Effect of foot posture and inverted foot orthoses on hallux dorsiflexion

The effect of varus rearfoot wedges on hallux dorsiflexion resistance

BACKGROUND

The first metatarsophalangeal joint (MTPJ), which includes the first metatarsal and proximal phalanx, plays a crucial role in gait and impacts the windlass mechanism. Disruptions to this mechanism are implicated in various foot pathologies. Jack's Test serves as a valuable tool for clinicians to assess the functionality of the MTPJ. Varus rearfoot wedges (VRFWs) are a common treatment employed in the management of lower limb pathologies. The impact of VRFWs on the resistance of the first MTPJ during Jack´s Test is currently unknown. This study aimed to measure the influence of VRFWs on the resistance of the first MTPJ during Jack´s Test. The secondary objective was to validate a new measurement method using a digital force gauge.

METHODS

Thirty participants (17 women and 13 men) were enrolled. A digital force gauge measured the weight-bearing force needed for Jack's Test, thereby evaluating the effects of VRFWs of different angulations. The Kolmogorov-Smirnov test confirmed that the data followed a normal distribution (p > 0.05). The nonparametric Friedman test (p < 0.001) showed that there were significant differences among all VRFWs, while the Wilcoxon test (p < 0.001) showed that there were differences between barefoot conditions and 3°, 5°, and 8° VRFWs.

RESULTS

The use of 8° VRFWs yielded a statistically significant reduction in the passive dorsiflexion force of hallux during Jack's Test (12.51 N ± 4.12, p < 0.001).

CONCLUSIONS

The use of VRFWs has been observed to reduce dorsiflexion resistance in the proximal phalanx of the first MTPJ during Jack's Test. Additionally, the digital force gauge was proven to be a valid tool for conducting Jack's Test, thus offering a reliable measurement method.

Effect of Different Foot Orthosis Inverted Angles on Walking Kinematics in Females with Flexible Flatfeet

Background

Although the inverted technique was shown to be more effective compared to other orthotic designs for the treatment of flatfeet, the biomechanical mechanisms underlying the therapeutic effect of the inverted angle orthoses is still unclear. Therefore, the aim of this study was to examine the effect of different inverted angles of foot orthoses on walking kinematics in females with flexible flatfeet.

Methods

Thirty-one female adults with flexible flatfeet aged 18-35 years old participated in this study. Kinematic data of the hip, knee, and ankle were collected via BTS motion-capture system during walking under three test conditions in random order: with shoes only; with 15° inverted orthoses; and with 25° inverted orthoses.

Results

Compared to the shoes only condition, both the 15° and 25° inverted orthotic conditions significantly decreased the maximum ankle plantarflexion angle during loading response, maximum ankle dorsiflexion angle during mid-stance, maximum ankle external rotation angle, and maximum ankle internal rotation angle. The maximum ankle plantarflexion angle at toe-off showed a significant decrease with the 25° inverted angle orthosis compared to both the 15° inverted angle and shoes only conditions. No significant differences were found in the knee kinematic variables, maximum hip extension angle, and maximum hip adduction angle between test conditions.

Conclusion

Using inverted orthoses at 15° and 25° inverted angles resulted in significant changes in ankle joint kinematics during walking in female adults with flexible flatfeet. A 25° inverted angle orthosis significantly decreased ankle plantarflexion during push-off, potentially impacting gait mechanics. This suggests that a smaller inverted angle may be more effective for managing flexible flatfeet in female adults.

A comparison of the hallux valgus angle, range of motion, and patient satisfaction after use of dynamic and static orthoses

BACKGROUND

Conservative treatment is recommended for mild and moderate hallux valgus. The treatment may include two different types of orthoses: a dynamic orthosis and a static orthosis. The aim of this study was to compare the hallux valgus angle, hallux valgus range of motion, and patient satisfaction after the use of a dynamic and a static orthosis for the treatment of hallux valgus.

METHODS

Twenty-four participants contributed to this cross-over study. Participants were randomly allocated to orthotic treatments at the start. The hallux valgus angle and range of motion were measured using a goniometer. Pain, signs and symptoms, function in activities of daily living (ADL), function in sport and recreation, and foot and ankle-related quality of life (QOL) were measured using the Foot and Ankle Outcome Score (FAOS) questionnaire. The participants then switched to using the other orthosis. A one-way repeated measure ANOVA was conducted to compare the measured variables in subjects at 4 conditions before and after of using each orthosis.

