Effects of an auditory biofeedback device on plantar pressure in patients with chronic ankle instability

Chronic ankle instability (CAI) patients have been shown to have increased lateral column plantar pressure throughout the stance phase of gait. To date, traditional CAI rehabilitation programs have been unable to alter gait. We developed an auditory biofeedback device that can be worn in shoes that elicits an audible cue when an excessive amount of pressure is applied to a sensor. This study determined whether using this device can decrease lateral plantar pressure in participants with CAI and alter surface electromyography (sEMG) amplitudes (anterior tibialis, peroneus longus, medial gastrocnemius, and gluteus medius). Ten CAI patients completed baseline treadmill walking while in-shoe plantar pressures and sEMG were measured (baseline condition). Next, the device was placed into the shoe and set to a threshold that would elicit an audible cue during each step of the participant's normal gait. Then, participants were instructed to walk in a manner that would not trigger the audible cue, while plantar pressure and sEMG measures were recorded (auditory feedback (AUD FB) condition). Compared to baseline, there was a statistically significant reduction in peak pressure in the lateral midfoot–forefoot and central forefoot during the AUD FB condition. In addition, there were increases in peroneus longus and medial gastrocnemius sEMG amplitudes 200 ms post-initial contact during the AUD FB condition. The use of this auditory biofeedback device resulted in decreased plantar pressure in the lateral column of the foot during treadmill walking in CAI patients and may have been caused by the increase in sEMG activation of the peroneus longus.     

Effect of customised preformed foot orthoses on gait parameters in children with juvenile idiopathic arthritis: A multicentre randomised clinical trial

BackgroundChildren with juvenile idiopathic arthritis (JIA) can experience significant physical impairment of the lower extremity. Prolonged joint disease and symptoms may cause gait alterations such as reduced walking speed and increased plantar pressures in diseased areas of their feet. There is limited robust clinical trials investigating the effect of non-invasive mechanical therapies such as foot orthoses (FOs) on improving gait parameters in children with JIA.Research questionAre customised preformed FOs effective in improving gait parameters in children with JIA?MethodsA multicentre, parallel design, single-blinded randomised clinical trial was used to assess the gait impacts of customised preformed FOs on children with JIA. Children with a diagnosis of JIA, exhibiting lower limb symptoms and aged 5–18 were eligible. The trial group received a low-density full length, Slimflex Simple device which was customised chair side and the control group received a sham device. Peak pressure and pressure time integrals were used as the main gait outcomes and were measured using portable Tekscan gait analysis technology at baseline, 3 and 6 months. Differences at each follow-up were assessed using the Wilcoxon rank sum test.Results66 participants were recruited. Customised preformed FOs were effective in altering plantar pressures in children with JIA versus a control device. Reductions of peak pressures and pressure time integrals in the heel, forefoot and 5th metatarsophalangeal joint were statistically significant in favour of the trial group. This was associated with statistically significant increased midfoot contact with the trial device at baseline, 3 and 6-month data collections. The trial intervention was safe and well accepted by participants, which is reflected in the high retention rate (92%).SignificanceClinicians may prescribe customised preformed FOs in children with JIA to deflect pressure from painful joints and redistribute from high pressure areas such as the rearfoot and forefoot.     

Effects of gait training with auditory biofeedback on biomechanics and talar cartilage characteristics in individuals with chronic ankle instability: A randomized controlled trial

