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Live Updates: iFab; New York; April 2018

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Craig Payne, Apr 11, 2018.

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  1. Craig Payne

    Craig Payne Moderator

    Articles:
    6

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    Posting live from the conference

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  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
  3. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Plantar pressures, footwear adherence and ulcer recurrence in patients with diabetes and a Charcot midfoot deformity
    Sicco Bus

    "The data suggest that while in-shoe midfoot peak pressures are considered to be low and substantially improved from barefoot peak pressure, and while footwear adherence is almost optimal, this does not necessarily protect patients with midfoot Charcot deformity against plantar foot ulcer recurrence. "
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Plantar System and Dysproprioception. Clinical evaluation of participation.
    Janin Marc

    This one was from France and I so desperately wanted to understand it - they had two posters as well, but I could not make much sense of it. I assume it was in the translation, but it doe appear to be a lot of wishful thinking in it --- ie wishing the effects were "sensory"
    Here is the abstract:
     
  5. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    What are the immediate effects of foot orthosis geometry on tibialis posterior EMG activity and foot biomechanics?
    Joanna Reeves

    What was good about this one is that they used five different orthotic designs and looked at emg changes in post tib.
    Conditions:
    i) a flat inlay and
    ii) a standard Salfordinsole®, and
    iii) a Salfordinsole® with a 6 mm increase in arch height,
    iv) an 8 mm increase in medial heel wedging and
    v) both a 6 mm increase in arch height and an 8 mm increase in medial wedging.

    They found differences but with a lot of variability.

    BUT, what was not good about this study was the participants were all "healthy" (ie no indication if they had a foot type that would probably get foot orthotics if they were symptomatic) and no indication if there could be a clinical need for one of the two design features tested (arch support vs wedging) .... next.
     
  6. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Effect of thong style flip-flops and supportive shoes on children’s midfoot joint power during the propulsive phase of walking
    Angus Chard

    This study was based on the complaint that thongs/flip flops weren't good for the feet
    Angus looked at kinematic data barefoot, in the flip flops and supportive shoes and pretty much showed that midfoot dynamic parameters were no different between barefoot and using the flip flops, so no reason to think that they are no good.
     
  7. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Paediatric Flatfeet – Identifying the Boomerangs
    Angela Evans

    Angela used the Boomerang metaphor:
    - she from Australia (and we have boomerangs here)
    - the paediatric flat foot is somewhat shaped like a boomerang
    - and the whole presentation were about identifying the foot needs to come back (ie like a boomerang) and does need treatment vs does not need treatment.

    (I talked to Angela about exploring this further for a PodChatLive and she agreed, so watch this space)
     
    Last edited by a moderator: May 21, 2018
  8. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    BTW, I being selective in what I comment on; not commenting on everything.
     
  9. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Association between Foot Structure and Subsequent Lower-extremity and Ankle Injury in a Young and Active Military Population
    Kenneth L. Cameron

    This was not and West Point - 1090 subjects
    They used arch height index.

    Normal feet were more likely to have an injury. Pes planus and pes cavus feet less likely!!!!
     
  10. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    The effect of a 3-week functional hip strengthening programme on centre of pressure progression during barefoot walking
    Tim Clarke

    Centre of pressure moved laterally in the strengthening group compared to the control group
     
  11. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Accuracy of Self-Reported Foot Strike Pattern and Running Cadence
    Erin M. Miller

    I think we could guess what this study found before hearing about it!! ??

    BUT, it was not as bad as expected from several others:
    77% could correctly describe their foot strike pattern.
    - 30 participants that incorrectly identified their foot strike pattern - 80% of them reported a nonrearfoot strike when they were rearfoot strikers.

    ie runners still pretty poor at identifying their foot strike pattern
     
  12. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    This one interesting:
    Association Between Shoe Selection and Lower Extremity Injuries in United States Military Academy Cadets.
    Gary L. Helton

    1025 army cadets
    shoe torsion stiffness measured.
    followed for 9 weeks

    Those wearing shoes with moderate lateral torsional stiffness - "49% less likely to incur any type of injury and 52% less likely to incur an overuse injury than cadets wearing shoes with minimal lateral torsional stiffness. "
    "Risk of injury was similar among cadets wearing shoes with minimal and extreme lateral torsional stiffness. "
    " The results of this study indicate that a shoe with mild to moderate lateral torsional stiffness and mild to moderate heel height may be most appropriate in efforts to reduce the risk of lower extremity injuries during training in young physically active athletic and military populations. Furthermore, shoes with minimal lateral torsional stiffness and heel height should be discouraged within these populations due to the significantly increased risk of injury"
     
  13. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Effects of Speed, Grade, and Shoe Stiffness on Plantar Fascia Strain During Walking
    Jeff Mettler

    Plantar fascia strain more affected by the MTP joint (r=0.57) than by the rearfoot-forefoot angle (r=-0.25).
     
