Effectiveness of gait plate insole and lateral sole wedged shoes on foot progression angle in children with in-toeing gait: A prospective randomized control trial.

BACKGROUND: In-toeing gait is defined as the internal rotation of the long axis of the foot to the line of progression. Although most of the time it is corrected spontaneously but sometimes causes torsional misalignment syndrome and maybe patellofemoral instability and arthritis of the knee. RESEARCH QUESTION: What is the effect of gait plate insoles and lateral sole wedged shoes on foot progression angle (FPA) in children with in-toeing? METHOD: In this study, a randomized control trial was conducted with 11 participants (18 feet) who were girls aged between seven and ten years old. They were randomly assigned to either the gait plate group (6 girls, 11 feet) or the lateral sole wedge group (5 girls, 11 feet). The foot progression angle was measured using the RS scanner pressure platform before and after four weeks of intervention, both with and without interventions. The interaction effects of time and group on outcomes were analyzed using Mixed ANOVA and post-hoc complementary tests with a confidence interval of 95%. RESULTS: It was observed that none of the interventions had an immediate impact on the FPA (P > 0.05). However, after four weeks, the FPA increased by 9.96 degrees with the lateral sole wedge and by 3.51 degrees with the gate plate insole. During the immediate and short-term evaluation, no significant difference was noticed between the two groups (P > 0.05). However, there was a large effect size (eta square = 0.269) observed in the time group interaction between the two groups (P = 0.028). SIGNIFICANCE: Conservative methods like using a gait plate insole or modifying shoes with a lateral sole wedge can improve the foot progression angle in children with in-toeing gait. However, longer studies with larger sample sizes are needed to reach a conclusion.

The effect of dextrose prolotherapy versus placebo/other non-surgical treatments on pain in chronic plantar fasciitis: a systematic review and meta-analysis of clinical trials.

BACKGROUND: Prolotherapy is the injection of a small volume of sclerosing or irritant solutions into an injured tissue. We aimed to investigate the effect of dextrose prolotherapy (DPT) versus placebo/other non-surgical treatments on pain in chronic plantar fasciitis. METHODS: We searched seven electronic databases (PubMed/MEDLINE, Web of Science, EMBASE, Scopus, ProQuest, CENTRAL, PEDro) from inception to December 31, 2021 with no language restriction for publications comparing the effect of DPT with placebo/other non-surgical treatments in patients with chronic plantar fasciitis. Our primary outcome was pain and the secondary outcomes were foot function and plantar fascia thickness. The risk of bias was assessed using the Cochrane Collaboration's tool. RESULTS: Overall, eight studies with a total of 449 patients were included in the meta-analysis. All the included studies reported short-term pain. A large effect size (dppc2 = -0.97, 95% confidence interval [CI] -1.84 to -0.10) was observed favoring the use of DPT to reduce pain in patients with chronic plantar fasciitis in the short-term. The results for foot function improvement (dppc2 = -1.28, 95% CI -2.49 to -0.07) and plantar fascia thickness reduction (dppc2 = -1.02, 95% CI -1.99 to -0.05) in the short-term were also in favor of DPT. CONCLUSIONS: Since almost all the included studies had high risk of bias and multiple trials lacked long-term follow-ups, further high-quality research is required to determine the long-term effects of DPT vs placebo/other non-surgical interventions.

Effect of Different Placement of Heel Rockers on Lower-Limb Joint Biomechanics in Healthy Individuals.

BACKGROUND: Rocker shoes are commonly prescribed to healthy and pathologic populations to decrease stress on the lower limbs. An optimal rocker shoe design must consider both toe and heel rockers. Heel rockers are as effective as toe rockers in relieving foot plantar pressures. However, most studies have focused on the position of toe rockers. The aim of this study was to assess the effect of different heel rocker apex placements on lower-limb kinetics and kinematics. METHODS: Eighteen healthy females participated in this study. Three pairs of rocker shoes with rocker apex positions anterior to the medial malleolus (shoe A), at the medial malleolus (shoe B), and posterior to the medial malleolus (shoe C) were fabricated and then compared with a flat shoe (shoe D). Kinetic and kinematic data were collected, and lower-extremity joint ranges of motion and moments were calculated. RESULTS: Ankle range of motion was increased by shoe C ( P = .04) during initial contact and by shoe A ( P = .02) during single-limb support. Peak knee moment was significantly larger for shoes A and B ( P < .05) during single-limb support. CONCLUSIONS: Results showed that forward and backward shifting of the heel rocker apex could change the knee moment and ankle joint range of motion in the stance phase of gait. Therefore, placement of the heel rocker in a rocker-bottom shoe can be manipulated to promote the desired lower-limb motion, at least in healthy individuals.