BackgroundAltered walking gait is a typical impairment following ankle sprains which may increase susceptibility to recurring injuries and development of posttraumatic osteoarthritis at the ankle. There is a lack of targeted gait training interventions focusing on specific modifications in individuals with chronic ankle instability (CAI). Additionally, there is a need to focus on cartilage health changes following gait training to mitigate osteoarthritis progression.Research questionTo determine the immediate and retention effects of gait training using auditory biofeedback (AudFB) in patients with chronic ankle instability (CAI) on biomechanics and talar cartilage characteristics.MethodsEighteen participants with CAI were randomly assigned into Control (n = 7) or AudFB (n = 11) groups. Each group completed 8-sessions of 30-minute treadmill walking. The AudFB group received biofeedback through a pressure sensor fashioned to the lateral foot and instructions to walk while avoiding noise from the sensor. The Control group did not receive instructions during sessions. An in-shoe insole system measured peak pressure, maximum force, and center of the pressure gait line (COP) during walking. Ultrasonography captured talar cartilage thickness and echo intensity before and after walking. Biomechanics and ultrasound were measured at baseline, immediately, and 1-week after the intervention. Repeated measures mixed-methods analysis of variance assessed changes within groups across time.ResultsThe AudFB group significantly reduced pressure and force in the lateral foot and medially shifted their COP at Immediate and 1-week Post. There were no observed changes in the Control group. In addition, neither group demonstrated changes in ultrasound measures at follow-up.SignificanceImplementation of auditory biofeedback during gait training can be a valuable tool for clinicians treating patients with CAI.     

Acute Vibration Feedback During Gait Reduces Mechanical Ankle Joint Loading in Chronic Ankle Instability Patients

BackgroundIndividuals with chronic ankle instability (CAI) exhibit altered vertical ground reaction forces (vGRF), a laterally shifted center of pressure, and an inverted foot position during walking. These neuromechanical alterations are linked with altered ankle joint loading in this population. Vibration-based gait retraining improves center of pressure positioning but effects on neuromechanical variables influencing joint loading remains unknown.Research QuestionDo patients with CAI exhibit altered vGRF and ankle joint contact forces (JCF) after receiving a single session of vibration-based gait retraining?MethodsTen individuals with CAI underwent a single session of vibration-based gait retraining. Kinematic and kinetic data were collected during walking on an instrumental treadmill with force plates embedded in it. Following a baseline gait assessment without feedback, participants walked at a self-selected speed for 10 minutes while receiving feedback. Data was collected during an early (1 st and 2 nd minute) and late adaptation phase (9 th and 10 th minute) and, compared to baseline values. Impact and propulsive vGRF variables (i.e. peak, time to peak, and loading rate) were obtained. Musculoskeletal modeling was used to calculate ankle JCF variables (peak, impulse, and loading rate) during stance phase.ResultsPropulsive vGRF and ankle JCF outcomes were significantly reduced during the early and late adaptation phases (p ≤ 0.039).SignificanceThese results indicate that vibration-based gait retraining can immediately reduce propulsive vGRF and ankle JCF and may represent a modality that could help restore appropriate ankle joint loading patterns in those with CAI.     

Understanding the role of foot biomechanics on regional foot orthosis deformation in flatfoot individuals during walking

BackgroundFoot orthoses (FOs) are one of the most common interventions to restore normal foot mechanics in flatfoot individuals. New technologies have made it possible to deliver customized FOs with complex designs for potentially better functionalities. However, translating the individuals’ biomechanical needs into the design of customized FOs is not yet fully understood.Research questionOur objective was to identify whether the deformation of customized FOs is related to foot kinematics and plantar pressure during walking.MethodsThe kinematics of multi-segment foot and FOs contour were recorded together with plantar pressure in 17 flatfoot individuals while walking with customized FOs. The deformation of FOs surface was predicted from its contour kinematics using an artificial neural network. Plantar pressure map and deformation were divided into five anatomically based regions defined by the corresponding foot segments. Forward stepwise linear mixed models were built for each of the four gait phases to determine the feet-FOs interaction.ResultsIt was observed that some associations existed between foot kinematics and pressure with regional FOs deformation. From heel-strike to foot-flat, longitudinal arch angle was associated with FOs deformation in forefoot. From foot-flat to midstance, rearfoot eversion accounted for variation in the deformation of medial FOs regions, and forefoot abduction for the lateral regions. From midstance to heel-off, rearfoot eversion, longitudinal arch angle, and plantar pressure played significant role in deformation. Finally, from heel-off to toe-off, forefoot adduction affected the deformation of forefoot and midfoot.SignificanceThis study provides guidelines for designing customized FOs. Flatfoot individuals with excessive rearfoot eversion or very flexible medial arches require more support on medial FOs regions, while the ones with excessive forefoot abduction need the support on lateral regions. However, a compromise should be made between the level of support and the level of increase in plantar pressure to avoid stress on foot structures.     

