The biomechanical characteristics of wearing FitFlop™ sandals highlight significant alterations in gait pattern: a comparative study

The effects of shoe type on lower limb venous status during gait or exercise: A systematic review

This systematic review evaluated the literature pertaining to the effect of shoes on lower limb venous status in asymptomatic populations during gait or exercise. The review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed-NCBI, EBSCO Host, Cochrane Library and Science Direct databases were searched (March 2019) for words around two concepts: shoes and venous parameters. The inclusion criteria were as follows: (1) the manuscript had to be published in an English-language peer-reviewed journal and the study had to be observational or experimental and (2) the study had to suggest the analysis of many types of shoes or orthotics on venous parameters before, during and/or after exercise. Out of 366 articles, 60 duplications were identified, 306 articles were analyzed, and 13 articles met the eligibility criteria after screening and were included. This review including approximately 211 participants. The methodological rigor of these studies was evaluated with the modified Downs and Black quality index. Nine studies investigated the effect of shoes on blood flow parameters, two on venous pressure and two on lower limb circumferences with exercise. Evidence was found that unstable shoes or shoes with similar technology, sandals, athletic or soft shoes, and customized foot orthotics elicited more improvement in venous variables than high-heeled shoes, firm shoes, ankle joint immobilization and barefoot condition. These venous changes are probably related to the efficiency of muscle pumps in the lower limbs, which in turn seem to be dependent on shoe features associated with changes in the kinetics, kinematics and muscle activity variables in lower limbs during gait and exercise.

Biomechanical analysis of walking gait when simulating the use of an Ilizarov external fixator

The Ilizarov frame is an external fixation device, primarily used for the treatment of complex fractures. The authors postulate that the size and weight of the frame may lead to biomechanical adaptations to gait, independent to any injury. Temporospatial characteristics, kinetics and kinematics were assessed when simulating the use of an Ilizarov frame. Fifteen healthy participants performed walking trials, with and without the simulated frame. Significant changes to temporospatial characteristics were identified, with a decreased mean walking speed (with: 1.24 m s–1; without: 1.29 m s–1) and increased mean step width (with: 0.14 m; without: 0.11 m). The push-off phase of gait differed significantly between test conditions with mean increases in ankle dorsiflexion angles (with: 90.4°; without: 89.0°) and extension moments (proportional to body weight or P BWT) at the knee and ankle (knee with: 0.8 P BWT·m; without: 0.7 P BWT·m; ankle with: 1.6 P BWT·m; without: 1.6 P BWT·m). Although changes were small and likely to be clinically insignificant, the size and weight of the frame led to adaptations which may be magnified for patient groups with associated injury and pain at the lower limb. Results provide an argument for the potential redesign of the frame.

Lower limb muscle co-contraction and joint loading of flip-flops walking in male wearers

Flip-flops may change walking gait pattern, increase muscle activity and joint loading, and predispose wearers to foot problems, despite that quantitative evidence is scarce. The purpose of this study was to examine the lower limb muscle co-contraction and joint contact force in flip-flops gait, and compare with those of barefoot and sports shoes walking. Ten healthy males were instructed to perform over-ground walking at self-selected speed under three footwear conditions: 1) barefoot, 2) sports shoes, and 3) thong-type flip-flops. Kinematic, kinetic and EMG data were collected and input to a musculoskeletal model to estimate muscle force and joint force. One-way repeated measures ANOVA was conducted to compare footwear conditions. It was hypothesized that flip-flops would induce muscle co-contraction and produce different gait kinematics and kinetics. Our results demonstrated that the musculoskeletal model estimation had a good temporal consistency with the measured EMG. Flip-flops produced significantly lower walking speed, higher ankle and subtalar joint range of motion, and higher shear ankle joint contact force than sports shoes (p < 0.05). There were no significant differences between flip-flops and barefoot conditions in terms of muscle co-contraction index, joint kinematics, and joint loading of the knee and ankle complex (p > 0.05). The variance in walking speed and footwear design may be the two major factors that resulted in the comparable joint biomechanics in flip-flops and barefoot walking. From this point of view, whether flip-flops gait is potentially harmful to foot health remains unclear. Given that shod walking is more common than barefoot walking on a daily basis, sports shoes with close-toe design may be a better footwear option than flip-flops for injury prevention due to its constraint on joint motion and loading.

Evaluation of factors that affect hip moment impulse during gait: A systematic review

BACKGROUND

Decreasing the daily cumulative hip moments in the frontal and sagittal planes may lower the risk of hip osteoarthritis. Therefore, it may be important to evaluate factors that affect hip moment impulse during gait.

RESEARCH QUESTION

It is unclear what factors affect hip moment impulse during gait. This systematic review aimed to evaluate different factors that affect hip moment impulse during gait in healthy adults and patients with hip osteoarthritis.

METHODS

Four databases (Scopus, ScienceDirect, PubMed, and PEDro) were searched up to August 2017 to identify studies that examined hip moment impulse during gait. Data extracted for analysis included the sample size, age, height, body mass, type of intervention, and main findings.

RESULTS

After screening, 10 of the 975 studies identified were included in our analysis. Several factors, including a rocker bottom shoe, FitFlop™ sandals, ankle push-off, posture, stride length, body-weight unloading, a rollator, walking poles, and a knee brace, were reviewed. The main findings were as follows: increasing ankle push-off decreased both the hip flexion and extension moment impulses; body-weight unloading decreased both the hip extension and adduction moment impulses; the FitFlop™ sandal increased the sum of the hip flexion and extension moment impulses; long strides increased the hip extension moment impulse; and the use of a knee brace increased hip flexion moment impulse. Of note, none of the eligible studies included patients with hip osteoarthritis.

SIGNIFICANCE

The hip moment impulses can be modified by person-specific factors (ankle push-off and long strides) and external factors (body-weight unloading and use of the FitFlop™ sandals and a knee brace). Effects on the progression of hip osteoarthritis remain to be evaluated.

Effects of unstable footwear on gait characteristic: A systematic review

BACKGROUND

Over the last three decades, several designs of unstable footwear have been developed in the forms of shoes, sandals and boots. There are marketing claims related to the positive effects of these shoes on the training of lower limb muscles and improving gait. Many studies have been performed on the effects of unstable footwear on muscle activity, balance, posture, energy expenditure, lower extremity disorders, and biomechanical changes. The analysis of the kinetics and kinematics characteristics of gait would provide objective representation of body movement.

OBJECTIVE

To systematically review available evidence on the use of unstable footwear on kinetic and kinematic parameters to make specific recommendation for practice and future studies.

METHOD

A computer-based search was undertaken through PubMed, Cochrane Library, Embase, PEDro, Web of Science and Google Scholar from 2005 to 2015. The included studies were appraised using McMaster Critical Review Form for Quantitative Studies.

RESULT

Ten studies (quasi-experimental design) were included.

CONCLUSION

Considering kinetic and kinematic interaction of variables in the included studies revealed that confounding factors may have high impact on biomechanical findings of unstable footwear. Then, more homogeneous studies, considering these factors, should be implemented in future studies to inform the best clinical practice.