Supportive Footwear Research Articles

Prevalence and Association of Risk Factors for Plantar Fasciitis Among Nurses in Government Tertiary Care Hospitals of Peshawar

Background: Plantar fasciitis is a common cause of heel discomfort and pain, resulting from inflammation of the plantar fascia, a thickened fibrous aponeurosis extending from the medial calcaneal tuberosity to the metatarsal heads. It affects more than 1 million people worldwide annually, with a lifetime prevalence that may reach 10% of the general population. Despite its widespread impact, the exact incidence remains unknown. Objective: This study aimed to determine the prevalence and associated risk factors of plantar fasciitis among nurses working in government tertiary care hospitals in Peshawar. Methods: A cross-sectional survey was conducted over six months, utilizing a convenient sampling technique. A total of 332 female nurses aged 25 to 50 years with clinical duties exceeding five hours per day participated in the study. Data were collected using the Plantar Fasciitis Pain and Disability Scale and the Visual Analogue Scale (VAS) for pain intensity. Face-to-face interviews and physical assessments were conducted by trained healthcare professionals. Statistical analysis was performed using SPSS version 25.0, with descriptive statistics calculated for quantitative variables and Chi-Square tests used to examine associations between variables. Ethical approval was obtained from the Institutional Review Board, and informed consent was secured from all participants. Results: The mean age of participants was 29.8042 ± 3.67743 years. The mean total score for plantar fasciitis was 31.4096, and the mean VAS score was 1.9458. Pain occurrence per week was reported as 1-2 days by 44.0% of participants, 3-4 days by 46.7%, and 5-7 days by 9.3%. Pain was most commonly worse in the afternoon (35.8%) and interfered with walking occasionally (52.7%). High heel standing was uncomfortable for 54.5% of participants. A significant relationship was found between age and VAS scores (p=0.001), as well as between high heel usage and increased pain levels (p=0.000). Conclusion: The mean score of plantar fasciitis among the nurses was below the threshold indicating significant prevalence. However, a significant association was found between high heel usage and plantar fasciitis, suggesting that footwear choices play a critical role in the development of this condition. Ergonomic interventions promoting supportive footwear and regular breaks are recommended to mitigate the risk of plantar fasciitis among nurses.

Theoretical Evaluation of Ankle Foot Orthosis Made of Carbon Fiber, Polyethylene and Structural Steel

Due to substantial developments in prosthetic foot research and development over the past 20 years, many people living in industrialized countries who had their lower limbs amputated today enjoy improved function and a higher quality of life. The great majority of end users in underdeveloped countries are unable to exploit this new R&D due to the components' high cost, low durability, high maintenance needs, and restricted accessibility. A prosthetic foot that is exceedingly useful, complies with monetary, environmental, and physical regulations, and can resist challenging working conditions and weather requires more study. A good prosthesis often depends on the elasticity of its component materials to generate a “spring,” which matches a physiological foot's stride, in order to optimize performance while minimizing manufacture costs. This study studied the mechanical properties of AFOs, especially structural stiffness, rotational motion, and strut deflection, to uncover design variables impacting superior functional results. AFO and footwear are routinely prescribed for diabetic patients to assist prevent the onset of foot ulcers. In regions of interest, plantar peak pressure (PPP) is reduced utilizing AFO and supportive footwear (ROI). This paper has main concentration on find out best suitable material available for manufacturing of AFO by comparing three standard materials to each other and check their performance by theoretical calculations method.

