Wedge Shoe Research Articles

Effectiveness of Lateral Shoe Wedging along with Quadriceps Strengthening and Life Style Modification in Knee Osteoarthritis

Background: Knee osteoarthritis (OA), a common degenerative joint disorder, significantly impairs quality of life due to pain and functional limitations. Non-surgical interventions like lateral shoe wedging and quadriceps strengthening exercises are increasingly considered viable options for managing OA symptoms. Objective: To assess the efficacy of lateral shoe wedges, both alone and in combination with quadriceps strengthening exercises, in treating medial knee OA. Methods: In this randomized controlled trial, 60 adults with medial knee OA were assigned to one of three groups: Group A received only lateral shoe wedges; Group B received lateral shoe wedges and quadriceps strengthening exercises; Group C received lateral shoe wedges with lifestyle modifications. Measurements for pain, stiffness, and physical function were taken using the Numeric Pain Scale and WOMAC scale at baseline, 8 weeks, and 16 weeks. Results: By Week 16, Group A (wedge only) reported a 70% compliance rate, with no significant changes in WOMAC stiffness and physical function scores. Group B (wedge & exercise) showed an 80% compliance rate, with pain scores reducing from 2.50±0.945 to 1.40±1.231 and significant improvements in WOMAC stiffness (1.40±1.231) and physical function (1.50±1.147). Group C (wedge & lifestyle modification) achieved a 100% compliance rate, with moderate improvements in all measured parameters. Conclusion: The study concludes that the combination of lateral shoe wedging and quadriceps strengthening exercises (Group B) was most effective in alleviating pain and improving physical function in patients with medial knee OA. This suggests that a multimodal approach may be superior to singular interventions for managing OA symptoms.

Comparison of ground reaction force and contact time during various-direction lunges between badminton shoes without and with a lateral forefoot wedge sole

This study compared the ground reaction force (GRF), GRF ratio, and contact time between badminton shoes without and with a lateral forefoot wedge sole during lunges in three directions. Fifteen collegiate athletes wore forefoot wedge shoes (5° incline) and control shoes without a lateral forefoot wedge sole (in random order) and performed three typical badminton lunge movements (forward, lateral, and backward directions). A total of nine GRF, GRF ratio, and contact time parameters were analyzed. A paired t test was performed to assess the differences between two shoes. The significance level was set at p < 0.0056 (0.05/9) based on Bonferroni correction to avoid chances of type 1 errors. In the forward lunge, the forefoot wedge shoes resulted in a significantly higher average vertical ground reaction force (GRFv, 3.9%), average horizontal GRF (GRFh, 7.8%) in the braking phase and higher average GRFh (3.9%) in the propulsion phase than the control shoes. In the lateral lunge, the forefoot wedge shoes resulted in a significantly shorter total contact time (−4.6%) than the control shoes in the backward lunge, the forefoot wedge shoes resulted in a significantly higher GRFh to GRFv ratio (6.4%) in the braking phase compared with the control shoes. Thus, shoes with a lateral forefoot wedge sole can effectively enhance mechanical performance in direction changes during forward and backward badminton lunges, and shorter the contact time during lateral badminton lunges. Shoes with a lateral forefoot wedge sole can be considered when designing athletic footwear.

Assessing dynamic characteristics for friction draft gears with worn wedge shoes

A friction draft gear model was developed to assess the degraded dynamic characteristics of worn draft gears in the vehicle impact condition. It presents an approach to simulate multiple typical wear profiles of wedge shoes and reflect their effects on the draft gear performance. Based on the rated design indexes and existing overhaul regulations of MT-2 type friction draft gears in China, the safety wear limits for wedge shoes with different wear profiles were classified and assessed. The results indicate that wedge shoes with uniform or concave wear can significantly worsen draft gear performance, and the existing maintenance limit of 1 mm only applies to wedge shoes with uniform wear but not to the most common wedge shoes with concave wear. Also, for wedge shoes with concave wear, when the wear area covers 50%, 75%, and 100% of the total main friction surface, the corresponding safety wear limits are 0.5 mm, 0.8 mm, and 1.3 mm, respectively. Therefore, it is proposed to design multiple graded and dynamic maintenance limits to ensure the service safety of MT-2 type friction draft gears.

