Footwear characteristics are related to running mechanics in runners with patellofemoral pain

Running footwear is known to influence step rate, foot inclination at foot strike, average vertical loading rate (VLR) and peak patellofemoral joint (PFJ) force. However, the association between the level of minimalism of running shoes and running mechanics, especially with regards to these relevant variables for runners with patellofemoral pain (PFP), has yet to be investigated. The objective of this study was to explore the relationship between the level of minimalism of running shoes and habitual running kinematics and kinetics in runners with PFP. Running shoes of 69 runners with PFP (46 females, 23 males, 30.7 ± 6.4 years) were evaluated using the Minimalist Index (MI). Kinematic and kinetic data were collected during running on an instrumented treadmill. Principal component and correlation analyses were performed between the MI and its subscales and step rate, foot inclination at foot strike, average VLR, peak PFJ force and peak Achilles tendon force. Higher MI scores were moderately correlated with lower foot inclination (r = −0.410, P < 0.001) and lower peak PFJ force (r = −0.412, P < 0.001). Moderate correlations also showed that lower shoe mass is indicative of greater step rate (ρ = 0.531, P < 0.001) and lower peak PFJ force (ρ = −0.481, P < 0.001). Greater shoe flexibility was moderately associated with lower foot inclination (ρ = −0.447, P < 0.001). Results suggest that greater levels of minimalism are associated with lower inclination angle and lower peak PFJ force in runners with PFP. Thus, this population may potentially benefit from changes in running mechanics associated with the use of shoes with a higher level of minimalism.     

The influence of cadence and shoes on patellofemoral joint kinetics in runners with patellofemoral pain

Objectives

To determine the effect of a combination of a minimalist shoe and increased cadence on measures of patellofemoral joint loading during running in individuals with patellofemoral pain.

The effectiveness of real-time haptic feedback gait retraining for reducing resultant tibial acceleration with runners

ObjectivesTo examine the effectiveness of real-time haptic feedback gait retraining for reducing resultant tibial acceleration (TA-R) with runners, the retention of changes over four weeks, and the transfer of learning to overground running.DesignCase control.SettingBiomechanical laboratory treadmill, and track-based overground, running.Participants18 experienced uninjured high tibial acceleration runners.Main outcome measuresTA-R measured while treadmill and overground running assessed at pre-, post- and 4-weeks post-intervention.ResultsAcross the group, a 50% reduction in TA-R was measured post-intervention (ES: 0.9, z = −18.2, p < .001), and 41% reduction at 4-weeks (ES: 0.8, z = −12.9, p < .001) with treadmill running. A 28% reduction (ES: 0.7, z = −13.2, p < .001), and a 17% reduction in TA-R were measured at these same time points when runners ran overground (ES: 0.7, z = −11.2, p < .001). All but two runners responded positively to the intervention at the post-intervention assessment. Eleven runners were categorised as positive responders to the intervention at the 4-week post-intervention.ConclusionsHaptic feedback based on TA-R appears to be as effective, but less invasive and expensive, compared to other more established modalities, such as visual feedback. This new approach to movement retraining has the potential to revolutionise the way runners engage in gait retraining.     

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.     

The influence of sagittal trunk posture on the magnitude and rate of patellofemoral joint stress during stair ascent in asymptomatic females

Background: Excessive patellofemoral joint stress (PFJS) is thought to be a contributory factor to patellofemoral pain (PFP). Thus, treatment strategies that minimize PFJS rate and magnitude during painful activities like stair ascent may be useful for optimizing outcomes for PFP patients. Sagittal plane trunk posture has been shown to influence PFJS during running although it is unknown if a similar relationship exists during stair ascent. Research Question: Does altering sagittal plane trunk posture affect PFJS rate and/or magnitude during stair ascent? Methods: Twenty asymptomatic females (23.4±2.5 yr; height: 164.4±7.9 cm; mass: 63.0±12.2 kg) performed 5 stair ascent trials (96 steps/min) during 3 conditions: self-selected trunk (SS), flexed trunk (FLX), and extended trunk (EXT). Three-dimensional kinematics (200 Hz) and ground reaction forces (2000 Hz) were collected during each trial. A previously described mathematical model was used to calculate PFJS that included subject-specific and non-subject-specific model inputs. Dependent variables included sagittal plane trunk angle, and the rates and magnitudes of PFJS, patellofemoral joint reaction force (PFJRF), and PFJ contact area during the stance phase of stair ascent. Results: Compared to SS, peak PFJS decreased during FLX (mean difference (MD)=2.6 MPa; p<0.001; 95%CI=2.2 to 2.9; effect size (ES)=5.2) and increased during EXT (MD=-3.3 MPa; p<0.001; 95%CI=-3.9 to -2.6; ES=-3.4). Similarly, PFJS rate decreased during FLX (MD=17.8 MPa/sec; p<0.001; 95%CI=13.6 to 21.9; ES=3.6) and increased during EXT (MD=-14 MPa/sec; 95%CI=-19.4 to -8.7; p<0.001; ES=-2.2). Significance: Sagittal plane trunk posture influences PFJS rate and magnitude during stair ascent in asymptomatic females. Increasing and decreasing forward trunk flexion resulted in decreased and increased PFJS respectively. Future studies should examine the effects of these movement strategy modifications on pain and function in patients with PFP.     

