Assessment of body plantar pressure in elite athletes: an observational study

Static Plantar Pressure under Different Conditions in Children with Surgically Treated Unilateral Slipped Capital Femoral Epiphysis

BACKGROUND

Slipped capital femoral epiphysis (SCFE) is the most common hip disease during infancy and adolescence. Our study aimed to analyze static plantar pressure in children with surgically treated unilateral SCFE.

METHODS

Twenty-two children with right SCFE with in situ fixation with one percutaneous screw were assessed by PoData plantar pressure analysis under three different conditions (open eyes, eyes closed, and head retroflexed).

RESULTS

The total foot loading was significantly higher on the unaffected limb compared with the affected one for all the three testing conditions (p < 0.05). When assessing the differences between testing conditions, there were no significant differences for the right and left foot loadings, or for the three sites of weight distribution, except for the right fifth metatarsal head (lower loading in eyes-closed condition in comparison to eyes open, p = 0.0068), left fifth metatarsal head (increased loading in head-retroflexed condition in comparison to eyes open, p = 0.0209), and left heel (lower loading in head-retroflexed condition in comparison to eyes open, p = 0.0293).

CONCLUSION

Even after a successful surgical procedure, differences in foot loading can impact the postural static activities in different conditions (natural eyes-open, eyes-closed, or head-retroflexed posture).

Influence of the mandibular position on various postural anatomical segments

OBJECTIVE

To determine postural changes in relation to mandibular position in maximum intercuspation and at rest in adult patients of both sexes.

METHODS

: A descriptive observational clinical study was carried out in 76 patients. Using an analyzer and the Meersseman test, the necessary dermal points for postural analysis were located.

RESULTS

: The authors found significant differences in the posture adopted by the patient between maximum intercuspation and mandibular rest in the frontal, sagittal, and dorsal planes. Foot support in the right foot went from cavus to normal in 6% of the sample, and from flat to normal in 2.5% of the sample in the jaw rest position.

CONCLUSION

Postural changes were observed in various segments, with clinical and statistical significance at cervical level in the frontal plane, in the biscapular variable in the dorsal plane, and at the level of the lower limbs in the bipopliteal and bimalleolar variables.

Randomized Feasibility Pilot Trial of Adding a New Three-Dimensional Adjustable Posture-Corrective Orthotic to a Multi-Modal Program for the Treatment of Nonspecific Neck Pain

The aim of this study was to investigate the feasibility and effect of a multimodal program for the management of chronic nonspecific neck pain CNSNP with the addition of a 3D adjustable posture corrective orthotic (PCO), with a focus on patient recruitment and retention. This report describes a prospective, randomized controlled pilot study with twenty-four participants with CNSNP and definite 3D postural deviations who were randomly assigned to control and study groups. Both groups received the same multimodal program; additionally, the study group received a 3D PCO to perform mirror image® therapy for 20−30 min while the patient was walking on a treadmill 2−3 times per week for 10 weeks. Primary outcomes included feasibility, recruitment, adherence, safety, and sample size calculation. Secondary outcomes included neck pain intensity by numeric pain rating scale (NPRS), neck disability index (NDI), active cervical ROM, and 3D posture parameters of the head in relation to the thoracic region. Measures were assessed at baseline and after 10 weeks of intervention. Overall, 54 participants were screened for eligibility, and 24 (100%) were enrolled for study participation. Three participants (12.5%) were lost to reassessment before finishing 10 weeks of treatment. The between-group mean differences in change scores indicated greater improvements in the study group receiving the new PCO intervention. Using an effect size of 0.797, α > 0.05, β = 80% between-group improvements for NDI identified that 42 participants were required for a full-scale RCT. This pilot study demonstrated the feasibility of recruitment, compliance, and safety for the treatment of CNSNP using a 3D PCO to a multimodal program to positively affect CNSNP management.