Shoes for self-managing chronic hip Pain: the SCHIPP randomized clinical trial protocol

BackgroundChronic hip pain is common and disabling and is largely due to osteoarthritis (OA). Self-management is recommended by international OA clinical guidelines yet there are few effective treatment options. Footwear has been suggested as a self-management approach, given that foot motion influences hip forces. Currently, guidelines advocate ‘stable supportive’ shoes for people with OA, however this is based solely on expert opinion given no research has investigated whether these shoes are effective at reducing symptoms in people with OA-related chronic hip pain. Therefore, this randomized controlled trial (RCT) aims to determine if stable supportive footwear reduces hip pain during walking compared to flat flexible footwear in people with chronic hip pain consistent with OA.MethodsThis trial is a 6-month, participant- and assessor-blinded, pragmatic, comparative effectiveness, superiority RCT conducted in Melbourne, Australia. We are recruiting 120 participants aged over 45 years with chronic hip pain consistent with OA from the community. Following baseline assessment, participants are randomized to receive either i) stable supportive shoes or ii) flat flexible shoes. Participants are permitted to choose two different pairs of shoes in their allocated group from a range of options that match prespecified shoe classification criteria. They are advised to wear either pair of study shoes daily for a minimum of 6 hours each day for 6 months. The primary outcome is the 6-month change in average hip pain on walking in the last week. Secondary outcomes include changes in other measures of hip pain, symptoms, function in daily living and sports and recreation, hip-related quality of life, pain at other sites, adverse events, and physical activity. Other measures include co-intervention use, adherence, shoe comfort, descriptive characteristics, footwear characteristics, and objective foot measures.DiscussionThis RCT will determine whether stable supportive shoes reduce hip pain during walking more than flat flexible shoes in people with chronic hip pain. Outcomes will help to inform footwear recommendations in international clinical guidelines for OA-related chronic hip pain, which to date have been based solely on expert opinion because of an absence of RCTs.Trial registrationAustralian New Zealand Clinical Trials Registry reference: ACTRN12621001532897.

Effects of supportive and minimalist footwear on standing balance and walking stability in older women

BackgroundFootwear has been shown to influence balance and is an important consideration in relation to the prevention of falls. However, it remains unclear as to what type of footwear is most beneficial for balance in older people: sturdy, supportive footwear, or minimalist footwear to maximise plantar sensory input. The objectives of this study were therefore to compare standing balance and walking stability in older women wearing these two footwear styles, and to investigate participants’ perceptions in relation to comfort, ease of use and fit.MethodsOlder women (n = 20) aged 66 to 82 years (mean 73.4, SD 3.9) performed a series of laboratory tests of standing balance (eyes open and closed on floor and foam rubber mat, near tandem standing) and walking stability (treadmill, level and irregular surface) using a wearable sensor motion analysis system. Participants were tested wearing supportive footwear (incorporating design features to improve balance) and minimalist footwear. Perceptions of the footwear were documented using structured questionnaires.ResultsThere were no statistically significant differences in balance performance between the supportive and minimalist footwear. Participants perceived the supportive footwear to be significantly more attractive to self and others, easier to put on and off but heavier compared to the minimalist footwear. Overall comfort was similar between the footwear conditions, although the supportive footwear was reported to be significantly more comfortable in the heel, arch height, heel cup, heel width and forefoot width regions. Eighteen participants (90%) reported that they felt more stable in the supportive footwear and 17 (85%) reported that they would consider wearing them to reduce their risk of falling.ConclusionBalance performance and walking stability were similar in supportive footwear designed to reduce the risk of falling and minimalist footwear, although participants preferred the supportive footwear in relation to aesthetics, ease of use, comfort and perceived stability. Prospective studies are now required to ascertain the longer-term advantages and disadvantages of these footwear styles on comfort and stability in older people.Trial registrationAustralian New Zealand Clinical Trials Registry. ACTRN12622001257752p, 20/9/2022 (prospectively registered).

P03 Utilizing a videography platform for the therapeutic management of chronic pain relating to Hypermobility in children and young people

