive review of literature.

Hallux valgus (HV) is a frequent forefoot deformity affecting about 23% of adults and 35.7% of people over 65. The exact etiology is not fully understood. The first ray plays a significant role in walking cause it bears the principal amount of weight and maintains the position of the medial arch. Several factors that deteriorate the integrality of the first ray, such as foot deformities, restrictive footwear, and pes planus, may be ascribed to the HV occurrence. Before any surgical correction, conservative treatment should always be initiated first. Currently, there is no consensus that conservative management by shoe modification and foot orthoses could correct the pathology or terminate the clinical worsening of the condition.From a careful analysis of the literature, proper footwear should be a shoe with an adequate length, wide toe box, cushioned sole, and a lowered heel to not increase the load on the metatarsal heads and cause pain. Personalized 3D printed customized toe spreaders may be applied in patients with HV, improving symptoms and bringing pain relief. Compensating the subtalar joint hyperpronation through foot orthoses plays a fundamental role in the HV development, preventing or at least controlling the condition's progress; this, along with weight reduction and regular physical activity.Data obtained suggest that dynamic foot orthoses prefer a biomechanical type with 3/4-length, which is less likely to negatively affect the dorsal or medial pressures, which instead were noted to increase with the sulcus- and full-length orthoses.Although some studies suggest that foot orthoses would favor the correction of HV deformity, results have been very variable and just in few studies appear to correct HV or reduce its progression, improving symptoms and bringing pain relief. In the case of HV surgical correction, orthoses seem to maintain the correct position acquired over time.

Outcomes Following Surgical Correction of Talocalcalcaneal Joint Dislocation in Diabetes Associated Charcot Foot Arthropathy.

Growing clinical interest in the treatment of acquired foot deformity due to diabetes-associated Charcot foot arthropathy has led to multiple reports of favorable clinical outcomes in patients when their acquired deformity is at the midfoot level. Clinical failures and less than optimal clinical outcomes are achieved when the deformity is at the hindfoot or ankle levels. A retrospective review was performed of all patients who underwent surgical correction of diabetes-associated Charcot foot arthropathy with talocalcaneal dislocation over an 18-year period. Reduction of the talocalcaneal dislocation, and maintenance of the correction with percutaneous pins and circular external fixation after subtalar joint preparation for fusion, was used as the method of surgically achieving a clinically plantigrade foot. Clinical outcomes were based on resolution of infection, limb salvage, and the ability to ambulate with commercially available therapeutic footwear. Forty-three feet in 39 patients were included. A favorable clinical outcome was achieved in 32 of 43 feet (74%) with 26 (60%) considered to have an "excellent" result with minimal shoeing issues and 6 (14%) considered to have a "good" outcome based on their need for a custom shoe modification and/or some form of short ankle-foot orthosis. Eleven feet (26%) were judged to have a "poor" clinical outcome and among those 11 feet, 6 underwent partial, or whole-foot amputation, 2 had persistent wounds, and 5 required the use of a standard ankle foot orthosis or Charcot Restraint Orthotic Walker (CROW). Subtalar dislocation in Charcot arthropathy is a complex clinical problem. In our series, reduction and maintenance of the reduction after subtalar dislocation was essential for a favorable clinical outcome.

TREATMENT OF PAEDIATRIC ARTHROGRYPOTIC CLUBFOOT: 20 YEARS OF CLINICAL EXPERIENCE

BackgroundTreatment of arthrogrypotic clubfoot (AC) presents a challenging problem. Over time many different methods have been proposed, with variable rates of success, recurrence and other complications. In this study we describe our 20-year experience in treatment of AC.Materials and methodsBetween 1996 and 2016, 165 AC in 90 children (51 males and 39 females) were treated in our department. Their mean age was 7.6 years (3 months-16 years). Ponseti casting and Achilles tendon release (PCATR) was performed on 38 children (68 feet) and soft tissue release and casting (STRC) on 35 children (67 feet). The remaining 17 children (30 feet) underwent wide soft tissue release and correction using the Ilizarov method (STRIL). The results of each subgroup were graded according to clinical (pain, foot appearance, residual deformities, walking and standing status and shoe modifications) and radiological (anteroposterior and lateral talocalcanear angles, the angle between longitudinal axes of talus and the first metatarsal and the position of talus in the lateral view) criteria.ResultsThe average follow up was 6.4 (2–10) years. Results were excellent (plantigrade, painless, properly loaded feet, without deformities, adapted to common shoes) in 56 PCATR group feet, 59 STRC group feet and 23 STRIL group feet. Good results (required orthopaedic shoes) were obtained in 10 PCATR group feet, 6 STRC group feet and 7 STRIL group feet. Fair results (residual temporary pain and/or mild deformity) presented 2 PCATR group feet and 1 STRC group foot, while bad results (reoccurrence of clubfoot) were found in 1 STRC group foot.ConclusionsOn the basis of our 20-year clinical experience we believe that pediatric AC can be successfully treated with PCATR in the age of less than 1 year old (y.o), with STRC between 1–5 y.o. and with STRIL in children over the age of 5 y.o.