RESULTS

There was a significant difference in the hallux valgus angle (p=0.001). The Bonferroni test indicated that both static and dynamic orthoses significantly decrease the angle of hallux valgus, respectively before static, after static (mean difference=-2.67, p=0.001) and before dynamic, after dynamic conditions (mean difference=-2.13, p=0.02). There was also a significant difference in subjects range of motion by using a dynamic orthosis in before dynamic, after dynamic conditions (mean difference=9.77, p=0.01). There was no significant difference in total FAOS score within the conditions (p=0.067).

CONCLUSION

The use of both static and dynamic orthoses for 1 month can reduce the hallux valgus angle up to 2-3°. To achieve better results, it is suggested to wear orthoses for longer time. The dynamic orthosis also increases the passive range of motion of the first metatarsophalangeal joint and it seems to be effective during walking.

Falls rate increase and foot dorsal flexion limitations are exhibited in patients who suffer from asthma: A novel case-control study

Purpose: Based on the possible association between reduced foot dorsiflexion and high risk of falls, the main objective was to determine the ankle and 1º metatarsophalangeal joint (1^stMTTP) dorsiflexion range of motion and falls rate in patients with asthma compared to healthy matched-paired controls. Methods: A case-control study was carried out. Eighty participants were recruited and divided into patients with asthma (case group; n=40) and matched-paired healthy participants (control group; n=40). Foot dorsal flexion range of motion (assessed by the Weight-Bearing Lunge Test [WBLT]) and falls rate (evaluated as falls number during the prior year) were considered as the primary outcomes. Indeed, ankle dorsiflexion was measured by a mobile app (º) and a tape measure (cm) as well as 1^stMTTP dorsiflexion was determined by and universal goniometer (º). Results: Statistically significant differences (P<.05) showed that patients with asthma presented a greater falls rate than healthy participants and reduced bilateral ankle and 1^stMTTP dorsiflexion ranges of motion than healthy participants, except for the left ankle dorsiflexion measured as degrees (P>.05). Conclusions: These study findings showed that a falls rate increase and bilateral foot dorsal flexion limitations of the ankle and 1^stMTTP joints are exhibited in patients who suffer from asthma.

Challenging the foundations of the clinical model of foot function: further evidence that the root model assessments fail to appropriately classify foot function

BACKGROUND

The Root model of normal and abnormal foot function remains the basis for clinical foot orthotic practice globally. Our aim was to investigate the relationship between foot deformities and kinematic compensations that are the foundations of the model.

METHODS

A convenience sample of 140 were screened and 100 symptom free participants aged 18-45 years were invited to participate. The static biomechanical assessment described by the Root model was used to identify five foot deformities. A 6 segment foot model was used to measure foot kinematics during gait. Statistical tests compared foot kinematics between feet with and without foot deformities and correlated the degree of deformity with any compensatory motions.

RESULTS

None of the deformities proposed by the Root model were associated with distinct differences in foot kinematics during gait when compared to those without deformities or each other. Static and dynamic parameters were not correlated.

CONCLUSIONS

Taken as part of a wider body of evidence, the results of this study have profound implications for clinical foot health practice. We believe that the assessment protocol advocated by the Root model is no longer a suitable basis for professional practice. We recommend that clinicians stop using sub-talar neutral position during clinical assessments and stop assessing the non-weight bearing range of ankle dorsiflexion, first ray position and forefoot alignments and movement as a means of defining the associated foot deformities. The results question the relevance of the Root assessments in the prescription of foot orthoses.

Effect by custom-made foot orthoses with added support under the first metatarso-phalangeal joint in hallux limitus patients: Improving on first metatarso-phalangeal joint extension

BACKGROUND

Hallux limitus is one of the most common disorders affecting foot biomechanics. Custom-made foot orthoses can improve the function of the first metatarso-phalangeal joint.

OBJECTIVES

The objective underlying this study was to test whether custom-made foot orthoses increased the range of mobility of metatarso-phalangeal joint in patients with hallux limitus.

STUDY DESIGN

Randomized, double-blinded, and clinical trial.

