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Dan Minert

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Anne Mündermann, Benno M. Nigg, R. Neil Humble and Darren J. Stefanyshyn

In order to accommodate patients to new foot orthoses over time, two steps are required: The first is to obtain a baseline reading of the immediate effects across several weeks to ensure consistency. The second step is to look at changes with progressively longer wear periods similar to what occurs in general practice. This study addressed the first step. The purpose of this study was to determine whether the baseline reading of the immediate effects of foot orthoses on comfort and lower extremity kinematics, kinetics, and muscle activity is consistent between days. Participants were 21 recreational runners who volunteered for the study. Three orthotic conditions (posting, custom-molding, posting and custom-molding) were compared to a control (flat) insert. Lower extremity kinematic, kinetic, and EMG data were collected for 108 trials per participant and condition in 9 sessions for each person for running at 4 m/s. Comfort for all orthotic conditions was assessed in each session using a visual analog scale. Statistically significant session effects were detected using repeated-measures ANOVA (α = .05). Three of the 93 variables had a significant session effect. A significant interaction between orthotic condition and session was observed for 6 of the 93 variables. The results of this study showed that the effects of foot orthoses on comfort, lower extremity kinematics, kinetics, and muscle activity are consistent across a 3-week period when the wear time for each condition is restricted. Thus, foot orthoses lead to immediate changes in comfort, kinematics, kinetics, and muscle activity with limited use. These immediate effects of foot orthoses on comfort, kinematics, kinetics, and muscle activity are consistent between days.

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Jordan Anderson and Justin Stanek

Clinical Scenario:

Plantar fasciitis is a debilitating and painful problem present in the general population. It most often presents with moderate to severe pain in the proximal inferior heel region and is most commonly associated with repeated trauma to the plantar fascia. Plantar fasciitis, itself, is an injury at the site of attachment at the medial tubercle of the calcaneus, often due to excessive and repetitive traction. Plantar fasciitis is the most common cause of heel pain and is estimated to affect 2 million people in the United States alone.

Focused Clinical Question:

For adults suffering from plantar fasciitis, are foot orthoses a viable treatment option to reduce pain?

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Jan Andrysek, Susan Klejman and John Kooy

The goal of this study was to investigate clinically relevant biomechanical conditions relating to the setup and alignment of knee-ankle-foot orthoses and the influence of these conditions on knee extension moments and orthotic stance control during gait. Knee moments were collected using an instrumented gait laboratory and concurrently a load transducer embedded at the knee-ankle-foot orthosis knee joint of four individuals with poliomyelitis. We found that knee extension moments were not typically produced in late stance-phase of gait. Adding a dorsiflexion stop at the orthotic ankle significantly decreased the knee flexion moments in late stance-phase, while slightly flexing the knee in stance-phase had a variable effect. The findings suggest that where users of orthoses have problems initiating swing-phase flexion with stance control orthoses, an ankle dorsiflexion stop may be used to enhance function. Furthermore, the use of stance control knee joints that lock while under flexion may contribute to more inconsistent unlocking of the stance control orthosis during gait.

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Andrew R. Boldt, John D. Willson, Joaquin A. Barrios and Thomas W. Kernozek

We examined the effects of medially wedged foot orthoses on knee and hip joint mechanics during running in females with and without patellofemoral pain syndrome (PFPS). We also tested if these effects depend on standing calcaneal eversion angle. Twenty female runners with and without PFPS participated. Knee and hip joint transverse and frontal plane peak angle, excursion, and peak internal knee and hip abduction moment were calculated while running with and without a 6° full-length medially wedged foot orthoses. Separate 3-factor mixed ANOVAs (group [PFPS, control] x condition [medial wedge, no medial wedge] x standing calcaneal angle [everted, neutral, inverted]) were used to test the effect of medially wedged orthoses on each dependent variable. Knee abduction moment increased 3% (P = .03) and hip adduction excursion decreased 0.6° (P < .01) using medially wedged foot orthoses. No significant group x condition or calcaneal angle x condition effects were observed. The addition of medially wedged foot orthoses to standardized running shoes had minimal effect on knee and hip joint mechanics during running thought to be associated with the etiology or exacerbation of PFPS symptoms. These effects did not appear to depend on injury status or standing calcaneal posture.

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Monique Mokha and Michael G. Dolan

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Christopher L. MacLean, Richard van Emmerik and Joseph Hamill

The purpose of this study was to analyze the influence of a custom foot orthotic (CFO) intervention on lower extremity intralimb coupling during a 30-min run in a group of injured runners and to compare the results to a control group of healthy runners. Three-dimensional kinematic data were collected during a 30-min run on healthy female runners (Shoe-only) and a group of female runners who had a recent history of overuse injury (Shoe-only and Shoe with custom foot orthoses). Results from the study revealed that the coordination variability and pattern for the some couplings were influenced by history of injury, foot orthotic intervention and the duration of the run. These data suggest that custom foot orthoses worn by injured runners may play a role in the maintenance of coordination variability of the tibia (transverse plane) and calcaneus (frontal plane) coupling during the Early Stance phase. In addition, it appears that the coupling angle between the knee (transverse plane) and rearfoot (frontal plane) joints becomes more symmetrical in the late stance phase as a run progresses.

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Christopher L. MacLean, Irene S. Davis and Joseph Hamill

The purpose of this study was to analyze the influence of varying running shoe midsole composition on lower extremity dynamics with and without a custom foot orthotic intervention. Three-dimensional dynamics were collected on 12 female runners who had completed 6 weeks of custom foot orthotic therapy. Participants completed running trials in 3 running shoe midsole conditions—with and without a custom foot orthotic intervention. Results from the current study revealed that only maximum rearfoot eversion velocity was influenced by the midsole durometer of the shoe. Maximum rearfoot eversion velocity was significantly decreased for the hard shoe compared with the soft shoe. However, the orthotic intervention in the footwear led to significant decreases in several dynamic variables. The results suggest that the major component influencing the rearfoot dynamics was the orthotic device and not the shoe composition. In addition, data suggest that the foot orthoses appear to compensate for the lesser shoe stability enabling it to function in a way similar to that of a shoe of greater stability.

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Lachlan E. Garrick, Bryce C. Alexander, Anthony G. Schache, Marcus G. Pandy, Kay M. Crossley and Natalie J. Collins

rating criteria proposed by Crossley et al, 7 but it may also highlight particular body segments or aberrant movement patterns that contribute to poor dynamic control during the single-leg squat, identifying potential treatment targets. Foot orthoses are an intervention that may improve single-leg squat

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Laura A. Verbruggen, Melissa M. Thompson and Chris J. Durall

Clinical Scenario Plantar fasciitis is one of the most common musculoskeletal disorders of the foot. 1 – 5 Initial treatment of plantar fasciitis is typically conservative and may include heel padding, steroid injections, night splinting, calf-stretching, ultrasound, foot orthoses, and taping