Outcomes of Operative Versus Nonoperative Management for Hallux Rigidus: A Tertiary Care Center Experience.

Background This study aims to investigate and report the outcomes of various management modalities used for hallux rigidus, a common form of degenerative joint disease affecting the foot and ankle. The research focuses on understanding the pathophysiology, classification systems, and nonoperative approaches such as medical therapy, intra-articular injections, shoe modifications, and physical therapy. Surgical techniques, including joint-sparing and joint-sacrificing procedures, are explored, considering factors such as disease stage and patient preferences. Methods A retrospectivecohortstudy was conducted at King Abdulaziz Medical City(KAMC), Riyadh.The study included all patientswho were diagnosed with hallux rigidus fromthe period 2016to 2022.Data were collected through theBESTCaresystem at KAMC.All the data were collected through Microsoft Excel(Microsoft Corporation, Redmond, Washington) and transferredfor analysis. Statistical analysis was performed using the IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York). Frequencies and percentages were used to detail categorical variables, whereas continuous variables were examined by the mean and standard deviation.A p-value of <0.05 was considered to report the statistical significance. Results A total of 84 patients were included. The majority were women (60.7%). Diabetes and hypertension were prevalent comorbidities, affecting 21.4% and 35.7% of patients, respectively. Nonoperative management was the most common approach (66.7%). Complications were minimal (2.4% infections, 1.2% metatarsalgia), and 67.9% of patients reported no persistence of symptoms after treatment. Conclusion The low complication rates and the lack of significant associations between treatment modalities and outcomes suggest the generally safe and effective nature of the employed interventions. These findings can guide clinicians in making informed decisions regarding the management of hallux rigidus, while also highlighting areas for further research to improve treatment strategies and outcomes.

To Cut or to Cast? An Evaluation of Demographics &amp; Mortality in Operative, Conservative, and Failed- Conservative Management of Charcot Neuroarthropathy

Category: Midfoot/Forefoot; Diabetes Introduction/Purpose: Charcot neuroarthropathy (CN) is a chronic, destructive disease linked with diabetic neuropathy that affects the bone structure, joints, and soft tissues of the foot. Treatment can vary from a conservative shoe modification to a below-the-knee amputation (BKA). With no evidence based guidelines for CN management, treatment regimens are physician specific and dependent on stage of CN, comorbidities, and ulceration status. Further, no previous literature has compared the mortality rates of patients that are treated with casting versus common surgical procedures for CN. Here, we provide demographic and all-cause mortality data for patients who underwent casting, arthrodesis, exostectomy, and amputation, to evaluate the outcomes and characterize the populations treated for Charcot neuroarthropathy of the foot. Methods: Institutional review board approval was obtained. A database of all patients from 1/1/2000 to 1/31/2022 with CPT and ICD codes indicating a diagnosis of Charcot neuroarthropathy who underwent exostectomy, arthrodesis, minor amputation, major amputation, and/or casting was created from the electronic medical record. Demographic and mortality data was collected, including date-of-birth, sex, race, and all-cause mortality. Procedure data was collected, which included date, code, and description. Major amputations include transtibial and trans-metatarsal, whereas minor amputations include toe and metatarsal. In the casting group, patients were separated into two groups: casting as the sole intervention and failed casting that ultimately went on to have surgery. Patients who had postoperative casting or multiple instances of casting and surgery were excluded. Descriptive statistics were conducted and single-factor ANOVA and Chi squared tests were used for analysis. Results: A total of 2,130 patients were identified; 546 had arthrodesis, 488 had exostectomy, 677 had minor amputations, 332 had major amputations, 64 had casting only, and 23 failed casting. Of the 23 patients who failed casting and went on to have surgery, 11 had arthrodesis, 5 had exostectomy, 4 had minor amputation, and 3 had major amputation. The average overall was 57.7 ± 13.9. Mortality rates were 10.3%, 11.3%, 34.0%, 32.2%, 7.8%, 17.4% in the arthrodesis, exostectomy, minor amputation, major amputation, casting only, and failed casting groups, respectively (Figures 1A and 1B). Of those that failed casting and then had surgery, arthrodesis was the most common procedure. Conclusion: Treatment options for patients with CN range from simple casting to invasive amputation. Overall, patients who underwent casting as their sole intervention had a significantly lower all-cause mortality (7.8%) compared to those who had amputation (34% for minor amputations and 32.2% for major amputations). There was no significant difference in all-cause mortality between casting only and failed casting groups. These findings demonstrate a significant disparity in outcomes between conservative and operative management for CN. Understanding the mortality of the various treatment options for CN can help optimize standards of care to improve patient outcomes.

