High Rate of Change of the Foot in Ecuadorian Children: The Need for Proper Shoe Design.

BACKGROUND: Physiological changes in the foot may be influenced by external factors such as shoe types or demographic parameters, leading to podiatric conditions in adulthood. The aim of this study was to assess the changes in morphological measurements of the feet of boys and girls during childhood and adolescence. METHODS: A total of 1678 Ecuadorian children aged 8 to 17 years participated in the study. The length, width, and height of the foot were analyzed using a 3D scanner to obtain the arch height ratio for the diagnosis of pediatric flat foot. RESULTS: Statistical differences were observed for lengths, widths, and perimeters of the foot in boys aged 5 to 15-16 years and girls aged 5 to 12-13 years. Differences in the height of the navicular bone were found in all age groups, with changes from 2.8 to 4.1% in boys and from 1.3 to 1.5% in girls. The greatest differences between boys and girls of the same age were found at 14 years old onwards. The highest prevalence of flat foot was found in 8-year-old girls (64.9%) and in 12-year-old boys (82.5%). CONCLUSIONS: The feet of Ecuadorian children develop progressively during childhood and adolescence. Boys presented with longer and wider feet than girls of the same age. The highest prevalence of flat foot was found in 12-year-old boys and 8-year-old girls.

Lateral wedge insoles and their use in ankle instability.

The aim of the present study is to assess the immediate effects of applying lateral wedge insoles of different heights (0.00, 0.3, 0.4, and 0.6 cm) in patients with chronic ankle instability (CAI) in normal and supinated feet during a Star Excursion Balance Test (SEBT) and in the reflex response of Peroneus Longus (PL), Peroneus Brevis (PB), and Tibialis Anterior (TA) over a 30° inversion of the feet. The effects of the height of the wedges were assessed using a double-blind, crossover design. In total, 25 participants were allocated into two groups, depending on the foot posture (Normal = 12, Supinated = 13) and performed the tests in a random fashion. Reaction time (RT) of stabilizing muscles of the ankle was measured using superficial electromyography (EMG) and postural balance with the SEBT. Foot posture did not show any significant effects on the analyzed variables. Nonetheless, the use of a 0.3 cm external rearfoot wedge (PB p = 0.002; PL p = 0.066 and TA p = 0.006) and 0.6 cm (PB p = 0.043; PL p = 0.058 and TA p = 0.071) reduces RT in stabilizing muscles of the ankle and improves results in SEBT, except for the anterolateral direction, in subjects with CAI. Therefore, our results suggest that the use of lateral wedge insoles could reduce RT and improve dynamic balance in chronic ankle instability.

Foot morphology as a predictor of hallux valgus development in children.

An excess of body weight can produce morphological changes in the feet of children. The aim of this study was to assess the morphological differences of the foot in children based on their body mass index and to determine the risk factors for the development of a hallux valgus in childhood and adolescence. One Thousand Six Hundred Seventy-Eight children (5-17 years) were classified as group with obesity, overweight, and normal weight. Lengths, widths, heights and angles of both feet was measured with a 3D scanner. The risk of developing hallux valgus was calculated. Group with overweight and obesity presented longer feet (p = 0.00), wider metatarsals (p = 0.00) and wider heels (p = 0.00). Arch height was lower (p > 0.01) in the group with obesity, and the hallux angle was greater in the group with normal weight (p < 0.05). The relative risk of a lateral hallux deviation increases with age, foot length and heel width (Exp (B) > 1). Children with overweight and obesity had longer and wider feet. The arch height was higher in children with overweight, and lower in children with obesity. Age, foot length, and heel width could be risk factors for the development of hallux valgus, while metatarsal width and arch height could be protective factors. Monitorization of the development and characterization of the foot in childhood as a clinical tool could help professionals to early identify the patients presenting risk factors and prevent future deformities and other biomechanical conditions in adulthood by implementing protecting measures.