Effect of gait retraining for reducing ambulatory knee load on trunk biomechanics and trunk muscle activity

The purpose of this study was to test the hypothesis that walking with increased medio-lateral trunk sway is associated with lower external knee adduction moment and lower extremity muscle activation, and higher external ipsilateral trunk moment and trunk muscle activity than walking with normal trunk sway in healthy participants. Fifteen participants performed walking trials with normal and increased medio-lateral trunk sway. Maximum trunk sway, first maximum knee adduction moment, lateral trunk bending moment, and bilateral vastus medialis, vastus lateralis, gluteus medius, rectus abdominis, external oblique and erector spinae muscle activity were computed. Walking with increased trunk sway was associated with lower maximum knee adduction moment (95% confidence interval (CI): 0.50–0.62 Nm/kg vs. 0.62–0.76 Nm/kg; P < .001) and ipsilateral gluteus medius (−17%; P = .014) and erector spinae muscle activity (−24%; P = .004) and greater maximum lateral trunk bending moment (+34%; P < .001) and contralateral external oblique muscle activity (+60%; P = .009). In all participants, maximum knee adduction moment was negatively correlated and maximum trunk moment was positively correlated with maximum trunk sway. The results of this study suggest that walking with increased trunk sway not only reduces the external knee adduction moment but also alters and possibly increases the load on the trunk. Hence, load-altering biomechanical interventions should always be evaluated not only regarding their effects on the index joint but on other load-bearing joints such as the spine.     

The effects of dual-task balance training on gait in older women with osteoporosis: A randomized controlled trial

BackgroundAlthough there is a growing body of literature showing promising effects of balance training on gait in older adults, little is known about the effects of dual-task training on varying domains of spatial and temporal gait parameters.Research questionDoes the short-term effects of dual-task balance training differ between single and dual-task gait in older women with osteoporosis with regards to different gait domains (pace, rhythm, variability, asymmetry and postural control)?MethodsElderly women with osteoporosis who experienced fear of falling and/or ≥1 fall the last 12 months were recruited. Ninety-five participants were randomized to 12 weeks of balance training or to a control group. The participants in the training group (n = 65) received 12 weeks (3 times/week) of balance and gait exercises including dual-tasks, and the control group (n = 30) received care as usual. Single- and dual-task gait were assessed before and after the intervention with an electronic walkway system and analyzed using non-parametric statistics and effect sizes.Results68 participants completed the study. The training group walked faster for single- and dual-task gait following training (P ≤ .044) by increasing their cadence (P ≤ .012) and reducing step and swing time (P ≤ .045) compared with the control group. Significant between-group differences in favor of the training group were found for gait variability during dual-task gait (P ≤ .041). The improvement in speed were greater for dual- than single-task gait (0.10 vs. 0.05 m/s) and the effect sizes revealed small to medium effects for dual-task gait, and either non-existent or small for single-task gait.SignificanceGreater training effects found on a variety of domains of dual-task gait compared to single-task gait support the role of cognitively demanding exercises for the maintenance of safe ambulation in older women with osteoporosis.     

Quantified self and human movement: A review on the clinical impact of wearable sensing and feedback for gait analysis and intervention

