Maria Auhl

Biomechanical Effects of Prefabricated Foot Orthoses and Rocker-Sole Footwear in Individuals With First Metatarsophalangeal Joint Osteoarthritis

To evaluate the effects of prefabricated foot orthoses and rocker‐sole footwear on spatiotemporal parameters, hip and knee kinematics, and plantar pressures in people with first metatarsophalangeal (MTP) joint osteoarthritis (OA). Methods. A total of 102 people with first MTP joint OA were randomly allocated to receive prefabricated foot orthoses or rocker‐sole footwear. The immediate biomechanical effects of the interventions (compared to usual footwear) were examined using a wearable sensor motion analysis system and an in‐shoe plantar pressure measurement system.

Effectiveness of Foot Orthoses Versus Rocker-Sole Footwear for First Metatarsophalangeal Joint Osteoarthritis: Randomized Trial

To compare the effectiveness of prefabricated foot orthoses to rocker‐sole footwear in reducing foot pain in people with first metatarsophalangeal (MTP) joint osteoarthritis (OA).

Effectiveness of Off-the-Shelf, Extra-Depth Footwear in Reducing Foot Pain in Older People: A Randomized Controlled Trial

BACKGROUND Foot pain is highly prevalent in older people and in many cases is associated with inappropriate footwear. This study evaluated the effectiveness of off-the-shelf, extra-depth footwear in reducing foot pain. METHODS Community-dwelling older people with disabling foot pain (72 men and 48 women aged 65 to 96 years; mean age 82 [SD 8]) were randomly allocated to an intervention group (n = 59) or control group (n = 61). The intervention group was provided with off-the-shelf, extra-depth footwear. Participants in the control group received their footwear at the completion of the study. Both groups continued to receive usual podiatry care for the study period. The primary outcome measure was the Foot Health Status Questionnaire (FHSQ), measured at baseline and 16 weeks. RESULTS There was a significant improvement in the FHSQ pain domain (ANCOVA-adjusted mean difference 11.5 points, 95% confidence interval 4.2 to 18.8, p = .002) and FHSQ function domain (10.0 points, 0.9 to 19.1, p = .032) in the intervention group compared to the control group. The intervention group also developed fewer keratotic lesions (mean difference -1.4, -2.5 to -0.2, p = .021), were less likely to report the use of co-interventions (relative risk [RR] 0.74, 0.56 to 0.98, p = .026) and were more likely to report that their foot pain had moderately or markedly improved during the study (RR = 7.93, 2.51 to 25.00, p < .001; number needed to treat = 3, 2 to 5). CONCLUSIONS Off-the-shelf, extra-depth footwear significantly reduces foot pain, improves foot function and is associated with the development of fewer keratotic lesions in older people.

The effect of Masai Barefoot Technology (MBT) footwear on lower limb biomechanics: A systematic review

This systematic review evaluated the available evidence for the effects of Masai Barefoot Technology (MBT) footwear on lower limb biomechanics during gait. Electronic databases (MEDLINE, EMBASE, CINAHL, SPORTDiscus, and PubMed) were searched in January 2015. Methodological quality of included studies was evaluated using the Quality Index. Standardised mean differences and 95% confidence intervals were calculated, and meta-analysis was conducted where possible. 17 studies satisfied the inclusion criteria; 16 cross-sectional studies and one randomised control trial (RCT). Quality Index scores ranged from 7 to 12 (out of 15). All 17 studies investigated walking gait only. Evidence showed that MBT footwear caused asymptomatic individuals to walk with a shorter stride length, reduced peak hip flexion, increased peak knee extension, and reduced hip and knee range of motion throughout gait. All kinematic effects occurred in the sagittal plane. There was a trend towards a decrease in internal and external joint moments and power, except for the foot, where increases in force were observed. There were only a small number of changes to lower limb muscle amplitude and timing. No statistically significant effects were observed in symptomatic individuals with knee osteoarthritis or following total knee replacement, but there was an increase in cadence and a decrease in step length in individuals following tibiotalar arthrodesis. These findings suggest that MBT footwear does change lower limb biomechanics in both asymptomatic and symptomatic individuals during gait. However, further clinical trials need to be undertaken to determine whether these changes are therapeutically beneficial.