Introduction/BackgroundMany patients present to Paediatric Rheumatology clinic, (53%) with chronic pain related to Hypermobility. Pre-Covid, an evidenced based hypermobility class was developed and run by the Allied Health Professional team for children and young people (C & YP), and their parents/carers. These 6 classes were group-based and included education and exercise therapy but were stopped due to the pandemic. Feedback gained was good from the class, although reported issues included reduced school attendance, accessibility due to location, parental time off work, financial and time implications of travel, and unsuitability of group interventions for CYP with social anxiety and autism disorders.Description/MethodA digital platform (Vimeo) was used to present Hypermobility education and exercise content created by the Paediatric Rheumatology team. The video aims to address these barriers, allowing more equality of access for all CYP; digital access allows CYP and parents to re-visit this information at any time, providing ongoing support for long term management of this condition. The digital platform is being developed to maximize the effectiveness of therapy resources and to improve the patients experience to promote self-management of their hypermobility.Funding was applied for via the Transformation service. Meeting with the hospital videographer enabled the AHP team to devise a template for the video including education on what is Hypermobility, on the role of exercise - targeted versus general, the benefits of exercise, supportive footwear, pain management, pacing, sleep hygiene, and hand function advice to manage hypermobility. The class exercise programme including hand therapy was videoed using a model.The video was filmed in half a day. It was filmed using an unscripted question- and- answer format. The Paediatric Rheumatology MDT were filmed in the video. The digital platform is currently with our videography team for further edit. Further signposting to established resources will be included in the Vimeo resource.Following a final edit, this resource will be used for this patient population group. Feedback from CYP and parents, along with other health professionals is planned.Discussion/ResultsOn receipt of the first edit, multi-source feedback from parents/carers, CYP and other health professionals is planned via Microsoft Teams. It is hoped to show the video via Teams and seek anonymized feedback on the Teams chat function. This feedback will be discussed by the Paediatric Rheumatology MDT and will inform the final edit of the Hypermobility video resource.Further data from Vimeo analytics will be gathered e.g. how many times video watched, how long video is watched for, and what devices are being used.It is hoped that the Hypermobility Video will help support CYP and families in the long-term management and pain resulting from this condition.Key learning points/ConclusionIt is hoped that the use of new technologies and innovative ways of delivering care can enable health professionals to implement clinical support, improve self-management of chronic pain related to hypermobility, whilst improving equitable patient access to therapy across the North-West.Multi-source feedback will help inform the final edit of the video resource. Ongoing evaluation and analysis of Vimeo data will inform whether the resource is a useful adjunct in long term management of pain arising from Hypermobility.

Flat flexible compared to stable supportive footwear for self-managing knee osteoarthritis symptoms: a randomised clinical trial

Introduction: International clinical guidelines advise stable supportive shoes for knee osteoarthritis (OA) however evidence suggests flat flexible shoes may reduce knee joint loading and symptoms. We hypothesised that flat flexible shoes would lead to greater improvements in pain and function, compared to stable supportive shoes. Methods: This was a two-arm, participant- and assessor-blinded comparative effectiveness randomised controlled trial. We recruited 164 people aged 50 years or older with knee pain on most days of the past month and moderate to severe radiographic medial tibiofemoral OA. Participants were randomised to receive either flat flexible shoes (n=82) or stable supportive shoes (n=82), classified based on: i) differences in shoe heel height/thickness, ii) shoe pitch, iii) arch support/motion control features, iv) sole flexibility and v) weight. Shoes were worn >6 hours/day for 6 months. Primary outcomes were changes in walking knee pain (11-point numerical rating scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index subscale, 0-68) at 6-months. Secondary outcomes included additional measures of pain, function, physical activity, quality of life and adverse events. Results: 164 participants were recruited and 161 (98%) completed 6-month primary outcomes. There was evidence of a between-group difference in change in walking knee pain favoring stable supportive shoes (mean difference=1.1 units (95%CI 0.5 to 1.8; p=0.001) but no strong evidence of difference in function (2.3 (-0.9 to 5.5; p=0.17)). Furthermore, 46 (58%) participants in the stable supportive group achieved the minimal clinically important difference (MCID) in pain, compared to 32 (40%) in the flat flexible group (relative risk 1.56, 1.05 to 2.02). Improvements in knee-related quality of life and ipsilateral hip pain also favored stable supportive shoes (-5.3 (-10.0 to -0.5; p=0.03) and 0.7 (0.0 to 1.4; p=0.04), respectively), with no evidence of between-group differences in other secondary outcomes. Fewer participants reported adverse events with stable supportive shoes (n=12 (15%)) compared to flat flexible shoes (n=26 (32%); relative risk=0.46 (0.25 to 0.84; p=0.012)). Discussion: Flat flexible shoes were not superior to stable supportive shoes. Contrary to our hypothesis, stable supportive shoes improved knee pain on walking more than flat flexible shoes. Furthermore, a greater proportion of participants allocated to stable supportive shoes achieved the MCID in walking pain compared to those allocated to flat flexible shoes. Findings from this trial are the first to show that stable supportive shoes may be an inexpensive, low burden self-management strategy to improve pain associated with knee OA. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract

