Comparison between the plantar pressure effects of toe separators and insoles in patients with hallux valgus at a one-month follow-up.

BACKGROUND: Various designs of foot orthoses for hallux valgus have been developed to reduce foot pain. The plantar pressure assessment can determine the better intervention. This study aimed to compare the effectiveness of plantar pressure distribution in patients with hallux valgus during walking with toe separator and insole. METHOD: Patients with hallux valgus were randomized into one of two interventions: prefabricated toe separator or customized insole. The plantar pressure distribution of the participants was measured during walking with the devices after use for one month with an in-shoe measurement system. RESULTS: Twenty-three participants were analyzed. After 1-month, significant peak pressures and pressure-time integral reductions were observed during walking in the middle forefoot (64.28 kPa and 28.97 kPa s, respectively) and lateral forefoot regions (54.03 kPa and 22.30 kPa s, respectively) after insole use compared with a toe separator. CONCLUSIONS: After one month of use, the customized insole was more effective in plantar pressure reduction than the toe separator for a hallux deformity.

The insole materials influence the plantar pressure distributions in diabetic foot with neuropathy during different walking activities.

BACKGROUND: Abnormal peak plantar pressure in neuropathic diabetic foot during walking activities is well managed through the use of appropriate design and material selection for the fabrication of custom made insoles (CMI). The redistribution of plantar pressure is possible by selecting an appropriate material for the fabrication of CMI. The walking activities may alter the plantar pressure distribution; which may differ while using CMI with different materials. OBJECTIVE: The objective of the study was to evaluate the effectiveness of CMI's materials on plantar pressure distribution during different walking activities, in diabetic feet with neuropathy. METHODS: The study was conducted on sixteen diabetic neuropathic subjects. The subjects were provided with two types of CMI; CMI-A (Plastazote® and microcellular rubber) and CMI-B (Multifoam, Plastazote® and microcellular rubber). Maximum peak plantar pressure and plantar pressure distribution were determined by Pedar-X® sensor insole during level walking, ramp walking and stair walking. RESULTS: The CMI-B lessened the maximum peak plantar pressure from the forefoot throughout the walking activities compared to CMI-A. The contact area was observed as lower using CMI-A compared to CMI-B, while performing walking activities. CONCLUSION: CMI-B, with multifoam as an additional top layer, provided more effective peak plantar pressure reduction at forefoot and it had better plantar pressure distribution compared to CMI-A during level walking and ramp ascending in diabetic foot with neuropathy.

Effect of total-contact orthosis on medial longitudinal arch and lower extremities in flexible flatfoot subjects during walking.

BACKGROUND: Total-contact orthosis (TCO) is one kind of foot orthosis (FO) that is used to adjust biomechanics in flexible flatfoot. OBJECTIVE: To determine the effects of a TCO on the MLA moment, MLA deformation angle and lower limb biomechanics. STUDY DESIGN: Cross-sectional study. METHODS: Seven-flatfoot and thirteen-normal foot subjects were recruited by footprint and radiographs. The biomechanics of subjects with normal foot (NF), flatfoot with shoe only (FWOT) and flatfoot with TCO (FWT) were collected in a 3D motion analysis laboratory and force plates. The MLA and lower limb biomechanics in each condition during specific sub-phases of stance were analyzed. RESULTS: The NF had larger MLA eversion moment after shod walking ( p = 0.001). The FWT condition compared with the FWOT condition had a significantly larger peak MLA upward moment ( p = 0.035) during pre-swing, larger peak knee external rotation angle ( p = 0.040) during mid stance, smaller peak knee extension moment during terminal stance ( p = 0.035) and a larger ground reaction force in the anterior-posterior direction during early stance ( p < 0.05). CONCLUSION: Our study found positive effects from the customized TCOs which included an increased TCO angle that led to a decreased peak MLA moment in the frontal plane in flexible flatfoot subjects during walking. Clinical relevance Lower limb biomechanics is different from normal in subjects with flexible flatfoot. The design of a TCO affects MLA, ankle and knee biomechanics and may be used to clinically correct biomechanical changes in flexible flatfoot.

Effectiveness of Total Contact Orthosis for Plantar Pressure Redistribution in Neuropathic Diabetic Patients During Different Walking Activities.

BACKGROUND: Using a total contact orthosis (TCO) is an effective method to offload in diabetic patients with foot neuropathy. However, the redistribution of peak plantar pressure is mostly observed during level walking, which may differ from other walking activities. The aim of this study was to investigate the plantar pressure from 4 regions of the foot during different walking activities (level walking, ramp ascending, ramp descending, stair ascending, and stair descending) in neuropathic diabetic patients with and without a TCO. METHODS: Sixteen neuropathic diabetic patients aged 40 to 60 years with calluses and hallux valgus were included in this study and were provided with TCOs made up of multifoam, Plastazote, and microcellular rubber. The plantar pressure and contact area with the TCO and without the TCO were recorded using the Pedar X system during different walking activities. RESULTS: A significant reduction of plantar pressure during different walking activities at the toes and forefoot regions was observed while walking with the TCO compared with walking without the TCO (control condition). Plantar pressure increased at the midfoot region when walking with the TCO, and no significant difference was observed at the hindfoot region between the control and TCO conditions. Furthermore, maximum contact area was observed during level walking with the TCO compared with other walking activities. CONCLUSION: The TCO significantly reduced and redistributed the peak plantar pressure from the sites where the ulceration rate is higher at the toes and forefoot compared with the other regions of the foot. LEVEL OF EVIDENCE: Therapeutic level II, lesser quality randomized controlled trial.