  14. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Foot Structure, Function, and Flexibility in MS Patients
    Cheryl Fields

    MS people more overpronated than controls.
     
  15. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Static Foot Structure May Predict Midfoot Mechanics
    Mark Olsen

    I wasn't going to comment on this one, but will (similar issue to post #5 above on that disconnect between researchers and clinically useful info)

    Measured static arch height, then subjects landed from height to measure kinetics an kinematics. Found that static foot structure predicted 31-48% of variation of midfoot function during the landing task.

    They also said that pes planus feet more predictive .... BUT if you think about it, why do they have a pes planus - it could be a osseous forefoot varus, could be weak post tib muscles, could be tight calf muscles, could be etc etc ... so would assume that all those different caused of the "pes planus" may have different correlations between static arch height and dynamic function of midfoot .... now that would be more valuable study (hence my comparison to what I said in #5 above)
     
  16. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Identifying variables which may affect an individual’s response to insole design
    Martinez-Santos

    This a big first step in the right direction of making some of this research clinical relevant.....but only looked at designs related to lowering plantar pressures and not other foot orthotic designs....so probably on relevant to diabetic off loading type issues.

    Probably easier if I cut and paste this from the abstract:
    METHODS: National Health Service (NHS) and University ethical approval were obtained and 60 participants (65.9 ± 12.6 years and BMI 29.4 ± 5.2) with diabetes and neuropathy were recruited. They attended two test sessions. On the first session, tissue stiffness at different areas of the foot sole, multi segment foot kinematics, and range of ankle, 1st metatarsophalangeal joint (MPJ) and subtalar joint range of motion were collected (ROM). Also, barefoot plantar pressures and a 3D foot scan were collected and used to design customized insoles. These insoles had a metatarsal bar and a void tailored to the participant’s plantar pressures. Nine insole designs were tested, including variations where the metatarsal bar was moved distally and proximally by 2% of foot length and using soft EVA or Poron as forefoot cushioning in the void. On the second visit, in-shoe plantar pressures were collected while walking with each of the 9 insole designs. Logistic regression tests were performed to investigate the relationship and influence of each foot variable (tissue stiffness, kinematics, ROM) with the changes in PP due to each insole collected at session 2. Accordingly, two sets of logistic regressions were made (1) to investigate the characteristics that may have influenced a PP reduction due to the insole, and (2) to investigate which characteristics may influence a PP increase due to the insole.

    I screen shot the results as pasting did not work:
     

    Attached Files:

  17. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Muscle activation with two types of foot orthoses in participants with cavus feet during walking
    Gabriel Moisan

    Lateral posting on orthotic did not increase peroneus longus activity.
     
  18. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Talocural manipulation effects walking speed in a young and older population
    Akshay Patel

    Yes, walk faster after having the ankle manipulated.

    They speculated that this could reduce incidence of falls in older people ... I not so sure about that ...
     
  19. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Great Toe Adduction Decreases Blood Flow to Plantar Fascia: A Pilot Study
    Julia L. Dunbar

    This was done non-weightbearing using ultrasound
    Adduction of hallux resulted in 42% decrease in blood flow via lateral plantar artery presumably due to compression from abductor hallucis

    Would be awesome if they could do this weightbearing and even better with different foot orthotic designs to see how they affect blood flow .... esp in those with plantar fasciitis and if increased blood flow affects clinical outcomes.

    Maybe we should be using toe spacers in those with plantar fasciitis (please do not go and do that just because I speculating!)
     
  20. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    This one is like #4 above and I so want to understand it, but don't, so post full abstract. If you get it, can you please explain it:

    Foot Orthoses reduce repercussions of Ns4 Noxious stimulus.
    Janin Marc1,2 , Dupui Philippe1 .
    1: Laboratory of Physiology, University of Toulouse, France.
    2 : PhD, Podiatrist ; Applied Podiatry College, Poitiers, France. Email of Presenting Author: marcjanin@cegetel.net

    INTRODUCTION: Previous studies reported that heterotopically painful stimulation could both depress the nociceptive spinal reflex (1). This effect could represent the neural basis for counter-irritation phenomena, that is, the paradoxical pain relief produced by heterotopic painful stimulation (2, 3). Noxious stimuli of type 4 (Ns4), condition labelled épine irritative, represents one of several counter-irritation phenomena and designates a nociceptive capacity of plantar irritating stimulus (4, 5). In fact, NS4 is a specific heterotopic nociceptive stimulus produces pain, no expressed by the patient, when all of the four following criteria are met: 1) score variation of clinical PDN-6 into hard and foam ground (6-8); 2) asymmetrical perception of pain on the Ns4 area (5, 8); 3) loss of spatial discrimination (5); and 4) loss of perception of somesthesia (9). We evaluate the efficacy of sensorimotor orthoses/insoles (SO, 9, 10) to reduce the repercussion in patients presenting with Ns4.