The effect of laboratory and real world gait training with vibration feedback on center of pressure during gait in people with chronic ankle instability

BackgroundExternal feedback has can medially shift the center of pressure (COP) location in people with chronic ankle instability(CAI) during walking. However, previous modalities are restricted to controlled environments which limits motor learning. Vibration feedback during gait may maximize motor learning by allowing for training in the laboratory and real world (RW) but has not been investigated in those with CAI.Research questionDoes vibration feedback change COP location in people with CAI following laboratory and RW training?MethodsNineteen CAI participants walked for 10 min on a treadmill (lab training) and a one mile loop on a sidewalk (RW training) with vibration feedback. When pressure under the 5th metatarsal exceeded a threshold, a vibration stimulus was applied to the lateral malleolus encouraging the participant to medially shift the COP. One minute baseline, posttest, and short term retention gait assessments were taken for each environment. The stance phase of gait was divided into 10 subphases and data were averaged within each subphase. Repeated measures ANOVAs were completed for each subphase to compare COP location over time.ResultsAfter lab based training the COP was more medial at posttest for the first 90 % of stance versus baseline (Mean differences (MD): −0.57 to −5.12 mm, p < 0.023). Relative to baseline, the COP remained more medial at retention from 20 to 90% of stance (MD: −1.69 to −4.40 mm, p < 0.049). For RW training, the COP was more medial at posttest for the first 70 % of stance versus baseline (MD: −4.24 to −8.27 mm, p < 0.017) and the first 60 % of stance at retention versus baseline (MD: −4.14 to −6.42 mm, p < 0.049).SignificanceVibration feedback during laboratory and RW gait training has the ability to immediately shift the COP location medially and retain this shift for a short period in individuals with CAI.     

Immediate effect of visual,auditory and combined feedback on foot strike pattern

BackgroundA growing body of literature supports the promising effect of real-time feedback to re-train runners. However, no studies have comprehensively assessed the effects of foots trike and cadence modification using different forms of real-time feedback provided via wearable devices.Research questionThe purpose of the present study was to determine if a change could be made in foot strike pattern and plantar loads using real-time visual, auditory and combined feedback provided using wearable devices.MethodsVisual, auditory and combined feedback were provided using wearable devices as fifteen recreational runners ran on a treadmill at self-selected speed and increased cadence. Plantar loads and location of initial contact were measured with a flexible insole system. Repeated measures ANOVAs with Bonferroni adjusted pair-wise comparisons were used to assess statistical significance.Results and significanceA significant effect of condition was noted on location of center of pressure (p < 0.01). Bonferroni-adjusted post-hoc comparisons showed that feedback conditions differed from baseline as well as the new cadence conditions, however did not differ from each other. A significant interaction effect (region x feedback) was found for plantar loads (maximum force P < 0.001). Significant effects of feedback were noted at the heel (P < 0.001), medial midfoot (P < 0.001), lateral midfoot (P < 0.001), medial forefoot (P = 0.003), central forefoot (P = 0.003), and great toe (P = 0.004) but not at the lateral forefoot (P = 0.6) or lateral toes (P = 0.507).SignificanceThe unique findings of our study showed that an anterior shift of the center of pressure, particularly when foot strike modification was combined with 10% increased cadence. We found lower heel and midfoot loads along with higher forefoot and great toe loads when foot strike modification using real-time feedback was combined with increased cadence. Our findings also suggest that auditory feedback might be more effective than visual feedback in foot-strike modification.     