Republication of "Uses of Braces and Orthotics for Conservative Management of Foot and Ankle Disorders".

Nonsurgical management is almost always considered the first-line treatment for the vast majority of foot and ankle pathologies. Foot orthoses, shoe modifications, and therapeutic footwear are considered essential tools for successful conservative management of different foot and ankle disorders. Orthopedic foot and ankle surgeons should have a meticulous understanding of the lower extremity biomechanics as well as the pathoanatomy and the sequelae of diseases affecting the foot and/or ankle. This is essential to the understanding of the desired effects of the different inserts, orthotics, shoe modifications, or braces that may be prescribed for these conditions. In this article, we will summarize the orthoses used for treatment of the most commonly encountered foot and ankle pathologies, with the exclusion of treatment for the diabetic foot because of the unique requirements of that disease process.

A comparative prospective study of platelet rich plasma versus corticosteroid injection in chronic plantar fasciitis

Background: The Plantar fasciitis is a common reason for heel pain which manifests as pain at medial process of calcaneal tuberosity. Patients are mostly diagnosed clinically on the basis of history. Conservative treatment in the form of stretching, non-steroidal anti-inflammatories, night splinting, ice packs, strapping, orthosis, and shoe modifications have been in use traditionally. Recently, the use of injectables like corticosteroids and platelet rich plasma (PRPs) has increased. This study aims at comparing the clinic-radiological outcomes of the two injectables in the treatment of chronic plantar fasciitis. Methods: This was a Prospective, Comparative, Randomized, Hospital-based clinical case study conducted in the Department of Orthopaedics, Sawai Man Singh Medical College, Jaipur, Rajasthan. 60 patients of chronic plantar fasciitis were taken and divided randomly into group A (PRP) and group B (corticosteroids) and the results were assessed based on the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and the plantar fascia thickness. Results: Mean VAS in Group A decreased from 8.07 before injection to 2.9 after injection and in Group B decreased from before 8.33 injection to 3.13 after injection, at the final follow-up. Mean AOFAS score improved from 54.06 to 90.60 and from 54.86 to 75.13 in the respective groups at the 6-months follow-up. Plantar fascia thickness (as measured using ultrasonography) decreased from 5.77 to 3.32 and from 5.6 to 3.73 in the respective groups. The improvements observed were statistically significant. Conclusions: Local injection of platelet rich plasma is an effective treatment option for chronic plantar fasciitis when compared with steroid injection with long lasting beneficial effects.

The Association of Night Splint to NSAID+ ADL Instruction in Improving Pain and Functional Performance: An Observational Study

Background: Plantar fasciitis causes heel pain. The disease normally develops without injury. Clinically, standing or walking causes sole of foot pain, usually under the heel. Planter fasciitis is diagnosed clinically. Rest, stretching, strengthening exercises, shoe modification, arch supports, orthotics, night splints, anti-inflammatory medications, and surgery can treat plantar fasciitis. Injections and NSAIDs provide brief relief. Calf and plantar fascia stretching may help. When conservative treatment fails for chronic plantar fasciitis, surgery is recommended. In this trial, night splints were used to treat plantar fasciitis. Objective: In this study our main goal is to evaluate the association of Night splint to NSAID + ADL instruction in improving pain and functional performance. Method: This randomized clinical experiment was undertaken on 50 plantar fasciitis patients at NITOR, Dhaka. Group A and Group B was randomly assigned. Group A received NSAID, ADL, and a night splint; Group B received NSAID and ADL. Pain score, Tenderness index, and Visual analogue scale data were gathered from both groups every 2 weeks from the initial visit for up to 6 weeks. SPSS version 23 analyzed all data. Results: The present study showed pain and tenderness were significantly improved in Group A who were treated with Night Splint, NSAID &amp; ADL instructions than in Group B who were treated with NSAID &amp; ADL instructions after 6 weeks (P&lt;0.05). Conclusion: The results of this study suggest that application of Night Splint along with NSAIDs and ADL instructions is more effective in reduction of pain and other symptoms in patient with planter fasciitis than the drugs and ADL.

