Shoes In Patients Research Articles

Kinematic Comparison of Orthopedic Shoes and Ankle-Foot Orthoses in Children With Cerebral Palsy

Background. In patients with cerebral palsy (CP), secondary orthopedic deformities and violations of the walking pattern are often observed, so various methods of treatment are used for its correction, including orthosis. Abroad, orthoses (AFO) for ankle joints are most often used in clinical practice, whereas in Russia complex orthopedic shoes are used. At the same time, there are no comparative studies investigating the influence of these orthopedic products on the biomechanical parameters of gait.
 The aim of the study was to compare the kinematic parameters of walking in children with cerebral palsy, depending on the type of fixation of the foot and ankle joint.
 Methods. 25 biomechanical studies (9 barefoot tests; 7 tests in orthopedic shoes; 9 tests in AFO) were conducted in 9 patients with GMFCS 2 and GMFCS 3 levels of global motor function impairment.
 Results. The analysis showed that using AFO compared to walking barefoot, regardless of the GMFCS level, positively affects the space-time characteristics of walking, the kinematics of the ankle and knee joints, without significantly affecting the function of the hip joint. In this regard, an improvement in the integral indicator the gait index was noted. The use of orthopedic shoes in patients with GMFCS 2 and GMFCS 3 levels of global motor functions led to an improvement in the kinematics of the ankle and knee joints. At the same time, in patients in the GMFCS 2 group, the use of orthopedic shoes provided an improvement in more components of the gait index, whereas in the GMFCS 3 group, the number of such variables was significantly less. A comparative analysis of the results showed that the kinematic parameters of walking in orthopedic shoes are better in patients of the GMFCS 2 group, but in the GMFCS 3 group it is significantly better when using AFO.
 Conclusion. The choice of the type of foot fixation in patients with cerebral palsy, taking into account the level of global motor functions impairment, can significantly affect the correction of biomechanical parameters of walking.

Experience and outcome: Walking in the shoes of patients’ loved ones

Experience and outcome: Walking in the shoes of patients’ loved ones

Shoes with elastic upper vs. shoes with a round toe box for perceived comfort and interdigital forefoot pressure in patients with hallux valgus deformity

Although shoes act as a protective covering for the feet, they can be an important source of pain and foot disorder if not properly fitted. The purpose of this study was to investigate the effect of a shoe with highly compliant upper on the dorsal digital and interdigital pressure in comparison with shoes with a rounded toe box and participant’s own shoes in patients with Hallux Abducto Valgus (HAV) deformity. Eighteen participants with moderate to severe HAV were recruited. The patients’ perceived comfort and interdigital forefoot pressure were measured using force sensitive resistance sensors while wearing shoes with a round toe box and shoes with stretchable fabric upper and were compared to when the participants were wearing their own preferred shoes. Shoes with stretchable fabric upper significantly reduced the dorsal digital and interdigital pressure and increased perceived comfort. The results of the present study showed the superiority of shoes with stretchable fabric upper in reducing the pressure on the forefoot and the overall comfort compared to shoes with a round toe box and participant’s own shoes in people with HAV. It, therefore, seems that shoes with stretchable fabric upper can be recommended to ameliorate the treatment outcome in people with HAV.

Results of the full-factor experiments of prophylactic footwear construction recommended for patients with insular diabetes

The article covers the results of full-factor experiments of prophylactic footwear recommended for patients with diabetes. Comparative effects results of production determined the optimal parameters of prophylactic footwear are given. The article evaluates the use of orthopedic shoes in patients with diabetes mellitus with a foot ulcer or a minor previous one. Special prophylactic footwear with inner insole have been studied and applied and have been proven to relieve toenail pain in diabetes, thereby reducing the maximum pressure of the toe. The analysis of the dependence graphs obtained on the basis of analytical solutions of the regression equations obtained as a result of the conducted experiments and full factorial experiments is given.

