Long-term use of minimal footwear in older adult women with knee osteoarthritis: Mechanisms of action in the knee adduction moment

Minimalist Footwear in the Treatment and Rehabilitation of Lower Limb Impairments Across the Life Course: A Scoping Review

BACKGROUND

Minimalist footwear has emerged as an alternative to traditional footwear styles and advocated for the management of several foot and lower limb pathologies.

OBJECTIVE

The objective of this scoping review was to map the clinical potential of minimalist footwear (concept) in the treatment and/or rehabilitation of lower limb impairments (context) across the life course (population).

DATA SOURCES

Systematic searches were undertaken across MEDLINE, EMBASE, and CINAHL from 2000 to 2024.

STUDY SELECTION OR ELIGIBILITY CRITERIA

Studies evaluating minimalist footwear as an intervention or adjunct to an intervention in clinical populations, or where a clinical need has been defined, across all age groups, were included. Eligible studies were primary research published in English from the year 2000 onwards.

DATA SYNTHESIS

A narrative analysis was undertaken and our findings were reported in accordance with the PRISMA-ScR guidelines.

RESULTS

Sixteen studies were identified in clinical populations ranging from adolescents with patello-femoral pain (14.3; SD: 1.7 years) to older adults with balance ability (73.4; SD: 3.9 years); studies focussing on knee pathology were the most common (n = 9). The influence of minimalist footwear on outcome measures varied across the studies and reported mechanisms of action included somatosensory, biomechanical and neuromuscular factors.

CONCLUSION AND IMPLICATIONS

Our review has mapped the clinical populations where minimalist footwear has been tested and most focus on knee pathology, specifically knee osteoarthritis. Our review has identified the biomechanical, functional, and clinical variables reported in studies and future work testing the clinical benefits of minimalist footwear interventions is recommended.

Effects of a foot-ankle muscle strengthening program on pain and function in individuals with knee osteoarthritis: a randomized controlled trial

BACKGROUND

Foot-ankle exercises could improve pain and function of individuals with KOA and need to be tested.

OBJECTIVE

To investigate whether an 8-week foot-ankle muscle strengthening program is effective for individuals with KOA to reduce pain and improve function.

METHODS

In this randomized controlled trial, individuals diagnosed with clinical and radiographic KOA were randomized into the intervention (supervised foot-ankle strengthening exercise program three times a week for 8 weeks) or control (usual care and recommendations of the healthcare team) group. Effectiveness was assessed by changes in clinical and functional outcomes between baseline and 8 weeks with pain as the primary outcome. ANCOVA tests using the intervention group as a reference and sex, body mass index, and baseline values as covariates assessed between-group differences.

RESULTS

The intervention group showed lower pain scores (-4.4 units; 95%CI = -7.5, -1.1), better function (-7.1 units; 95%CI = -12.7, -1.4), higher total functional score (-11.9 units; 95%CI = -20.7, -3.1), with confidence intervals indicating a potential for the differences to be clinically meaningful, and better scores for the 30-s chair stand test (2.7 repetitions; 95%CI = 1.1, 4.1), with a confidence interval indicating a moderate clinically meaningful difference, compared to the controls.

CONCLUSION

The 8-week foot-ankle exercise program showed positive, and potentially clinically meaningful, effects on knee pain and physical function among individuals with KOA, when compared to usual care.

TRIAL REGISTRATION

NCT04154059. https://clinicaltrials.gov/ct2/show/NCT04154059.

Impact of biomechanics on therapeutic interventions and rehabilitation for major chronic musculoskeletal conditions: A 50-year perspective

The pivotal role of biomechanics in the past 50 years in consolidating the basic knowledge that underpins prevention and rehabilitation measures has made this area a great spotlight for health practitioners. In clinical practice, biomechanics analysis of spatiotemporal, kinematic, kinetic, and electromyographic data in various chronic conditions serves to directly enhance deeper understanding of locomotion and the consequences of musculoskeletal dysfunctions in terms of motion and motor control. It also serves to propose straightforward and tailored interventions. The importance of this approach is supported by myriad biomechanical outcomes in clinical trials and by the development of new interventions clearly grounded on biomechanical principles. Over the past five decades, therapeutic interventions have been transformed from fundamentally passive in essence, such as orthoses and footwear, to emphasizing active prevention, including exercise approaches, such as bottom-up and top-down strengthening programs for runners and people with osteoarthritis. These approaches may be far more effective inreducing pain, dysfunction, and, ideally, incidence if they are based on the biomechanical status of the affected person. In this review, we demonstrate evidence of the impact of biomechanics and motion analysis as a foundation for physical therapy/rehabilitation and preventive strategies for three chronic conditions of high worldwide prevalence: diabetes and peripheral neuropathy, knee osteoarthritis, and running-related injuries. We conclude with a summary of recommendations for future studies needed to address current research gaps.

Cushioned Footwear Effect on Pain and Gait Characteristics of Individuals with Knee Osteoarthritis: A Double-Blinded 3 Month Intervention Study

One of the recommendations for individuals with knee osteoarthritis (OA) is the use of specific footwear, such as sturdy or cushioned shoes. However, the long-term use effects of using cushioned shoes on the pain and spatiotemporal gait parameters in individuals with knee OA are yet to be reported. We therefore aimed to compare the efficacy of cushioned sport footwear versus sham shoes on motor functions, pain and gait characteristics of individuals with knee OA who used the shoes for 3 months. In a double-blinded study, we provided 26 individuals with knee OA with cushioned sport shoes and 12 individuals with knee OA with similar sport shoes without cushioning for 3 months. The gait analysis, the timed up and go (TUG) test and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were conducted and the pain levels were measured at the baseline, 1 month, and 3 months after the baseline. We found that the cushioned shoes reduce the amount of pain (based on WOMAC) in the affected knee and increase functionality in the research group, but not in the control group. Gait velocity and cadence were increased in both groups. Gait spatiotemporal parameters and their symmetry were unaffected during the intervention. We conclude that the use of cushioned shoes should be recommended to individuals with knee OA for alleviating pain.

Osteoarthritis year in review 2021: mechanics

Osteoarthritis (OA) has a complex, heterogeneous and only partly understood etiology. There is a definite role of joint cartilage pathomechanics in originating and progressing of the disease. Although it is still not identified precisely enough to design or select targeted treatments, the progress of this year's research demonstrates that this goal became much closer. On multiple scales - tissue, joint and whole body - an increasing number of studies were done, with impressive results. (1) Technology based instrument innovations, especially when combined with machine learning models, have broadened the applicability of biomechanics. (2) Combinations with imaging make biomechanics much more precise & personalized. (3) The combination of Musculoskeletal & Finite Element Models yield valid personalized cartilage loads. (4) Mechanical outcomes are becoming increasingly meaningful to inform and evaluate treatments, including predictive power from biomechanical models. Since most recent advancements in the field of biomechanics in OA are at the level of a proof op principle, future research should not only continue on this successful path of innovation, but also aim to develop clinical workflows that would facilitate including precision biomechanics in large scale studies. Eventually this will yield clinical tools for decision making and a rationale for new therapies in OA.