Musculoskeletal anomalies in children with Down syndrome: an observational study

BackgroundMusculoskeletal complications of Down syndrome (DS) are common but infrequently reported. The combination of ligamentous laxity and low muscle tone contributes to increased risk of a number of musculoskeletal disorders...

Walking in Minimalist Shoes Is Effective for Strengthening Foot Muscles.

Weakness of foot muscles may contribute to a variety of loading-related injuries. Supportive footwear may contribute to intrinsic foot muscle weakness by reducing the muscles' role in locomotion (e.g., absorbing forces and controlling motion). Increased stimulus to the foot muscles can be provided through a variety of mechanisms, including minimalist footwear and directed exercise. To determine the effect of walking in minimalist footwear or performing foot strengthening exercises on foot muscle size and strength. Fifty-seven runners were randomly assigned to one of three groups-minimalist shoe walking (MSW), foot strengthening (FS) exercise, or control (C). All groups maintained their prestudy running mileage throughout the study. The MSW group walked in provided footwear, increasing weekly the number of steps per day taken in the shoes. The FS group performed a set of progressive resistance exercises at least 5 d·wk. Foot muscle strength (via custom dynamometers) and size (via ultrasound) were measured at the beginning (week 0), middle (week 4), and end (week 8) of the study. Mixed model ANOVA were run to determine if the interventions had differing effects on the groups. There were significant group-time interactions for all muscle size and strength measurements. All muscle sizes and strength increased significantly from weeks 0 to 8 in the FS and MSW groups, whereas there were no changes in the C group. Some muscles increased in size by week 4 in the FS and MSW groups. Minimalist shoe walking is as effective as foot strengthening exercises in increasing foot muscle size and strength. The convenience of changing footwear rather than performing specific exercises may result in greater compliance.

Abnormal Foot Position and Standing and Walking Ability in Rett Syndrome: an Exploratory Study

This study aimed to determine whether there is a relationship between abnormal foot position and standing and walking ability in individuals with Rett syndrome (RTT), a rare neurological condition primarily affecting females, often accompanied by impaired gross motor function and musculoskeletal deformities. Through means of an online survey, physiotherapists were asked to share information about their work and experience with individuals with RTT. They were asked about their clients’ scores on the Rett Syndrome Gross Motor Scale and measures of their foot deformity, passive range of motion of dorsiflexion of the foot, use of supportive footwear, pressure load on the foot, and symmetry in weight bearing. 45 physiotherapists gave answers relating to 67 individuals with RTT who ranged in age from 2 to over 50 years. Almost 80% had an abnormal foot position which required support of special shoes or orthoses. Approximately 55% experienced abnormal pressure load on the foot and 65% demonstrated asymmetrical weight-bearing; 22% could sit independently and 17% were able to stand and walk independently. Of all the variables investigated, only abnormal distribution of pressure on the foot and asymmetry in weight bearing through the legs were found to be (negatively) correlated with standing and walking ability. Physiotherapists can use this information to give advice on othopedic support for the feet of individuals with RTT.

