Effects of morphological and mechanical properties of plantar fascia and heel pad on balance performance in asymptomatic females

Effects of neural mobilization of sciatic nerve and its branches in plantar foot pressures and stabilometry

Benefits of neural mobilization (NM) have been described in musculoskeletal patients. The effects of NM on balance appear to be unclear in research, and no studies have tested the possible effects of NM on plantar pressures. Eighteen subjects were evaluated pre and post bilateral gliding of the sciatic nerve and its branches posterior tibial nerve, lateral dorsocutaneous, medial and intermediate dorsocutaneous nerves. Static variables of the plantar footprint and stabilometric variables were measured in a pre-post study. We found no differences in plantar pressure variables, Rearfoot maximum pressure (p = 0.376), Rearfoot medium pressure (p = 0.106), Rearfoot surface (p = 0.896), Midfoot maximum pressure (p = 0.975), Midfoot medium pressure (p = 0.950), Midfoot surface (p = 0.470) Forefoot maximum pressure (p = 0.559), Forefoot medium pressure(p = 0.481), Forefoot surface (p = 0.234), and stabilometric variables either, X-Displacement eyes-open (p = 0.086), Y-Displacement eyes-open (p = 0.544), Surface eyes-open (p = 0.411), Medium speed latero-lateral displacement eyes-open (p = 0.613), Medium speed anteroposterior displacement eyes-open (p = 0.442), X Displacement eyes-closed (p = 0.126), Y-Displacement eyes-closed (p = 0.077), Surface eyes-closed (p = 0.502), Medium speed latero-lateral displacement eyes-closed (p = 0.956), Medium speed anteroposterior displacement eyes-closed (p = 0.349). All variables don´t have significant differences however the measurements had a high reliability with at least an ICC of 0.769. NM doesn´t change plantar pressures or improve balance in healthy non-athletes subjects. NCT05190900.

Plantar fascia stiffness in patients with type 2 diabetes mellitus: Stiffness effect on fall risk and gait speed

AIMS

The primary objective was to compare patients with type 2 diabetes mellitus (T2DM) and healthy peers in terms of plantar fascia (PF) stiffness, fall risk, and gait speed. The second objective was to examine the relationship between stiffness of PF and fall risk, gait speed.

METHODS

Fifty patients diagnosed with T2DM (mean duration = 10.74 ± 7.07 years) were included. Myotonometer was used to evaluate the stiffness of PF. To assess the risk of falling, and gait speed, the International Fall Efficiency Scale (FES-I) and the 4-Meter Gait Speed Test (4mGST) were used, respectively.

RESULTS

Compared to healthy controls, PF stiffness (right foot mean difference = 148.99 N/m, left foot mean difference = 113.13 N/m p < .001) was higher in the T2DM group. The FES-I and 4mGST scores were worse in the group with T2DM (p < .05). 12.8 % of FES-I and 23.4 % of 4mGST variance were explained by stiffness of PF.

CONCLUSIONS

The results of the study showed that the stiffness of PF changed in patients with T2DM. There was a decrease in gait speed and an increase in the risk of falling as PF stiffness increased.

Association of the intrinsic foot muscles and plantar fascia with repetitive rebound jumping and jump landing in adolescent athletes: An ultrasound-based study

BACKGROUND

The characteristics of foot structure in adolescents and adults are different, affecting sports performance and leading to the progression of foot and lower extremity disorders.

RESEARCH QUESTION

This study aimed to investigate the relationship between the intrinsic foot muscles (IFM) and plantar fascia morphology and the repetitive rebound jumping and jump landing ability in adolescent athletes.

METHODS

A total of 60 adolescent athletes (35 boys and 25 girls) participated in this study. B-mode ultrasonography was used to obtain images of the IFM and plantar fascia morphology [thickness and cross-sectional area (CSA) of the abductor hallucis (AbH), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), and thickness of the plantar fascia]. The repetitive rebound jump performance was evaluated using the Optojump™ system. Participants were instructed to jump five times continuously with one leg, jumping as high as possible with minimal ground contact time. The jump landing was assessed by measuring the dynamic posture stability index (DPSI) using forward one-legged jump landings.

RESULTS

The thickness and CSA of the AbH and FDB were positively correlated with the jump height and reactive jump index. The DPSI score was significantly correlated with the thickness of the AbH, but not with other IFMs or plantar fascia. In the multiple regression analysis, only the thickness of the FDB was associated with the jump height and reactive jump index, indicating that FDB thickness might facilitate adolescent athletes to jump higher with minimal contact time in repetitive rebounding movements.

SIGNIFICANCE

The IFM (especially FDB) should be focused on when examining sports performance in adolescent athletes.