Influence of orthopedic shoes on the indicators of the interzonal load distribution on the foot when walking patients with cerebral palsy

BACKGROUND: Clinical observations of patients with spastic forms of cerebral palsy and surveys showed the most commonly used technical rehabilitative device of this patient contingent are orthopedic shoes. However, almost no clinical and instrumental studies examine the effect of such shoes on the walking characteristics of patients with cerebral palsy (CP).
 AIM: This study aims to estimate the effect of orthopedic shoes on the interzonal load distribution on the plantar foot surface in children with CP and adolescents with different levels of gross motor function disorders (GMFCS).
 MATERIALS AND METHODS: Biomechanical studies were conducted in 42 patients with CP 5-16 years old with GMFCS 13 level while wearing standard and orthopedic shoes. In 14 healthy children controls while wearing standard shoes (a total of 112 feet). Biomechanical examinations were performed on the software and hardware complex DiaSled-M-Scan with matrix plantar pressure meters in the form of insoles. Statistical data analysis was performed using nonparametric methods via SPSS software for Windows.
 RESULTS: The use of complex orthopedic shoes in patients with level GMFCS 1 did not improve but worsened their foot loading parameters. The shoes reduced the loading of the heel, increased the toe-heel load ratio, and mediolateral load distribution in the fascicle area. In patients with GMFCS 2, the positive effect of orthopedic shoes was limited to improving the mediolateral load distribution in the fascicle area. In patients with GMFCS 3, the positive effect of orthopedic shoes was noted in the majority of the tested parameters.
 CONCLUSION: Thus, the study showed that in children and adolescents with CP using complex orthopedic shoes led to the most significant normalization of interzonal load distribution under the foot in GMFCS 3 patients, less significant in GMFCS 2 patients, and worsened the parameters in GMFCS 1 patients.

Comparing walking biomechanics of older females in maximal, minimal, and traditional shoes

BackgroundKnee osteoarthritis (OA) is a degenerative joint disease that affects millions of individuals each year. Several biomechanical variables during walking have been identified as risk factors for developing knee OA, including the peak external knee adduction moment (KAM) and the knee flexion angle at initial contact. Many interventions have been studied to help mitigate these risk factors, including footwear. However, it is largely unknown how varying shoe cushioning may affect walking biomechanics related to knee OA risk. Research QuestionWhat is the effect of maximally and minimally cushioned shoes on walking biomechanics compared to a traditionally cushioned shoe in older females? MethodsWalking biomechanics in three shoes (maximal, traditional, minimal) were collected on 16 healthy females ages 50–70 using an 8-camera 3D motion capture system and two embedded force plates. Key biomechanical variables related to knee OA disease risk were compared between shoes using repeated measures ANOVAs. ResultsThe KAM was significantly larger in the maximal shoe (p = 0.005), while the knee flexion angle at initial contact was significantly larger in both the maximal and minimal shoe compared to the traditional shoe (p = .000). Additionally, the peak knee flexion angle (p = .000) and the loading rates of the vertical ground reaction force were (instantaneous: p = 0.001; average: p = .010) were significantly higher in the minimal shoe. SignificanceWhile these results are specific to the shoes used in this study, clinicians should exercise caution in prescribing maximal or minimal shoes to females in this age group who may be at risk of knee OA given these results. Research is needed on the effect of these shoes in patients with knee OA.

The biomechanical behaviour of ankle and foot joints during walking with shoes in patients with haemophilia.

Patients with haemophilia (PwH) often prefer shod walking over barefoot walking as footwear offers ankle joint stability and comfort during gait. Yet, the biomechanical mechanisms contributing to the latter remain poorly understood. To explore the effect of shoes on the biomechanical functioning of the ankle and foot complex in PwH with and without haemophilic ankle arthropathy and to determine the amount of ankle joint loading during shod walking. We analysed data of PwH without haemophilic ankle arthropathy (n=5) and PwH with severe haemophilic ankle arthropathy (n=17) and a control group (n=17). During 3D gait analysis, a four-segment kinetic foot model was used to calculate kinematic and kinetic parameters of the ankle, Chopart, Lisfranc and first metatarsophalangeal (MTP 1) joints during both barefoot and shod walking. We found a significantly greater ankle joint power generation during shod walking compared to barefoot walking in PwH with severe haemophilic ankle arthropathy (P<.001). Chopart joint biomechanics were significantly lowered in all three groups during shod walking compared to barefoot walking. During shod walking, the ankle joint load was significantly lowered in both PwH groups (P=.039 and P=.002), but not in the control group (P=.952). Explorations in this study uncover a tendency that shoes alter the biomechanical functioning of the ankle and foot complex in PwH and simultaneously lower the ankle joint load during walking.

Clinical and Radiological Outcomes of Forefoot Offloading Versus Rigid Flat Shoes in Patients Undergoing Surgery of the First Ray.

