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Effects of customised foot orthoses and low-Dye taping on in-shoe multi-segment foot biomechanics
18
Abstract: 4 footwear / Foot and Ankle Surgery 22S (2016) 16–19
In terminal stance, increased UM ankle stiffness relates to the deforming midsole requiring increased stabilisation for push-off. Joint stiffness in UM and PS demonstrate angle-moment relationships applicable to uneven terrain. Whether these responses are passive or active will be investigated with electromyography. http://dx.doi.org/10.1016/j.fas.2016.05.030
27 FI2016_Footwear_06 Sustainable flat insoles to reduce foot pain and increase physical activity in obese people C. Giacomozzi 1,*, E. Mancuso 1, M. Mancuso 1, A. Rigato 2, S. Masiero 2 1
Istituto Superiore di Sanita`, Italy Padua University Hospital, Italy *Corresponding author. 2
Background: Obesity more than doubled since 1980, its burden becoming hardly sustainable by healthcare systems. While WHO recommends physical activity for at least 150 min/week (http:// www.who.int), metatarsal pain prevents many people from reaching this goal (Tanamas et al., Arthritis Care Res 2012, 64(2):262;8). Aims: The study aims at proposing effective and sustainable flat insoles to reduce metatarsal pain and promote physical activity. Methods: Preliminary gait analysis highlighted that metatarsal peak pressure (MPP) is an effective indicator of pain reduction under heavy load (obese patients: BMI 37.5 4.8, MPP 758 367 kPa; controls: BMI 24.3 3.2, MPP 490 215 kPa; n = 13). 9 painful patients (age 35 16, BMI 34.5 2.7; MPP 951 209 kPa) were thus examined on an EMED pressure platform; damping materials were randomly interposed (Shore A 25-70, thickness 3–10 mm); auto-selected cadence was imposed during all tests. Shore A 25 6 mm EVA best performed for all patients – MPP reduction 54 12%; consistent gait biomechanics. EVA insoles were delivered to patients and tested at baseline (T0) and after one month (T1) by using the wearable Pedar-X system. Results: The insoles partially reduced their damping capability at T1 (T0: 44 8%; T1: 31 8%), however they still effectively minimized pain. Extremely relevant, all T0 cadences < 95 steps/min increased of at least 10 steps/min at T1. Conclusions: MPP measurements, patients; diary and clinical examination proved compliance, safety, effectiveness and at least one-month duration of the insoles; as expected, foot pain minimization contribute to increase and improve physical activity. Evidence for sustainability and adherence needs a longer follow-up on an enlarged population. http://dx.doi.org/10.1016/j.fas.2016.05.031
28 FI2016_Footwear_07 Treatment of Nociceptive Capacity of Plantar Irritating Stimulus by Sensorimotor Orthoses improves postural performances and balance function M. Janin * Laboratory of Physiology, Health University of Toulouse, France *Corresponding author. Aim: Nociceptive Capacity of Plantar Irritating Stimulus type 4 (NCPIS t4) affects plantar system and is defined by: loss of spatial
discrimination (two-point discrimination test), unilateral pressure pain, even without foot disorder or pain expressed by the subject. NCPISt4 impact is highlighted by clinical procedure: variations of the posturodynamic test on hard vs foam podiatrist treatments must take into consideration NCPISt4. This study evaluated the effects of treatment of NCPISt4 using Sensorimotor Orthoses. Method: 60 patients were included: 30 healthy without NCPISt4 (control group, Ct); 30 with NCPISt4 under the first metatarsal head (pathological group, P). Postural performance and balance function were performed using Force platform (Medicapteurs Fusyo3, Toulouse, France) through Ground Reaction Force parameters in two conditions: bi and one leg stance randomised with Sensorimotor Orthoses (SO) and without. Two quotients, Sensory Organisation Test (SOT) and Quotient Sensorimotor Postural (QSP), were selected to highlight variation on balance function and postural performances. Results: Effects are reported between C and P: feet with NCPISt4 are different of all others. SO improve SOT and QSP for C and P. Higher performances are reported for P with differences for feet with or without NCPISt4. Discussion: SO induce plantar pressure repartition. Patients used this new somatosensory perception to control posture and balance function. Better results of feet with NCPISt4 may be due to efficient integration of the afferent plantar cues. Reduction of the NCPISt4 impact produces the best action: improvement of the stabilization. SOT and QSP highlight beneficial influence of NCPISt4 treatments using SO. http://dx.doi.org/10.1016/j.fas.2016.05.032