Optical flow balance perturbations alter gait kinematics and variability in chronic ankle instability patients

BackgroundIndividuals with chronic ankle instability (CAI) have known balance impairments thought to be the result of an inability to reweight sensory information. CAI patients place greater emphasis on visual information during single-limb stance than healthy controls but this evidence is based on removing visual information during static conditions.Research questionDoes perturbed optical flow effect step kinematics and variability in those with CAI differently than healthy controls? What is the relationship among ankle laxity, plantar cutaneous sensation, and susceptibility to perturbed optical flow in those with CAI?Methods17 CAI patients and 17 healthy individuals participated in a crossover experimental study. Participants walked on a treadmill at 1.25 m/s while watching a speed-matched virtual hallway with and without continuous mediolateral (ML) optical flow perturbations. Three-dimensional pelvic and foot kinematics were recorded at 100 Hz for at least 300 consecutive steps in each condition. Step width (SW) and step length (SL) values were calculated from consecutive heel positions. Gait variability was characterized as the standard deviation of step width (SWV), step length (SLV), and ML sacrum motion (SMV) across all steps performed in each condition.ResultsThe CAI group exhibited a greater change in SWV (p = 0.037), SLV (p = 0.040), and ML SMV (p = 0.047) from the perturbed to unperturbed conditions relative to the healthy controls. A condition main effect was also noted for SW (p < 0.001) and SL (p < 0.001) as ML optical flow perturbations resulted in significant changes in SW and SL relative to the normal walking condition.SignificanceWalking with ML optical flow perturbations induced greater variability changes in those with CAI relative to controls. When combined with the existing literature, this finding suggests that CAI individuals have a greater reliance on visual information in both static and dynamic (i.e. walking gait) conditions relative to healthy individuals.     

The influence of population characteristics and measurement system on barefoot plantar pressures: A systematic review and meta-regression analysis

BackgroundThe measurement of plantar pressure distributions during gait can provide insights into the effects of musculoskeletal disease on foot function. A range of hardware, software, and protocols are available for the collection of this type of data, with sometimes disparate and conflicting results reported between individual studies. In this systematic review and meta-regression analysis of dynamic regional peak pressures, we aimed to test if 1) the system used to obtain the pressure measurements and 2) the characteristics of the study populations had a significant effect on the results.MethodsA systematic review of the literature was undertaken to identify articles reporting regional peak plantar pressures during barefoot walking. A mixed-effects modeling approach was used to analyze the extracted data. Initially, the effect of the system used to collect the data was tested. Following this, the effect of participant characteristics on the results were analyzed, using moderators of cohort type (defined as the primary health characteristic of the participants), age, sex, and BMI.Results115 participant groups were included in the analysis. Sufficient cohorts were available to test those that consisted of healthy individuals, and those with diabetes and diabetic neuropathy. Significant differences were found between results reported by studies using different pressure measurement systems in 8 of the 16 regions analyzed. The analysis of participant characteristics revealed a number of significant relationships between regional peak pressures and participant characteristics, including: BMI and midfoot plantar pressures; elevated forefoot pressures as a result of diabetic neuropathy; and sex-differences in regional loading patterns.ConclusionsAt the level of the literature, we confirmed significant effects of disease status, age, BMI, and sex on regional peak plantar pressures. Researchers and clinicians should be aware that measurements of peak plantar pressure variables obtained from different collection equipment are not directly comparable.     

Vertical ground reaction forces during gait in children with and without calcaneal apophysitis

BackgroundHeightened vertical load beneath the foot has been anecdotally implicated in the development of activity-related heel pain of the calcaneal apophysis in children but is supported by limited evidence.Research questionThis study investigated whether vertical loading patterns during walking and running differed in children with and without calcaneal apophysitis.MethodsVertical ground reaction force, peak plantar pressure (forefoot, midfoot, heel) and temporospatial gait parameters (cadence, step length, stride, stance and swing phase durations) were determined in children with (n = 14) and without (n = 14) calcaneal apophysitis. Measures were acquired during barefoot walking and running at matched and self-selected speed using an instrumented treadmill, sampling at 120 Hz. Statistical comparisons between groups were made using repeated measure ANOVAs.ResultsThere were no significant between group differences in vertical ground reaction force peaks or regional peak plantar pressures. However, when normalised to stature, cadence was significantly higher (≈ 5%) and step length shorter (≈ 5%) in children with calcaneal apophysitis than those without, but only during running (P <.05). Maximum pressure beneath the rearfoot during running was significantly correlated with self-reported pain in children with calcaneal apophysitis.SignificancePeak vertical force and plantar pressures did not differ significantly in children with and without calcaneal apophysitis during walking or running. However, children with calcaneal apophysitis adopted a higher cadence than children without heel pain during running. While the findings suggest that children with calcaneal apophysitis may alter their cadence to lower pressure beneath the heel and, hence pain, they also highlight the benefit of evaluating running rather than walking gait in children with calcaneal apophysitis.     