Conservative Management of Freiberg Disease with Shoe Modification and Insole: A Case Report with 2-Year Follow-up

Conservative Management of Freiberg Disease with Shoe Modification and Insole: A Case Report with 2-Year Follow-up

Impacts of Ultrasonogram-Guided, Intra-fascial, Autologous, Activated Platelet-Rich Plasma Injection in Chronic Plantar Fasciitis: A Quasi-experimental Study.

Background Plantar fasciitis is the most common cause of foot pain. Patients with plantar fasciitis typically present with 'first step pain,'which tends to decrease with activity and worse with heavy use. This study determines the effect of ultrasound-guided, single-dose, platelet-rich plasma (PRP) injection in patients with chronic plantar fasciitis. Materials and methods It was a quasi-experimental trial carried out in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2019 to March 2022. A total of 148 patients diagnosed with chronic plantar fasciitis were selected as samples. A total of 75 patients were allocated to group A (intra-lesional injection of autologous PRP with conservative management) and 73 patients to Group B (only conservative management). Both groups of patients were allocated to conservative management with exercises, shoe modification, activities ofdaily living (ADLs) instruction, and oral paracetamol. Results This study shows that in group A, the mean visual analog scale(VAS) score significantly reduced to 1.47±0.51 after six months of single-dose PRP injection (p<0.001). In group B, the VASscorealso decreased substantially after conservative treatment. Though in groups A and B, pain reduction was significant, in group A, the pain was decreased more compared to group B and statistically significant differences were found between the two groups at the 12th week and 24th week. The foot function index (FFI) scores decreased significantly in group A after a single dose PRP injection, compared with group B treated with conventional therapy. In group A, FFI scores decreased from 49.09±5.72 to 7.67±3.41. The study revealed a significant difference between study groupsin the 12th week and 24th week regarding FFI scores. Conclusion Ultrasound-guided intra-lesional autologous PRP Injection is safe and effective and recommended in patients with chronic plantar fasciitis, especially in recalcitrant cases after the failure of conservative treatment and corticosteroid injection.

Comparison between Ultrasound-guided Pulsed Radiofrequency Ablation of the Medial Calcaneal Nerve and Extracorporeal Shockwave Therapy in Managing Recalcitrant Plantar Fasciitis: A Randomised Controlled Trial

Introduction: Plantar Fasciitis (PF) is one of the most common causes of heel pain, with a prevalence ranging from 3.6-7% in the general population. Approximately 90% of patients with PF respond well to conservative therapy, including rest, stretching, analgesics, physical therapy, shoe modifications, or steroid injections. However, around 10% of patients have recalcitrant cases that require invasive or surgical interventions. Pulsed Radiofrequency Ablation (PRFA) is a non neurodestructive method that provides non surgical pain relief in such cases. Aim: To compare the effectiveness of ultrasound-guided PRFA of the Medial Calcaneal Nerve (MCN) and Extracorporeal Shockwave Therapy (ESWT) in managing recalcitrant PF. Materials and Methods: This randomised controlled trial was conducted at the Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences, Imphal, Manipur, India over a two-year period from September 2018 to August 2020. A total of 78 patients with PF were included in the study, divided equally into two groups: a study group and a control group, each consisting of 39 participants. The study group received PRFA of the MCN, while the control group received ESWT of the plantar fascia. The Visual Analog Scale (VAS), Plantar Fascia Thickness (PFT), and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were measured at 1, 4, 12, and 24 weeks as outcome variables. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0, and statistical tests like Chi-square test, t-test, and repeated measures Analysis of Variance (ANOVA) were used. A p-value of &lt;0.05 was considered significant. Results: Of the 78 patients included in the study, 42 (53.8%) were females and 36 (46.2%) were males, with a mean age of 41.08±10.09 years. The VAS score in the study group improved from 5.51±0.82 at baseline to 1.92±0.80 at 24 weeks, while in the control group, the VAS score improved from 5.36±0.97 at baseline to 2.33±0.66 at 24 weeks. PFT in the study group improved from 4.45±0.374 at baseline to 2.26±0.231 at 24 weeks, while in the control group, PFT improved from 4.42±0.366 at baseline to 2.49±0.357 at 24 weeks. The AOFAS score also improved from 50.49±13.13 at baseline to 74.03±11.53 in the study group, and in the control group, the AOFAS score improved from 49.74±12.26 at baseline to 71.36±10.72 at 24 weeks (p-value &lt;0.05). Conclusion: Significant improvements were observed in all outcome measures in both the study and control groups, with a p-value &lt;0.05. However, the improvements were more pronounced in the study group, with minimal to no sideeffects. Hence, ultrasound-guided PRFA of the MCN can be considered an effective minimally invasive treatment modality for recalcitrant PF.