Rocker-sole footwear versus prefabricated foot orthoses for the treatment of pain associated with first metatarsophalangeal joint osteoarthritis: study protocol for a randomised trial

BackgroundOsteoarthritis affecting the first metatarsophalangeal joint of the foot is a common condition which results in pain, stiffness and impaired ambulation. Footwear modifications and foot orthoses are widely used in clinical practice to treat this condition, but their effectiveness has not been rigorously evaluated. This article describes the design of a randomised trial comparing the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with first metatarsophalangeal joint osteoarthritis.MethodsEighty people with first metatarsophalangeal joint osteoarthritis will be randomly allocated to receive either a pair of rocker-sole shoes (MBT® Matwa, Masai Barefoot Technology, Switzerland) or a pair of individualised, prefabricated foot orthoses (Vasyli Customs, Vasyli Medical™, Queensland, Australia). At baseline, the biomechanical effects of the interventions will be examined using a wireless wearable sensor motion analysis system (LEGSys™, BioSensics, Boston, MA, USA) and an in-shoe plantar pressure system (Pedar®, Novel GmbH, Munich, Germany). The primary outcome measure will be the pain subscale of the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8 and 12 weeks. Secondary outcome measures will include the function, footwear and general foot health subscales of the FHSQ, severity of pain and stiffness at the first metatarsophalangeal joint (measured using 100 mm visual analog scales), global change in symptoms (using a 15-point Likert scale), health status (using the Short-Form-12® Version 2.0 questionnaire), use of rescue medication and co-interventions to relieve pain, the frequency and type of self-reported adverse events and physical activity levels (using the Incidental and Planned Activity Questionnaire). Data will be analysed using the intention to treat principle.DiscussionThis study is the first randomised trial to compare the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with osteoarthritis of the first metatarsophalangeal joint, and only the third randomised trial ever conducted for this condition. The study has been pragmatically designed to ensure that the findings can be implemented into clinical practice if the interventions are found to be effective, and the baseline biomechanical analysis will provide useful insights into their mechanism of action.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12613001245785

Comparison of the responsiveness of the Foot Health Status Questionnaire and the Manchester Foot Pain and Disability Index in older people

BackgroundIn recent years, several questionnaires have been developed for the assessment of foot health and its impact on quality of life. In order for these tools to be useful outcome measures in clinical trials, their ability to detect change over time (responsiveness) needs to be determined. Therefore, the aim of this study was to assess the responsiveness of two commonly-used questionnaires in older people with foot pain.MethodsParticipants (n = 59; 24 women and 35 men, mean age [SD] 82.3 [7.8] years) allocated to the intervention arm of a randomised controlled trial assessing the effectiveness of extra-depth footwear compared to usual care completed the Foot Health Status Questionnaire (FHSQ) and Manchester Foot Pain and Disability Index (MFPDI) at baseline and 16 weeks. Responsiveness of the FHSQ subscales (pain, function, footwear and general foot health) and MFPDI subscales (pain, functional limitation and concern about appearance) was determined using (i) paired t-tests, (ii) Cohens d, (iii) the standardised response mean (SRM), and (iv) the Guyatt index.ResultsOverall, the FHSQ pain subscale exhibited the highest responsiveness, as evidenced by a highly significant paired t-test (p <0.001), Cohens d = 0.63 (medium effect size), SRM = 0.50 (medium effect size) and Guyatt index = 1.70 (huge effect size). The next most responsive measure was the FHSQ function subscale, as evidenced by a borderline paired t-test (p = 0.050), Cohens d = 0.37 (small effect size), SRM = 0.26 (small effect size) and GI = 1.22 (very large effect size). The FHSQ footwear, FHSQ general foot health and MFPDI pain, functional limitation and concern about appearance subscales demonstrated lower responsiveness, with negligible to medium effect sizes.ConclusionThe FHSQ pain and function subscales were most responsive to change in older people with foot pain receiving a footwear intervention. These findings provide useful information to guide researchers in selecting appropriate outcome measures for use in future clinical trials of foot disorders.

Effects of Indoor Footwear on Balance and Gait Patterns in Community-Dwelling Older Women.