The proliferation of miniaturized electronics has fueled a shift toward wearable sensors and feedback devices for the mass population. Quantified self and other similar movements involving wearable systems have gained recent interest. However, it is unclear what the clinical impact of these enabling technologies is on human gait. The purpose of this review is to assess clinical applications of wearable sensing and feedback for human gait and to identify areas of future research. Four electronic databases were searched to find articles employing wearable sensing or feedback for movements of the foot, ankle, shank, thigh, hip, pelvis, and trunk during gait. We retrieved 76 articles that met the inclusion criteria and identified four common clinical applications: (1) identifying movement disorders, (2) assessing surgical outcomes, (3) improving walking stability, and (4) reducing joint loading. Characteristics of knee and trunk motion were the most frequent gait parameters for both wearable sensing and wearable feedback. Most articles performed testing on healthy subjects, and the most prevalent patient populations were osteoarthritis, vestibular loss, Parkinson's disease, and post-stroke hemiplegia. The most widely used wearable sensors were inertial measurement units (accelerometer and gyroscope packaged together) and goniometers. Haptic (touch) and auditory were the most common feedback sensations. This review highlights the current state of the literature and demonstrates substantial potential clinical benefits of wearable sensing and feedback. Future research should focus on wearable sensing and feedback in patient populations, in natural human environments outside the laboratory such as at home or work, and on continuous, long-term monitoring and intervention.     

Dual-task training effect on gait parameters in children with spastic diplegic cerebral palsy: Preliminary results of a self-controlled study

BackgroundChildren with cerebral palsy (CP) may have difficulties under dual-task conditions. Spatiotemporal gait parameters have deteriorated with concurrent tasks in children with CP. However, how dual-task training affects gait parameters in children with spastic diplegic CP has not been clarified.Research questionHow does dual-task training program effect gait, functional skills, and health-related quality of life in children with spastic diplegic CP?MethodsEleven children with spastic diplegic CP (median age 11 y, range 7–16 y; 4 female; 7 male) Gross Motor Function Classification System level 1–2 and obtained 27 and higher scores from Modified Mini Mental Test included in the study. The study was planned as a self-controlled clinical research design. Children were recruited to conventional physiotherapy program for 8 weeks and dual-task training program added to conventional physiotherapy program for following 8 weeks. Children were evaluated at baseline, after conventional physiotherapy program, and after dual-task training program. Children’s gait was evaluated with Zebris™ FDM-2 device and Edinburgh Visual Gait Score, functional mobility skills with 1 min Walk Test (1MWT), and health-related quality of life with the Pediatric Quality of Life Inventory (PedsQL) - CP module.ResultsThe difference in step length, step time, stride time, cadence and gait speed of spatiotemporal parameters of gait during dual-task performance were found statistically significant in children with spastic diplegic CP, after dual-task training program (p < 0,05). After dual-task training, statistically significant gains were found in 1MWT, movement and balance subtitle of PedsQL-CP module Parent Form (p < 0,05).SignificanceDual-task training program added to a conventional physiotherapy program provides more gains in terms of functionality of children with spastic diplegic CP will contribute to the improvement of the motor functional level.     

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.     

The effect of a dual task on gait speed in community dwelling older adults: A systematic review and meta-analysis

Background and purposeReduced walking speed in older adults is associated with adverse health outcomes. This review aims to examine the effect of a cognitive dual-task on the gait speed of community-dwelling older adults with no significant pathology affecting gait.Data sources and study selectionElectronic database searches were performed in, Web of Science, PubMed, SCOPUS, Embase and psychINFO. Eligibility and methodological quality was assessed by two independent reviewers. The effect size on gait speed was measured as the raw mean difference (95% confidence interval) between single and dual-task performance. Pooled estimates of the overall effect were computed using a random effects method and forest plots generated.Data extraction and data synthesis22 studies (27 data sets) with a population of 3728 were reviewed and pooled for meta-analysis. The mean walking speed of participants included in all studies was >1.0 m/s and all studies reported the effect of a cognitive dual-task on gait speed. Sub-analysis examined the effect of type of cognitive task (mental-tracking vs. verbal-fluency). Mean single-task gait speed was 1.21 (0.13) m/s, the addition of a dual-task reduced speed by 0.19 m/s to 1.02 (0.16) m/s (p < 0.00001), both mental-tracking and verbal-fluency tasks resulted in significant reduction in gait speed.Limitations and conclusionThe cross-sectional design of the studies made quality assessment difficult. Despite efforts, high heterogeneity remained, possibly due to participant characteristics and testing protocols. This meta-analysis shows that in community-dwelling older adults, the addition of a dual-task significantly reduces gait speed and may indicate the value of including dual-task walking as part of the standard clinical assessment of older people.     