Effect of lateral wedged insole shoe in knee osteoarthritis: A 12 month randomized controlled trial

Introduction: Knee osteoarthritis (OA) is a chronic degenerative musculoskeletal condition that imposes a major healthcare burden due to considerable pain, disability and loss of quality of life especially among the older adults. Most knee OA researchers have focused on tertiary management strategies i.e pain relief with effective drug therapies (Non steroidal anti inflammatory drugs, chondroitin supplements etc). However, long-term use of NSAIDS have significant side effects and are expensive. With the exception of knee joint arthroplasty, typically reserved for end-stage disease, there is no definitive cure for osteoarthritis. Accordingly, there is an urgent need for conservative treatment modalities, that not only alleviate painful symptoms of OA, but also reduce the progression of the degenerative pathology over time. Patients with knee OA usually show major involvement in only one compartment; medial tibiofemoral compartment being more common than the lateral compartment. The lateral wedge shoe insole is an orthotic device, which is hypothesized to reduce the moment arm of the ground reaction force vector relative to the knee joint center during walking. They are an inexpensive and feasible treatment modality, that has shown to reduce medial knee load. Materials and Methods: 80 patients with bilateral medial compartment osteoarthritis of knee were included in the present study. They were randomly divided into two groups ; Group A (n = 40) included patients who were given lateral wedged insole shoes and Group B (n = 40) included those who were given normal flat soled shoes. All patients who fulfilled the inclusion and exclusion criteria were recruited for the study. The present study was carried between January 2020 to January 2021 in Krishna Institute Of Medical Sciences, “Deemed to be University” Karad. Severity of pain using WOMAC score, FTA using plain knee radiograph in AP view and frequency of intake of NSAIDS were calculated at the start of study, thereafter at each follow up every 2 months up to 12 months. Results: At the initial 2nd month follow up group A patients showed significant reduction in severity pain scale (66.74+/-19.44) as compared to group B (72.78+/-17.04), but neither of group A or group B showed any significant change in remaining variable characters (p>0.005). At the end of 12 months follow up assessment, Group A patients showed a marked reduction in severity of pain (average 46.8+/-16.24) as compared to Group B (mean 59.26+/-18.74). Patients in Group A showed significant decrease in the frequency of intake of NSAIDS for pain relief as compared to patients in Group B (p

The Efficacy of a Lateral Wedge Insole for Painful Medial Knee Osteoarthritis After Prescreening: A Randomized Clinical Trial.

Lateral wedge shoe insoles decrease medial knee loading, but trials have shown no effect on pain in medial knee osteoarthritis (OA). However, loading effects of insoles are inconsistent, and they can increase patellofemoral loading. We undertook this study to investigate the hypothesis that insoles would reduce pain in preselected patients. Among patients with painful medial knee OA, we excluded those with patellofemoral OA and those with a pain rating of <4 of a possible 10. We further excluded participants who, in a gait analysis using lateral wedges, did not show at least a 2% reduction in knee adduction moment (KAM), compared to wearing their shoes and a neutral insole. We then randomized subjects to lateral wedge versus neutral insole for 8-week periods, separated by an 8-week washout. The primary outcome measure was knee pain (0-10 scale) during the past week, and secondary outcome measures included activity pain and pain rated in the Knee Injury and Osteoarthritis Outcome Score questionnaire. We carried out mixed model analyses adjusted for baseline pain. Of 83 participants, 21 (25.3%) were excluded from analysis because of insufficient reduction in KAM. In the 62 patients included in analysis, the mean ± SD age was 64.2 ± 9.1 years, and 37.1% were women. Lateral wedge insoles produced a greater reduction in knee pain than neutral insoles (mean difference of 0.7 on 0-10 scale [95% confidence interval 0.1, 1.2]) (P = 0.02). Findings for secondary outcome measures were mixed. In participants prescreened to eliminate those with patellofemoral OA and biomechanical nonresponders, lateral wedge insoles reduced knee pain, but the effect of treatment was small and is likely of clinical significance in only a minority of patients. Targeting patients may identify those who respond to this treatment.