Environmental Factors as a Cause of Differences in the Feet of Ecuadorian Children and Its Relation to Their Footwear.

The objective of this study was to analyze the differences in foot measurements of Ecuadorian children according to their geographical location of residence, taking into account climatic differences (1). A total of 1662 children (2) participated in the study. Three groups were established: coast, mountains and amazonia. The type of footwear (3) used was recorded and the lengths, widths, perimeters, heights and angles of both (4) feet were analyzed with a 3D foot digitizer (5). The variable 'fitting of the foot to footwear' was also obtained. Children living in coastal areas presented greater lengths, widths, perimeters and heights compared to those living in the mountain (p > 0.001) and amazonia (p < 0.001) between ages 5 to 13. Mountain residents showed a greater first toe angle than coast residents (p > 0.001) aged 8 to 17. Children used shoes smaller than required by their foot length (p < 0.01). Ecuadorian children from the coast presented longer and wider feet with higher foot arches, whilst those from mountains presented greater first toe angle. The studied sample used footwear up to one size smaller than the size corresponding to their foot length. The fitting and type of footwear used according to climatic differences could be interfering with normal foot development.

¿Afecta una clase de Educación Física a las dimensiones del pie de los niños? / Does a Physical Education lesson affect the foot morphology in school-aged children?

Resumen: Introducción: Analizar las variaciones que se producen en las medidas morfológicas del pie de los niños escolares, tras la realización de una clase de Educación Física. Metodología: Participaron voluntariamente 10 escolares (5 niños y 5 niñas) con una media de edad de 9.3 ± 0.5 años. Se llevó a cabo la digitalización de ambos pies de manera consecutiva, a través de un escáner en 3D modelo IFU-S-01, Japón. Se calcularon las dimensiones del pie en dos momentos diferentes, antes y después de una clase de Educación Física (pre y post ejercicio) donde se realizaron diferentes actividades que implicaban desplazamientos, saltos y amortiguaciones. Resultados: Al comparar las medidas del pie antes y después del ejercicio se observaron diferencias significativas en la altura del arco plantar, que fue mayor tras la realización de actividad física (p<0.05). El ancho del antepié presentó mayores valores tras el ejercicio sin significancia estadística (p=0.07; tamaño del efecto [ES] = 0.2). Además, se observaron correlaciones positivas entre el ancho del antepié y la altura del arco (r = 0.6; p<0.05); y negativas entre la longitud del talón a la cabeza del metatarso I y el ancho del antepié (r = - 0.7; p<0.05). Conclusiones: El tipo de actividades realizadas durante la clase de Educación Física (desplazamientos, saltos y amortiguaciones) podría causar mayor presión en la zona del antepié, provocando mayor altura del arco plantar. Los sistemas de desarrollo del calzado deportivo infantil deberían tener en cuenta tanto las longitudes del pie, cómo sus anchuras y alturas, para un mejor ajuste del zapato, previniendo lesiones osteomusculares futuras.

Abstract: Background: To analyze the changes in foot morphology in school-age children, after a Physical Education lesson. Methods: A total of 10 school-age children (5 girls and 5 boys) were recruited with a mean age of 9.3 ± 0.5 years that voluntary participated in this study. Measurements of both feet were obtained using a 3D foot digitizer model IFU-S-01 (Japan) in two different moments, before and after a physical education lesson (per-exercise and post-exercise), where different activities involving displacements, jumps and landings were performed. Results: By comparing foot morphology before and after exercise, significant differences in the arch height were found, which increased after exercise (p<0.05). The ball width shows greater changes after exercise but without significant differences (p= 0.07; effect size [ES] = 0.2). Furthermore, a positive correlation between the ball width and the arch height (p<0.05) and negative correlation between the distance from the heel to the first metatarsal and the ball width (r = - 0.7; p<0.05), were observed. Conclusions: The type of activities undertaken during physical education lesson (displacements, jumps and landings) increased the pressure on the forefoot, which would lead to a lager arch height. Development of children's sport footwear systems should take into account the foot lengths, widths and heights, for a better fit, preventing future musculoskeletal injuries.