Towards the importance of minimum toe clearance in level ground walking in a healthy elderly population

Tripping is presumed to be the principal cause for falls during walking. At minimum toe clearance, the potential for trip-related falls is considered to be highest. Thus, controlling minimum toe clearance is essential for walking without tripping. In theory, the central nervous system should therefore give priority to accurate control of the variability in minimum toe clearance, as compared to other gait parameters, since people tend to only modify variability in any given task if it interferes with the task performance. The aim of this study was to determine whether elderly individuals show less increase in variability of minimum toe clearance during a dual-task condition (where an increase of gait variability is provoked), while allowing a larger range of variability in the other gait parameters. Forty elderly participants walked back and forth on a 25 m long track for five minutes. They then walked a second time performing an additional cognitive task. The variability in stride time, stride length and minimum toe clearance as well as dual-task costs of each gait parameter were calculated for each walk. The variability in minimum toe clearance did not change during dual task-walking, whereas the variability of stride length and stride time increased, showing dual-task costs of about 66% and 84%, respectively. To avoid additional detrimental load on the central nervous system, the modification of task-irrelevant variability may be tolerated during dual-task conditions, whereas minimum toe clearance is controlled with high priority.     

Towards the importance of minimum toe clearance in level ground walking in a healthy elderly population

Tripping is presumed to be the principal cause for falls during walking. At minimum toe clearance, the potential for trip-related falls is considered to be highest. Thus, controlling minimum toe clearance is essential for walking without tripping. In theory, the central nervous system should therefore give priority to accurate control of the variability in minimum toe clearance, as compared to other gait parameters, since people tend to only modify variability in any given task if it interferes with the task performance. The aim of this study was to determine whether elderly individuals show less increase in variability of minimum toe clearance during a dual-task condition (where an increase of gait variability is provoked), while allowing a larger range of variability in the other gait parameters. Forty elderly participants walked back and forth on a 25 m long track for five minutes. They then walked a second time performing an additional cognitive task. The variability in stride time, stride length and minimum toe clearance as well as dual-task costs of each gait parameter were calculated for each walk. The variability in minimum toe clearance did not change during dual task-walking, whereas the variability of stride length and stride time increased, showing dual-task costs of about 66% and 84%, respectively. To avoid additional detrimental load on the central nervous system, the modification of task-irrelevant variability may be tolerated during dual-task conditions, whereas minimum toe clearance is controlled with high priority.     

Effects of manual task complexity on gait parameters in school-aged children and adults

This study examined the dual-task interference effects of complexity (simple vs. complex), type of task (carrying a pitcher vs. tray), and age (young adults vs. 7–10 year old children) on temporal-spatial and variability measures of gait. All participants first walked on the GAITRite^® walkway without any concurrent task, followed by four dual-task gait conditions. The group of children had a more variable step length and step time than adults across all walking conditions. They also slowed down, took fewer, smaller steps and spent more time in double limb support than adults in the complex dual task conditions. Gait in healthy young adults and school aged children was relatively unaffected by concurrent performance of simple versions of the manual tasks. Our overall analysis suggests that dual-task gait in school aged children is still developing and has not yet reached adult capacity. This study also highlights the critical role of task demand and complexity in dual-task interference.     

Effects of manual task complexity on gait parameters in school-aged children and adults

This study examined the dual-task interference effects of complexity (simple vs. complex), type of task (carrying a pitcher vs. tray), and age (young adults vs. 7–10 year old children) on temporal-spatial and variability measures of gait. All participants first walked on the GAITRite^® walkway without any concurrent task, followed by four dual-task gait conditions. The group of children had a more variable step length and step time than adults across all walking conditions. They also slowed down, took fewer, smaller steps and spent more time in double limb support than adults in the complex dual task conditions. Gait in healthy young adults and school aged children was relatively unaffected by concurrent performance of simple versions of the manual tasks. Our overall analysis suggests that dual-task gait in school aged children is still developing and has not yet reached adult capacity. This study also highlights the critical role of task demand and complexity in dual-task interference.     

Effects of dual task on turning ability in stroke survivors and older adults

BackgroundTurning is an integral component of independent mobility in which stroke survivors frequently fall.ObjectiveThis study sought to measure the effects of competing cognitive demands on the stepping patterns of stroke survivors, compared to healthy age-match adults, during turning as a putative mechanism for falls.MethodsWalking and turning (90°) was assessed under single (walking and turning alone) and dual task (subtracting serial 3 s while walking and turning) conditions using an electronic, pressure-sensitive walkway. Dependent measures were time to turn, variability in time to turn, step length, step width and single support time during three steps of the turn. Turning ability in single and dual task conditions was compared between stroke survivors (n = 17, mean ± SD: 59 ± 113 months post-stroke, 64 ± 10 years of age) and age-matched healthy counterparts (n = 15).ResultsBoth groups took longer, were more variable, tended to widen the second step and, crucially, increased single support time on the inside leg of the turn while turning and distracted.ConclusionsIncreased single support time during turning may represent biomechanical mechanism, within stepping patterns of turning under distraction, for increased risk of falls for both stroke survivors and older adults.     