A Comparative Study of the Effects of Lateral Wedge Insole Shoe Modification on the Patients with Knee Osteoarthritis

Background: Knee osteoarthritis (OA) is the common form of disability in comparatively elderly patient. Lateral wedge shoe insole is an easy, simple and cost effective approach which can be applied as an adjunct to pharmacotherapy to treat the patients with OA knee. The objective of the study is to evaluate the effectiveness of using lateral wedge shoe insole on pain and physical functioning in patients with OA knee.Method: A randomized prospective study was carried out in the department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January, 2012 to March, 2012. Patients with OA knee by American College of Rheumatology Criteria were selected. Two intervention groups were compared. In patients of Group-A (32 patients) were treated with aceclofenac100mg and, omeprazole20mg bid, and daily instructions of activities of daily living (ADLs), isometric quadriceps muscle strengthening exercise. Patients of Group-B were given lateral wedge shoe insole along with above treatment. The change between two weeks post intervention and baseline WOMAC (Western Ontario and McMaster Universities) subscale and scores were calculated. There were 4 visits and in each visit, patients were assessed for pain, stiffness and physical function by WOMAC index.Results: A total 65 patients with OA knee were included in this study. The mean age was 56.5± 10 years. Male to female ratio was 1.32:1. Comparison of mean pretreatment and 8th week post treatment WOMAC physical function subscale score in Group A (4.9 ± 1.2 vs. 2.4 ± 0.8) showed significant improvement and in Group B (4.3 ± 1.2 vs. 1.9 ± 0.5) which also shows significant improvement more than group A. The result was compared and student t-test was done to see the level of significance. Method was found significant after treatment (p &lt;0.05).Interpretation: Effects of use of lateral wedge shoe insole in patients with knee OA is beneficial.TAJ 2017; 30(2): 13-19

Akin osteotomy as an adjunct to hallux MTPJ fusion

Category: Midfoot/Forefoot, Hallux MTP fusion Introduction/Purpose: It is not uncommon to note residual valgus at the hallux interphalangeal joint when performing a hallux MTPJ fusion. On occasion, despite optimum positioning of hallux MTPJ for fusion, we found that in some cases the hallux was still abutting the second toe. We noted that these cases had either a high hallux interphalangeus valgus angle or the proximal phalanx had a shorter, concave lateral border due to eccentric wear. These two variables were difficult to correct despite optimum positioning of the hallux MTPJ. Consequently the hallux abuts the second toe causing irritation. We have used Akin osteotomy as an adjunct to hallux MTPJ fusion to address this intraoperative problem Methods: Between 2013 to 2016 this technique was utilised in 16 patients in whom residual hallux valgus interphalangeus was noted once the hallux MTPJ was stabilised in the appropriate position. We used two 4.0 mm AO cannulated partially threaded screws inserted in a crossed configuration for MTPJ fusion and a 8 mm x 90 degree varisation staple for the Akin osteotomy. The Akin osteotomy was performed in the mid to distal diaphyseal region of the proximal phalanx to avoid the screw position. Postoperatively, patients were given a toe spica plaster cast and were advised to walk in a heel weight bearing wedge shoe for six weeks. Results: Despite the osteotomy not being in the metaphyseal region, we have not encountered any immediate post-operative complications. We accept that this technique may not be suitable when using plates and screws for fusion but would be suitable for use with screws or staples. We have not encountered any postoperative complications. All hallux MTPJ joints have fused and Akin osteotomies have healed uneventfully Conclusion: This technique has not been reported before. Akin osteotomy is commonly used as an adjunct to corrective hallux valgus surgery. It is a relatively quick and reproducible technique with minimal incidence of complications. We suggest that this technique be considered when carrying out a hallux MTPJ fusion, although may not be required in all cases.