Effects of rocker radii with two longitudinal bending stiffnesses on plantar pressure distribution in the forefoot

IntroductionOutsole parameters of the shoe can be adapted to offload regions of pain or region of high pressures. Previous studies already showed reduced plantar pressures in the forefoot due to a proximally placed apex position and higher longitudinal bending stiffness (LBS). The aim of this study was to determine the effect of changes in rocker radii and high LBS on the plantar pressure profile during gait.Method10 participants walked in seven shoe conditions of which one control shoe and six rocker shoes with small, medium and large rocker radii and low and high longitudinal bending stiffness. Pedar in-shoe plantar pressure measuring system was used to quantify plantar pressures while walking on a treadmill at self-selected walking speed. Peak plantar pressure, maximum mean pressure and force-time integral were analyzed with Generalized Estimated Equation (GEE) and Tukey post hoc correction (α = .05).ResultsSignificantly lower plantar pressures were found in the first toe, toes 2–5, distal and proximal forefoot in all rocker shoe conditions as compared to the control shoe. Plantar pressures in the first toe and toes 2–5 were significantly lower in the small radius compared to medium and large radii. For the distal forefoot both small and medium radii significantly reduced plantar pressure compared to large radii. Low LBS reduced plantar pressure at the first toe significantly compared to high LBS independent of the rocker radius. Plantar pressures in the distal forefoot and toes 2–5 were lower in high LBS compared to low LBS.ConclusionManipulation of the rocker radius and LBS can effectively reduce peak plantar pressures in the forefoot region during gait. In line with previous studies, we showed that depending on the exact target location for offloading, different combinations of rocker radius and LBS need to be adopted to maximize treatment effects.     

Longitudinal study of foot pressures during real-world walking as infants develop from new to confident walkers

BackgroundOnset of walking in infants leads to regular cyclic loading of the plantar foot surface for the first time. This is a critical period for evolving motor skills and foot structure and function. Plantar pressure literature typically studies gait only once walking is established and under conditions that artificially constrain the walking direction and bouts compared to how infants move in the real-world. We therefore do not know how the foot is loaded when self-directed walking is first achieved and whether it changes as walking is practiced.Research questionHow do pressures on the plantar foot in real-world walking change from new to confident walking?MethodsFifty-seven infants participated in a two-site longitudinal study. Bespoke child-friendly spaces incorporated large pressure platforms and video. Data was collected at two milestones: new (403 days) and confident (481 days) walking. Steps were defined as walking straight or turning medially/laterally. Pressure variables were calculated for eight-foot regions and compared between milestones.ResultsConfident walking resulted in more steps (median: 18 v 35) and almost twice as many turning steps. During straight-line steps, confident walking increased peak pressures in the medial heel (median: 99.3 v 106.7kPa, p < .05) and lateral forefoot (median: 53.9 v 65.3kPa, p < .001) and reduced medial toe pressure (median: 98.1 v 80.0kPa, p < .05). Relative medial midfoot contact area reduced (median: 12.4 v 11.2%, p < .05) as absolute foot contact increased. A faster transition across stance and a reduced relative contact time in the forefoot were recorded in confident walking.SignificancePressures change rapidly as walking is initiated with significant differences in foot loading evident within an average 77 days. Importantly, these changes differ in straight and turning walking. Continued reliance on assessment of straight-line walking during early stages of ambulation likely fails to characterise 26% of steps experienced by infant feet.     