It is common clinical practice to use either flat or reverse camber shoes to protect the foot for up to 6 weeks after surgery for hallux valgus or hallux rigidus. To date there is a paucity of evidence as to whether there is any difference between these 2 postoperative shoes, in either patient satisfaction or clinical outcomes. One hundred consecutive patients undergoing scarf/Akin osteotomies or first metatarsophalangeal joint (MTPJ) arthrodesis were recruited. Patients were randomized 50:50 to either flat or reverse camber postoperative shoes. Patients undergoing ancillary lesser toe procedures were not excluded. Patient satisfaction was assessed by visual analog scale (VAS) pain score and Likert satisfaction survey. Radiographic outcomes were reviewed at 1 year observing differences in fusion rates or deformity recurrence. There were 47 patients in the reverse cam and 43 in the flat shoe group. No difference in primary forefoot operation, additional operation, age at surgery, or preop VAS pain score was seen. At 6 weeks, there was no significant difference in postop VAS pain score. The flat shoe group was significantly more likely to be satisfied with their general mobility (86.0% vs 61.7%; P = .01) and with their stability in the shoe (90.7% vs 69.6%; P = .03). No significant difference was seen between groups for nonunion or hallux valgus recurrence rates. Both forms of postoperative footwear were effective in enabling patients to mobilize and in preventing adverse outcomes. Patients were more likely to be satisfied with a flat postoperative shoe due to improved stability and ease of mobilizing. The results of this study aid surgeon decision making for postoperative footwear in forefoot surgery. Level II, prospective randomized controlled trial.

The effectiveness of therapeutic shoes in patients with rheumatoid arthritis: a systematic review and meta-analysis.

The study summarizes the evidence on the effectiveness of therapeutic shoes on foot function, foot pain, physical functioning, health-related quality of life, adherence, adverse events and patient satisfaction in patients with rheumatoid arthritis (RA). Studies investigating the effect of (ready- or custom-made) therapeutic shoes were included. For between-group designs, studies comparing therapeutic shoes versus non-therapeutic shoes were included. A literature search was conducted in The Cochrane Central Registry for Controlled Trials (CENTRAL), PubMed, EMBASE and PEDro up to January 19, 2017. Quantitative data analysis was conducted; when this was not possible qualitative data analysis was performed. Eleven studies were identified. For custom-made shoes, no studies reporting between-group differences were available. Qualitative data-syntheses of the within-group differences resulted in weak evidence for the reduction of foot pain and improvement of physical functioning. For ready-made shoes, one study reported between-group differences, resulting in inconclusive evidence for improvement of foot function. Quantitative data-analyses of within-group differences resulted in a medium to large effect for the reduction of foot pain (SMD 0.60, 95% CI 0.28-0.92; P ≤ 0.001; 184 participants) and a small to medium effect for the improvement of physical functioning (SMD 0.30, 95% CI 0.04-0.56; P = 0.02; 150 participants). Qualitative data-synthesis of within-group differences resulted in weak evidence for improvement of foot function. Within-group results indicate that therapeutic shoes are likely to be effective in patients with RA. Definitive high-quality RCTs are necessary to investigate the between-group effectiveness of therapeutic shoes in patients with RA.

Development of self powered walking support shoes for patients with diabetic neuropathy

Development of self powered walking support shoes for patients with diabetic neuropathy

A Randomized Comparison of the Biomechanical Effect of Two Commercially Available Rocker Bottom Shoes to a Conventional Athletic Shoe During Walking in Healthy Individuals

Rocker bottom shoes have recently gained considerable popularity, likely in part because of the many purported benefits, including reducing joint loading and toning muscles. Scientific inquiry about these benefits has not kept pace with the increased usage of this shoe type. A fundamental premise of rocker bottom shoes is that they transform hard, flat, level surfaces into more uneven ones. Published studies have described a variety of such shoes—all having a somewhat rounded bottom and a cut heel region or a cut forefoot region, or both (double rocker). Despite the fundamentally similar shoe geometries, the reported effects of rocker bottom shoes on gait biomechanics have varied considerably. Ten healthy subjects agreed to participate in the present study and were given appropriately sized Masai Barefoot Technology (St. Louis, MO), Skechers™ (Manhattan Beach, CA), and New Balance (Boston, MA) conventional walking shoes. After a 12-day accommodation period, the subjects walked wearing each shoe while 3-dimensional motion and force data were collected in the gait laboratory. The key findings included (1) increased trunk flexion, decreased ankle plantarflexion range, and reduced plantarflexion moment in the early stance; (2) increased ankle dorsiflexion and knee flexor moment in the midstance; (3) decreased peak ankle plantarflexion in the late stance; and (4) decreased ankle plantarflexion and decreased hip flexor and knee extensor moments in the pre-swing and into swing phase. The walking speed was unconstrained and was maintained across all shoe types. A biomechanical explanation is suggested for the observed changes. Suggestions for cautions are provided for using rocker bottom shoes in patients with neuromuscular insufficiency.