Postural Stability in Single-Leg Quiet Stance in Highly Trained Athletes: Sex and Sport Differences

This study aimed to determine if there is a difference in postural stability in highly trained adolescents and young adult athletes regarding sex and sport. The participants were young athletes (n = 464) from seven different sports. We considered the center of pressure (CoP) velocity (total, anterior–posterior (AP) and medial–lateral (ML)), CoP amplitude (AP and ML), and CoP frequency (AP and ML), as assessed by single-leg quiet stance test. Significant interactions were found between sex and sport for all CoP variables (p < 0.02). Additionally, a significant main effect of sport was also found in all CoP variables (p = 0.01). Regarding sex, significant effects were found for all CoP amplitude variables (p = 0.01), as well as for CoP velocity variables, except for CoP ML (p = 0.06). Moreover, there was no sex effect for CoP frequency AP (p = 0.18). The results of the current study confirm the claim that the criteria for optimal postural strategies for elite athletes likely depend on a given sport.

Characteristics of Plantar Pressure with Foot Postures and Lower Limb Pain Profiles in Taiwanese College Elite Rugby League Athletes

Background: This study aimed to explore the differences in the distributions of plantar pressure in static and dynamic states and assess the possible pain profiles in the lower limb between elite rugby league athletes and recreational rugby players. Methods: A cross-sectional study of 51 college elite rugby athletes and 57 recreational rugby players was undertaken. The arch index (AI) and plantar pressure distributions (PPDs) with footprint characteristics were evaluated via the JC Mat. Rearfoot alignment was examined to evaluate the static foot posture. The elite group’s lower-limb pain profiles were examined for evaluating the common musculoskeletal pain areas. Results: The recreational group’s AI values fell into the normal range, whereas the elite group’s arch type fell into the category of the low arch. Results from the elite group were: (1) the PPDs mainly exerted on the entire forefoot and lateral midfoot regions in static standing, and transferred to the forefoot region during the midstance phase of walking; (2) the static rearfoot alignment matched the varus posture pattern; (3) the footprint characteristics illustrated the features of low-arched, supinated, dropped metatarsal heads and dropped cuboid feet; and (4) the phalanx and metatarsophalangeal joints, and the abductor hallucis and abductor digiti minimi of the plantar plate were common musculoskeletal pain areas. Conclusions: Characteristics of higher plantar loads beneath forefoot and midfoot associated with low-arched supinated feet in bipedal static stance could be the traceable features for the foot diagram of elite rugby league athletes. The limb pain profiles of the elite rugby league athletes within this study echoed the literature on rugby injuries, and reflected the features of metatarsophalangeal joint pains and dropped cuboids. The relationships among the low-arched supinated feet, metatarsophalangeal joint pains and cuboid syndrome are worth further studies.

Relationship between ankle strength and range of motion and postural stability during single-leg quiet stance in trained athletes

The aim of this study was to determine the relationship between strength of ankle plantar and dorsal flexors and range of motion (RoM), and body sway variables during single-leg quiet stance, in highly trained athletes. The participants for this study were young athletes from 9 disciplines (n = 655). Center of pressure (CoP) velocity, amplitude, and frequency were measured during single-leg quiet stance. Moreover, athletes were measured for passive ankle plantar flexion (PF) and dorsal flexion (DF) RoM, and for rate of torque development (RTD) in the 0–50 (RTD50) and 0–200 ms time windows (RTD200). Ankle strength and RoM could not predict CoP velocity total, anterior–posterior (AP), and medial–lateral (ML) (p > 0.05). However, PF_RTD50 and PF_RoM and PF_RoM positively influenced CoP amplitude in ML direction (p < 0.001, R² = 0.10). Moreover, CoP frequency in ML direction significantly increased with lower PF_RTD50, DF_RTD50, DF_RTD200, PF_RoM, and DF_RoM (p < 0.05). We have demonstrated that ankle strength and RoM were related to single-leg quiet stance postural balance in trained athletes. The ankle RoM showed the greatest influence on CoP variables in ML directions.

Smartphone Use and Postural Balance in Healthy Young Adults

Maintaining an upright posture while talking or texting on the phone is a frequent dual-task demand. Using a within-subjects design, the aim of the present study was to assess the impact of a smartphone conversation or message texting on standing plantar pressure and postural balance performance in healthy young adults. Thirty-five subjects (mean age 21.37 ± 1.11 years) were included in this study. Simultaneous foot plantar pressure and stabilometric analysis were performed using the PoData system, under three conditions: no phone (control), talking on a smartphone (talk) and texting and sending a text message via a smartphone (text). Stabilometric parameters (center of pressure (CoP) path length, 90% confidence area and maximum CoP speed) were significantly affected by the use of different smartphone functions (p < 0.0001). The CoP path length and maximum CoP speed were significantly higher under the talk and text conditions when compared to the control. CoP path length, 90% confidence area and maximum CoP speed were significantly increased in talk compared to text and control. Talking on the phone also influenced the weight distribution on the left foot first metatarsal head and heel as compared with message texting. Postural stability in healthy young adults was significantly affected by talking and texting on a smartphone. Talking on the phone proved to be more challenging.