[Does a Physical Education lesson affect the foot morphology in school-aged children?] / ¿Afecta una clase de Educación Física a las dimensiones del pie de los niños?

BACKGROUND: To analyze the changes in foot morphology in school-age children, after a Physical Education lesson. METHODS: A total of 10 school-age children (5 girls and 5 boys) were recruited with a mean age of 9.3 ± 0.5 years that voluntary participated in this study. Measurements of both feet were obtained using a 3D foot digitizer model IFU-S-01 (Japan) in two different moments, before and after a physical education lesson (per-exercise and post-exercise), where different activities involving displacements, jumps and landings were performed. RESULTS: By comparing foot morphology before and after exercise, significant differences in the arch height were found, which increased after exercise (p<0.05). The ball width shows greater changes after exercise but without significant differences (p= 0.07; effect size [ES] = 0.2). Furthermore, a positive correlation between the ball width and the arch height (p<0.05) and negative correlation between the distance from the heel to the first metatarsal and the ball width (r = - 0.7; p<0.05), were observed. CONCLUSIONS: The type of activities undertaken during physical education lesson (displacements, jumps and landings) increased the pressure on the forefoot, which would lead to a lager arch height. Development of children's sport footwear systems should take into account the foot lengths, widths and heights, for a better fit, preventing future musculoskeletal injuries.

Diferencias de comportamiento del tobillo funcionalmente recuperado en test de salto monopodales / Behavioral differences of functional ankle sprain recoveries during single-leg jump test

Objetivo: Analizar las diferencias en las fuerzas de reacción verticales intra-sujeto entre una extremidad que presentó signo de bostezo articular en el tobillo frente a la extremidad sin bostezo. Métodos: Participaron 18 sujetos voluntarios (8 mujeres y 10 hombres), físicamente activos, con una media de edad, de20,4 ± 1,9 años. Con una plataforma de fuerzas se midieron las fuerzas de reacción verticales, el tiempo de estabilización yel desplazamiento del centro de presiones en las caídas y estabilización de 3 test de salto en apoyo monopodal: salto hacia delante, salto lateral desde un escalón y saltos laterales continuos. Resultados: En el test de salto hacia delante la extremidad sin bostezo presento un 2º pico de fuerza mayor (bostezo =1142,08 ± 242,50 N; no bostezo = 1213,39 ± 299,89 N) (p<0,05). El tiempo de estabilización en el eje medio-lateral fue mayor en la extremidad con bostezo en el test de caída lateral desde un escalón (bostezo = 12.83 ± 1,77 s; no bostezo = 11,42 ± 2,14 s) (p<0,05). Conclusiones: La extremidad con bostezo presentó menores impactos verticales en el segundo pico de fuerza en la caída del test de salto hacia delante, compatible con una mayor amortiguación que pudiera obedecer a un mecanismo de protección. Se vieron aumentos en el tiempo de estabilización en el test de caída lateral desde un escalón en los tobillos que habían padecido esguince. No obstante no se observaron incrementos en las áreas barridas por el centro de presiones en ninguno de los tests. Los tests dinámicos funcionales son capaces de detectar déficits en los ejes específicos en los que se realiza el test y detectar déficits tras un esguince (AU)

