Foot Orthotics and Intrinsic Factors on Strain Measurements in the Fifth Metatarsal

NewsBot · Nov 11, 2020

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Influence of Foot Orthotics and Intrinsic Factors on Strain Measurements in the Fifth Metatarsal
Jeffrey W. Hoffman, MS, Rogerio C. Bitar, MD, Daniel R. Sturnick, MS, ...
Foot & Ankle Orthopaedics November 6, 2020

Introduction/Purpose:
Fractures of the fifth metatarsal occur in young, athletic populations and often result in sub-optimal clinical outcomes, even after surgical fixation. With such a high demand for decreased return to play in athletic populations, the development of intervention strategies which mitigate intrinsic and extrinsic risk factors of initial injury is important. Foot orthotics have been shown to decrease strain in the 2nd metatarsal. However, limited research has investigated the influence of intrinsic risk factors and the use of foot orthotics on fifth metatarsal strain. Therefore, the purpose of our study was to investigate the effect of foot orthotics and intrinsic risk factors on fifth metatarsal strain during cadaveric simulation.

Methods:
Ten specimens were loaded to simulate the stance phase of normal gait using a validated 6-degree of freedom robot with tendon actuators. Strain gauges were placed at the metaphyseal - diaphyseal junction (Zone II), and the proximal diaphysis (Zone III) to measure principal strain. Specimens were tested in a sneaker-only control condition and ten orthotic conditions, which include combinations of a commercial orthotic insole, three plates, and two foam wedges (Figure 1A). The average peak strain from three simulations were recorded for each orthotic condition. Relevant intrinsic factors were recorded from reconstructions of axially loaded computed tomography scans. A two-way repeated measures ANOVA was conducted to determine the effect of orthotic conditions on fifth metatarsal strains, with significantly correlated intrinsic factors included as covariates. Tukey-Kramer post-hoc analysis with a Bonferroni correction was used to analyze differences between individual orthotic conditions and main effects of components.

Results:
Metatarsus adductus angle, 4-5 intermetatarsal angle, and Meary’s angle (R2= 0.944; p<0.001) were included as covariates in analysis of Zone III strain. Significant (p<0.05) differences in Zone III strain were found for the both the main effect of a plate and individual orthotic cond

itions with statistical adjustment for previously stated intrinsic measurements. However, post- hoc testing revealed no significant differences between non-plate conditions and full plate conditions(p=0.23), lateral plate conditions (p=0.025), or lateral cut plate conditions (p=0.026). Additionally, the Full Plate with Lateral Wedge condition reduced strains by 285 µΕ relative to the sneaker condition, no significant differences (p = 0.07) were found in post-hoc analysis. No significant differences were found in Zone II with the models considered.

Conclusion:
Zone III strains were shown to be significantly correlated with intrinsic factors in the current analysis. Plate conditions demonstrated a trend towards significant reduction of Zone III strain relative to the sneaker condition, despite failing to achieve statistical significance in conservative post-hoc analysis. However, these results may be clinically significant as the reduction of strain in plate conditions exceeded previously reported significant decreases in the 2nd metatarsal. Correlations found between intrinsic risk factors and strain in this study corroborate with previous studies. This indicates that the effectiveness of foot orthotics to reduce strain is strongly influenced by individual foot structure.
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NewsBot · Nov 11, 2020

Related Thread:
Fifth metatarsal stress fracture

NewsBot · Mar 21, 2022

Orthosis and Foot Structure Affect the Fifth Metatarsal Principal Strains During Simulated Level Walking
Jeffrey W. Hoffman, MS, Rogerio C. Bitar, MD, Nicholas Williams, MPH, ...
The American Journal of Sports Medicine March 18, 2022

Background:
Fractures of the proximal fifth metatarsal bone are common injuries in elite athletes and are associated with high rates of delayed union and nonunion. Structural features of the foot may increase fracture risk in some individuals, emphasizing the need for intervention strategies to prevent fracture. Although orthotic devices have shown promise in reducing fractures of the fifth metatarsal bone, the effect of orthosis on fifth metatarsal strains is not well understood.

Purpose:
To quantify the effects of different foot orthotic constructs on principal tensile strains in the proximal fifth metatarsal bone during cadaveric simulations of level walking. An additional purpose was to investigate the relationships between structural features of the foot and corresponding strains on the fifth metatarsal bone during level walking.

Study Design:
Controlled laboratory study.

Methods:
A total of 10 midtibial cadaveric specimens were attached to a 6 degrees of freedom robotic gait simulator. Strain gauges were placed at the metaphyseal-diaphyseal junction (zone II) and the proximal diaphysis (zone III) during level walking simulations using 11 different foot orthotic configurations. Images of each specimen were used to measure structural features of the foot in an axially loaded position. The peak tensile strains were measured and reported relative to the sneaker-only condition for each orthotic condition and orthotic-specific association between structural features and principal strains of both zones.

Results:
In total, 2 of the 11 orthotic conditions significantly reduced strain relative to the sneaker-only condition in zone II. Further, 6 orthotic conditions significantly reduced strain relative to the sneaker-only condition in zone III. Increased zone II principal strain incurred during level walking in the sneaker-only condition showed a significant association with increases in the Meary’s angle. Changes in zone III principal strain relative to the sneaker-only condition were significantly associated with increases in the Meary’s angle and fourth-fifth intermetatarsal angle.

Conclusion:
The use of orthotic devices reduced principal strain relative to the condition of a sneaker without any orthosis in zone II and zone III. The ability to reduce strain relative to the sneaker-only condition in zone III was indicated by increasing values of the Meary’s angle and levels of the fourth-fifth intermetatarsal angle.

Clinical Relevance:
Clinicians can use characteristics of foot structure to determine the proper foot orthosis to potentially reduce stress fracture risk in high-risk individuals.
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NewsBot · Aug 4, 2023

Fifth metatarsal strain distribution during cutting motions in soccer
Yusuke Miyazaki et al
Sports Biomech. 2023 Aug 2

The objective of this study was to determine the fifth metatarsal strain generation mechanism during cutting motions performed while playing soccer using a finite element foot model. Five collegiate soccer players performed the side-step cutting and the cross-step cutting motions to measure the three-dimensional foot kinematics, ground reaction force, and plantar pressure distribution. In addition, a finite-element model of a foot consisting of bony structures, ligaments, and skin was constructed from computed tomography images. Simulations were conducted to perform the cutting motions, using the measured foot motion and distributed load on the plantar surface as boundary conditions for the model. During the side-step cutting, the maximum principal strain on the fifth metatarsal was correlated to forefoot adduction angle during stepping out. For cross-step cutting, the maximum principal strain was correlated with plantar pressure at the distal end of the fifth metatarsal. Therefore, to prevent a fracture, it is necessary to take measures to reduce the lateral bending deformation of the forefoot while stepping out during side-step cutting and to reduce the plantar pressure on the distal end of the fifth metatarsal during cross-step cutting.
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Foot Orthotics and Intrinsic Factors on Strain Measurements in the Fifth Metatarsal

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Foot Orthotics and Intrinsic Factors on Strain Measurements in the Fifth Metatarsal

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Training intrinsic foot muscles; orthotics

Foot orthotics and tibial strain

Deep learning algorithms to design foot orthotics

Foot Orthotics in Older Individuals with Cognitive Impairment

Review process after issue of foot orthotics

Foot Orthotics in Archery

3d printed metal foot orthotics

Share This Page

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