Modifying the Height of Horseshoes: Effects of Wedge Shoes, Studs, and Rocker Shoes on the Phalangeal Alignment, Pressure Distribution, and Hoof-Ground Contact During Motion

This study was designed as a comparative study with the intention to accumulate fundamental data on a wide variety of farriery methods. Twenty-five warmblood/crossbred horses, allocated into five groups (n = 5), underwent radiological and kinetic examination of the barefoot hoof, the shod hoof with a standard horseshoe, and finally a modified horseshoe. For radiographic measurements, a special podoblock with embedded reference points and changeable ground surfaces was used. Kinetic examinations were performed by placing one sensor between the shoe and the hoof and the second sensor between the shoe and the ground and then walking the horses on four different ground surfaces. When wedges were applied, the palmar angle increased by approximately 5° on all surfaces. However, this effect was only seen on firm surfaces combined with studs. Using a rocker shoe, the palmar angle increased on a firm surface (0.6 ± 0.3°) and decreased on a deformable surface (0.8 ± 0.3°). No consistent data were noted for the orientation of the proximal and middle phalanx in relation to the palmar angle. Pressure distribution showed wedges and studs to cause an increased pressure load on both the toe and the heels on a firm surface. Rocker shoes led to pressure peaks at the inner section of the toe, and high pressure was exerted on the quarters. In conclusion, all modified horseshoes showed unintended side effects and their influence on biomechanical parameters varied depending on the ground surface.

Acute effects of lateral shoe wedges on joint biomechanics of patients with medial compartment knee osteoarthritis during stationary cycling

Cycling is commonly prescribed for individuals with knee osteoarthritis (OA) but very little biomechanical research exists on the topic. Individuals with OA may be at greater risk of OA progression or other knee injuries because of their altered knee kinematics. This study investigated the effects of lateral wedges on knee joint biomechanics and pain in patients with medial compartment knee OA during stationary cycling. Thirteen participants with OA and 11 paired healthy participants volunteered for this study. A motion analysis system and a customized instrumented pedal were used to collect 5 pedal cycles of kinematics and kinetics, respectively, during 2 minutes of cycling in 1 neutral and 2 lateral wedge (5° and 10°) conditions. Participants pedaled at 60 RPM and an 80W workrate and rated their knee pain on a visual analog scale during each minute of each condition. There was a 22% decrease in the internal knee abduction moment with the 10° wedge. However, this finding was not accompanied by a decrease in knee adduction angle or subjective pain. Additionally, there was an increase in vertical and horizontal pedal reaction force which may negate the advantages of the decreased internal knee abduction moment. For people with medial knee OA, cycling with 10° lateral wedges may not be sufficient to slow the progression of OA beyond the neutral riding condition.

A small integrated lateral wedge does not alter knee joint moments during walking

Knee osteoarthritis (OA) is one of the most common degenerative disorders. Recently, it has been proposed that lateral wedged footwear could play a preventative role by reducing the frontal plane knee joint moments during walking. However, these interventions can be uncomfortable, so it is important to determine whether minimal wedging can still have a positive influence. The aim of this study was to test the influence of a 2° full-length lateral wedge on frontal plane knee joint internal moments during walking. It was hypothesized that the lateral wedge would shift the centre of pressure (COP) laterally and decrease the knee abduction moment. Joint kinematics, joint kinetics and the COP trajectory of 15 healthy subjects (seven males and eight females) were obtained when the subjects walked at 1.4 m s−1 with a Control shoe and a Lateral Wedge shoe (2° wedge). The results of this study showed no difference between the Lateral Wedge and the Control shoe condition in the internal peak knee abduction moment and the position of the COP. This suggests that a 2° wedge is not sufficient to influence the position of the COP nor to decrease the internal knee abduction moment.

