Customized orthotic insoles improve the gait and balance of hemiplegic stroke survivors more effectively than an ankle-foot orthosis / 中华物理医学与康复杂志

Objective:To observe the effect of customized orthotic insoles on the gait and balance of hemiplegic stroke survivors.Methods:Sixty stroke survivors with gait abnormalities were randomly divided into a group fitted with ankle foot orthoses (AFO) ( n=30) and a group who received customized orthotic insoles ( n=30). All received conventional rehabilitation training for 4 weeks. Before the fitting, as well as 8 hours and 4 weeks afterward, both groups were evaluated using the Tinetti gait scale (TGS), the plantar pressure balance index, the difference in length between their right and left step, step width, the Timed Up and Go test (TUGT), the Fugl-Meyer lower extremity assessment (FMA-LE), the 6-minute walk test (6MWT), a trunk impairment scale (TIS), the Berg Balance Scale (BBS) and the Barthel Index (BI). Results:At 8 hours after the fitting all of the insole group′s measurements were better than those of the AFO group, on average, but the differences were not statistically significant. After 4 weeks the average TGS, balance index barefoot and wearing the orthosis, step length difference, BBS and BI of the insoles group were significantly better than the AFO group′s averages. The other indicators were not significantly different.Conclusions:Customized orthotic insoles are more effective than an AFO in relieving the biomechanical abnormalities in hemiplegic patients′ feet and ankles, and enhancing their balance and gait.

Palmilhas de reprogramação postural na diminuição da pressão arterial e do desalinhamento postural em indivíduos hipertensos: ensaio clínico randomizado / Postural reprogramming insoles for blood pressure fall and posture misalignment in hypertensive individuals: randomized clinical trial

Testar a hipótese que Palmilhas de Reprogramação Postural (PRP) melhoram a postura e podem modificar média e picos de pressão arterial (PA) em indivíduos hipertensos. DESENHO DE ESTUDO: ECR, registrado no Clinical Trials (NCT02401516), com 24 indivíduos hipertensos. CONFIGURAÇÃO: Todos foram submetidos à Monitorização Ambulatorial da Pressão Arterial (MAPA) e avaliação da postura (SAPO) no início e após seis semanas. INTERVENÇÃO: grupo intervenção (GI) utilizou PRP e grupo controle (GC) SHAM. DESFECHO PRIMÁRIO: Médias da PA. DESFECHOS SECUNDÁRIOS: Picos de PA, durante vigília e sono e ângulo posturais. A melhora da postura ocorreu quando valores angulares diminuíram ou chegaram a zero. Para comparar a PA, foram utilizados os testes t de Student, pareado e não-pareado, com nível de significância de 5%. O tamanho do efeito (TDE) foi avaliado com D de Cohen. Para postura, Wilcoxon e Mann-Whitney. Variáveis categóricas, através do teste do Qui-quadrado. RESULTADOS: As variáveis de linha de base não diferiram entre grupos. Foram obtidos os seguintes deltas: pico da PAS em vigília (+9,3mmHgVs-7,5mmHg) (p<0,05, grande TDE); pico da PAS no sono (+2,3mmHgVs-6,8mmHg) (p<0,05, TDE moderado); e pico da PAD durante vigília (+3,2mmHgVs-4,7mmHg) (p<0,05, grande TDE), GC e GI respectivamente. Para os ângulos posturais, 33% da PAS foram explicados pelo deslocamento anterior do corpo. Para a PAD, 46% e 55%, pelos ângulos de Joelho e Tornozelo, respectivamente. CONCLUSÕES: A PRP reduziu picos de PAS e PAD durante vigília, sem efeito na média da PA. Embora PRP não tenha mostrado melhora na postura geral, o deslocamento anterior do corpo e os ângulos de joelho e tornozelo explicaram 33-55% da PA mais alta.