METHODS

The study consisted of 20 participants (40 feet) diagnosed with hallux limitus. A control group and an experimental group both wore the same custom-made foot orthoses and, in the experimental group, a support element under the first metatarso-phalangeal joint was added to the orthoses. Two measurements were made with both groups: the relaxed position of the first metatarso-phalangeal joint and the maximum extension of the hallux. These measurements were made before first placing the foot orthoses and 6 months after application of the treatment.

RESULTS

In the experimental group, the results showed an improvement of 4.5° in the relaxed position and 22.2° in the maximum extension being statistically significant (p < 0.001) for both measurements.

CONCLUSION

Custom-made foot orthoses with added support under the first metatarso-phalangeal joint were proved to be an effective treatment to restore functionality of this joint in hallux limitus patients.

CLINICAL RELEVANCE

Limitation of hallux movement in the joints propulsive phase of gait negatively affects the biomechanics of the lower extremity, causing changes in the rest of the joins. The use of foot orthoses designed in this study restores range of motion of the first metatarso-phalangeal joint.

Severity of pronation and classification of first metatarsophalangeal joint dorsiflexion increases the validity of the Hubscher Manoeuvre for the diagnosis of functional hallux limitus

BACKGROUND

Functional hallux limitus (FHL) is diagnosed with a static test known as the Hubscher Manoeuvre, the validity of which has been previously questioned.

OBJECTIVES

To investigate the validity of this Manoeuvre and whether introducing severity of pronation as a second concurrent test would increase this validity.

METHOD

30 participants with a hallux dorsiflexion <12° were divided into 2 equal groups, depending on their severity of pronation according to the Foot Posture Index. A single video camera, placed perpendicular to the plane of motion of the 1st MPJ, captured its movement, from which the angle of maximum dorsiflexion of this joint was measured.

RESULTS

10 males and 20 females, aged 18-56 years (mean 28 yrs, SD ± 12.1 yrs) participated. There was no significant relationship between non-weight bearing and dynamic maximum dorsiflexion (p=0.160), and between weight bearing and dynamic maximum dorsiflexion (p=0.865). A significant relationship between 1st MPJ dynamic maximum dorsiflexion and severity of pronation (p=0.004) was found.

CONCLUSIONS

None of the participants exhibited a complete lack of hallux dorsiflexion. A positive Hubscher Manoeuvre test, on its own, is not a good indicator of limited 1st MPJ dorsiflexion during dynamic motion. However, as pronation increases, 1st MPJ maximum dorsiflexion during gait decreases.

How effective is orthotic treatment in patients with recurrent diabetic foot ulcers?

BACKGROUND

We assessed the efficacy of customized foot orthotic therapy by comparing reulceration rates, minor amputation rates, and work and daily living activities before and after therapy. Peak plantar pressures and peak plantar impulses were compared with the patients not wearing and wearing their prescribed footwear.

METHODS

One hundred seventeen patients with diabetes were prescribed therapeutic insoles and footwear based on the results of a detailed biomechanical study and were followed for 2 years. All of the patients had a history of foot ulcers, but none had undergone previous orthotic therapy.

RESULTS

Before treatment, the reulceration rate was 79% and the amputation rate was 54%. Two years after the start of orthotic therapy, the reulceration rate was 15% and the amputation rate was 6%. Orthotic therapy reduced peak plantar pressures in patients with reulcerations and in those without (P < .05), although a significant decrease in peak plantar impulses was achieved only in patients not experiencing reulceration. Sick leave was reduced from 100% to 26%.

CONCLUSIONS

Personalized orthotic therapy targeted at reducing plantar pressures by off-loading protects high-risk patients against reulceration. Treatment reduced the reulceration rate and peak plantar pressures, leading to patients' return to work or other activities.

Rocker-sole footwear versus prefabricated foot orthoses for the treatment of pain associated with first metatarsophalangeal joint osteoarthritis: study protocol for a randomised trial

BACKGROUND

Osteoarthritis affecting the first metatarsophalangeal joint of the foot is a common condition which results in pain, stiffness and impaired ambulation. Footwear modifications and foot orthoses are widely used in clinical practice to treat this condition, but their effectiveness has not been rigorously evaluated. This article describes the design of a randomised trial comparing the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with first metatarsophalangeal joint osteoarthritis.