Objective: To analyze within subject differences in ground reaction forces. The tests were carried out by comparing the ankle with a previous lateral ligament injury (with permanent ligament loosening) and the one without ligament loosening. Material and methods: Eighteen volunteers were recruited for the study (8 women and 10 men), all of them physically active, with a mean age of 20.4 ± 1.9. The vertical ground reaction forces, the time of stabilization and the path of the center of pressures were measured during the landing and posterior stabilization in 3 single-leg jump tests on a force platform: jump landing test, lateral drop jump test and side hop test. Results: The second peak of the vertical force were greater in the uninjured limb during the jump landing test (injured= 1142.08 ± 242.50 N; uninjured = 1213.39 ± 299.89 N) (p<0.05). The medio-lateral time of stabilization was greater in the uninjured limb during the lateral drop jump test (injured = 12.83 ± 1.77 s; uninjured = 11.42 ± 2.14 s) (p<0.05).Conclusions: The injured limb presented lower vertical impact at the second peak force during the jump landing test, compatible with a softly landing which could be a defense mechanics. The injured limb showed an increased in the time of stabilization during the lateral drop jump test. However, there were no changes in any of the 3 tests in the excursion area of the center of pressure. The dynamic functional tests are useful to detect deficits in the specific axis where the tests are performed, as well as deficits after and an ankle injury (AU)

La estimulación eléctrica neuromuscular del tibial anterior vs superficie viscoelástica en la reeducación de la propiocepción del tobillo. Un estudio piloto / Neuromuscular electrical stimulation on the tibialis anterior vs viscoelastic surface in the re-education of ankle proprioception. A pilot study

Objetivo: Analizar las diferencias en el recorrido del centro de presiones durante la realizaciónde 3 tests de equilibrio estáticos, en que se incluyen dos de las técnicas usadas en lostratamientos de la rehabilitación del esguince de tobillo.Material y método: Participaron voluntariamente 14 sujetos sanos, sin signo de bostezo articular(8 hombres y 6 mujeres), deportistas, con una media de edad de 19,9±3,8 años. Se midióel recorrido del centro de presiones durante tests de equilibrio monopodal sobre plataformade fuerzas (duración de 60 s), en tres condiciones: sobre superficie estable (plataforma), sobresuperficie viscoelástica, y aplicando estimulación eléctrica neuromuscular en el músculo tibialanterior.Resultados: La amplitud de desplazamiento del centro de presiones en el eje anteroposteriorfue mayor en el test con estimulación eléctrica neuromuscular que en el realizado sobre superficieestable (p < 0,01) y viscoelástica (p < 0,05). La posición media del centro de presiones sesituó más lateral (53,00±7,60mm) y anterior (128,40±10,70mm) en el test sobre superficieviscoelástica. Las mayores áreas barridas por el centro de presiones se obtuvieron en el testcon estimulación eléctrica neuromuscular (1.115,96±411,40mm2).Conclusiones: Con la electroestimulación se obtuvieron mayores amplitudes de desplazamientodel centro de presiones en el eje anteroposterior, una posición media más retrasada, y mayoresáreas barridas. Con la superficie viscoelástica se obtuvo un mayor recorrido y velocidad, y unaposición media del centro de presiones más lateral(AU)

Objective: To analyse the differences in the path of the centre of pressures during the performanceof 3 static balance tests, which included two of the techniques used in the rehabilitationof ankle sprain rehabilitation.Material and method: Fourteen healthy subjects, without ligament loosening in the ankle wererecruited for the study (8 male and 6 female) voluntary participated in this study, all of themphysically active, with a mean age of 19.9±3.8 years. The path of the centre of pressures wasmeasured during monopodal balance tests on a force platform (60 s last), in three different conditions:on stable surface (force platform), on a viscoelastic surface, and during the applicationof electrical stimulation on the tibialis anterior muscle.Results: The anterior-posterior path of the centre of pressures was greater in the test with electricalstimulation than in the tests on the stable surface (P < .01), and on the viscoelastic surface(P < .05).The mean position of the centre of pressures was more lateral (53.00±7.60mm) andmore posterior (128.40±10,70mm) in the test on the viscoelastic surface. The greatest excursionareas of the centre of pressures were found in the test with neuromuscular electricalstimulation (1115.96±411.40mm2).Conclusions: Greater anterior-posterior path length and excursion areas and a more posteriormean position of the centre of pressures were found in the neuromuscular electrical stimulationtest. We also found greater total excursions and velocity, and a more lateral mean position ofthe centre of pressures in the viscoelastic surface tests(AU)