The use of orthopaedic shoes in patients with diabetes at high risk of foot amputation and Charcot arthropathy

Aim. To evaluate the use of orthopaedic shoes in patients with diabetes with foot ulcers and/or previous minor amputations or Charcot arthropathy (CA) and factors influencing this use.Patients and methods. One hundred twenty-one patients with diabetes (55 men and 66 women; 36 in the inactive stage of CA) were included. A questionnaire based on footwear was used to evaluate patients’ compliance. Daily activity and the severity of the foot deformities were recorded. Further, foot geometry and forefoot and midfoot circumferences were measured.Results. Fifty-eight patients did not use orthopaedic shoes. Users and non-users did not differ in terms of gender and type of diabetes. The causes of refusal included ill-fitting shoes (56%), ugly appearance (11%), traumatisation with shoes (11%), inability to walk (5%) and other causes (17%). The percentages of patients in each category of deformity severity were mild (41.2%), moderate (37%) and severe (54%. Frequency of refusal of CA vs non-CA patients: 72.2% and 43.5%; with severe deformities,70.8% vs 34%; with moderate deformities, 83.3% vs 57.2% (p 0.05 for all). In patients with CA, the only significant parameter was the difference in the circumference of the midfoot between the affected and non-affected foot; in CA users and non-users, this parameter was 1.93 ± 1.25 vs 0.70 ± 0.83 cm, respectively (р = 0.01).Conclusions. The high frequency of refusing to wear orthopaedic shoes is related to severe foot deformities and the inability to accommodate them in off-the-shelf footwear. Most of the patients used orthopaedic shoes for outdoor use, but the frequency of use was low. Shoe compliance did not depend on gender but increased with ageing, low levels of daily activity and in patients with severe deformities. Patients with CA are characterised with extremely low compliance. In this group, foot parameters and other objective parameters did not rely on footwear compliance.

Walking in the shoes of patients, not just in their genes: a patient-centered approach to genomic medicine.

Genomic technologies are increasing the precision with which clinicians can assess an individual patient's risk for developing diseases and identify which patients are likely to benefit from specific treatments. Also advocating for a shift away from a one-size-fits-all approach is the growing emphasis on "patient-centered" care. Using examples from breast cancer, we make a case for why, in order to optimize patient health outcomes, genomic medicine will need to be practiced within a patient-centered framework. We present a six-function conceptual framework for patient-centered care and discuss findings from a national survey evaluating the patient-centeredness of care delivered in the USA.

Poster 26 The Effect of Balance Training Using Visual Feedback in Barefoot and Shoes in Patients with Stroke

Poster 26 The Effect of Balance Training Using Visual Feedback in Barefoot and Shoes in Patients with Stroke

Orthoses in diabetic foot treatment and prevention

Aim. To define the role of orthoses in the treatment and rehabilitation of patients with diabetic foot syndrome. Methods. The review of the literature addressing the use of special orthopedic shoes in the treatment and rehabilitation of patients with complicated diabetes mellitus was performed. Results. The common requirements for orthopedic shoes for patients with complicated diabetes mellitus are the following: (1) rigid sole with an artificial curvature; (2) boot-tree elevated by 8 mm due to arch supporter, adequate volume, wide sole, removable insole; (3) insole without functional memory; (4) thermally variable elastic material, advisably with silver ions, for the lining; (5) minimal number of sutures at the lining; (6) no elastic material at the front of the shoe and at the lining at the toes; (7) increased volume and enough space for the toes; (8) front slant of 15°; (9) potential ability to adjust the inner volume of the shoe; (10) hard counter - stabilizing hard back with additional softening at the lining side; (11) heel with a front slant or a solid sole without a heel; (12) smooth non-traumatic surface suitable for scrubbing including cleansing with antiseptics. The indications for orthopedic relief in patients with diabetic foot syndrome are explained. Economic superiority of organ-preserving approaches in such patients is shown. There is an opposition for conservative methods of treatment of patients with diabetic foot syndrome, nevertheless, an amputation can not be estimated as a positive treatment outcome in such patients. Almost 70-90% of ulcers in this group of patients are healed without amputation. Limb-saving treatment and the use of specially selected shoes are cheaper and more cost-effective compared to the limb loss. Conclusion. The use of orthopedic shoes in patients with diabetic foot syndrome is used both for treatment and rehabilitation. This technique can reduce the risk of ulceration and prevent organ-sparing surgeries.