Do different dental conditions influence the static plantar pressure and stabilometry in young adults?

Background

Posture is influenced by many factors and dental occlusion seems to have its role on postural stabilization. Our rationale to perform the study was to find out if there are differences of static plantar pressure and stabilometric parameters depending on different dental conditions.

Methods

The observational study consisted in plantar pressure assessment and stabilometric analysis of 95 right-handed healthy volunteer subjects (mean age 22.94 ± 2.52 years) by using the PoData system. Each subject followed four measurements with open eyes: mandibular postural position, maximum intercuspation, biting on cotton rolls and maximum mouth opening. Plantar pressure was recorded on 1^st and 5^th metatarsal heads and heel, and was expressed as percentage of weight distribution on each foot. The recorded centre of pressure (CoP) parameters were: CoP path length, 90%confidence ellipse area and maximum CoP speed. Statistical analysis used repeated-measures ANOVA with Bonferroni posthoc analysis and Friedman test.

Results

Loading on the left 5^th metatarsal head was significantly higher in maximum mouth opening condition when compared to maximum intercuspation and to biting on cotton rolls. The left heel loading was significantly lower in the maximum mouth opening in comparison to maximum intercuspation. The CoP path length and maximum CoP speed were significantly higher in maximum mouth opening compared to the other three conditions. Confidence ellipse area had significantly lower values in maximum intercuspation and in the biting on cotton rolls conditions compared to the mandibular postural position, and in maximum intercuspation compared to maximum mouth opening.

Conclusion

In young adults with an optimum functional occlusion the static plantar pressure is influenced by the maximum mouth opening. An improved postural stability was recorded in maximum intercuspation (a condition used during swallowing) in comparison to mandibular postural position (a condition that allows relaxation of the masticatory muscles after functional moments).

Static plantar pressure and functional capacity in children with femoral shaft fractures treated by titanium elastic nailing

Background

Femoral shaft fractures represent common fractures of the lower limb in the paediatric population. The objectives of our study were to analyse the static plantar pressure and functional capacity in children with surgically treated unilateral femoral shaft fractures, 1 month after the metallic implant removal.

Methods

Our study included 24 children with unilateral femoral shaft fracture (fracture site contralateral to the dominant leg) treated by titanium elastic nailing (TEN) implants, with the removal of the implant 6 months after initial surgery. The patients were divided into two groups: Group 1 (12 patients without inpatient rehabilitation) and Group 2 (12 patients who attended inpatient rehabilitation). The patients and 12 gender and age-matched healthy controls performed plantar pressure analysis and functional capacity testing (6-min walk test: 6MWT). For patients in Group 1 and 2 the assessments were performed 1 month after the TEN implant removal. Paired t-tests were used to compare the intragroup data. A one-way ANOVA test for independent measures was performed to assess the differences for plantar pressure, and 6MWT among study groups and controls.

Results

All study patients had left femoral shaft fractures (affected limb). The patients and controls were all right leg dominant. In both Group 1 and Group 2 total foot loading was significantly higher on the non-affected limb compared with the affected limb. When compared to the non-affected limb, the loadings on the affected limb were significantly increased on the first and fifth metatarsal in Group 1, and on the fifth metatarsal in Group 2, with a significantly smaller heel loading. When compared with the controls we found significant differences for all pressure parameters, except for the right foot load for the rehabilitation group. Although the functional capacity values were higher in the rehabilitation group the two patients groups had significantly lower 6MWT values.

Conclusions

When compared to healthy controls children with surgically treated unilateral femoral shaft fractures, although assessed after 7 months, had a different weight distribution on the feet and a decreased functional capacity. A rehabilitation programme included in the management of these patients is important for regaining their functional level.