Modifications in lower leg muscle activation when walking barefoot or in minimalist shoes across different age-groups

Ageing is associated with a decline in muscle strength and impaired sensory mechanisms which contribute to an increased risk of falls. Walking barefooted has been suggested to promote increased muscle strength and improved proprioceptive sensibility through better activation of foot and ankle musculature. Minimalist footwear has been marketed as a method of reaping the suggested benefits of barefoot walking whilst still providing a protective surface. The aim of this study was to investigate if walking barefoot or in minimalist footwear provokes increased muscle activation compared to walking in conventional footwear. Seventy healthy adults (age range 20–87) volunteered for this study. All participants walked along a 7m walking lane five times in four different footwear conditions (barefoot (BF), minimalist shoes (MSH), their own shoes (SH) and control shoes (CON)). Muscle activity of their tibialis anterior (TA), gastrocnemius medialis (GCM) and peroneus longus (PL) were recorded simultaneously and normalised to the BF condition. MSH are intermediate in terms of ankle kinematics and muscle activation patterns. Walking BF or in MSH results in a decrease in TA activity at initial stance due to a flatter foot at contact in comparison to conventional footwear. Walking BF reduces PL activity at initial stance in the young and middle age but not the old. Walking in supportive footwear appears to reduce the balance modulation role of the GCM in the young and middle age but not the old, possibly as a result of slower walking speed when BF.

Comparison Of Intrinsic Foot Muscle Size And Strength Between Gymnasts And Shod Runners

PURPOSE: Wearing supportive footwear during athletic activity may decrease the activity of the intrinsic foot muscles (IFM), leading to weaker muscles and suboptimal foot function. The purpose of this study was to compare the IFM size and strength of two athletic populations - gymnasts who train barefoot and runners who wear cushioned running shoes during training. METHODS: IFM size and toe flexor strength were measured from 13 female gymnasts (age: 19.8 ± .9 years; height: 158.9 ± 4.98 cm; weight: 56.9 ± 4.27 kg) and 21 female runners (age: 22.1 ± 2.95 years; height: 167.4 ± 8.88 cm; weight: 63.0 ± 9.38 kg). Strength was assessed from the big toe individually, and the 2nd, 3rd, and 4th toes together. During testing, the subject was seated with the knee flexed at 90°and the foot on the floor. The toes were aligned with a customized dynamometer. The subject gripped an S-beaner (great toe flexion) or a bar (lateral toe flexion) with their toe(s) and flexed to a maximal contraction for 3 seconds. The average of 3 trials was used for analysis. . Ultrasound images (10 MHz GE LogiqP6) were recorded of the abductor hallucis (ABDH), quadratus plantae (QP), flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB). Measurements included the cross-sectional areas of the ABDH, QP, FDB and thickness of the FHB. ANCOVAs (with height and weight as covariates) were run to compare the IFM size and flexor strength between the groups of subjects. RESULTS: Gymnasts had larger FDB and FHB, as well as stronger great toe flexion than runners (see table). CONCLUSION: The IFM responsible for toe flexion and great toe flexion strength were greater in gymnasts than runners. Based on these data, training without cushioned footwear, in a task that requires finer control of the foot, has resulted in increased great toe flexion strength. Though it’s difficult to separate training task from footwear in this study, these findings lend support to the idea that training in cushioned footwear may hinder optimal IFM function.Table: No title available.

Physical Examination Variables Predict Response to Conservative Treatment of Nonchronic Plantar Fasciitis: Secondary Analysis of a Randomized, Placebo-Controlled Footwear Study