29 FI2016_Footwear_08 Effects of customised foot orthoses and low-Dye taping on in-shoe multi-segment foot biomechanics J. Arnold *, C. Bishop, T. May University of South Australia, Australia *Corresponding author. Rationale: Despite widespread clinical use, the biomechanical effects of foot taping and foot orthoses in realistic conditions are not well understood. This study aimed to determine the immediate effect and relationships between changes in multi-segment foot biomechanics with foot taping and customized foot orthoses in adults with flat-arched feet. Methods: Multi-segment foot biomechanics were measured in 18 adults with flat-arched feet (age 25.1 SD 2.8 yrs; height 1.73 SD 0.13 m, body mass 70.3 SD 15.7 kg) during walking in four conditions in random order: neutral athletic shoe, neutral shoe with tape (low-Dye method and modified method) and neutral shoe with customised foot orthoses. In-shoe foot biomechanics were compared between conditions using a purpose developed foot model with three-dimensional kinematic analysis and inverse dynamics. Results: Deformation across the midfoot and medial longitudinal arch was reduced with both the low-Dye taping (2.48, P < 0.001) and modified taping technique (5.58, P < 0.001). Foot orthoses significantly delayed peak hindfoot eversion compared to the neutral shoe (44% stance vs 39%, P = 0.002). All interventions increased peak dorsiflexion of the first metatarsophalangeal joint (1.4;3.28, P < 0.001;0.023). Biomechanical responses to taping significantly predicted corresponding changes to foot orthoses (R2 = 0.08;0.52, P = 0.006 to <0.001).
Abstract: 4 footwear / Foot and Ankle Surgery 22S (2016) 16–19
Conclusions: Foot orthoses more effectively altered timing of hindfoot motion and taping was superior in supporting the midfoot and medial longitudinal arch. The biomechanical response to taping was significantly related to the subsequent change observed with foot orthoses. http://dx.doi.org/10.1016/j.fas.2016.05.033
30 FI2016_Footwear_09 Design, development and evaluation of therapeutic insole for neuropathic foot S. Manoharan 1,*, S. Mahajan 2, P. Shah 2, S. Nageshwaran 2, M. Ebenezer 1 1
S. I. H. R & L.C Karigiri, India VIT University, India *Corresponding author. 2
Background: Offloading is key in preventing and treating plantar neuropathic foot ulcers. Among the health professionals it is widely accepted that an appropriate insole prevents ulceration
19
in a neuropathic feet. With the increase in the number of patients with diabetes foot ulcers a need for an appropriate footwear in reducing the plantar pressures is the need of the hour. Aims: This study aims to design an appropriate therapeutic footwear insole model that help prevent and reduce the high plantar pressures of a neuropathic foot. Methods: Using an isotactical redistribution of pressure a footwear insole model was designed in SolidWorks 13. The finite elemental analysis and the computational fluid analysis of the insole model were carried out in ANSYS 14. Results: The analysis showed to have a maximal deformation in the heel region. Further the foot deformation varied while simulating the altering pressure in accordance to the contact surface of the foot. Variations in the contact surface area also decreased the pressure in certain specific areas in foot. Conclusion: In general, design characteristics of the insole plays a major role in the re-distribution of the pressure in the plantar surface. The results showed that elastic properties of insole models would provide protection to foot and redistribute pressure across the plantar surface. The deformation of the footwear model also increases the contact surface area. Increase in the contact surface area decreases the pressure at particular area. http://dx.doi.org/10.1016/j.fas.2016.05.034