Effects of dual task on turning ability in stroke survivors and older adults

BackgroundTurning is an integral component of independent mobility in which stroke survivors frequently fall.ObjectiveThis study sought to measure the effects of competing cognitive demands on the stepping patterns of stroke survivors, compared to healthy age-match adults, during turning as a putative mechanism for falls.MethodsWalking and turning (90°) was assessed under single (walking and turning alone) and dual task (subtracting serial 3 s while walking and turning) conditions using an electronic, pressure-sensitive walkway. Dependent measures were time to turn, variability in time to turn, step length, step width and single support time during three steps of the turn. Turning ability in single and dual task conditions was compared between stroke survivors (n = 17, mean ± SD: 59 ± 113 months post-stroke, 64 ± 10 years of age) and age-matched healthy counterparts (n = 15).ResultsBoth groups took longer, were more variable, tended to widen the second step and, crucially, increased single support time on the inside leg of the turn while turning and distracted.ConclusionsIncreased single support time during turning may represent biomechanical mechanism, within stepping patterns of turning under distraction, for increased risk of falls for both stroke survivors and older adults.     

Directional effects of biofeedback on trunk sway during gait tasks in healthy young subjects

Biofeedback of trunk sway is a possible remedy for patients with balance disorders. Because these patients have a tendency to fall more in one direction, we investigated whether biofeedback has a directional effect on trunk sway during gait.Forty healthy young participants (mean age 23.1 years) performed 10 gait tasks with and without biofeedback. Combined vibrotactile, auditory and visual feedback on trunk sway in either the lateral or anterior–posterior (AP) direction was provided by a head-mounted actuator system. Trunk roll and pitch angles, calculated from trunk angular velocities measured with gyroscopes, were used to drive the feedback.A reduction in sway velocities occurred across all tasks regardless of feedback direction. Reductions in sway angles depended on the task. Generally, reductions were greater in pitch. For walking up and down stairs, or over barriers, pitch angle reductions were greater with AP than lateral feedback. For tandem and normal walking, reductions were similar in pitch and roll angles for both feedback directions. For walking while rotating or pitching the head or with eyes closed, only pitch angle was reduced for both feedback directions.These results indicate that the central nervous system is able to incorporate biofeedback of trunk sway from either the AP or lateral direction to achieve a reduction in both pitch and roll sway. Greater reductions in pitch suggest a greater ability to use this direction of trunk sway biofeedback during gait.     

Immediate effects of foot orthoses on gait biomechanics in individuals with persistent patellofemoral pain

BackgroundThe efficacy of foot orthoses in reducing patellofemoral pain (PFP) is well documented; however, the mechanisms by which foot orthoses modulate pain and function are poorly understood.Research questionThis within-subject study investigated the immediate effects of foot orthoses on lower limb kinematics and angular impulses during level walking and stair ambulation in individuals with persistent PFP.MethodsForty-two participants with persistent PFP (≥3 months duration) underwent quantitative gait analysis during level walking, stair ascent and stair descent while using: (i) standard running sandals (control); and (ii) standard running sandals fitted with prefabricated foot orthoses. Hip, knee, and ankle joint kinematics and angular impulses were calculated and statistically analyzed using paired t-tests (p < 0.05).ResultsRelative to the control condition, foot orthoses use was associated with small but significant decreases in maximum ankle inversion angles during walking (mean difference [95% confidence interval]: −1.00° [−1.48 to −0.53]), stair ascent (−1.06° [−1.66 to −0.45]) and stair decent (−0.94° [−1.40 to −0.49]). Foot orthoses were also associated with decreased ankle eversion impulse during walking (−9.8Nms/kg [−12.7 to −6.8]), and decreased ankle dorsiflexion and eversion impulse during stair ascent (−67.6Nms/kg [−100.7 to −34.6] and −17.5Nms/kg [−23.6 to −11.4], respectively) and descent (−50.4Nms/kg [−77.2 to −23.6] and −11.6Nms/kg [−15.6 to −7.5], respectively). Ankle internal rotation impulse decreased when participants ascended stairs with foot orthoses (−3.3Nms/kg [−5.4 to −1.3]). Limited changes were observed at the knee and hip.SignificanceIn individuals with persistent PFP, small immediate changes in kinematics and angular impulses – primarily at the ankle – were observed when foot orthoses were worn during walking or stair ambulation. The clinical implications of these small changes, as well as the longer-term effects of foot orthoses on lower limb biomechanics, are yet to be determined.