Non-surgical management of a pediatric &amp;ldquo;intoed&amp;rdquo; gait pattern &amp;ndash; a systematic review of the current best evidence

BackgroundAn intoed gait pattern is one of the most common referrals for children to an orthopedic consultation. Parental concern as to the aesthetics of the child’s gait pattern and/or its symptomatic nature will primarily drive these referrals during a child’s early developmental years. Whilst some of these referrals prove to be the result of a normal growth variant, some children will present with a symptomatic intoed gait pattern. Various treatments, both conservative and surgical, have been proposed including: braces, wedges, stretches and exercises, shoe modifications, and surgical procedures. However, which treatments are effective and justified in the management of this condition is not clear within the literature. The aim of this systematic review was to therefore identify and critique the best available evidence for the non-surgical management of an intoed gait pattern in a pediatric population.MethodA systematic review was conducted of which only experimental studies investigating a management option for an intoeing gait pattern were included. Studies needed to be written in English, pertaining to a human pediatric population, and published within a peer reviewed journal. Electronic databases were searched: Ovid (Medline), EMBASE, AMED, PubMed, SportDiscus, CINAHL, and Cochrane Library. The National Health and Medical Research Council’s designation of levels of hierarchy and the Critical Appraisal Skills Programme cohort studies critical appraisal tool were used.ResultsFive level IV studies were found. The studies were of varied quality and with mixed results. Gait plates, physiologic/standardized shoes, and orthotic devices (with gate plate extension) were shown to produce a statistically significant improvement to an intoed gait pattern. Shoe wedges, torqheels, and a leather counter splint were not able to reduce an intoed gait pattern.ConclusionThere is limited evidence to inform the non-surgical management of a pediatric intoed gait pattern. The body of evidence that does exist is small (n = 5) and of varied quality, which means recommendations arising from this evidence base should be interpreted with caution. There is generally weak evidence that suggests that gait plates and orthotic devices with a gait plate extension may assist in the management of a pediatric intoed gait pattern.

Planned Arthritis Guidelines Stress Exercise

Planned Arthritis Guidelines Stress Exercise

Physiotherapy management of knee osteoarthritis

Knee osteoarthritis (OA) is a prevalent chronic joint disease causing pain and disability. Physiotherapy, which encompasses a number of modalities, is a non-invasive treatment option in the management of OA. This review summarizes the evidence for commonly used physiotherapy interventions. There is strong evidence to show short-term beneficial effects of exercise on pain and function, although the type of exercise does not seem to influence treatment outcome. Delivery modes, including individual, group or home exercise are all effective, although therapist contact may improve benefits. Attention to improving adherence to exercise is needed to maximize outcomes in the longer-term. Knee taping applied with the aim of realigning the patella and unloading soft tissues can reduce pain. There is also evidence to support the use of knee braces in people with knee OA. Biomechanical studies show that lateral wedge shoe insoles reduce knee load but clinical trials do not support symptomatic benefits. Recent studies suggest individual shoe characteristics also affect knee load and there is current interest in the effect of modified shoe designs. Manual therapy, while not to be used as a stand-alone treatment, may be beneficial. In summary, although the research is not equivocal, there is sufficient evidence to indicate that physiotherapy interventions can reduce pain and improve function in those with knee OA.

Postoperative Cast Necessity after a Lapidus Arthrodesis

The incidence of non union following a first tarsometatarsal arthrodesis (Lapidus procedure) has decreased significantly with modern techniques of minimal bone resection, meticulous bone surface preparation and rigid internal fixation. We evaluated whether a postoperative wedge shoe would increase our non-union rate. Nineteen adult female patients (27 feet; eight bilateral, five simultaneous) undergoing a first tarsometatarsal arthrodesis for hallux valgus associated with a hypermobile first ray or for recurrent hallux valgus were managed postoperatively by allowing them to bear weight in a wedge shoe instead of a cast. Radiographs were evaluated for signs of fusion. All 27 feet went on to successful union after 6 to 24 weeks. There was one superficial wound infection and one case of recurrence of the hallux valgus. Based on our results, we allow adult patients undergoing a Lapidus type procedure to be managed in a postoperative wedge shoe.