Do orthopaedic shoes improve local dynamic stability of gait? An observational study in patients with chronic foot and ankle injuries

BackgroundComplex foot and ankle fractures, such as calcaneum fractures or Lisfranc dislocations, are often associated with a poor outcome, especially in terms of gait capacity. Indeed, degenerative changes often lead to chronic pain and chronic functional limitations. Prescription footwear represents an important therapeutic tool during the rehabilitation process. Local Dynamic Stability (LDS) is the ability of locomotor system to maintain continuous walking by accommodating small perturbations that occur naturally during walking. Because it reflects the degree of control over the gait, LDS has been advocated as a relevant indicator for evaluating different conditions and pathologies. The aim of this study was to analyze changes in LDS induced by orthopaedic shoes in patients with persistent foot and ankle injuries. We hypothesised that footwear adaptation might help patients to improve gait control, which could lead to higher LDS:MethodsTwenty-five middle-aged inpatients (5 females, 20 males) participated in the study. They were treated for chronic post-traumatic disabilities following ankle and/or foot fractures in a Swiss rehabilitation clinic. During their stay, included inpatients received orthopaedic shoes with custom-made orthoses (insoles). They performed two 30s walking trials with standard shoes and two 30s trials with orthopaedic shoes. A triaxial motion sensor recorded 3D accelerations at the lower back level. LDS was assessed by computing divergence exponents in the acceleration signals (maximal Lyapunov exponents). Pain was evaluated with Visual Analogue Scale (VAS). LDS and pain differences between the trials with standard shoes and the trials with orthopaedic shoes were assessed.ResultsOrthopaedic shoes significantly improved LDS in the three axes (medio-lateral: 10% relative change, paired t-test p < 0.001; vertical: 9%, p = 0.03; antero-posterior: 7%, p = 0.04). A significant decrease in pain level (VAS score -29%) was observed.ConclusionsFootwear adaptation led to pain relief and to improved foot & ankle proprioception. It is likely that that enhancement allows patients to better control foot placement. As a result, higher dynamic stability has been observed. LDS seems therefore a valuable index that could be used in early evaluation of footwear outcome in clinical settings.

Correlation between lesion site and concentration of dimethyl fumarate in different parts of shoes in patients with contact dermatitis caused by dimethyl fumarate in footwear

Dimethyl fumarate (DMF) has been identified as being responsible for an outbreak of shoe contact dermatitis in Europe. All reported cases to date have involved the dorsa of the toes and the dorsa of the feet, sometimes in association with other areas. To establish a correlation between the site of the lesions and the concentration of DMF in different parts of the footwear from patients suffering from shoe contact dermatitis. We performed a retrospective study of 8 patients with shoe contact dermatitis caused by DMF. Clinical data and patch test results obtained with DMF were recorded. The contents of DMF in different parts of eight samples of shoes involved were analysed with gas chromatography-mass spectrometry. The chemical analysis of all samples studied showed the presence of DMF, both in the uppers and the soles of the shoes. A clinical-analytical correlation was found in all cases. The presence of DMF in a child's boot was detected 1 year after withdrawal of the sachet with DMF from the shoe box. A correlation exists between the concentrations of DMF in the different parts of the shoe and the localization of the lesions. Although DMF is a volatile substance, it can remain impregnated in shoes for a long period of time.