Assessing Caregiver Burden and Relationship between Caregiver Burden and Basic Activities of Daily Living in Stroke Patients with Spasticity.

Objective: To evaluate caregiver burden of stroke patients with spasticity and to study the relationship between the caregiver burden and the ability to perform basic activities of daily living (bADL) of these patients. Material and Method: The study design was a cross-sectional descriptive research. The demographic data of 52 stroke patients with spasticity and their caregivers at Songklanagarind Hospital in Thailand were recorded. The Zarit Burden Interview (ZBI) in the Thai version measured the caregiver burdens. The modified Barthel Index (BI) evaluated the bADL of the patients. The correlation between the ZBI and modified BI were calculated by The Spearman's rank correlation coefficient (rs) with p<0.05 considered as a significant level. Results: The caregivers were mainly female (80.8%) who felt no burden (57%). The ZBI score did not significantly relate to the modified BI in either the activity or total score. However, the ZBI score was significantly associated to the caring hours per day (median 14 hours/day, rs = 0.37, p = 0.007) and left hemiparesis (p = 0.03). Conclusion: Most caregivers realized that stroke survivors with spasticity were not a burden. There was no relationship between the caregiver burden and the bADL of the patients, but the burden was related to daily caregiving hours and stroke that affected the left side of the body.

Medial longitudinal arch biomechanics evaluation during gait in subjects with flexible flatfoot.

PURPOSE: Medial longitudinal arch (MLA) strengthening has been considered an important part of successful flatfoot treatment. But, to date, the biomechanical loading behavior of the medial arch in flatfoot has not been evaluated. This study aimed to evaluate the MLA moment, MLA deformation angle, foot kinematics and ground reaction forces (GRF) in both normal foot and flatfoot groups. METHODS: Each participant's foot was classified according to arch type using foot prints and radiographs. Twenty-eight non-obese adults (13 flatfeet and 15 normal feet) were involved. The biomechanics data were collected in a 3D motion analysis laboratory. The MLA biomechanics were calculated. Hindfoot and forefoot kinematics were also analyzed. RESULTS: The flatfoot group had a significantly greater peak eversion MLA moment (p = 0.005) and a smaller peak MLA deformation angle (p < 0.05) during specific subphases. The peak of hindfoot plantarflexion (p < 0.05) and internal rotation (p < 0.05) and the peak of forefoot abduction ( p < 0.05) in the specific subphases were greater in the flatfoot group. The flatfoot group also had significantly smaller peak vertical GRF ( p < 0.05) during late stance and larger peak medial GRF (p < 0.05) during mid stance. CONCLUSIONS: This study found a significantly greater eversion deforming force acting at the MLA structure, greater hindfoot and forefoot motion, less MLA flexibility and abnormal GRF in a flatfoot group during walking, which reflected the deficit of foot function in a flatfoot group.

Associations of intracompartmental leg pressures and radiographic findings in congenital talipes equinovarus.

The etiopathogenesis of congenital talipes equinovarus remains mysterious. The authors investigated the role of increased intracompartmental leg pressures as a causal relationship with this deformity by measuring the pressures in 25 children aged between 6 months and 1 year with unilateral talipes equinivarus before surgical release. The deep posterior intracompartmental pressure in the leg with talipes equinovarus was greater than the other compartments, and the deep and superficial posterior intracompartmental pressures were also significantly higher than those of the contralateral normal sides (p < 0.05). There were linear correlations between the posterior intracompartmental pressure of affected legs and the Kite index, tibiocalcaneal angle and talo-first metatarsal angle of the affected legs. Deep posterior intracompartmental pressure is a strong predictor of abnormality in the Kite index. The present study showed a probable causal relationship between increased deep posterior intracompartmental pressure and etiopathogenesis of talipes equinovarus.

Clinical abnormalities, intervention program, and school attendance of Down syndrome children in southern Thailand.

BACKGROUND: Down syndrome is the most common chromosomal abnormality with an incidence of 1:700 livebirths. In southern Thailand, most Down syndrome patients are referred to Songklanagarind Hospital for surgical, medical treatment and/or stimulation intervention. OBJECTIVE: To study the clinical features and school attendance of Down syndrome children. MATERIAL AND METHOD: A total of 295 Down syndrome children attended Songklanagarind Hospital. The clinical features of Down syndrome, percentage of children receiving the stimulation intervention program, and attending school were studied. RESULTS: Congenital heart disease was found in 38.6%, gastrointestinal anomalies 16.9%, hematologic malignancy 6.1%, and thyroid disorders 11.4%. The mortality rate of Down syndrome children was 13.2%. Most children (65.6%) received the early stimulation, but only 38.9% attended the speech intervention program within the first 2 years of life. Of the total 109 Down syndrome children aged over 5 years that are still being followed, only 74 (67.9%) attended school. The school attendance was correlated with the family income, but not correlated with the level of maternal or paternal education. CONCLUSION: Congenital heart disease and gastrointestinal anomalies are commonly found in Down syndrome children. Most children received an early intervention program, but only 38.9% received speech intervention. In children aged >5 years, only 68% attended school, and school attendance was correlated with the family income.