Effects of foot orthoses and valgus bracing on the knee adduction moment and medial joint load during gait

Background Lateral shoe wedges and valgus knee braces are designed to decrease the force acting in the medial knee compartment by reducing the external adduction moment applied at the knee. The biomechanical changes introduced by these orthoses can be relatively small. Computer modeling and simulation offers an alternative approach for assessing the biomechanical performance of these devices. Methods A three-dimensional model of the lower-limb was used to calculate muscle, ligament, and joint loading at the knee during gait. A lateral shoe wedge was simulated by moving the center of pressure of the ground reaction force up to 5 mm laterally. A valgus knee brace was simulated by applying abduction moments of up to 12 Nm at the knee. Findings Knee adduction moment and medial compartment load decreased linearly with lateral displacement of the center of pressure of the ground reaction force. A 1 mm displacement of the center of pressure decreased the peak knee adduction moment by 2%, while the peak medial compartment load was reduced by 1%. Knee adduction moment and medial compartment force also decreased linearly with valgus moments applied about the knee. A 1 Nm increase in brace moment decreased the peak knee adduction moment by 3%, while the peak medial compartment load was reduced by 1%. Interpretation Changes in knee joint loading due to lateral shoe wedges and valgus bracing are small and may be difficult to measure by conventional gait analysis methods. The relationships between lateral shift in the center of pressure of the ground force, valgus brace moment, knee adduction moment, and medial joint load can be quantified and explained using computer modeling and simulation. These relationships may serve as a useful guide for evaluating the biomechanical efficacy of a generic wedge insole or knee brace.

The effect of plain, eggbar and 6°-wedge shoes on the distribution of pressure under the hoof of horses at the walk

AIM: To quantify the effect of plain, wedged and eggbar shoes on the distribution of pressure under the hoof of horses at the walk, at selected areas of interest (AOI), to find scientific evidence for the perceived efficacy of these shoes in the treatment of palmar heel pain. METHODS: Six clinically sound adult Warmblood mares weighing 551 (SD 25) kg were shod (forelegs) with either plain, eggbar or 6°-wedge shoes using a latin-square experimental design. All horses were shod by the same farrier, and each balanced and aligned for its individual conformation. Data were collected on three walking strides for each foreleg using a 550 × 4057minus; mm pressure plate to quantify the distribution of pressure under each type of shoe at five AOI. RESULTS: Landing of the hoof with all three shoes was predominantly from lateral to medial (range 7–15 msec). Irrespective of the type of shoe, the greatest pressure was found in the lateral and medial toe (lateral 39.7 (SE 0.6) N/cm2 and medial 35.0 (SE 0.5) N/cm2) and the point of the toe (33.3 (SE 0.5) N/cm2). The lowest peak pressure was in the heel (lateral 25.9 (SE 0.5) N/cm2 and medial 21.1 (SE 0.4) N/cm2; p < 0.05). Eggbar and wedge shoes increased total stance time (938 (SE 8) msec and 952 (SE 6) msec, respectively) compared with plain shoes (898 (SE 14) msec) (p<0.05). The wedge shoe reduced breakover compared with the plain and eggbar shoes (13.8% vs 15.8% and 14.5%, respectively; p<0.05). The eggbar shoe had lower total shoe peak pressure (29.5 (SE 0.7) N/cm2) than plain (31.8 (SE 0.5) N/cm2) and wedge (30.9 (SE 0.6) N/cm2) shoes. CONCLUSIONS AND CLINICAL RELEVANCE: Both the eggbar and 6°-wedge shoe offer advantages for palmar heel pain. In comparison to the plain shoe, the eggbar shoe had less peak pressure at the heel AOI, and across the entire shoe, due to the greater bearing surface and the effect of the longer heel. The 6°- wedge shoe had greater loading on the lateral heel AOI, but promoted earlier breakover at the toe. Both shoes offer advantages for the horse with palmar heel pain, though choice of shoe will depend on clear identification of the causative factors, to provide therapeutic shoeing that maximises the individual horse7's response.

The effectiveness of wedge shoes in patients with insufficient vestibular compensation

Objectives Patients who fail to achieve sufficient vestibular compensation after acute vestibular deafferentation show a tendency to deviate toward the affected side. This study evaluated the effectiveness of wedge shoes specially manufactured with a 4 mm inclination on the affected side to patients with chronic vestibular insufficiency. Methods Subjects comprised 13 patients with chronic vestibular insufficiency for >6 months after acute unilateral vestibular dysfunction and 9 healthy volunteers. Subjects underwent vestibular tests wearing wedge shoes and regular shoes. Differences in results were compared. Results Patients showed significant improvements in the straight gait test ( p < 0.01), Unterberger–Fukuda stepping test ( p < 0.01) and posturography test ( p = 0.015) when wearing wedge shoes compared with wearing regular shoes. Conclusion Our results suggested that raising the lateral sole of shoes on the affected side could effectively ameliorate the effects of chronic vestibular insufficiency.