Effects of ankle destabilization devices and rehabilitation on gait biomechanics in chronic ankle instability patients: A randomized controlled trial

Patients with chronic ankle instability (CAI) have altered gait patterns, which are characterized by increased inversion positioning during gait. Ankle destabilization devices increase peroneus longus muscle activation during gait, which may increase eversion.ObjectiveTo determine whether incorporating destabilization devices into a 4-week impairment-based rehabilitation program has beneficial effects on gait biomechanics and surface electromyography (sEMG) compared to impairment-based rehabilitation without destabilization devices in CAI patients.DesignRandomized controlled trial.SettingLaboratory.ParticipantsTwenty-six CAI patients.Outcome measuresPatients completed baseline gait trials and were randomized into no device or device groups. Groups completed 4-weeks of rehabilitation with or without devices, and then completed post-intervention gait trials. Lower extremity sagittal and frontal plane kinematics and kinetics and sEMG activity were measured.ResultsThe device group increased dorsiflexion during mid-late stance and had lower normalized sEMG amplitude for the peroneus longus during early stance and mid-swing after rehabilitation. The no device group had less peroneus brevis sEMG activity during early stance after rehabilitation.ConclusionIncorporating destabilization devices in a 4-week rehabilitation program was an effective method of improving dorsiflexion during the stance phase of gait. However, impairment-based rehabilitation, regardless of instability tool, was not effective at improving frontal plane motion.     

Elevated plantar pressure in diabetic patients and its relationship with their gait features

PurposeHigh plantar pressure is a major risk factor for diabetic foot ulcers. The relationship between plantar pressure and foot mobility has been investigated in some studies. However, when the foot is in motion, foot mobility is only a small feature of the gait. Therefore, we investigated relationship between high plantar pressure and gait and also studied the motion of the trunk. In addition, we investigated the relationship between gait and patient characteristics to identify patients at high-risk of developing diabetic foot ulcers.MethodsThe relationships between elevated plantar pressure, gait features, and patient characteristics were analyzed. Plantar pressure distribution in the stance phase was divided on the four plantar segments. Elevated plantar pressure was defined as being more than the mean plus one standard deviation of the corresponding segment in non-diabetic subjects. Plantar pressure distribution was measured by an F-scan system, and gait features were measured using wireless motion sensors attached to the sacrum and feet. Patient characteristics were obtained from medical records or by interview.ResultsSmall roll and yaw motions of the body and yaw motion of the foot during the mid-stance phase were related to the elevated plantar pressure in 57 diabetic patients. Furthermore, these gait features were related to sensory neuropathy, diabetes duration, patient weight, toe-gap force, and ankle range of motion.ConclusionGiven our findings, it may be possible to prevent diabetic foot ulcers by increasing foot motion during the mid-stance phase. Passive exercise aimed at expanding ankle range of motion in patients with sensory neuropathy or long-standing diabetes may assist in achieving this.     

Footsteps required for reliable and valid in-shoe plantar pressure assessment during gait per foot region in people with hallux valgus

BackgroundPlantar pressure assessment is commonly performed to identify pathognomonic gait characteristics and evaluate therapeutics against them in people with various foot disorders. Little is known about the reliability and validity of this assessment in people with hallux valgus (HV) per foot region.Research questionThis study aimed to assess the reliability and validity of the in-shoe plantar pressure measurement method during gait in people with HV and the required number of footsteps, as an intra-subject sample size, to ensure a reliable and valid use of this method.MethodsWith an inserted disposable insole plantar pressure sensor in shoes, 17 females with HV (HV angle > 15°) completed three gait trials over the ground at a comfortable speed. Peak plantar pressure data and its distribution in 15 stance phases on the foot clinically diagnosed with HV in each participant were extracted by dividing the foot into eight regions. The intraclass correlation coefficient per foot region and the number of footsteps required to produce a valid peak plantar pressure and distribution (intraclass correlation coefficient > 0.90) were used to measure reliability. Based on the limit of agreement analysis, the coefficient of variation between the averaged value from each incremental footstep (2–14 footsteps) and 15 reference footsteps was calculated.ResultsThe intraclass correlation coefficient of plantar pressure assessment with the in-shoe sensor was 0.606–0.847 in the eight foot regions in people with HV. Additionally, the number of steps required for a valid assessment ranged from two to nine. Hence, the application of averaged values from more than nine footsteps is recommended for this evaluation.SignificanceThis reference sample size is intended to be used in future studies and clinical settings to determine the efficacy of HV treatment.     