Addition of a new three-dimensional adjustable cervical thoracic orthosis to a multi-modal program in the treatment of nonspecific neck pain: study protocol for a randomised pilot trial

BACKGROUND

Nonspecific neck pain (NSNP) is one of the most common musculoskeletal problems treated by orthopaedic physicians and physiotherapists. Posture has emerged as one of the major risk factors associated with NSNP, but most previous studies ignored correct posturing as an effective treatment. Therefore, one of the major challenges faced by clinicians is how to incorporate 3D posture findings into the treatment plane. The present study will evaluate the feasibility of conducting a larger randomized trial. This pilot study is designed to investigate the hypothesis that a multimodal programme supplemented with the addition of a 3D adjustable cervico thoracic posture corrective orthotic (CTPCO) will yield short- and long-term improvement on NSNP management outcomes.

METHODS/DESIGN

This pilot, single-blind, randomized controlled trial will divide 24 patients into two groups (study and control) using block randomization. Both groups will receive conventional treatment consisting of a moist hot pack, soft tissue mobilization, manual therapy and therapeutic exercise. The study group will undergo ambulatory mirror-image functional re-training wearing a 3D adjustable CTPCO. The primary outcome is feasibility, including recruitment (e.g., time to complete enrolment, recruitment rate), patient retention and adherence to treatment allocation (e.g., session attendance, home practice, use of non-study treatments). The secondary outcomes used to assess the effectiveness of the treatment will include neck pain (measures using the visual analogue scale (VAS)) and neck disability (measures using the neck disability index (NDI)), among other outcome measures, compared between the experimental and control groups. Three-dimensional posture parameters of head measurements will be provided by a Global Posture System (GPS). The outcome measures for determining the treatment effect will be assessed at three intervals: pre-treatment, after 10 weeks of intervention and after 3 months at follow-up.

DISCUSSION

This randomized controlled pilot trial will inform the design of a future full-scale trial. The outcomes will provide some resources for the incorporation of ambulatory mirror-image functional re-training intervention compared to a control group intervention for neck pain, disability and 3D posture parameters.

TRIAL REGISTRATION

Prospectively registered at ClinicalTrials.gov, NCT03331120 . Registered on 22 October 2017.

Dynamic rheological comparison of silicones for podiatry applications

PURPOSE

This work shows an effective methodology to evaluate the dynamic viscoelastic behavior of silicones for application in podiatry. The aim is to characterize, compare their viscoelastic properties according to the dynamic stresses they can be presumably subjected when used in podiatry orthotic applications. These results provide a deeper insight which extends the previous creep-recovery results to the world of dynamic stresses developed in physical activity. In this context, it shoulod be taken into account that an orthoses can subjected to a set of static and dynamic shear and compressive forces.

METHODS

Two different podiatric silicones, Blanda-blanda and Master, from Herbitas, are characterized by dynamic rheological methods. Three kinds of rheological tests are considered: shear stress sweep, compression frequency sweep and shear frequency sweep, all the three with simultaneous control of the static force at three different levels. The static force represents a static load like that produced by the weight of a human body on a shoe insole. In a practical sense, dynamic stresses are related to physical activity and are needed to evaluate the frequency effect on the viscoelastic behavior of the material. It is considered that the dynamic stresses can be applied in compression and shear since, in practice, the way the stresses are applied in real life depends on the orthoses geometry and its exact location with respect to the foot and shoe. The effects of static and dynamic loads are individualized and compared to each other through the relations between the elastic constants for isotropic materials.

CONCLUSIONS

The overall proposed experimental methodology can provide very insightful information for better selection of materials in podiatry applications. This study focuses on the rheological characterization to choose the right silicone for each podiatric application, taking into account the dynamic viscoelastic requirements associated to the physical activity of user. Accordingly, one soft and one hard silicones of common use in podiatry were tested. Each of the two silicones exhibit not only different moduli values, but also, a different kind of dependence of the dynamic moduli with respect to the static load. In the case of the soft sample a linear trend is observed but in the case of of the hard one the dependence is of the power law type. Moreover, these samples exhibit very different Poisson's coefficient values for compression stresses lower than 20 kPa, and almost the same values for stresses above 40 kPa. That different dependence of the Poisson's ratio on the static load should also be taken into account for material selection in customized podiatry applications, where static and dynamic loads are strongly dependent on the individual weight and activity.