The influence of sole wedges on frontal plane knee kinetics, in isolation and in combination with representative rigid and semi-rigid ankle–foot-orthoses

In earlier stages of knee osteoarthritis orthotic treatments with knee orthoses or modified footwear are often considered. Although the load reducing effects of knee orthoses have been well established, wearing modified footwear would be more comfortable for the patient and less encumbering. The effect of modified footwear on the frontal load of the knee is controversial. This article describes the effect of medial or lateral shoe wedges alone or together with two different types of ankle-stabilizing orthoses. The effect on frontal knee loading was measured during standing and walking with medially and laterally placed wedges under the sole of the shoe. The wedges were also combined with two types of orthotic devices - an Ankle-Foot-Orthosis that was rigid in the frontal plane but allowed unrestricted sagittal plane motion and an ankle support that was semi-rigid in the frontal plane. Joint loading of 10 healthy persons (mean (standard deviation): age 34 (9) years, height 178 (4)cm, mass 73 (9)kg) was investigated by means of a special measuring device that accurately determines static loads (Lasar Posture) and with instrumented gait analysis (Vicon/Kistler). Using a lateral wedge under the sole of the shoe (without orthotic support) showed no significant reduction in the mean maximal knee moment in the frontal plane. Adding an Ankle-Foot-Orthosis that is rigid in the frontal plane resulted in significant reduction in the maximal frontal moment from 0.54 Nm/kg to 0.38Nm/kg (p0.01). Using a medial wedge, without and with Ankle-Foot-Orthosis, produced a significant increase in the maximal frontal moment to 0.59 Nm/kg (p0.05) or 0.67 Nm/kg (p0.01), respectively. These results suggest that the application of a sole wedge significantly influences frontal knee loading when used in combination with an Ankle-Foot-Orthosis that is rigid in the frontal plane.

Wedge and Eggbar Shoes Change the Pressure Distribution Under the Hoof of the Forelimb in the Square Standing Horse

Summary The shoe types most commonly applied to horses with navicular disease or other forms of palmar heel pain are shoes with heel wedges and eggbar shoes, although their efficacy has been a matter of debate among veterinarians and farriers for centuries. To quantify the effect of these different types of “navicular” shoeing on static hoof pressure distribution, 6 warmblood horses were shod with 6° wedge, eggbar, and plain shoes. While standing square with weight evenly distributed across both forelimbs, the center of pressure and pressures at selected areas of interest (AOI: toe, medial and lateral toe, medial and lateral heel) were measured using a Footscan (RsScan International, Belgium) pressure plate in a Latin square design using the plain shoe as a reference. Wedge shoes did not provide a significant shift in the center of pressure. The application of eggbar shoes did not alter the relative position of the center of pressure under the hoof. However, the absolute distance from the toe to the center of pressure was significantly larger with eggbar shoes (77 + 12 mm) compared with plain and wedged shoes (70 ± 8 mm, P < .05) resulting in an absolute, caudal shift of the center of pressure. When pressure (N/cm 2) values at the five AOIs were averaged for each shoe type, the wedge and eggbar shoe recordings showed a significantly lower mean pressure than plain shoes ( P < .05). In conclusion, mean AOI pressures decreased with wedge and eggbar shoes, and eggbar shoes provided a caudal shift in the center of pressure. These effects are believed to decrease the moment of the coffin joint and reduce the pressure on the navicular bone. Thus, the findings of this study might contribute to the scientific evidence of efficacy of the use of wedge and eggbar shoes in “navicular” lame horses.

Wedge and eggbar shoes change the pressure distribution under the hoof of the forelimb in the square standing horse

Wedge and eggbar shoes change the pressure distribution under the hoof of the forelimb in the square standing horse