BackgroundPlantar fasciitis is a common, disabling condition, and the prognosis of conservative treatment is difficult to predict. ObjectiveTo determine whether initial clinical findings could help predict patient response to conservative treatment that primarily consisted of supportive footwear and stretching. SettingPatients were recruited and seen at 2 outpatient podiatric clinics in the Chicago, Illinois, metropolitan area. PatientsSeventy-seven patients with nonchronic plantar fasciitis were recruited. Patients were excluded if they had a heel injection in the previous 6 months or were currently using custom foot orthoses at the time of screening. Sixty-nine patients completed the final follow-up visit 3 months after receiving the footwear intervention. MethodsTreatment failure was considered a <50% reduction in heel pain at 3 month follow-up. Logistic regression models evaluated the possible association between more than 30 clinical and physical examination findings prospectively assessed at enrollment, and treatment response. ResultsInability to dorsiflex the ankle past −5° (odds ratio [OR] 3.9, P = .024), nonsevere (≤7 on ordinal scale) first-step pain (OR 3.8, P = .021), and heel valgus in relaxed stance (OR 4.0, P = .014) each predicted treatment failure in multivariable analysis (receiver operating characteristic area under the curve = .769). Limited ankle dorsiflexion also correlated with greater heel pain severity at initial presentation (r = − 0.312, P = .006). ConclusionsPatients with severe ankle equinus were nearly 4 times more likely to experience a favorable response to treatment centered on home Achilles tendon stretching and supportive therapy. Thus, earlier use of more advanced therapies may be most appropriate in those presenting without severe ankle equinus or without severe first step pain. The findings from our study may not be clinically intuitive because patients with less severe equinus and less severe pain at presentation did worse with conservative care.

A survey of footwear advice, beliefs and wear habits in people with knee osteoarthritis

Expert opinion recommends cushioned and supportive footwear for people with knee osteoarthritis (OA). However, little is known about the footwear advice people receive from healthcare professionals, or the beliefs and footwear habits of people with knee OA. This study aimed to determine i) what types of shoes people are advised to wear for their knee OA and by whom; ii) establish which types of shoes people with knee OA believe are best for managing their knee OA symptoms and (iii) which shoes they wear most often. 204 people with symptomatic knee OA completed an online survey. The survey comprised 14 questions asking what footwear advice people had received for their knee OA and who they received it from, individual beliefs about optimal footwear styles for their knee OA symptoms and the types of footwear usually worn. Only one third (n = 69, 34%) of participants reported receiving footwear advice for their knee OA, and this was most frequently received from a podiatrist (n = 47, 68%). The most common advice was to wear sturdy/supportive shoes (n = 96, 47%) or shoes with arch supports (n = 84, 41%). These were also amongst the shoe styles that participants believed were best for their knee OA (n = 157 (77%) and n = 138 (68%) respectively). The type of shoes most frequently worn were athletic (n = 131, 64%) and sturdy/supportive shoes (n = 116, 57%). Most people with knee OA who completed our survey had not received advice about footwear for their knee OA symptoms. Our participants typically believed that sturdy/supportive shoes were best for their knee OA and this shoe style was most frequently worn, which is reflective of expert opinion. Future research is needed to confirm whether sturdy/supportive shoes are indeed optimal for managing symptoms of knee OA.

A survey of footwear advice, beliefs and wear habits in people with knee osteoarthritis.

BackgroundExpert opinion recommends cushioned and supportive footwear for people with knee osteoarthritis (OA). However, little is known about the footwear advice people receive from healthcare professionals, or the beliefs and footwear habits of people with knee OA. This study aimed to determine i) what types of shoes people are advised to wear for their knee OA and by whom; ii) establish which types of shoes people with knee OA believe are best for managing their knee OA symptoms and (iii) which shoes they wear most often.Methods204 people with symptomatic knee OA completed an online survey. The survey comprised 14 questions asking what footwear advice people had received for their knee OA and who they received it from, individual beliefs about optimal footwear styles for their knee OA symptoms and the types of footwear usually worn.ResultsOnly one third (n = 69, 34%) of participants reported receiving footwear advice for their knee OA, and this was most frequently received from a podiatrist (n = 47, 68%). The most common advice was to wear sturdy/supportive shoes (n = 96, 47%) or shoes with arch supports (n = 84, 41%). These were also amongst the shoe styles that participants believed were best for their knee OA (n = 157 (77%) and n = 138 (68%) respectively). The type of shoes most frequently worn were athletic (n = 131, 64%) and sturdy/supportive shoes (n = 116, 57%).ConclusionsMost people with knee OA who completed our survey had not received advice about footwear for their knee OA symptoms. Our participants typically believed that sturdy/supportive shoes were best for their knee OA and this shoe style was most frequently worn, which is reflective of expert opinion. Future research is needed to confirm whether sturdy/supportive shoes are indeed optimal for managing symptoms of knee OA.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-014-0043-8) contains supplementary material, which is available to authorized users.