Ankle kinematics of individuals with chronic ankle instability while walking and jogging on a treadmill in shoes

ObjectivesTo evaluate frontal and sagittal plane ankle kinematics between subjects with chronic ankle instability (CAI) and healthy controls while walking and jogging shod on a treadmill.DesignCross-sectional study.SettingMotion analysis laboratory.ParticipantsFifteen subjects with self-reported CAI and 13 healthy subjects volunteered.Main outcome measuresSagittal and frontal plane ankle kinematics were calculated throughout the gait cycle. For each speed, the means and associated 90% confidence intervals (CIs) were calculated in each plane across the entire gait cycle and increments in which the CI bands for the groups did not cross each other for at least 3 consecutive percentage points of the gait cycle were identified.ResultsAt various increments while both walking and jogging, CAI subjects were found to be more plantar flexed compared to controls. In the frontal plane, CAI subjects were found to be more inverted at three different increments while jogging only.ConclusionsWhile shod, kinematic differences were observed between groups. The alterations may indicate that while shod, CAI subjects may adjust their gait in order to successfully accomplish the given task.     

Effects of orthotic insole on gait patterns in children with mild leg length discrepancy

BackgroundLeg length discrepancy (LLD) is commonly associated with compensatory gait strategies leading to musculoskeletal disorders of the lower extremity and lumbar spine. Orthotic insole (OI) is considered as a conservative treatment for patients with mild LLD, especially for children. However, the restoration of normal gait when wearing OI with foot lift are still poorly understood.Research questionWhat are the immediate effects of OI on the gait patterns in children with mild LLD?MethodsGait data and plantar pressure data were collected for 12 children with mild anatomical LLD in barefoot and OI conditions. Paired t-test was performed to determine the changes in gait between these two conditions, and also the symmetry between limbs in the same condition for spatiotemporal, kinematic, and kinetic variables.ResultsChildren with mild LLD showed an immediate gait improvement confirmed by increased step length and velocity, decreased peak plantar pressure in both limbs with OI. Additionally, the significant between-limb differences disappeared for peak ankle dorsiflexion, hip adduction, pelvis upward obliquity and also second peak plantar pressure with OI, which improved gait symmetry.SignificanceThis study provides a better understanding of the immediate effect of OI with foot lift on biomechanical changes in gait, which identify that OI with foot lift could be a potential therapeutic option for children with mild structural LLD to improve gait metrics.     

Changes in plantar pressure and spatiotemporal parameters during gait in older adults after two different training programs

BackgroundImproving gait is in exercise programs for older adults (OAs) but little is known about how different gait-training approaches affect spatiotemporal parameters and plantar pressure distributions in OAs. High plantar pressures are linked to tissue injury risk, ulceration, and pain in OAs, but no studies have yet compared how they affect podobarometric variables.Research questionThe effect of changing plantar pressure on absolute and mean maximum pressure, the pressure-time integral, stride time, stance time, and gait speed in OAs following either a multicomponent training program (EG) or interval-walking training (WG).MethodsComfortable gait speed, strength (seat-to-stand test), and plantar pressure (Pedar-X mobile in-shoe system), were evaluated in 23 OAs (EG: n = 12, 7 female, 71.58 ± 4.56 years; WG: n = 11, 6 female, 69.64 ± 3.56 years), by dividing the plantar area into 9 regions.ResultsAfter 14 weeks, the maximum pressure in medial and central metatarsus areas in the dominant leg were reduced in the EG (p = 0.01 & p = 0.04, respectively), but increased in the non-dominant leg lateral heel in the WG (p = 0.03). The mean maximum pressure also increased in the WG in medial heel in the dominant leg (p = 0.02) and lateral heel in the non-dominant leg (p = 0.03). The overall pressure-time integral reduced in the whole plantar area in both legs in both groups. WG reduced stride time (dominant: p = 0.01; non-dominant: p = 0.01) and stance time (dominant: p < 0.005; non-dominant: p < 0.005). Gait speed did not change in any group. As expected, lower limb strength improved after both exercise programs (EG: p = 0.02; WG: p = 0.01).SignificanceAlthough these training interventions were short, they indicate the importance of exercise types. Our results suggest that OAs might benefit from periodized training, especially when multicomponent programs are introduced prior to the walking goals. Future, larger studies should explore situations in which special populations with specific foot problems might benefit from these interventions.     