METHODS

Eighty people with first metatarsophalangeal joint osteoarthritis will be randomly allocated to receive either a pair of rocker-sole shoes (MBT® Matwa, Masai Barefoot Technology, Switzerland) or a pair of individualised, prefabricated foot orthoses (Vasyli Customs, Vasyli Medical™, Queensland, Australia). At baseline, the biomechanical effects of the interventions will be examined using a wireless wearable sensor motion analysis system (LEGSys™, BioSensics, Boston, MA, USA) and an in-shoe plantar pressure system (Pedar®, Novel GmbH, Munich, Germany). The primary outcome measure will be the pain subscale of the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8 and 12 weeks. Secondary outcome measures will include the function, footwear and general foot health subscales of the FHSQ, severity of pain and stiffness at the first metatarsophalangeal joint (measured using 100 mm visual analog scales), global change in symptoms (using a 15-point Likert scale), health status (using the Short-Form-12® Version 2.0 questionnaire), use of rescue medication and co-interventions to relieve pain, the frequency and type of self-reported adverse events and physical activity levels (using the Incidental and Planned Activity Questionnaire). Data will be analysed using the intention to treat principle.

DISCUSSION

This study is the first randomised trial to compare the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with osteoarthritis of the first metatarsophalangeal joint, and only the third randomised trial ever conducted for this condition. The study has been pragmatically designed to ensure that the findings can be implemented into clinical practice if the interventions are found to be effective, and the baseline biomechanical analysis will provide useful insights into their mechanism of action.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12613001245785.

The effects of ankle mobilization and active stretching on the difference of weight-bearing distribution, low back pain and flexibility in pronated-foots subjects

The purpose of this study was designed to analyze the effects mobilization and active stretching on the difference of weight-bearing distribution, low back pain, and flexibility in pronated-foot subjects. The subjects of this study were 16 chronic low back pain patients. They were randomly divided into the control and experimental group. The experimental group had used the model of ankle mobilization and calf muscle active stretching three times per week, for 4 weeks. The control group did same method without an ankle mobilization. The range of flexion and extension motion of the lumbar vertebrae and low back pain degree and difference of weight-bearing were measured before and after the experiment. The model of ankle mobilization and calf muscle stretching of pronated-foot significantly improved the range of flexion and extension motion of the vertebrae. And the visual analogue scale and distribution of weight-bearing were decreased in both of two groups. In other word, the exercise of this study showed that the model of ankle mobilization and calf muscle stretching of pronated-foot had positive effects on improving the range of flexion and extension motion of the vertebrae. The calf muscle stretching was easy and it is effective in therapy that patients by themselves and helped to recover the balance of the vertebrae to combine ankle mobilization and muscle stretching.

A case-series study to explore the efficacy of foot orthoses in treating first metatarsophalangeal joint pain

Background

First metatarsophalangeal (MTP) joint pain is a common foot complaint which is often considered to be a consequence of altered mechanics. Foot orthoses are often prescribed to reduce 1^st MTP joint pain with the aim of altering dorsiflexion at propulsion. This study explores changes in 1^st MTP joint pain and kinematics following the use of foot orthoses.

Methods

The effect of modified, pre-fabricated foot orthoses (X-line^®) were evaluated in thirty-two patients with 1^st MTP joint pain of mechanical origin. The primary outcome was pain measured at baseline and 24 weeks using the pain subscale of the foot function index (FFI). In a small sub-group of patients (n = 9), the relationship between pain and kinematic variables was explored with and without their orthoses, using an electromagnetic motion tracking (EMT) system.

Results

A significant reduction in pain was observed between baseline (median = 48 mm) and the 24 week endpoint (median = 14.50 mm, z = -4.88, p < 0.001). In the sub-group analysis, we found no relationship between pain reduction and 1^st MTP joint motion, and no significant differences were found between the 1^st MTP joint maximum dorsiflexion or ankle/subtalar complex maximum eversion, with and without the orthoses.

Conclusions

This observational study demonstrated a significant decrease in 1^st MTP joint pain associated with the use of foot orthoses. Change in pain was not shown to be associated with 1^st MTP joint dorsiflexion nor with altered ankle/subtalar complex eversion. Further research into the effect of foot orthoses on foot function is indicated.