Effectiveness of off-the-shelf footwear in reducing foot pain in Australian Department of Veterans� Affairs recipients not eligible for medical grade footwear: study protocol for a randomized controlled trial

BackgroundFoot pain is highly prevalent in older people, and in many cases is associated with wearing inadequate footwear. In Australia, the Department of Veterans’ Affairs (DVA) covers the costs of medical grade footwear for veterans who have severe foot deformity. However, there is a high demand for footwear by veterans with foot pain who do not meet this eligibility criterion. Therefore, this article describes the design of a randomized controlled trial to evaluate the effectiveness of low cost, off-the-shelf footwear in reducing foot pain in DVA recipients who are currently not eligible for medical grade footwear.MethodsOne hundred and twenty DVA clients with disabling foot pain residing in Melbourne, Australia, who are not eligible for medical grade footwear will be recruited from the DVA database, and will be randomly allocated to an intervention group or a ‘usual care’ control group. The intervention group will continue to receive their usual DVA-subsidized podiatry care in addition to being provided with low-cost, supportive footwear (Dr Comfort®, Vasyli Medical, Labrador, Queensland, Australia). The control group will also continue to receive DVA-subsidized podiatry care, but will not be provided with the footwear until the completion of the study. The primary outcome measure will be pain subscale on the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8, 12 and 16 weeks. Secondary outcome measures measured at baseline and 16 weeks will include the function subscale of the FHSQ, the Manchester Foot Pain and Disability Index, the number of DVA podiatry treatments required during the study period, general health-related quality of life (using the Short Form 12® Version 2.0), the number of falls experienced during the follow-up period, the Timed Up and Go test, the presence of hyperkeratotic lesions (corns and calluses), the number of participants using co-interventions to relieve foot pain, and participants’ perception of overall treatment effect. Data will be analyzed using the intention-to-treat principle.DiscussionThis study is the first randomized controlled trial to evaluate the effectiveness of off-the-shelf footwear in reducing foot pain in DVA recipients. The intervention has been pragmatically designed to ensure that the study findings can be implemented into policy and clinical practice if found to be effective.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12612000322831

A comparison of the spatiotemporal parameters, kinematics, and biomechanics between shod, unshod, and minimally supported running as compared to walking

Recreational running has many proven benefits which include increased cardiovascular, physical and mental health. It is no surprise that Running USA reported over 10 million individuals completed running road races in 2009 not to mention recreational joggers who do not wish to compete in organized events. Unfortunately there are numerous risks associated with running, the most common being musculoskeletal injuries attributed to incorrect shoe choice, training errors and excessive shoe wear or other biomechanical factors associated with ground reaction forces. Approximately 65% of chronic injuries in distance runners are related to routine high mileage, rapid increases in mileage, increased intensity, hills or irregular surface running, and surface firmness. Humans have been running barefooted or wearing minimally supportive footwear such as moccasins or sandals since the beginning of time while modernized running shoes were not invented until the 1970s. However, the current trend is that many runners are moving back to barefoot running or running in “minimal” shoes. The goal of this masterclass article is to examine the similarities and differences between shod and unshod (barefoot or minimally supportive running shoes) runners by examining spatiotemporal parameters, energetics, and biomechanics. These running parameters will be compared and contrasted with walking. The most obvious difference between the walking and running gait cycle is the elimination of the double limb support phase of walking gait in exchange for a float (no limb support) phase. The biggest difference between barefoot and shod runners is at the initial contact phase of gait where the barefoot and minimally supported runner initiates contact with their forefoot or midfoot instead of the rearfoot. As movement science experts, physical therapists are often called upon to assess the gait of a running athlete, their choice of footwear, and training regime. With a clearer understanding of running and its complexities, the physical therapist will be able to better identify faults and create informed treatment plans while rehabilitating patients who are experiencing musculoskeletal injuries due to running.