Hammer Toe Correction with Proximal Interphalangeal Joint Arthrodesis.

First described by Soule in 1910, arthrodesis of the proximal interphalangeal joint is a common operative method of treatment of hammer toe, or fixed-flexion deformity of the proximal interphalangeal joint of the lesser toes1. The deformity is often caused by imbalance in intrinsic and extrinsic muscle function across the interphalangeal joint and metatarsophalangeal joint2,3, which can be effectively addressed through proximal interphalangeal joint straightening and arthrodesis in conjunction with soft-tissue balancing of the metatarsophalangeal joint. Following longitudinal skin incision over the joint, a transverse extensor tenotomy and capsulotomy reveal the proximal interphalangeal joint and provide appropriate exposure of the head of the proximal phalanx. With the soft tissues protected, the proximal and middle phalanges undergo resection of the articular surfaces to allow osseous apposition. This step can be performed with a rongeur sagittal saw or with osteotomes4,5. The head of the proximal phalanx is resected proximal to the head-neck junction, and the proximal portion of the middle phalanx is removed to expose the subchondral bone. Often, there is a dorsal contracture of the metatarsophalangeal joint that is elevating the toe, which is addressed with use of a longitudinal incision over the metatarsophalangeal joint, a Z-lengthening of the long extensor tendon to the toe, and a subsequent capsulectomy. If there is an angular component to the deformity, the collateral ligaments are released from the metatarsal neck, and the toe can be balanced. If there is residual subluxation of the joint that is incompletely corrected by soft-tissue procedures, a metatarsal osteotomy should be considered. Fixation is then performed with use of a smooth Kirschner wire. The wire is inserted from the middle phalanx out the tip of the toe and subsequently inserted retrograde across the proximal interphalangeal joint, often into the metatarsal head and neck, holding the metatarsophalangeal joint in appropriate position. This step can also be completed with use of novel methods including screws, bioabsorbable pins, or intramedullary implants6-8. Nonoperative treatments for hammer toe deformity are generally pursued prior to surgery and include shoe modifications such as a wide toe-box, soft uppers, and padding of osseous prominences3,9,10. Alternative surgical treatments include proximal interphalangeal arthroplasty, soft-tissue capsulotomy, extensor tendon lengthening, and amputation11. Although nonoperative treatment can alleviate symptoms temporarily, surgical treatment is often necessary for definitive treatment of hammer toe. Soft-tissue procedures such as tendon lengthening can provide a stabilizing benefit, but the degenerative bone changes associated with hammer toe are better addressed with use of resection of the proximal interphalangeal joint3. Arthroplasty allows for some retained motion; however, this motion may lead to deformity and pain over time2. Arthrodesis provides less painful and more reliable fixation as well as equal outcomes compared with other operative techniques. Patient satisfaction rates after this procedure are high, with pain relief in up to 92% of patients and rare complications7-12. Outcomes of this procedure are favorable, with rates of osseous fusion ranging from 83% to 98%2,4,11,13. Patient satisfaction rates range from 83% to 100%4,11. Historically, patients have expressed dissatisfaction with pain and the appearance of exposed hardware, but novel internal fixative devices provide a more natural appearance to the toe without the need for secondary surgical procedures for pin removal8,14. Patients are often able to return to regular activity at 6 weeks postoperatively; however, there may be persistent pain or swelling in the toe. Wide shoes and activity modifications are frequently continued for several more weeks postoperatively, and some patients may benefit from formal physical therapy and at-home rehabilitation. Avoid vascular compromise by ensuring adequate resection of bone at the proximal interphalangeal joint.A longitudinal incision across the joint provides greater exposure but can lead to scar contracture that elevates the toe. One alternative is the use of an elliptically shaped incision over the proximal interphalangeal joint, which can improve cosmesis but does restrict exposure.Excessive osseous resection can lead to a cosmetically undesirable short toe.If using an implant for the arthrodesis, ensure the implant is not too big for the toe. Most implants are too big for fifth-toe arthrodesis.In toes with severe deformity, fixation with a Kirschner wire is often preferred because excessive stretching of the neurovascular bundle can lead to toe compromise and if Kirschner wire is used the pin can easily be removed at bedside.For flexible deformities, a nonoperative approach is recommended, such as stretching exercises, shoe-wear modifications, and metatarsal pads. A tenotomy of the flexor digitorum brevis is a soft-tissue procedure that can be considered if nonoperative treatment is insufficient to correct the deformity. If flexor digitorum brevis tenotomy does not adequately treat proximal interphalangeal joint deformity, a proximal interphalangeal joint arthrodesis should be the next step. MTP = metatarsophalangealPIP = proximal interphalangeal.