Revisión de las repercusiones de los esguinces de tobillo sobre el equilibrio postural / Review of the repercussions of ankle sprains on postural balance

El esguince lateral de tobillo es una de las lesiones más comunes ocurridas en deporte, pudiendo afectar a diferentes componentes del control postural. Esta revisión bibliográfica analiza los estudios en los que se evalúa el control postural a partir de tests de equilibrio estático, dinámico y dinámico funcional en personas que han sufrido un esguince y personascon tobillos sanos utilizando metodologías cuantitativas. Los tobillos lesionados presentan mayores rangos de desplazamiento del centro de presiones y mayores tiempos de latencia de la musculatura. También presentan mayores tiempos de estabilización en el eje anteroposterior y menor alcance en las posiciones extremas que puede adoptar el centro de presiones. Sin embargo, algunos de los trabajos encontrados usan métodos poco objetivos en la selección de los sujetos con esguince de tobillo y otros utilizan tests y variables poco sensibles para el estudio de las secuelas de déficits de control postural después de un esguince(AU)

The lateral ankle sprain is one of the most common injuries in sports and can affectdifferent components of postural control. This literature review analyses the studies that evaluatethe postural control through static balance tests, dynamic balance tests and dynamicbalance functional tests in subjects who have suffered an ankle sprain and healthy subjectsusing quantitative methods.Injured ankles lead to a greater total path of the centre of pressure and an increased musclelatency time. Furthermore, the antero-posterior time of stabilisation increases and decreasesthe reach distance that can be taken by the centres of pressure. However, in some of the studiesfound, less objective methods are used in the selection of the subjects with an ankle sprain, and in others, non-sensitive tests and variables are used to study the consequences of posturalcontrol deficits after an ankle sprain(AU)

Diferencias en test de equilibrio estático entre las extremidades con y sin bostezo articular de tobillo / Between limb differences during static balance tests with and without permanent ligament loosening

ObjetivoAnalizar las diferencias intrasujeto entre una extremidad que presentó signo de bostezo articular en el tobillo, fruto de una lesión previa de esguince lateral, frente a una extremidad sin bostezo.Material y métodosTomaron parte en el estudio 14 sujetos voluntarios (6 mujeres y 8 hombres), deportistas, con una media de edad de 19,9±3,8 años. Se midió el rango de movimiento del tobillo de manera estática y pasiva, y el desplazamiento del centro de presiones durante un test de equilibrio monopodal sobre una plataforma de fuerzas (duración de 60s), en tres condiciones: sobre plataforma, sobre espuma y aplicando estimulación eléctrica neuromuscular en el músculo tibial anterior.ResultadosEl rango de desplazamiento del centro de presiones en el eje anteroposterior fue mayor en la extremidad con bostezo en el test sobre espuma (bostezo=60,9±14,3mm; sin bostezo=51,8±9,5mm) (p<0,05). La posición media del centro de presiones de la extremidad con bostezo se situó significativamente más medial en los 3 test (p<0,05) y más posterior en el test con espuma (p<0,01). En el test con electroestimulación, el recorrido total (bostezo=3.097,4±899,3mm; sin bostezo=3.329,3±996,6mm) y la velocidad media (bostezo=51,6±15,1mm/s; sin bostezo=55,1±17,0mm/s) fueron mayores en la extremidad sin bostezo (p<0,05).ConclusiónAl aumentar la dificultad de los test, aumentaron las diferencias entre ambas extremidades. La extremidad con bostezo modificó la posición del centro de presiones situándolo de forma más medial y posterior(AU)

