Abstract
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 1st MTP joint pain with the aim of altering dorsiflexion at
propulsion. This study explores changes in 1st 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 1st 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 = 48mm) and
the 24 week endpoint (median = 14.50mm, z = -4.88, p <>
analysis, we found no relationship between pain reduction and 1st MTP joint motion,
and no significant differences were found between the 1st MTP joint maximum
dorsiflexion or ankle/subtalar complex maximum eversion, with and without the
orthoses.
Conclusions
This observational study demonstrated a significant decrease in 1st MTP joint pain
associated with the use of foot orthoses. Change in pain was not shown to be
associated with 1st MTP joint dorsiflexion nor with altered ankle/subtalar complex
eversion. Further research into the effect of foot orthoses on foot function is
indicated.
All patients were prescribed pre-fabricated, foot orthoses (X-line, Healthystep,
Mossley, UK). Sagittal and frontal plane pronatory control was increased using high
density (400kg/m3) ethyl-vinyl acetate wedged posting, adhered to the medial
underside of the foot orthoses.
En el estudio conducted have found that using orthotic planting reduces the pain of the 1 st MTP joint but in the subgroup you want to associate the use of orthotics plantar and hand kinematics have found no relative changes between the motion of the metatarsophalangeal, ankle, and ASA and without plantar orthoses.
As we return to the same dilemma as always if plantar orthoses and foot work by cinematic, or rather on kinetic and sensory receptors.
the study aside, what caught my attention is the following sentence:
The modified, prefabricated orthotic device Used in this study is of a type That Is Being
Favoured increasingly over more expensive, due to casted devices
Evidence That There May Be little functional difference entre the two types of orthotic device
say the prefabricated orthoses in this study is of a type that is being used instead of the brace as it is cheaper and and the effects are very similar. This assertion is based on only 1 study and to which I have addressed quickly to try:
Contoured, prefabricated foot orthoses Demonstrate mechanical properties comparable to contoured, of customized foot orthoses: a plantar pressure study
Anthony C Redmond 1, 2 , Karl B Landorf 3, 4 and Anne-Maree Keenan 1 , 2
1 Section of Musculoskeletal Disease, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds LS7 4SA, UK
2 NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds LS7 4SA, UK
3 Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora, 3086, Australia
4 Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, 3086, Australia
Abstract
Background
Foot orthoses have been demonstrated to be effective in the management of a range of conditions, but there is debate as to the benefits of customised foot orthoses over less expensive, prefabricated devices.
Methods
In a randomised, cross-over trial, 15 flat-footed participants aged between 18 and 45 years were provided with semi-rigid, customised orthoses and semi-rigid, contoured, prefabricated orthoses. Pressures and forces were measured using an in-shoe system with subjects wearing shoes alone, wearing customised orthoses, and again when wearing contoured prefabricated orthoses. Two weeks acclimatisation was included between cross-over of therapy. Repeated measures ANOVA models with post-hoc, pair-wise comparisons were used to test for differences.
Results
When compared to wearing shoes alone, wearing either the customised orthoses or the prefabricated orthoses was associated with increases in force and force time integrals in the midfoot region. Peak and maximum mean pressure and pressure-time, and force-time integrals were reduced in both the medial and lateral forefoot. There were, however, no significant differences between the customised orthoses and the prefabricated orthoses at any site.
Conclusion
There was a similar change in loading with both the semi-rigid customised and the semi-rigid prefabricated orthoses when compared to the shoe alone condition. However, while customised devices offered minor differences over prefabricated orthoses in some variables, these were not statistically significant. The results suggest that there may be only minor differences in the effects on plantar pressures between the customised and the less expensive prefabricated orthoses tested in this study, however further research is warranted.
Although the differences were not significant, the customised orthoses compared to the prefabricated devices produced decreased loading at the heel by up to 12% and increased the contact area of the midfoot (44% greater contact area than control for the customised orthoses, compared with 33% for the prefabricated devices) – Figure 2 . The loading characteristics of the foot in response to both types of device, however, were comparable Both at the midfoot (0.2% to 8% difference) and forefoot (0.2% to 3.7% difference).
Sample N = 15
plantar semi rigid orthoses used for "flat feet (flat feet put in quotes because I like to use this definition as a cause)
The results are that there is little difference between orthotics and bracing manufactured having a little effect on plantar pressure as orthoses.