Orthotic approach to prevention and management of diabetic foot: A narrative review.

Diabetic foot is a common complication affecting more than one-fifth of patients with diabetes. If not treated in time, it may lead to diabetic foot ulcers or Charcot arthropathy. For the management of diabetic foot, shoe modifications and orthoses can be used to reduce pressure on the affected foot or provide the foot with increased stability. In addition, the shoe modifications and orthotic devices can relieve patient discomfort during walking. Appropriate shoe modifications include changing the insole material, modifying the heel height, adding a steel shank or rocker sole, and using in-depth shoes. Alternatively, a walking brace or ankle-foot orthosis can be used to reduce the pressure on the affected foot. The purpose of this narrative review was to provide a reference guide to support clinicians in prescribing shoe modifications and foot orthoses to treat diabetic foot ulcers and Charcot arthropathy.

Sliding Oblique Metatarsal Osteotomy Fixated With K-Wires Without Cheilectomy for All Grades of Hallux Rigidus: A Case Series of 76 Patients.

Studies on decompression metatarsal osteotomy without cheilectomy for hallux rigidus are limited. This study aimed to review the data of patients who underwent this surgery for all grades of hallux rigidus. The medical records of patients who underwent this surgery between August 2017 and January 2021 were retrospectively reviewed. The outcomes were assessed using the visual analog scale (VAS), the Japanese Society for Surgery of the Foot (JSSF) score, and the hallux dorsiflexion angle. Patients who were followed up for more than 2 years were included. The plantar shift of the first metatarsal head (PS) and the shortening of the first metatarsal (SH) were measured to supplementally investigate the associations with other measurements. A total of 76 patients (female, 42; male, 34; mean age, 60.3 years; mean body mass index, 23.1) with 80 feet were enrolled. Six patients (7.5%) were grade 1, 20 (25.0%) were grade 2, 30 (37.5%) were grade 3, and 24 (30.0%) were grade 4. The mean follow-up duration was 3.5 years. Overall, the mean VAS score improved from 63.2 to 6.2, the mean JSSF score from 59.0 to 82.6, and the mean dorsiflexion angle from 37.3 to 56.3 degrees. These measures improved for all grades, but the dorsiflexion angles and JSSF scores decreased as the grade advanced. No clear associations were found between the postoperative VAS and the PS and SH. Eight patients (10.5%) had complications: 4 (5.2%) had occasional plantar discomfort under the metatarsal head, 2 (2.6%) required shoe modification, 1 (1.3%) had wound pain, and 1 (1.3%) experienced breakage of a K-wire. The VAS scores, dorsiflexion angles, and JSSF scores improved for all grades of hallux rigidus within a relatively short period of follow-up; however, the dorsiflexion angles and JSSF scores decreased as the grade advanced. Level IV, retrospective case series.

The effect of rocker sole shoes on ground reaction force in the elderly.