To test the hypothesis that Postural Reprogramming Insoles (PRI) improves posture and the effect of PRI on average and peaks of blood pressure (BP) in hypertensive individuals. DESIGN: RCT, registered at the Clinical Trials (NCT02401516), with 24 hypertensive individuals. SETTING: All patients underwent Ambulatory Blood Pressure Monitoring (ABPM) and posture assessment (PAS/SAPO software) at the beginning and the end of six weeks. INTERVENTION: intervention group (IG) used PRI and control group (CG) SHAM. MAIN OUTCOME MEASURES: BP averages. SECONDARY OUTCOMES: BP peaks, during awake and asleep periods. Improvement of posture was determined when the angle values assessed decreased or reached zero (perfect alignment). To compare BP, paired, and unpaired Student's t-tests were used, significance level of 5%. Effect size (ES) was assessed with Cohen's D. For posture assessment, Wilcoxon and Mann-Whitney were applied to analysis. Categorical variables, through Chi-square test. RESULTS: Baseline variables did not differ between groups. The following deltas were obtained-SBP peak in awake period (+9.3mmHgVs-7.5mmHg) (p<0.05, great ES); SBP peak during sleeping period (+2.3mmHgVs-6.8mmHg) (p<0.05, moderate ES); and DBP peak during awake period (+3.2mmHgVs-4.7mmHg) (p<0.05, great ES), in control and intervention groups, respectively. For postural angles, 33% of SBP were explained by anterior body shift. For DBP, 46% and 55% were explained by Knee and Ankle Angles, respectively. CONCLUSIONS: PRI reduced SBP and DBP peaks during awake period, with no effect on BP average. Even though PRI has not shown any improvement in overall posture, anterior body displacement and knee and ankle angles would solely explain 33-55% of the highest BP.

Design principle and biomechanical function of orthopedic insoles / 中国组织工程研究

BACKGROUND: The foot is an important part of the human motor system. Foot diseases and injuries have become a troubling problem. Orthopedic insoles can effectively treat and prevent foot diseases and injuries and reduce the risk of injuries. It has become the main method of physical correction. OBJECTIVE: To clarify the design principles of orthopedic insoles, to classify orthopedic insoles according to the production methods, to sort out the rehabilitation function of orthopedic insoles to human joint-related diseases, children’s hemiplegia, and sports injuries, to explore the current research status and shortcomings of orthopedic insoles, and to make suggestions for future research and development. METHODS: A search of CNKI, WanFang, Baichain, Baidu Library, and PubMed was performed for relevant literature published from 2005 to 2019. Search terms were “Orthopedic insoles,” “valgus hallux, flat feet, high arch, plantar fasciitis,” “knee varus, knee valgus, knee osteoarthritis,” “scoliosis,” “foot and ankle injury,” “gait,” and “abnormal gaits” in Chinese and “Orthopedic insoles, Corrective effect, Motion pattern characteristics” in English. Included articles were screened, summarized and analyzed. RESULTS AND CONCLUSION: The design principles of the insoles include four aspects: adjusting the force bearing point of the vola and dispersing plantar pressure; supporting the arch of the foot, improving cushioning ability; improving the force line of the l ower limb, providing a stable support; improving proprioception and foot comfort. Orthopedic insoles can be divided into three types: prefabricated, semi-customized and customized. Orthopedic insoles can play an effective prevention and rehabilitation function in ankle, knee, spinal deformity, hemiplegia-type cerebral palsy in children, and sports injuries. Orthopedic insoles have certain limitations in clinical application and in therapeutic effects. In the development and evaluation of orthopedic insoles, the changes in foot shape and shoe shape during human movement should be considered to reflect the concept of “foot-shoe integration.” Different shapes, materials, and hardness of orthopedic insoles can be used to conduct more in-depth research on the effects of orthopedic insoles to prevent and treat injuries and improve exercise capacity.

Biomechanical Study of Personalized Buffer Insoles for Heel Pain / 医用生物力学

Objective To study the effect from personalized insoles with different structural heel pads on plantar stress concentration of patients with heel pain. Methods Base on statistics and finite element analysis method, the finite element model of foot and personalized insoles for patient with heel pain were established. The effects from different insoles on stress of soft tissues and plantar fascia were simulated. Results The internal stress of plantar soft tissues was higher than that of plantar epidermis, and the stress of the third plantar fascia was the highest. During barefoot standing, the internal peak stress of plantar soft tissues was 1.34 times of plantar epidermis, and the stress of the third plantar fascia was 1.50 MPa. The result of orthogonal experiment showed that the optimized insole model could reduce the internal peak stress of plantar soft tissues by 51%, meanwhile relieve the stress of the third plantar fascia by 11.3%. Conclusions The optimum scheme of personalized buffer insole is the design of vertical ellipse and honeycomb groove. Such structure can assist the absorption or buffering of concussion from calcaneal fat pad, and relieve the plantar stress concentration and tension of the plantar fascia. This study is helpful to understand plantar stress distributions of patients with heel pain, which is of great significance to the study of pathology and prevention of heel pain.