Differences in temporal gait mechanics are associated with decreased perceived ankle joint health in individuals with chronic ankle instability

BackgroundChronic ankle instability (CAI) is associated with an increased risk of developing post-traumatic osteoarthritis (PTOA). Altered temporal gait parameters likely contribute to the early development and progression of PTOA in CAI. However, it is unknown if increased clinical symptoms of ankle PTOA influence temporal gait parameters among those with CAI.Research questionCompare temporal gait parameters and Ankle Osteoarthritis Scale (AOS) scores between individuals with and without CAI.MethodsThirty CAI participants and 30 healthy-controls volunteered to participate in this retrospective case-control study. Participants completed the Pain and Disability subscales of the AOS. Temporal gait parameters were assessed using a GAITRite® electronic walkway. Participants performed 5 walking trials, which were subsequently combined into a single test. Temporal variables (swing, stance, single-limb support and double-limb support) were extracted for the involved limb and normalized to percent of gait cycle (%GC).ResultsParticipants with CAI had higher scores on the Pain (P < 0.001) and Disability (P = 0.001, d = 0.87[0.33,1.39]) subscales of the AOS. CAI individuals spent less time during swing (P = 0.022]) and single-limb support (P = 0.030) phases and more time during the double-limb support (P = 0.021) phase. Single-limb support time was moderately correlated with higher scores on the AOS pain (r=-0.416, P = 0.011) and disability (r=-0.473 P = 0.004) subscales.SignificanceIndividuals with CAI spend varying times in each phase of the gait cycle compared to uninjured controls. Individuals with CAI may adopt this abnormal gait strategy due to increased clinical symptoms of ankle PTOA. Rehabilitation programs should focus on minimizing the symptoms of ankle PTOA to restore normal temporal gait parameters.     

The insole materials influence the plantar pressure distributions in diabetic foot with neuropathy during different walking activities

BackgroundAbnormal peak plantar pressure in neuropathic diabetic foot during walking activities is well managed through the use of appropriate design and material selection for the fabrication of custom made insoles (CMI). The redistribution of plantar pressure is possible by selecting an appropriate material for the fabrication of CMI. The walking activities may alter the plantar pressure distribution; which may differ while using CMI with different materials.ObjectiveThe objective of the study was to evaluate the effectiveness of CMI’s materials on plantar pressure distribution during different walking activities, in diabetic feet with neuropathy.MethodsThe study was conducted on sixteen diabetic neuropathic subjects. The subjects were provided with two types of CMI; CMI-A (Plastazote® and microcellular rubber) and CMI-B (Multifoam, Plastazote® and microcellular rubber). Maximum peak plantar pressure and plantar pressure distribution were determined by Pedar-X® sensor insole during level walking, ramp walking and stair walking.ResultsThe CMI-B lessened the maximum peak plantar pressure from the forefoot throughout the walking activities compared to CMI-A. The contact area was observed as lower using CMI-A compared to CMI-B, while performing walking activities.ConclusionCMI-B, with multifoam as an additional top layer, provided more effective peak plantar pressure reduction at forefoot and it had better plantar pressure distribution compared to CMI-A during level walking and ramp ascending in diabetic foot with neuropathy.