Background: Footwear worn indoors is generally less supportive than outdoor footwear and may increase the risk of falls. Objective: To evaluate balance ability and gait patterns in older women while wearing different styles of indoor footwear: a backless slipper and an enclosed slipper designed to optimise balance. Methods: Older women (n = 30) aged 65-83 years (mean 74.4, SD 5.6) performed a series of laboratory tests of balance ability (postural sway, limits of stability, and tandem walking, measured with the NeuroCom® Balance Master) and gait patterns (walking speed, cadence, and step length, measured with the GAITRite® walkway) while wearing (1) socks, (2) backless slippers with a soft sole, and (3) enclosed slippers with a firm sole and Velcro® fastening. Perceptions of the footwear were also documented using a structured questionnaire. Results: Significant overall effects of footwear were observed for postural sway, the limits of stability test (directional control), the tandem walk test (step width and end sway), and temporospatial gait patterns (walking speed, cadence, and step length). No footwear effects were observed for maximum excursion when performing the limits of stability test or for speed when performing the tandem walk test. Post hoc tests indicated that performances were best while wearing the enclosed slippers, intermediate with socks, and worst with backless slippers. The enclosed slippers were perceived to be more attractive, comfortable, and well fitted, but heavier than the backless slippers. Most participants (n = 23; 77%) reported that they would consider wearing the enclosed slippers to reduce their risk of falling. Conclusion: Indoor footwear with an enclosed heel, Velcro® fastening, and a firm sole optimises balance and gait compared to backless slippers, and is therefore recommended to reduce the risk of falling.

Foot problems as a risk factor for falls in community-dwelling older people: A systematic review and meta-analysis

BACKGROUND Foot problems are common in older people. The objective of this systematic review was to determine whether foot problems increase the risk of falling in community-dwelling older people. METHODS Electronic databases were searched from inception to May 2018. To be eligible for inclusion, papers needed to (i) include community-dwelling older participants, (ii) document falls either retrospectively or prospectively, and (iii) document or assess the presence of foot problems. Screening and data extraction were performed by two independent assessors, with disagreements resolved by consensus. RESULTS A total of 146 papers were screened by title and abstract, and nine met the inclusion criteria. An additional six eligible papers were identified by searching the reference lists of included papers, resulting in a total of 15 papers. Quantitative synthesis indicated that older people who fell were more likely to have foot pain, hallux valgus, lesser toe deformity, plantar fasciitis, reduced ankle dorsiflexion range of motion, reduced toe plantarflexion strength, impaired tactile sensitivity and increased plantar pressures when walking. Meta-analysis indicated that fallers were more likely to have foot pain (pooled odds ratio [OR] 1.95, 95% CI 1.38-2.76, p < 0.001), hallux valgus (pooled OR 1.89, 95% CI 1.19-3.00, p = 0.007) and lesser toe deformity (pooled OR 1.67, 95% CI 1.07-2.59, p = 0.020). CONCLUSION Foot problems, particularly foot pain, hallux valgus and lesser toe deformity, are associated with falls in older people. Documentation of foot problems and referral to foot care specialists should therefore be a routine component of falls risk assessment and prevention.

Centre of pressure characteristics during walking in individuals with and without first metatarsophalangeal joint osteoarthritis

OBJECTIVE The objective of this study was to compare centre of pressure characteristics during walking in individuals with and without first metatarsophalangeal joint osteoarthritis (1st MTPJ OA), in order to provide insights into alterations in foot function associated with this condition. METHODS Twenty people with 1st MTPJ OA and 20 asymptomatic controls matched for age, sex and body mass index underwent gait analysis using the emed®-x400 plantar pressure system (Novel GmbH, Germany). Average and maximum centre of pressure velocity and lateral-medial force index during loading, midstance, terminal stance and preswing were compared between the groups. RESULTS During the preswing phase of gait, maximum centre of pressure velocity was significantly slower in individuals with 1st MTPJ OA (0.78 ± 0.19 vs 1.13 ± 0.36 m/sec; p = 0.003), and both average and maximum lateral-medial force indices were significantly higher in individuals with 1st MTPJ OA (0.98 ± 0.14 vs 0.82 ± 0.13; p < 0.001 and 1.37 ± 0.29 vs 1.15 ± 0.15; p = 0.008, respectively). Non-weightbearing 1st MTPJ dorsiflexion range of motion was significantly associated with maximum centre of pressure velocity (r = 0.54, p < 0.001) and average lateral-medial force index (r = -0.44, p = 0.004) during preswing. CONCLUSIONS Individuals with 1st MTPJ OA exhibit significant differences in centre of pressure characteristics during propulsion, possibly due to decreased range of available 1st MTPJ dorsiflexion.

Preliminary evaluation of prototype footwear and insoles to improve balance and prevent falls in older people

Footwear has the potential to influence balance in either a detrimental or beneficial manner, and is therefore an important consideration in relation to falls prevention. Based on previous studies,...