    METHODS: 20 males and 20 females (29-54 years) with Ns4 (single-point on the first metatarsal head) participated to the study: half of the patients (10 male and 10 female participants) were fitted with SO while the rest was the control group (C). We collected score of pain intensity (v.a.s, 0-100mm), and somesthesia by comparison into Ns4 levels and forehead reference in terms of 2-point stimuli, delivered with two distances (10-20 mm). These measures were taken at baseline and after a period of SO use: 1-2-3-6-12 week’s adaptation period. ANOVAs and paired t-tests were used for statistics analyses.

    RESULTS: Reduction is observed for pain sensitivity (fig 1) and the number of errors of discrimination of 2-point stimuli (fig 2) was observed. The reduction of sensation of nociceptive signal became perceivable from the 3rd week of use, but proved only significantly beneficial after 4 weeks of use for pain and 20 mm and 4 weeks use from 10 mm. DISCUSSION: The use of SO induced a new repartition of plantar sensory field information and reduced the heterotopic nociceptive perception of Ns4, mediated by a complex loop involving supraspinal structures. The change in pain intensity diminished the nociceptive withdrawal reflex field size considerably. This effect optimized the fidelity of sensory discrimination by controlling the extent of the neuronal receptor field on decreasing control inhibition/facilitation. When induced by SO, pain stimuli were subject to greater inhibition, therefore improving the 2-point stimuli discrimination. Improvement in integration occurred earlier for 20 mm soles than 10 mm ones, certainly due to the modification of the plantar field in regard to the NS4 localization. Saliency detection is considered to have a pivotal role in sensory integration. The use of SO has the potential to induce a reduction of the Ns4 and to restore foot sole to a functional level. While the perception and the integration of somesthesia improved. Results need further investigations.

    SIGNIFICANCE/CLINICAL RELEVANCE: modulation of pain of Ns4, heterotopic nociceptive stimuli, pain perception and somesthesia discrimination by SO influence. SO influence of the repercussion of Ns4 in the sensory integration.

    Foot Function & Sensorimotor Orthoses of Ns4 Noxious stimulus
    Janin Marc, PhD,
    Podiatrist; Applied Podiatry College, Poitiers, France; Laboratory of Physiology, University of Toulouse, France. Email of Presenting Author: marcjanin@cegetel.net

    INTRODUCTION: The Foot Function Index (FFI) is one of the five health measurement scales most frequently used in podiatry (1). It was developed to measure the impact of foot pathology on function in terms of pain, disability and activity restriction (2, 3). The FFI was specifically designed to assess the effects of foot orthotics treatments on foot-related problems (e.g Gross et al. for patients with plantar fasciitis (4), Powell et al. for children with juvenile idiopathic arthritis (5) and Wrobel et al. for plantar heel pain (6)). One such foot pathology is an heterotopic nociceptive stimulus entitled Noxious stimuli type 4 (Ns4), épine irritative: a nociceptive capacity of plantar irritating stimulus (7,8) characterized by 4 sine qua non criteria: 1) score variation of the clinical PDN-6 into hard and foam ground (8, 9); 2) asymmetrical perception of pain on Ns4 area (7, 9-11); 3) loss of spatial discrimination (7) and 4) loss of feeling of somesthesia (10,11). For podiatrists, the most critical clinical issue is that pain cannot be expressed directly by the patients because it falls under the pain threshold (7, 9, 10). Sensorimotor Orthoses/insoles (SO) already proved potentially effective in reducing the impact of Ns4 and in improving postural performance of patient (10). A systematic literature search found no study using an established quality-oflife instrument to measure the impact of the noxious stimuli Ns4 and the effects of SO on Ns4. This study aims at evaluating the impact and efficacy of SO on patients with Ns4 with regards to pain thresholds, disability, and activity limitation.

    METHODS: 30 males and 30 females (aged 29-54 years), all presenting Ns4 (localized as a single-point on the first metatarsal head), participated in the study. Every study participant completed the 3 subscales pain, disability and activity restriction of the FFI at screening, baseline, after 7 and after 21 days (11, French validated translation, 13). Bilateral custommade SO were given to every patient (4, 10-12). The use of SO was expected to 1) reduce neurogenic cues (14), 2) change the muscular tone distribution (postural mechanical expression of sensory disorders), 3) improve the muscular chain integration of the patient’s and 4) limit the mechanical constraints, by stimulating the proprioceptors of the sole (15).

