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PHYSIO  December 2002

PHYSIO December 2002

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Subject:

Orthotic Devices?

From:

[log in to unmask]

Reply-To:

- for physiotherapists in education and practice <[log in to unmask]>

Date:

Fri, 6 Dec 2002 07:03:16 EST

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (203 lines)

Frequently we find that orthotic shoe inserts are prescribed for athletes
allegedly suffering from some sort of muscle imbalance, skeletal imbalance or
faulty running mechanics.  Are such devices always helpful and rarely harmful
to the non-pathological athlete?  The following studies address these issues.

Any comments about the use of orthotics in non-pathological situations?

-----------------

Clin Biomech (Bristol, Avon) 2000 Jan;15(1):54-64

Effects of foot orthoses on skeletal motion during running.

Stacoff A, Reinschmidt C, Nigg BM, van den Bogert AJ, Lundberg A, Denoth J,
Stussi E.

OBJECTIVE: To quantify the effects of medial foot orthoses on skeletal
movements of the calcaneus and tibia during the stance phase in running.

DESIGN:  Kinematic effects of medial foot orthoses (anterior, posterior, no
support) were tested using skeletal (and shoe) markers at the calcaneus and
tibia. BACKGROUND:  Previous studies using shoe and skin markers concluded
that medially placed orthoses control/reduce foot eversion and tibial
rotation. However, it is currently  unknown if such orthoses also affect
skeletal motion at the lower extremities.

METHODS: Intracortical Hofman pins with reflective marker triads were
inserted under  standard local anesthetic into the calcaneus and tibia of
five healthy male subjects. The three-dimensional tibiocalcaneal rotations
were determined using a joint  coordinate system approach. Eversion (skeletal
and shoe) and tibial rotation were calculated to study the foot orthoses
effects.

 RESULTS: Orthotic effects on  eversion and tibial rotations were found to be
small and unsystematic over all subjects. Differences between the subjects
were significantly larger (up to 10  degrees) than between the orthotic
conditions (1-4 degrees ). Significant orthotic effects across subjects were
found only for total internal tibial rotation).

CONCLUSIONS: This in vivo study showed that medially placed foot orthoses did
not change tibiocalcaneal movement patterns substantially during the stance
phase of running.

RELEVANCE: Orthoses may have only small kinematic effects on the calcaneus
and tibia (measured with bone pins) as well as on the shoes  (measured with
shoe markers) during running of normal subjects. Present results showed that
orthotic effects were subject specific and unsystematic across  conditions.
It is speculated that orthotic effects during the stance phase of running may
be mechanical as well as proprioceptive.

--------------

Arch Phys Med Rehabil 1999 May; 80(5):540-4

 Electromyographic effects of foot orthotics on selected lower extremity
muscles during running.

Nawoczenski DA, Ludewig PM.

OBJECTIVE: To study the effects of foot orthotics on the mean
electromyographic amplitude of proximal and distal lower extremity muscle
groups during the first  50% of the stance phase during treadmill running.

DESIGN: Repeated measures. SETTING: Subjects were recruited from the general
community. PARTICIPANTS:  Twelve recreational runners who were symptomatic
for lower extremity pain. Clinical and radiographic findings confirmed the
presence of structural malalignment of  the foot. INTERVENTION: Semirigid
orthotics were fabricated for each subject, and like footwear provided. MAIN
OUTCOME MEASURES: Surface  electromyogram activity from the tibialis
anterior, medial gastrocnemius, vastus medialis, vastus lateralis, and biceps
femoris was collected during treadmill running at  self-selected speeds for
orthotic and nonorthotic conditions. Root mean square values were averaged
across 10 cycles, normalized to time and expressed as a  percentage of the
nonorthotic condition.

RESULTS:

Paired t test results showed statistically significant changes for the biceps
femoris (-11.1%) and tibialis  anterior (+37.5%) muscle groups during the
orthotic condition. Electromyographic activity in the medial gastrocnemius,
vastus medialis, and vastus lateralis with  orthotic use was not
significantly different from the nonorthotic condition.

CONCLUSION: Although subjects' EMG responses to orthotic use were  highly
individualized, the findings of this study may enhance our understanding of
muscle activity changes associated with positive outcomes from orthotic use.

-------------

J Orthop Sports Phys Ther 1993 Oct;18(4):532-6

 The effects of foot orthotics on the EMG activity of selected leg muscles
during gait.

Tomaro J, Burdett RG.

Foot orthotics have been successfully used to treat muscular overuse leg
injuries in athletes. The purpose of this study was to examine the effects of
foot orthotics on the  electromyographic (EMG) activity of the tibialis
anterior, peroneus longus, and gastrocnemius muscles during walking.