Elasticity evaluation of the plantar fascia: A shear wave elastography study involving 33 early-stage plantar fasciopathy subjects

Background: Plantar fasciopathy, the most common foot condition seen in elderly and athletic populations, can be diagnosed and differentially diagnosed with imaging modalities such as ultrasound shear wave elastography (SWE). However, standard guidelines for ultrasound elastography of the plantar fascia are lacking. The purpose of this study was to determine the impact of the region of interest (ROI) on the evaluation of the plantar fascia elasticity and confirm the screening accuracy of SWE in the early-stage of plantar fasciopathy. Methods: This was an observational case‒control study involving 50 feet of 33 early-stage plantar fasciopathy subjects (the plantar fasciopathy group) and 96 asymptomatic feet of 48 healthy volunteers (the non-pain group). Clinical information, including age, gender, height, weight, visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Scale score (AOFAS), and the symptom duration, were recorded. All participants underwent both conventional ultrasound and SWE evaluation. The plantar fascia elastic parameters included SWE_single-point, calculated with a single-point ROI set at the greatest thickness of the plantar fascia, and SWE_multi-point, calculated by multipoint ROIs set continuously from the origin at the calcaneus to about 2 cm from the calcaneal origin. Results: The plantar fasciopathy group presented a higher VAS score (median [IQR), 4.00 (3.00) vs. 0.00 (0.00), p < 0.001] and lower AOFAS score [median (IQR), 79.50 (3.00) vs. 100.00 (10.00), p < 0.001] than the non-pain group. The median plantar fascia thickness of the plantar fasciopathy group was significantly greater than that of the non-pain group [median (IQR), 3.95 (1.37) mm vs 2.40 (0.60) mm, p < 0.001]. Abnormal ultrasound features, including echogenicity, border irregularities, and blood flow signals, were more prominent in the plantar fasciopathy group than in the non-pain group (29% vs. 0%, p < 0.001; 26% vs. 1%, p < 0.001; 12% vs. 0%, p < 0.001, respectively). Quantitative analysis of the plantar fascia elasticity revealed that the difference between the value of SWE_single-point and SWE_multipoint was significant [median (IQR), 65.76 (58.58) vs. 57.42 (35.52) kPa, p = 0.02). There was a moderate and significant correlation between the value of SWE_single-point and heel pain. However, there was no correlation between the value of SWE_multipoint and heel pain. Finally, we utilized the results of SWE_single-point as the best elastic parameter reflecting clinical heel pain and found that SWE_single-point could provide additional value in screening early-stage plantar fasciopathy, with an increase in sensitivity from 76% to 92% over conventional ultrasound alone. Additionally, compared with conventional ultrasound and SWE, the use of both improved the accuracy of screening for plantar fasciopathy. Although there were no significant differences in the negative predictive value of conventional ultrasound, SWE, and their combination, the positive predictive value when using both (90.20%) was significantly greater than that when using conventional ultrasound (74.50%) or SWE alone (76.50%). Conclusion: The plantar fascia elastic parameter calculated with single-point ROIs set at the greatest thickness of the plantar fascia is positively correlated with fascia feel pain. Single-point analysis is sufficient for the screening of the early-stage plantar fasciopathy using SWE. SWE_single-point may provide additional valuable information for assessing the severity of plantar fasciopathy.

Biomechanical Effects of Plastic Heel Cup on Plantar Fasciitis Patients Evaluated by Ultrasound Shear Wave Elastography

The plastic heel cup has been adopted to treat plantar heel problems for years. However, its mechanisms and biomechanical effects are yet to be fully understood. The purpose of this study was to investigate the effects of the plastic heel cup on the microchamber and macrochamber layers of the heel pad by comparing the stiffness (in terms of the shear wave speed) and thickness of these two layers with and without a plastic heel cup during static standing. Fifteen patients with unilateral plantar fasciitis were recruited. The shear wave speed and thickness of the microchamber and microchamber layers of each symptomatic heel pad during standing measured by ultrasound shear wave elastography were compared between conditions with and without a plastic heel cup. It was found that a plastic heel cup reduced the shear wave speed of the microchamber layer to 55.5% and increased its thickness to 137.5% compared with the condition without a plastic heel cup. For the microchamber layer, the shear wave speed was reduced to 89.7%, and thickness was increased to 113.6% compared with the condition without a plastic heel cup. The findings demonstrate that a plastic heel cup can help to reduce the stiffness and increase the thickness for both layers of the heel pad during standing, suggesting that the mechanism of a plastic heel cup, and its resulting biomechanical effect, is to reduce the internal stress of the heel pad by increasing its thickness through confinement.

Temporomandibular dysfunction affects aerobic capacity in females: A preliminary study

Objective: The purpose of this study was to investigate the aerobic capacity in patients with temporomandibular dysfunction (TMD) and to compare the results with those of the asymptomatic individuals.Methods: The TMD group included a total of 31 females between the ages of 18 and 25 years. The control group consisted of 31 asymptomatic females with an age range of 18 to 27 years. A graded exercise test was performed using an electronically braked arm crank ergometer. An indirect calorimeter system was used to calculate the peak oxygen consumption (VO₂peak). In addition, peak heart rate (HR_peak) and respiratory quotient were calculated for each participant.Results: The TMD group had lower VO₂peak (p = 0.017) and HRpeak (p = 0.012) in aerobic capacity tests; however, respiratory quotient was similar in both groups (p = 0.446).Discussion: The TMD group had lower aerobic capacity compared to the asymptomatic individuals.