Abstract: 4 footwear / Foot and Ankle Surgery 22S (2016) 16–19
In terminal stance, increased UM ankle stiffness relates to the deforming midsole requiring increased stabilisation for push-off. Joint stiffness in UM and PS demonstrate angle-moment relationships applicable to uneven terrain. Whether these responses are passive or active will be investigated with electromyography. http://dx.doi.org/10.1016/j.fas.2016.05.030
27 FI2016_Footwear_06 Sustainable flat insoles to reduce foot pain and increase physical activity in obese people C. Giacomozzi 1,*, E. Mancuso 1, M. Mancuso 1, A. Rigato 2, S. Masiero 2 1
Istituto Superiore di Sanita`, Italy Padua University Hospital, Italy *Corresponding author. 2
Background: Obesity more than doubled since 1980, its burden becoming hardly sustainable by healthcare systems. While WHO recommends physical activity for at least 150 min/week (http:// www.who.int), metatarsal pain prevents many people from reaching this goal (Tanamas et al., Arthritis Care Res 2012, 64(2):262;8). Aims: The study aims at proposing effective and sustainable flat insoles to reduce metatarsal pain and promote physical activity. Methods: Preliminary gait analysis highlighted that metatarsal peak pressure (MPP) is an effective indicator of pain reduction under heavy load (obese patients: BMI 37.5 4.8, MPP 758 367 kPa; controls: BMI 24.3 3.2, MPP 490 215 kPa; n = 13). 9 painful patients (age 35 16, BMI 34.5 2.7; MPP 951 209 kPa) were thus examined on an EMED pressure platform; damping materials were randomly interposed (Shore A 25-70, thickness 3–10 mm); auto-selected cadence was imposed during all tests. Shore A 25 6 mm EVA best performed for all patients – MPP reduction 54 12%; consistent gait biomechanics. EVA insoles were delivered to patients and tested at baseline (T0) and after one month (T1) by using the wearable Pedar-X system. Results: The insoles partially reduced their damping capability at T1 (T0: 44 8%; T1: 31 8%), however they still effectively minimized pain. Extremely relevant, all T0 cadences < 95 steps/min increased of at least 10 steps/min at T1. Conclusions: MPP measurements, patients; diary and clinical examination proved compliance, safety, effectiveness and at least one-month duration of the insoles; as expected, foot pain minimization contribute to increase and improve physical activity. Evidence for sustainability and adherence needs a longer follow-up on an enlarged population. http://dx.doi.org/10.1016/j.fas.2016.05.031
28 FI2016_Footwear_07 Treatment of Nociceptive Capacity of Plantar Irritating Stimulus by Sensorimotor Orthoses improves postural performances and balance function M. Janin * Laboratory of Physiology, Health University of Toulouse, France *Corresponding author. Aim: Nociceptive Capacity of Plantar Irritating Stimulus type 4 (NCPIS t4) affects plantar system and is defined by: loss of spatial
discrimination (two-point discrimination test), unilateral pressure pain, even without foot disorder or pain expressed by the subject. NCPISt4 impact is highlighted by clinical procedure: variations of the posturodynamic test on hard vs foam podiatrist treatments must take into consideration NCPISt4. This study evaluated the effects of treatment of NCPISt4 using Sensorimotor Orthoses. Method: 60 patients were included: 30 healthy without NCPISt4 (control group, Ct); 30 with NCPISt4 under the first metatarsal head (pathological group, P). Postural performance and balance function were performed using Force platform (Medicapteurs Fusyo3, Toulouse, France) through Ground Reaction Force parameters in two conditions: bi and one leg stance randomised with Sensorimotor Orthoses (SO) and without. Two quotients, Sensory Organisation Test (SOT) and Quotient Sensorimotor Postural (QSP), were selected to highlight variation on balance function and postural performances. Results: Effects are reported between C and P: feet with NCPISt4 are different of all others. SO improve SOT and QSP for C and P. Higher performances are reported for P with differences for feet with or without NCPISt4. Discussion: SO induce plantar pressure repartition. Patients used this new somatosensory perception to control posture and balance function. Better results of feet with NCPISt4 may be due to efficient integration of the afferent plantar cues. Reduction of the NCPISt4 impact produces the best action: improvement of the stabilization. SOT and QSP highlight beneficial influence of NCPISt4 treatments using SO. http://dx.doi.org/10.1016/j.fas.2016.05.032
