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Adam Kelly and Justin Stanek

footwear, and textured insoles may help to improve balance and ameliorate impairments of the foot and ankle complex. Previous research has investigated the impact of textured insoles, orthoses, and textured surfaces on balance. 4 – 6 , 11 – 25 Utilizing orthotics and insoles is not a novel clinical

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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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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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Walter L. Jenkins, D.S. Williams, Brandon Bevil, Sara Stanley, Michael Blemker, Drue Taylor and Kevin O’Brien

Excessive hip motion has been linked to lower extremity pathology. Foot orthoses are commonly used to control motion within lower extremity joints when lower extremity pathology and dysfunction are present. Few studies have investigated the effect of foot orthoses on hip angular kinematics during functional activities. Eighteen females and 18 males performed a vertical jump with and without a prefabricated foot orthoses to determine the biomechanical effect of foot orthoses on hip kinematics when landing from a jump. Data collection included three-dimensional motion analysis of the lower extremity. Paired t tests were performed to determine if differences existed within genders with and without foot orthoses. At the hip joint, there was significantly less hip adduction motion in the foot orthoses condition as compared with the no foot orthoses condition in females (p < .05). There were no differences between foot orthoses conditions in males. Females appear to have a different proximal response to foot orthoses when landing from a forward jump than males.

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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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J. Sinclair, J. Isherwood and P.J. Taylor

Chronic injuries are a common complaint in recreational runners. Foot orthoses have been shown to be effective for the treatment of running injuries but their mechanical effects are still not well understood. This study aims to examine the influence of orthotic intervention on multisegment foot kinematics and plantar fascia strain during running. Fifteen male participants ran at 4.0 m·s−1 with and without orthotics. Multisegment foot kinematics and plantar fascia strain were obtained during the stance phase and contrasted using paired t tests. Relative coronal plane range of motion of the midfoot relative to the rearfoot was significantly reduced with orthotics (1.0°) compared to without (2.2°). Similarly, relative transverse plane range of motion was significantly lower with orthotics (1.1°) compared to without (1.8°). Plantar fascia strain did not differ significantly between orthotic (7.1) and nonorthotic (7.1) conditions. This study shows that although orthotics did not serve to reduce plantar fascia strain, they are able to mediate reductions in coronal and transverse plane rotations of the midfoot.

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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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Dan Minert

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Monique Mokha and Michael G. Dolan

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James A. Yaggie and Stephen J. Kinzey

Context:

Ankle bracing has been used for many years in an attempt to prevent lateral ligamentous injuries of the ankle by restricting joint range of motion (ROM).

Objective:

To examine the influence of ankle bracing on ROM and sport-related performance.

Design:

Repeated measures.

Setting:

Biomechanics laboratory.

Participants:

30 volunteers. None reported ankle trauma within 2 years preceding the study or had other orthopedic conditions that would have affected physical performance.

Intervention:

Three brace conditions (McDavid A101™, Perform-8™ Lateral Stabilizer) were assessed during performance of the vertical jump and shuttle run.

Main Outcome Measures:

shuttle-run time, vertical jump height, inversion, and plantar flexion ROM.

Results:

Both braces restricted plantar flexion and inversion ROM and caused no change in shuttle-run time or vertical jump height.

Conclusions:

Our results indicate that bracing the ankle joint increases external lateral support to the joint without significantly restricting functional ability.