And these are the braces used:
| Customised orthoses | Prefabricated Orthoses |
Pre-manufacture p reparation | | |
Casting | Yes | No |
Measurements for individualised prescription | Yes | No |
Characteristics of the d evice | | |
Materials | Semi-rigid, 4mm polypropylene | Semi-rigid, 4mm polypropylene |
Length of the device | 10-15mm proximal to the metatarsal heads | 10-15mm proximal to the metatarsal heads |
Width of the device | Medial border – bisection of 1 st metatarsal. Lateral border - lateral aspect of foot. | Medial border – bisection of 1 st metatarsal. Lateral border - lateral aspect of foot. |
Heel cup height | Approximately 12.0 mm | A pproximately 12.0 mm |
Heel post | 450kg/m 3 ethyl vinyl acetate | 450kg/m 3 ethyl vinyl acetate |
Contoured arch area | Yes | Yes |
Extrinsic heel post | Yes | Yes |
Polypropylene 4 mm in both and the rest is almost all the same, possibly the only difference is the more precise adaptation as plantar orthoses.
As we used poly 4mms, something that little is done in Spain, but in countries whites as England, Australia and the U.S. is something that if used more frequently. I do not know if the cop is equal 4mms we buy here than that used in other countries .
For the conclusion I have reached is that one can not extrapolate the findings of these braces plantar to the previous case, since it is a small sample, are different diseases and treatment would be different.
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I left the article a few days kept unpublished order add some more and the truth is that studying I found something interesting to say.
Robbins and coworkers proposed that athletic shoes cause negative effects in athletes by decreasing mechanical stability and compromising normal muscular activation necessary for dissipation of impact forces. They further suggest that athletic footwear has the potential to decrease the position sense of the foot. Conversely, foot orthoses can potentially enhance postural control. A variety of studies have been performed that shed light on the mechanism by which foot orthoses can enhance neuromuscular control over the ankle.
One of the new theories of biomechanics is the neuromuscular, proprioceptive (explaining the operation of Kinesio??) Is something that has time and talking to the effects that any brace that we put in the foot, whether the material they are, and work because they get a proprioceptive effect, mechanoreceptors that will make the muscles and joints work as we should, but we do not do the templates that purpose. It is an ignorance that has been helping us but many were or are aware of it.
In studies conducted by these authors, say that the running shoe can be detrimental to the person because when it provides plenty of cushioning, decreases the mechanical stability and normal muscle activation compromises necessary to dissipate the impact forces (on this subject, muscle activation is something I read in almost every article lately and it is impressive to see how important it is and we have no knowledge about it Biomechanical considerations of the lower limb.)
What if you break cruciate ligaments of the knee? "Increased instability? ¿2 endure so tiny ligaments the immense forces they are subjected? Or rather, is that the ligaments are activating receptors that help the vast corresponding feature extensive active?
Continuing with the preceding paragraph:
also suggest that athletic footwear has the potential to diminish the sense of foot position. On the contrary, the foot orthoses can potentially improve postural control. A variety of studies have been conducted to shed light on the mechanism by which foot orthoses may improve neuromuscular control over ankle.
is important not only read but also podiatry neuroscience, physiology, engineering movement, kinesiology for physical therapists, rehabilitation physicians, chiropractors, and other publications that enrich us and give us more points of view in order to make a more valid.
OBBINS SE, Gouw GJ: Athletic footwear: unsafe due to perceptual illusions. Med Sci Sports Exerc 23: 217, 1991.
ROBBINS S, WAKED E: Balance and vertical impact in sports: role of shoe sole materials. Arch Phys Med Rehabil 78: 463, 1997
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ROBBINS S, WAKED E, GOUW GJ, ET AL: Athletic footwear affects balance in men. Br J Sports Med 28: 117, 1994.[Abstract/Free Full Text]
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ROBBINS S, WAKED E, ALLARD P, ET AL: Foot position awareness in Young and Older Men: The Influence of footwear sole properties. J Am Geriatr Soc 45: 61, 1997.
For today I think that is enough information. A reflection I ask is that I would like to see more publications on biomechanics, quality and new issues at the national level and we always have to go abroad to catch up. And it's not enough to present clinical cases, literature reviews should be done providing conclusions from reading numerous articles (many of them accessible to people who are at great distances from a university). Now with the bachelor's degree and doctorate think it's a moral responsibility to conduct studies. At the moment it is early but in 5 to 10 years should be growing exponentially.
dejaseis I would like constructive criticism, comments, information to which access, in that you do not agree and showing why in studies (again read and give my opinion if I was wrong.) So you can make this more interactive and what we can all learn (wrong we learning) and up to date, as not only good for us but for the profession.