Wedge Insoles Fail vs. Knee Osteoarthritis

BRUSSELS — Lateral wedge insoles placed in the shoes of patients with knee osteoarthritis gave no benefit and produced foot discomfort in a controlled study with 179 participants who completed 1 year of treatment. The withdrawal of wedge insoles as a recommended treatment option seems likely, as the new findings make the fourth – and largest – study to show no benefit in either pain or function and the first to show an absence of cartilage benefit by MRI examination, said researcher Kim Bennell, PhD, at the World Congress on Osteoarthritis. Based on the consistent results from four studies, “we can say [wedges] are not effective,” said Dr. Bennell, professor of physiotherapy and director of the center for health, exercise, and sports medicine at the University of Melbourne. Dr. Bennell said she thought her study might show something different. “There are good biomechanical data in the lab showing that insoles reduce load” on the knee, she pointed out. Also, the prior three studiesahad various flaws. The longest swhich ran 2 years, used patients with a variety of osteoarthritis types. Dr. Bennell's study used only patients with medial knee OA, the specific form most likely to respond to the knee unloading. Another study lasted only 6 weeks. The new study also used full-length wedges, which Dr. Bennell thought would work better than heel insoles. Plus, the new study used MRI to assess structural outcomes, whereas prior studies used less-sensitive x-rays, she said in an interview. The most recent recommendations for managing knee OA from the Osteoarthritis Research Society International (OARSI), published in 2008, say, “In patients with knee osteoarthritis [lateral wedge] insoles can reduce pain and improve ambulation” (Osteoarthritis Cartilage 2008;16:137-62). The new study recruited patients aged 50 years and older from the community who had knee pain on walking over the medial region with medial osteophytes and joint narrowing, a mechanical axis of 182 degrees or less, and a Kellgren-Lawrence (KL) grade of 2 or 3. The 200 patients who entered the study averaged 64 years old, about 60% were women, their average symptom duration was 7 years, their average body mass index was about 29 kg/m2, and they split evenly between having KL grade 2 or 3 disease. Every day, the randomized patients placed in their shoes either a wedge insole with a 5-degree pitch, or a flat, fully compressible control insole. Treatment ran for 1 year, with the insoles replaced quarterly. Patients in the wedge group reported wearing their insoles for an average of 7 hours daily, whereas the controls used theirs for an average of 9 hours daily. The study's primary outcomes (assessments of pain and cartilage structure) showed no significant differences between the 89 patients who completed 1 year in the wedge group and the 90 control patients who finished 1 year. The two groups also had no significant differences in measures of function. The main difference between the treatment groups was that 47% of wedge users and 23% of controls self-reported problems with the insoles. Reports of foot pain came from 36% of wedge users and 16% of controls. The discomfort was rated as severe by 10% of wedge users and 1% of controls. The difference in average time of insole use most likely had no effect on outcomes, Dr. Bennell said at the congress, which was organized by OARSI. Her group ran a model that extrapolated the impact of continuous wedge insole use and found that the results stayed the same. Dr. Bennell said that she has no disclosures for this study. She said that she had received research support for other studies from Essex, an Australian running-shoe manufacturer.

Randomized controlled trial for clinical effects of varying types of insoles combined with specialized shoes in patients with rheumatoid arthritis of the foot

Objective: To determine the effects of specialized shoes with insoles in patients with rheumatoid arthritis and the differences in terms of type of insole and anatomical location of foot pathology. Design: Single-blinded randomized controlled trial. Setting: Outpatients of physical medicine and rehabilitation clinic at university hospital. Subjects: Forty-two patients with rheumatoid foot lesions were randomly assigned to two different orthotic intervention groups. The anatomical locations of the foot lesions were recorded (hindfoot or forefoot). Intervention: Participants were provided with an extra deep forefoot-rockered shoe and either a custom-made semi-rigid insole or a ready-made simple soft insole. They wore the provided footwear for at least 3 hours a day over six months. Main outcome measures: Primary outcome measures were foot pain visual analogue scale (VAS) scores and Foot Function Index (FFI). Secondary outcome measures were erythrocyte sedimentation rate and C-reactive protein levels in blood, amounts of medications and active joint counts. These were checked at baseline and post intervention. Results: Eight patients dropped out at follow-up after six months of treatment. At six-month follow-ups, VAS scores and total Foot Function Index scores had decreased significantly in both groups versus baseline but intergroup comparison showed no significant differences in view of type of insoles and anatomical locations of foot pathology. Conclusions: We were unable to identify differences between the types of insoles in terms of their clinical effects or between anatomical locations of foot lesions in the two groups, but both groups improved. Therapeutic shoes plus soft insoles might be effective enough in terms of foot pain and foot function for specific patients with rheumatoid foot problems regardless of the location of foot pathology.

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.