Aging is associated with decreases in gait performance and mobility. Toe-only rocker sole is prescribed as a common shoe modification in restricted foot and ankle joints mobility. Therefore, this study aimed to determine the effect of toe-only rocker sole shoes on the ground reaction force (GRF) in the elderly. Twenty-one older adults walked on a walkway equipped with one force plate under six different conditions including barefoot (BF), normal shoe (NS), and four types of toe-only rocker sole shoes (RS) with various degrees of rocker angle (RS10, RS20, RS30, and RS40). The peaks of the GRFs in three planes were obtained. Different rocker angles could affect GRF parameters. The first peak of GRF (FZ1) significantly increased with both RS30 and RS40 compared to BF, NS, RS10, and RS20. FZ1 significantly decreased with RS30 compared to RS40. The braking force (FX1) was significantly lower with NS compared to RS30 and RS40. FX1 was significantly higher with RS40 compared to the other shoe conditions. The propulsive force (FX2) significantly decreased during walking with BF compared to NS, RS20, RS30, and RS40. A higher FX2 was observed in RS40 than the other shoe conditions except RS30. Also, FX2 was significantly lower with RS10 compared to RS30. Increasing rocker angle may result in an increase in the peak magnitude of FZ1, FX1, FX2 in the elderly without any improvement in walking speed.

Effects of Application of Night Splint in the Management of Plantar Fasciitis

Background: Plantar fasciitis is one of the most common causes of heel pain. The condition usually comes on gradually without any injury. Clinically there is pain and tenderness in the sole of the foot, mostly under the heel, with standing or walking. The diagnosis of patient with planter fasciitis is essentially clinical. Treatment options for planter fasciitis include rest, stretching, strengthening exercise, shoe modification, arch supports, orthotics, night splints, anti- inflammatory agents, and surgery. Although injections and Non-steroidal anti-inflammatory drugs (NSAIDs) bring relief, their effects are often only temporary. Stretching of the calf and plantar fascia may provide some benefit. In chronic planter fasciitis, surgical treatment is only advocated where adequate conservative management fails.&#x0D; Objective: The aim of this study is to evaluate the effects of the application of night splint in the management of plantar fasciitis.&#x0D; Materials and Methods: This randomised clinical trial included 50 (fifty) patients with planter fasciitis who were seen in the Physical Medicine and Rehabilitation department of the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) in Dhaka. The patients were divided randomly into two groups, Group A and Group B. Patients in Group A were treated with NSAID, ADL and Night splint, whereas Group B patients were treated with NSAID and ADL. The patients were evaluated clinically, and data was collected from both groups in a pre-designed data collection sheet for Pain score, Tenderness index, and Visual analogue scale in every 2 weeks interval from the first visit for up to 6 weeks. All the data were analyzed by SPSS version 16.1.&#x0D; Results: The present study showed pain and tenderness were significantly improved in Group A, who were treated with Night Splint, NSAID &amp; ADL instructions than in Group B who were treated with NSAID &amp; ADL instructions after 6 weeks( P&lt;0.05).&#x0D; Conclusion: Night splint is an easy, non-surgical and cost-effective one which can be applied with other modalities. Night Splint, along with NSAIDs and ADL instructions, is more effective in the reduction of pain and other symptoms in a patient with planter fasciitis.

Effect of Modified Shoe with Motor Relearning Programme on Timed Up and Go Test Values and Gait Parameters in Chronic Stroke Patients: Comparative Study

Background: Hemiplegia secondary to stroke contributes to problems associated with standing and walking.Hemiplegic patients suffer from poor balance, slow walking, and weak muscles. Shoe modification and foot orthosescan play an important role in the nonsurgical management of foot and ankle pathology. Therapeutic footwear maybe used to treat patients with diabetes, arthritis, neurologic conditions, traumatic injuries, congenital deformities,and sports-related injuries. These modalities may improve patient gait and increase the level of ambulation.Aims and objectives of the study: To analyse the effect of modified shoe with motor relearning programme onTimed Up and Go test values and gait parameters of chronic stroke patients.Data Analysis and Results: Pre intervention values of Timed Up and Go test (TUG) and gait parameters werehomogenous between control and experimental groups with p≥0.05 and post intervention values of TUG and gaitparameters were statistically significant improvement in experimental group where shoe modification with motorrelearning program with p≤0.05Conclusion: It was concluded that Modified Shoe with Motor Relearning Programme had statistically significantimprovement in the Timed Up and Go