Formulated Composite Insoles Reduce Foot Pain and Fatigue and Increase Working Efficiency in Healthcare Workers: A Pilot Non-controlled Experimental Study.

Aim: The aim was to evaluate self-assessed foot health status and working efficiency of healthcare workers when using composite insoles to treat foot problems. Introduction: Foot pain and fatigue are two of the most common problems facing healthcare workers owing to many hours of walking and standing per day. Many choices of conservative treatment are available such as the use of insoles and orthotic support. Commercially prefabricated insoles are one of the most widely used treatments for foot pain and fatigue as they are easily accessible at reasonable prices. However, there is limited evidence supporting the effectiveness of these treatments. Methodology: Test subjects included 49 volunteers from Tung Song Hospital screened by an orthopedist and physical therapist to meet predetermined criteria. Data collected included demographic data, validated foot function score of a Foot Health Status Questionnaire (FHSQ), and a synthetic working efficiency score generated using the Thai Questionnaire of Working Efficiency for Healthcare workers. A self-evaluation form was designed to record the efficacy of using Smile feet™ insoles before and after one month of treatment. Statistical analysis was performed using the Wilcoxon signed rank test. Results: Responses to the Foot Heath Status Questionnaire showed a statistically significant change in several foot health metrics (p-value < 0.01) after using the composite insoles for 1 month: Improvement greater than the minimal important difference was achieved by 75.5% in foot pain, 44.9% in foot function, 89.8% in foot wear, and a 57.1% in general foot health. Respondents to the Thai Working Efficiency questionnaire reported improvement in sections of working, reducing muscle soreness and fatigue in 30 of the 49 volunteers (61.2%). Among those that experienced improvement, [self-reported] work productivity increased by 73%. Conclusion: Healthcare workers reported improvements after using a commercially available composite insole in all criteria on a self assessment questionnaire, including muscle soreness, working efficiency, work productivity, fatigue, foot pain, foot function, foot wear, and general foot health. Level of Evidence: Level IV, therapeutic case series.

Diseño e implementación de sistema de plantilla para medición de presiones y cinemática del pie / Design and implementation of system for measurement pressures and foot kinematics

Este es un trabajo donde se desarrolló e implementó un sistema integrado que combina una plan-tilla instrumentada con sensores de presión y un módulo de sensores inerciales compuesto por un acelerómetro y un giroscopio, los cuales permitio la medición de variables baropodométricas (presiones plantares) y variables cinemáticas (aceleración, velocidad angular y desplazamiento angular) del pie. El sistema resultante le deja al especialista realizar un estudio biomecánico del pie a través del análisis estático y/o dinámico del movimiento y la visualización en pantalla de da-tos cuantitativos e información cualitativa, para la evaluación e intervención de los deportistas.

This paper presents the development and implementation of an integrated system that combi-nesan insole instrumented with pressure sensors and an inertial sensor module consists of an accelerometer and a gyroscope, which allows measurement of baropodometric variables (plantar pressures) and kinematic variables (acceleration, angular rate, and angular displacement) of the foot. The resulting system allows the specialist to conduct a foot biomechanical study through static and/or dynamic analysis and screen display of quantitative data and qualitative informa-tion, whose analysis allows prevention and intervention programs for musculoskeletal disorders that may affect the performance of athletes.

Clinical Efficacy of Shoes and Custom-made Insoles in Treating Children with Flatfoot / The Japanese Journal of Rehabilitation Medicine

We performed a prospective study to determine whether the walking pattern of children with flatfoot can be influenced by using shoes and custom-modeled insoles. One hundred and thirty-two children (mean age ; 4.20±2.53) who had been referred by a physiatrist, and who were diagnosed with flatfoot at the brace clinic in our institute, were assigned to three groups : The first group was asked to walk barefoot, the second one to walk with shoes without insoles and the last one to walk with shoes with insoles. We measured walking speed, cadence, step length, step width, the duration of right and left stance phases, both double-limb stance phases, both swing phases, walking angle, and toe angle using a 2.4 m sheet-type Gait Analyzer, the Walk Way MW-1000 ^TM, at the individual's self-selected speed. Compared with the barefoot group, a significant increase was observed in the group using shoes with custom-modeled insoles in both walking speed and step length on both sides, and there were reductions in swing phase and walking angle on both sides (paired t-test ; <i>p</i><0.002).