29 FI2016_Footwear_08 Effects of customised foot orthoses and low-Dye taping on in-shoe multi-segment foot biomechanics J. Arnold *, C. Bishop, T. May University of South Australia, Australia *Corresponding author. Rationale: Despite widespread clinical use, the biomechanical effects of foot taping and foot orthoses in realistic conditions are not well understood. This study aimed to determine the immediate effect and relationships between changes in multi-segment foot biomechanics with foot taping and customized foot orthoses in adults with flat-arched feet. Methods: Multi-segment foot biomechanics were measured in 18 adults with flat-arched feet (age 25.1 SD 2.8 yrs; height 1.73 SD 0.13 m, body mass 70.3 SD 15.7 kg) during walking in four conditions in random order: neutral athletic shoe, neutral shoe with tape (low-Dye method and modified method) and neutral shoe with customised foot orthoses. In-shoe foot biomechanics were compared between conditions using a purpose developed foot model with three-dimensional kinematic analysis and inverse dynamics. Results: Deformation across the midfoot and medial longitudinal arch was reduced with both the low-Dye taping (2.48, P < 0.001) and modified taping technique (5.58, P < 0.001). Foot orthoses significantly delayed peak hindfoot eversion compared to the neutral shoe (44% stance vs 39%, P = 0.002). All interventions increased peak dorsiflexion of the first metatarsophalangeal joint (1.4;3.28, P < 0.001;0.023). Biomechanical responses to taping significantly predicted corresponding changes to foot orthoses (R2 = 0.08;0.52, P = 0.006 to <0.001).
Abstract: 4 footwear / Foot and Ankle Surgery 22S (2016) 16–19
Conclusions: Foot orthoses more effectively altered timing of hindfoot motion and taping was superior in supporting the midfoot and medial longitudinal arch. The biomechanical response to taping was significantly related to the subsequent change observed with foot orthoses. http://dx.doi.org/10.1016/j.fas.2016.05.033
30 FI2016_Footwear_09 Design, development and evaluation of therapeutic insole for neuropathic foot S. Manoharan 1,*, S. Mahajan 2, P. Shah 2, S. Nageshwaran 2, M. Ebenezer 1 1
S. I. H. R & L.C Karigiri, India VIT University, India *Corresponding author. 2
Background: Offloading is key in preventing and treating plantar neuropathic foot ulcers. Among the health professionals it is widely accepted that an appropriate insole prevents ulceration
19
in a neuropathic feet. With the increase in the number of patients with diabetes foot ulcers a need for an appropriate footwear in reducing the plantar pressures is the need of the hour. Aims: This study aims to design an appropriate therapeutic footwear insole model that help prevent and reduce the high plantar pressures of a neuropathic foot. Methods: Using an isotactical redistribution of pressure a footwear insole model was designed in SolidWorks 13. The finite elemental analysis and the computational fluid analysis of the insole model were carried out in ANSYS 14. Results: The analysis showed to have a maximal deformation in the heel region. Further the foot deformation varied while simulating the altering pressure in accordance to the contact surface of the foot. Variations in the contact surface area also decreased the pressure in certain specific areas in foot. Conclusion: In general, design characteristics of the insole plays a major role in the re-distribution of the pressure in the plantar surface. The results showed that elastic properties of insole models would provide protection to foot and redistribute pressure across the plantar surface. The deformation of the footwear model also increases the contact surface area. Increase in the contact surface area decreases the pressure at particular area. http://dx.doi.org/10.1016/j.fas.2016.05.034