    RESULTS: SO induced a reduction of FFI scores at baseline, 7 and 21 days, for: a) pain: 40 28 13 (up to 90), b) distability 31 26 17 (up to 90), c) activity limitation 12 12 8 (up to 50) and d) total maximum score 83 65 38 (up to 230).

    DISCUSSION: This study proves that Ns4 negatively impact foot function for the first time. The influence of Ns4 on the FFI score is comparable to the influence of other foot pathologies (previous reports): scores on each subsections were lesser when wearing SO for all subjects. The effect of SO is comparable to the literature: pain and disability readings were better with SO, after 7 days and only after 21 days on activity limitation. There could be two explanations: a) Ns4 cannot be expressed by subjects which makes it more difficult to report; b) SO reduced the noxious expression of Ns4 but 21 days may be too short a time to observe its field impact. Also most patients reported their ability to perform everyday activities with less pain and better foot health with SO. A limitation to this study involves the absence of a control group or alternative treatment group in the design, and the inability to follow the patients for 3 to 6 month to study the lingering benefit of SO on Ns4.

    SIGNIFICANCE/CLINICAL RELEVANCE: Ns4, heterotopic nociceptive stimuli, affect foot function. This study supports that sensorimotor orthoses improved foot function of the patients with Ns4. SO also improves patients’ quality of life.
     
  21. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    This was a poster:

    Knee Adduction Moments Associated with Knee Osteoarthritis are Increased by Medial Arch Supports
    Andrew R. Roney , Nicholas Holowka , Ian J. Wallace , Daniel E. Lieberman

    Concluded: 'The findings suggest that footwear with arch supports should be used with some caution as they may increase KAMs that potentially contribute to OA
     
  22. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    The Effects of Subtalar Axis Orientation on Kinematics and Kinetics During Walking and Running
    Julia Noginova

    ": Changing the STJ orientation to match Inman’s mean inclination and deviation angles resulted in a significant increase (p=0.0384) in the ankle range of motion during walking. The range of ankle joint moments calculated using Inman’s mean axes during running was significantly different (p=.0074) as compared to Gait2392 STJ axes. Significant differences were also found in peak STJ joint moments in both walking (p=.0002) and running (p=.0007). Changing the STJ orientation also resulted in large variation of STJ moment patterns during walking, with the average Inman’s mean axes producing two large peaks while the axis used by Gait2392 showed little to no second peak at all"
     
  23. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    whole session on plantar mechanoreceptors and plantar sensory input (good to see how often "proprioception" was NOT mentioned!!!) ... interesting ... will write this one up for a blog post, so watch this space.
     
  24. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Development and evaluation of the Running Shoe Comfort Assessment Tool (RUN-CAT)
    John Arnold

    They used a whole lot of variables, got runners to rates them etc etc, did some regression analyses and got it down to 4 variables into the tool to assess comfort of running shoes:
    heel cushioning
    shoe stability
    forefoot cushioning
    forefoot flexibility

    tool was reliable
     
  25. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Metatarsal Loading In Runners Who Habitually Use Rearfoot or Mid/Forefoot Strikes
    James Becker

    found that met loads greater in mid/forefoot strikers
    " Recommendations regarding switching from a RFS to a FFS pattern should be made cautiously as habitual FFS runners experience higher loads in the metatarsals. "
     
  26. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Midfoot Angle Changes During Running After an 8-Week Intervention Program
    Adrienne Henderson

    3 groups:
    foot strengthening exercise group
    walking in minimalist shoes
    control group (CG)

    oxford foot model for kinematics; followed for 8 weeks

    arch deformation decreased in both groups; but only stat significant in strengthening group

    "This could help with patients who have over-use injuries associated with dropped arches" --> I do not see how
     
  27. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Association Between Concussion and Ankle Sprain History in Collegiate Athletes
    Megan N. Houston

    College athletes with history of concussion are 2.5 times more likely to have a history of ankle sprain.
     
  28. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    The last session was a commercial promo/cheerleading session for minimalist running with no critical appraisal or opposite views

    The number of people left for that session reflects the amount of interest left in minimalist running shoes - they only now make up (0.3% of the running shoe market)
     

  29. Who would have thought. Jeepers did we need this
     

  30. Was that Irene ? Was on twitter and saw some pictures she used and laughed. Did she use the phrase bracing?
     
    Last edited: Apr 12, 2018
  31. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Yep! There were quite a few papers like that. Bleedin obvious ... but I suppose its good to have data confirmaing it ... bit at what point does it become unethical to keep doing studies that tell us what we already know.
    I will be commenting on that issue in the PodChatLive we doing in about 13 hours ....
    She has tentatively agreed to do a PodChatLive with us at some stage.... watch this space.
     
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