Clinical Predictors of Foot Orthoses Efficacy in Individuals with Patellofemoral Pain

There is emerging evidence that foot orthoses are effective in the management of patellofemoral pain syndrome (PFPS). However, the identification of those most likely to benefit from foot orthoses has not been adequately explored. The aim of this study was to develop a preliminary clinical prediction rule to help identify individuals with PFPS who are most likely to benefit from foot orthoses. A total of 60 individuals with PFPS were issued with noncustomized prefabricated foot orthoses containing built-in arch supports and 4° rear foot varus wedging. Patient-reported level of improvement was documented at 12 wk. Potential baseline predictor variables of interest included patient demographics, pain characteristics, footwear motion control properties, foot and ankle characteristics, and functional performance measures. Fourteen (25%) participants reported marked improvement at 12 wk. The number of participants with marked improvement increased to 78% if three of the following four criteria were met: footwear motion control properties score of <5.0 (indicative of less supportive footwear), usual pain <22.0 mm, ankle dorsiflexion range of motion (knee flexed) <41°, and reduced single-leg squat pain when wearing the orthoses. Individuals with PFPS who wear less supportive footwear, report lower levels of pain, exhibit less ankle dorsiflexion range of motion, and report an immediate reduction in pain with foot orthoses when performing a single-leg squat are more likely to benefit from foot orthoses.

AORN Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings

Prolonged standing during surgical procedures poses a high risk of causing musculoskeletal disorders, including back, leg, and foot pain, which can be chronic or acute in nature. Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings provides recommendations for relieving the strain of prolonged standing, including the use of antifatigue mats, supportive footwear, and sit/stand stools, that are based on well-accepted ergonomic safety concepts, current research, and access to new and emerging technology.

Anatomical evidence for the antiquity of human footwear: Tianyuan and Sunghir

Trinkaus [Trinkaus, E., 2005. Anatomical evidence for the antiquity of human footwear use. J. Archaeol. Sci. 32, 1515–1526] provided a comparative biomechanical analysis of the proximal pedal phalanges of western Eurasian Middle Paleolithic and Middle Upper Paleolithic humans, in the context of those of variably shod recent humans. The anatomical evidence indicated that supportive footwear was rare in the Middle Paleolithic but became frequent by the Middle Upper Paleolithic. Based on that analysis, additional data are provided for the Middle Upper Paleolithic (∼27,500 cal BP) Sunghir 1 and the earlier (∼40,000 cal BP) Tianyuan 1 modern humans. Both specimens exhibit relatively gracile middle proximal phalanges in the context of otherwise robust lower limbs. The former specimen reinforces the association of footwear with pedal phalangeal gracility in the Middle Upper Paleolithic. Tianyuan 1 indicates a greater antiquity for the habitual use of footwear than previously inferred, predating the emergence of the Middle Upper Paleolithic.

Adult Cavovarus Foot

Cavovarus foot deformity, which often results from an imbalance of muscle forces, is commonly caused by hereditary motor sensory neuropathies. Other causes are cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot. In cavovarus foot deformity, the relatively strong peroneus longus and tibialis posterior muscles cause a hindfoot varus and forefoot valgus (pronated) position. Hindfoot varus causes overload of the lateral border of the foot, resulting in ankle instability, peroneal tendinitis, and stress fracture. Degenerative arthritic changes can develop in overloaded joints. Gait examination allows appropriate planning of tendon transfers to correct stance and swing-phase deficits. Inspection of the forefoot and hindfoot positions determines the need for soft-tissue release and osteotomy. The Coleman block test is invaluable for assessing the cause of hindfoot varus. Prolonged use of orthoses or supportive footwear can result in muscle imbalance, causing increasing deformity and irreversible damage to tendons and joints. Rebalancing tendons is an early priority to prevent unsalvageable deterioration of the foot. Muscle imbalance can be corrected by tendon transfer, corrective osteotomy, and fusion. Fixed bony deformity can be addressed by fusion and osteotomy.