Cavovarus Foot: Conservative Management Techniques/Case Studies

Category:OtherIntroduction/Purpose:The cavovarus foot is a true challenge for both the patient and the surgeon. This complex deformity can be a result of many different causal factors including genetics, Charcot-Marie-Tooth disease, diabetes and spina bifida. It may also be caused or worsened by trauma or surgical procedures. The cavovarus foot is difficult to manage conservatively as it tends to be rigid, is not a good shock absorber and causes the joints of the foot to process abnormal stresses. The mechanical construct of a cavus foot makes it susceptible to a multitude of complications and injuries like inversion ankle sprains and metatarsal stress fractures.Methods:While foot orthoses would likely be the most commonly considered conservative treatment option for the symptomatic cavus foot, other modalities like shoe modification, bespoke and/or therapeutic footwear and bracing have also proven effective. Oftentimes, a combination of the aforementioned options is employed. Given the individual complexities of each cavus foot, the conservative treatment plan is typically custom tailored to fit a particular patient's foot structure, biomechanical and corrective needs, and occupational or recreational demands. A so-called 'cookie cutter' approach is not appropriate for management of the cavovarus foot.Results:A review of published research demonstrates that foot orthoses - and other conservative modalities - are effective in the treatment of the cavus foot. These devices work by correcting the varus foot alignment (when applicable), offloading painful areas such as ball of the foot or the base of the fifth metatarsal, providing shock absorption and replacing lost motion. These applications work together to provide a more normal, safer and energy-efficient gait.Conclusion:Conservative management, specifically pedorthics, is not only a viable treatment option for the cavovarus foot but should be considered integral to the overall management of the cavus foot patient. Pedorthic modalities are successfully used post-operatively or in lieu of surgical intervention. Modern pedorthics (technological advances in shoe and orthotic design, construction and materials) allows for cosmetically pleasing, affordable and comfortable management allowing patients to return to a healthy and active lifestyle in many cases.

Effects of Longitudinal Bending Stiffness of forefoot rocker profile shoes on ankle kinematics and kinetics.

Rocker profile shoes with a proximally placed apex are currently one of the most prescribed shoe modifications for treatment and prevention of lower leg deficits. Three geometrical rocker design parameters apex position (AP), apex angle (AA) and rocker radius (RR) influence both plantar pressure redistribution and kinetic and kinematic alterations of the lower leg. In addition, longitudinal bending stiffness (LBS) of the outsole influences these parameters as well. This study aims to investigate the effects of the LBS in combination with different forefoot radii of rocker shoes on kinematics and kinetics of the lower limb. 10 participants walked in standard shoes and six experimental shoe conditions with high and low LBS and three different forefoot rocker radii with the same (proximal) AP and AA. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with a repeated measures ANOVA and Statistical Parametric Mapping (SPM) (α = .05; post hoc α = .05/6). SPM analyses revealed no significant differences for LBS and interaction LBS*RR for most research variables in terminal stance (ankle angle, ankle moment, ankle power, foot-to-horizontal angle, shank-to-vertical angle, external ankle moment, ground reaction force angle). A significant LBS effect was found for anterior-posterior position of the centre of pressure during pre-swing and peak ankle dorsiflexion angle. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle between low and high LBS. This study showed that longitudinal bending stiffness does not affect the biomechanical working mechanism of rocker profile shoes as long as toe plantarflexion is restricted. Providing that the forefoot rocker radius supports at least a normal foot-to-horizontal angle at toe-off, there is no reason to increase sole stiffness to change ankle kinematics and kinetics.

Therapeutic considerations for patients with chronic plantar fasciitis (Review)

Heel pain is a common complaint in the population, leading to a limitation in daily activities and a poor quality of life. Chronic plantar fasciitis is the most common cause of heal pain. Despite its name, which suggests inflammation, the underlying process is rather a degenerative one. The clinical course is often chronic or relapsing, as a challenge to physicians to find the most effective therapeutically approach. First‑line treatment consists of rest, shoe modification, orthosis and physiotherapy. Physical exercise is an important tool which can be combined with other therapeutic options. Medication is usually administered in acute cases, in the form of simple analgesics, non‑steroidal anti‑inflammatory drugs (NSAIDs) or opioids, in different regimens. For chronic evolution, the use of NSAIDs is controversial. Second‑line treatment includes extracorporeal shock wave therapy and corticosteroid local injection. New therapies have emerged, as autologous blood derivatives and prolotherapy, with growing evidence, to be included in clinical practice. The present review article discusses the therapeutic options for patients with chronic plantar fasciitis, to with an aim to shed light on the treatment strategies for this condition.