Acute effects of myofascial induction technique in plantar fascia complex in patients with myofascial pain syndrome on postural sway and plantar pressures: A quasi-experimental study

OBJECTIVES

The prevalence of myofascial pain syndrome varies from 21% 93%. Several studies have shown that myofascial induction is effective in treating myofascial pain syndrome. Although these techniques have shown some effectiveness in clinical practice, there have been little study into their effects, and have deep effects. The purpose of this study was to investigate if the application of a single myofascial induction technique for each foot, targeted to the plantar fascia resulted in changes in balance and footprint variables.

DESIGN

A quasi-experimental study.

SETTING

An outpatient clinic.

SUBJECTS

20 healthy participants (12 females and 8 males) were evaluated pre and post Myofascial induction technique for each foot in plantar fascia during 5 min.

METHODS

We measured static footprint and stabilometry variables in asymptomatic subjects. The footprint surface area was divided: bilateral rear foot, bilateral midfoot, bilateral fore foot.

RESULTS

We found differences in the footprint variables: maximun pressure in forefoot (p = 0.025), surface in forefoot (p = 0.03). The myofascial induction has no effects on stabilometry variables.

CONCLUSIONS

The immediate effects of the longitudinal technique of myofascial induction of the plantar fascia are the increase of surface and maximum pressure in fore foot.

An investigation of the sex-related differences in the stiffness of the Achilles tendon and gastrocnemius muscle: Inter-observer reliability and inter-day repeatability and the effect of ankle joint motion

PURPOSE

The purpose of the present study was to investigate sex-related differences in the stiffness of the Achilles tendon and gastrocnemius muscle at rest and tensioned state. Another purpose of the study was to investigate the inter-observer reliability and inter-day repeatability of MyotonPRO, a portable myotonometer, in measuring tendon and muscle stiffness.

METHODS

The study included 73 healthy participants (19 males for the reliability and repeatability study; 24 males and 30 females for the experimental study) with an age range of 19-27 years. The stiffness of the Achilles tendon and medial gastrocnemius muscle was measured with a portable myotonometer (MyotonPRO). The stiffness measurements of the Achilles tendon and medial gastrocnemius muscle were performed at 0° and 10° of ankle joint dorsiflexion. The stiffness measurements were performed by two physiotherapists to determine the inter-observer reliability of the device. For the inter-day repeatability (or between-day precision), the same individuals were reassessed by the same examiner after a 3-day interval.

RESULTS

It was found that MyotonPRO has excellent inter-observer reliability and inter-day repeatability in measuring the stiffness of the Achilles tendon and medial gastrocnemius muscle (ICC=0.83-0.98). The stiffness of the Achilles tendon and gastrocnemius muscle at neutral and 10° joint dorsiflexion was higher in males compared to females (p<0.05); however, the stiffness value of difference between neutral and 10° joint dorsiflexion for the Achilles tendon and gastrocnemius muscle was similar in both groups (p>0.05).

DISCUSSION

The obtained results suggest that MyotonPRO is a reliable and repeatable device in measuring the stiffness of the Achilles tendon and gastrocnemius muscle. Furthermore, males have stiffer Achilles tendon and gastrocnemius muscle, compared to females; however, the change in the stiffness of the assessed tissues caused by joint motion was similar in both sexes.

Thickness, cross-sectional area, and stiffness of intrinsic foot muscles affect performance in single-leg stance balance tests in healthy sedentary young females

The purpose of this study was to investigate the effect of thickness, cross-sectional area and stiffness of intrinsic foot muscles on performance in single-leg stance balance tasks in healthy sedentary young females. This study included a total of 40 healthy sedentary young females between the ages of 19 and 35 years. Single-leg stance balance assessments were carried out using Biodex Balance Systems (Biodex Medical Systems, Shirley, NY, USA). Performance in the single-leg stance balance tests was assessed using the overall stability index (OSI), mediolateral stability index (MLSI) and the anteroposterior stability index (APSI). Lower scores indicated better postural stability. Stiffness, thickness and cross-sectional area measurements of the abductor hallucis (AbH), flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB) muscles were performed using an ultrasonography device. Larger AbH and FHB muscles were correlated with higher OSI, APSI, and MLSI (r = 0.31-0.46, p < 0.05), whereas larger FDB muscle was correlated with higher OSI and MLSI (r = 0.28-0.38, p < 0.05). Higher stiffness of the AbH and FHB muscles were correlated with lower OSI, APSI, and MLSI (r = -0.32 to 0.58, p < 0.05), but stiffness of the FDB muscle was not significantly correlated with OSI, APSI, and MLSI (r = 0.03-0.22, p ˃ 0.05). These results suggest that larger AbH, FDB and FHB muscles are related to reduced performance in single-leg stance balance tests, whereas higher AbH and FHB stiffness are related to better performance in single-leg stance balance tests in healthy sedentary young females.