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Managing plantar fasciopathy in practice: The key to successful treatment is in the diagnosis
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Abstracts / Journal of Science and Medicine in Sport 20S (2017) 5–6
the longer-term effects of transitioning to minimalist shoes on time trial performance, running economy, muscle strength and bone mineral density, and (2) use a series of example cases from the study to explore potential moderating factors (shoe comfort, running biomechanics, and training volume) that might influence the effects of minimalist shoes on running performance, muscle strength, bone mineral density, pain and injury. The clinical and research implications of the findings from this planned follow-up study and case series investigation will be discussed. https://doi.org/10.1016/j.jsams.2017.09.199 11 The mechanical function of the subtalar joint and tibialis posterior muscle and tendon during walking J. Maharaj School of Human Movement and Nutrition Sciences, University of Queensland, Australia The human foot acts like a spring to store and return energy during walking and running, however, it’s mechanical role in controlling frontal plane mechanics has received very little attention. The subtalar joint (STJ) functions predominately in the frontal plane and is responsible for the majority of rear-foot motion in the foot. During walking, the STJ pronates during early stance as the foot absorbs energy and supinates as the foot generates power. The tibialis posterior (TP) muscle is a muscle that has a primary action in controlling STJ motion during walking. The TP generates forces across the stance phase, however the mechanical role of TP in absorbing energy and generating power at the STJ is relatively speculatively and is not well understood. It is conceivable that the TP tendon is responsible for the majority of energy absorption at the STJ during early stance as it resists pronation, predisposing it to high strains and potentially accounting for the high incidence of injury (e.g. TP tendon dysfunction). Here we aimed to quantify the mechanical function of the STJ during walking and examine how this might be controlled by the function of the TP muscle and tendon. The overarching hypothesis is that the TP muscle resists pronation and absorbs energy at the STJ (frontal plane) in early stance and that this function will be influenced by: (1) the functional anatomy of the foot; (2) the compliance of the TP tendon; and (3) interaction with external
structures (e.g. footwear or orthotics). In a series of experiments, we combined ultrasound imaging, multi-segment musculoskeletal foots model and intramuscular EMG to explore the mechanical function of the TP and STJ during walking. Results of these studies, illustrate that the STJ certainly absorbs energy during early stance and generates power during late stance of walking. Ultrasound imaging suggests that the fascicles act relatively isometrically during the energy absorption phase, storing the energy in tendinous tissue which is later recycled to help power supination at push-off. The total energy absorbed at the STJ increases in a flexible flat foot structure (i.e. with a low arch height index and high foot mobility magnitude) and may be reduced by increasing step width during gait and with the use of footwear, suggesting that the strains of the TP tendinous tissue vary depending on foot structure and with the interaction of external devices. https://doi.org/10.1016/j.jsams.2017.09.200 12 Managing plantar fasciopathy in practice: The key to successful treatment is in the diagnosis Pain in the plantar heel of the foot is one of the most common presentations of foot pain in clinical practice. The term ‘plantar fasciitis’ is widely used as an umbrella term to represent all potential pathology in the region, yet it does not always guide us towards the most appropriate treatment. Using an evidence based framework and expert consensus, this presentation will present a series of studies to represent the management workflow of plantar fasciopathy in clinical practice. First, a diagnostic framework will be presented to isolate the pathology at play and what clinical assessment processes will allow for specific diagnoses to be made. From here, we will focus on plantar fasciopathy as a diagnosis and present findings from a recent clinical trial investigating the effect of individually prescribed custom foot orthotics on individuals with unilateral plantar fasciopathy over 12 weeks. Where most orthotic related research on foot orthotics has examined purely their effect of pain and quality of life, we will delve into the individual mechanism of effect of foot orthotics and the shoes they are placed into in terms of their effect on foot function and the relationship between biomechanical function and pain reduction. https://doi.org/10.1016/j.jsams.2017.09.201
Abstracts / Journal of Science and Medicine in Sport 20S (2017) 5–6
the longer-term effects of transitioning to minimalist shoes on time trial performance, running economy, muscle strength and bone mineral density, and (2) use a series of example cases from the study to explore potential moderating factors (shoe comfort, running biomechanics, and training volume) that might influence the effects of minimalist shoes on running performance, muscle strength, bone mineral density, pain and injury. The clinical and research implications of the findings from this planned follow-up study and case series investigation will be discussed. https://doi.org/10.1016/j.jsams.2017.09.199 11 The mechanical function of the subtalar joint and tibialis posterior muscle and tendon during walking J. Maharaj School of Human Movement and Nutrition Sciences, University of Queensland, Australia The human foot acts like a spring to store and return energy during walking and running, however, it’s mechanical role in controlling frontal plane mechanics has received very little attention. The subtalar joint (STJ) functions predominately in the frontal plane and is responsible for the majority of rear-foot motion in the foot. During walking, the STJ pronates during early stance as the foot absorbs energy and supinates as the foot generates power. The tibialis posterior (TP) muscle is a muscle that has a primary action in controlling STJ motion during walking. The TP generates forces across the stance phase, however the mechanical role of TP in absorbing energy and generating power at the STJ is relatively speculatively and is not well understood. It is conceivable that the TP tendon is responsible for the majority of energy absorption at the STJ during early stance as it resists pronation, predisposing it to high strains and potentially accounting for the high incidence of injury (e.g. TP tendon dysfunction). Here we aimed to quantify the mechanical function of the STJ during walking and examine how this might be controlled by the function of the TP muscle and tendon. The overarching hypothesis is that the TP muscle resists pronation and absorbs energy at the STJ (frontal plane) in early stance and that this function will be influenced by: (1) the functional anatomy of the foot; (2) the compliance of the TP tendon; and (3) interaction with external
structures (e.g. footwear or orthotics). In a series of experiments, we combined ultrasound imaging, multi-segment musculoskeletal foots model and intramuscular EMG to explore the mechanical function of the TP and STJ during walking. Results of these studies, illustrate that the STJ certainly absorbs energy during early stance and generates power during late stance of walking. Ultrasound imaging suggests that the fascicles act relatively isometrically during the energy absorption phase, storing the energy in tendinous tissue which is later recycled to help power supination at push-off. The total energy absorbed at the STJ increases in a flexible flat foot structure (i.e. with a low arch height index and high foot mobility magnitude) and may be reduced by increasing step width during gait and with the use of footwear, suggesting that the strains of the TP tendinous tissue vary depending on foot structure and with the interaction of external devices. https://doi.org/10.1016/j.jsams.2017.09.200 12 Managing plantar fasciopathy in practice: The key to successful treatment is in the diagnosis Pain in the plantar heel of the foot is one of the most common presentations of foot pain in clinical practice. The term ‘plantar fasciitis’ is widely used as an umbrella term to represent all potential pathology in the region, yet it does not always guide us towards the most appropriate treatment. Using an evidence based framework and expert consensus, this presentation will present a series of studies to represent the management workflow of plantar fasciopathy in clinical practice. First, a diagnostic framework will be presented to isolate the pathology at play and what clinical assessment processes will allow for specific diagnoses to be made. From here, we will focus on plantar fasciopathy as a diagnosis and present findings from a recent clinical trial investigating the effect of individually prescribed custom foot orthotics on individuals with unilateral plantar fasciopathy over 12 weeks. Where most orthotic related research on foot orthotics has examined purely their effect of pain and quality of life, we will delve into the individual mechanism of effect of foot orthotics and the shoes they are placed into in terms of their effect on foot function and the relationship between biomechanical function and pain reduction. https://doi.org/10.1016/j.jsams.2017.09.201