ObjectiveThe purpose of this study was to analyse within subject differences in a number of static balance tests, performed during monopodal stance.Material and methodsThe tests were carried out comparing the ankle with a previous lateral ligament injury (with permanent ligament loosening) and the one without ligament loosening. Fourteen volunteer subjects were recruited for the study (6 women and 8 men), all of them physically active, with a mean age of 19.9±3.8 years. The measurements included the ankle range of motion (static and passive), and the path of the centre of pressures during a monopodal balance test on a force platform (60s last), in three different conditions: on the platform, on a foam pad and during the application of electrical stimulation on the tibialis anterior muscle. All the measurements and tests were applied on both legs, injured and uninjured.ResultsThe anterio-posterior path of the centre of pressures was greater in the previously injured limb in the test on the foam pad (injured=60.9±14.3mm; uninjured=51.8±9.5mm) (p<0.05). The mean position of the centre of pressures in the injured limb was more medial during the three tests (p<0.05) and more posterior in the test on the foam pad (p<0.01). In the test with electrical stimulation, the total path of the centre of pressures (injured=3097.4±899.3mm; uninjured=3329.3±996.6mm) and its average velocity (injured=51.6±15.1mm/s; uninjured=55.1±17.0mm/s) were significantly greater in the uninjured limb (p<0.05).ConclusionsWhen the tests became more challenging, the differences between injured and uninjured limbs were greater. The position of the injured extremity was more medial and posterior during the static tests(AU)

¿Afecta el sobrepeso a la huella plantar y al equilibrio de niños en edad escolar? / Does overweight affect the footprint and balance in school-aged children?

ObjetivosEl propósito de este estudio ha sido analizar en escolares de primaria las posibles diferencias en la capacidad de equilibrio y en la huella plantar según el sexo y el nivel de sobrepeso.Material y métodosSe estudiaron 26 escolares (edad=11,6±0,5 años), 15 niñas y 11 niños de 6.o curso de primaria. Se analizaron las áreas de sus huellas plantares, las presiones plantares medias y el equilibrio. Se empleó revelador, fijador, papel fotográfico y una plataforma de fuerzas.ResultadosDentro del grupo de las niñas, al comparar los subgrupos con sobrepeso y sin sobrepeso, se observaron mayores Arch Index (p=0,06; tamaño del efecto [ES]=1) y áreas de la huella plantar en las que tenían sobrepeso. En el área barrida en el test de apoyo monopodal, los subgrupos con sobrepeso obtuvieron mayores recorridos, sin significación estadística pero con ES grandes (niños con sobrepeso=225,71mm2 y sin sobrepeso=163,77mm2; niñas con sobrepeso=157,74mm2 y sin sobrepeso=83,52mm2; ES=0,86 y 0,74, respectivamente). No se encontraron diferencias en el test de ajuste postural entre sujetos con y sin sobrepeso.ConclusionesLas niñas con sobrepeso han mostrado alteraciones en la huella plantar, tendiendo a tener pies planos. En los test de equilibrio sólo se encontraron diferencias significativas entre los grupos niños y niñas, aunque la significación práctica de las diferencias entre los grupos con y sin sobrepeso apuntan a un peor rendimiento en niños y niñas con sobrepeso(AU)

PurposesThis study aimed to analyze the differences in the footprint and balance performance in school-aged children, with and without overweight.Material and methodsTwenty six school aged children, (age=11.6±0.5 years), 15 girls and 11 boys participated in the study. Their footprints, average plantar pressures and their balance performance were analyzed with photograph developer, fixer, photo paper and a force platform.ResultsThe girls with overweight showed greater Arch Index (p=0.06, effect size (es)=1) and footprint areas than their normalweight counterparts. The area covered by the center of pressure during the single-leg balance test was greater in the overweight groups (overweight boys=225.71mm2; normalweight boys=163.77mm2; overweight girls=157.74mm2; normalweight girls=83.52mm2; ES=0.86 and 0.74, respectively). There were no differences between overweight and normalweight subjects in the postural sway test.ConclusionsOverweight girls showed flatter feet than the normalweight ones. In the balance tests, only appeared statistically significant differences between boys and girls, although the practical significance of the differences between overweight and normalweight groups point to a lower balance performance in overweight children(AU)