Ten volunteers with leg symptoms resulting from  compensatory subtalar joint
pronation were fitted with foot orthotics. The duration of tibialis anterior
EMG activity following heel strike and the average EMG activity  of the
tibialis anterior, peroneus longus, and gastrocnemius muscles were collected
with surface electrodes. Comparisons were made between the orthotic and
nonorthotic  conditions. A t-test for non-independent samples with a
significance level of p<0.05 was used for data analysis.

There was a statistically significant increase in the  duration of tibialis
anterior activity following heel strike in the orthotic condition. There were
no significant differences in the average EMG activity for any of the three
muscles between the orthotic and the nonorthotic conditions.

This study suggests that foot orthotics had minimal effects on the muscles
studied and that further research  is necessary to determine the
effectiveness of orthotics on the EMG activity of other leg muscles.

-----------------

Phys Ther 1994 Sep;74(9):836-44

 The effect of soft foot orthotics on three-dimensional lower-limb kinematics
during walking and running.

Eng JJ, Pierrynowski MR.

BACKGROUND AND PURPOSE. Although foot orthotics are often prescribed to alter
the lower-extremity mechanics during the stance period of gait, there is
little  documentation of the actual effect of foot orthotics on the movement
of the lower-extremity joints during walking and running. This study examined
the effect of foot  orthotics on the range of motion of the
talocrural/subtalar joint and the knee joint in three dimensions during
walking and running.

SUBJECTS. Ten female adolescent  subjects, aged 13 to 17 years (X = 14.4, SD
= 1.1) who were diagnosed with patellofemoral pain syndrome and exhibited
forefoot varus greater than 6 degrees and/or  calcaneal valgus greater than 6
degrees participated in the study. METHODS. Thirty strides of walking and
running on a treadmill were recorded for each of the  orthotic and
nonorthotic conditions for each subject using an optoelectronic recording
technique. Analyses of variance for repeated measures were performed on the
range of motion of the talocrural/subtalar joint and knee joint for each
plane of motion (ie, six separate analyses). The main factors of each
analysis were the effect of  the orthotic (orthotic condition versus
nonorthotic condition), mode of ambulation (walking and running), and phase
of the stance period (contact, mid-stance, and  propulsion).

RESULTS. No differences were found in sagittal-plane movements. Reductions of
1 to 3 degrees occurred with orthotic use for the talocrural/subtalar  joint
during walking and running in the frontal and transverse planes. The
orthotics reduced knee motion in the frontal plane during the contact and
mid-stance phases  of walking, but increased the motion during the contact
and mid-stance phases of running.

CONCLUSIONS AND DISCUSSION. This study shows that corrections  to the static
position of forefoot varus and calcaneal valgus can result in changes in
transverse- and frontal-plane motion of the foot and knee during walking and
running.

---------------

J Orthop Sports Phys Ther 2000 Nov;30(11):664-75

 Effect of foot orthotics on calcaneal eversion during standing and treadmill
walking for subjects with abnormal pronation.

Genova JM, Gross MT.

STUDY DESIGN: Repeated measures analysis of intervention. OBJECTIVES: To de
termine the effects of foot orthotics and shoewear on calcaneal eversion for
standing and treadmill walking.

BACKGROUND: Foot orthotics are commonly used as an intervention for treating
lower extremity musculoskeletal pathology.  Qualitative research regarding
the benefit of foot orthotics tends to be favorable, while the results of
quantitative studies often conflict. METHODS AND  MEASURES: Eight men (mean
age = 35.8 +/- 12.7 years) and 5 women (mean age = 30.4 +/- 10.6 years), who
demonstrated abnormal pronation, walked quickly  (average velocity = 1.9 m/s)
on a treadmill with and without foot orthotics. Subjects were filmed using a
2-dimensional video system and plastic molds designed to  indicate calcaneal
position inside the shoe during static standing and treadmill walking.

RESULTS: Paired t tests indicated that foot orthotics significantly reduced
the  mean maximum calcaneal eversion angle by 2.2 degrees and the mean
calcaneal eversion angle at heel rise by 2.1 degrees during fast walking.
Orthotic and nonorthotic  conditions did not differ significantly for the
remaining kinematic variables. A one-way ANOVA indicated that calcaneal
eversion in standing was significantly greater  for barefoot standing
compared with standing in shoes with or without orthotics. ANOVA also
indicated that the plastic molds provided reliable measures of calcaneal
position.

CONCLUSIONS: Foot orthotics have a significant effect on calcaneal eversion
and shoes also should be considered in conjunction with foot orthotic
prescription.

------------

Dr Mel C Siff
Denver, USA
http://groups.yahoo.com/group/Supertraining/

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