Nilgün Bek

Outcome of Orthoses Intervention in the Rheumatoid Foot

This study was carried out to determine the effect of foot orthoses on pain, gait, and energy expenditure in patients with rheumatoid arthritis. Eighteen patients were evaluated for these parameters. Each patient was given a foot insert or shoe modification suitable for his or her foot deformity. Following 3 months of orthosis use, a significant difference was found in regards to pain (p <.05), step length and stride length (p <.05), and physiological cost index (p <.05). The results suggest that foot orthoses are an important feature in the rehabilitation of the rheumatoid foot.

The effect of orthotic treatment of posterior tibial tendon insufficiency on pain and disability

AbstractPosterior Tibial Tendon Insufficiency (PTTI) is the major reason for acquired flat-foot. The purpose of this study, which was planned as a single-group pre- and post-intervention repeated measures design, was to investigate whether orthotic intervention is effective in treating pain caused by PPTI. Ten males and 15 females, whose mean age was 30.66 ± 12.67 years, completed the pain and disability subscales of the foot function index at their first visit and after 6 weeks of orthotic wear. There was a 47.64% decrease in pain and a 53.07% decrease in disability levels, and a high correlation between pain and disability subscales. The results of our study imply that orthotic management of PTTI is effective in alleviating pain and the amount of difficulty expressed by the patient.

Comparison of connective tissue massage and spray-and-stretch technique in the treatment of chronic cervical myofascial pain syndrome

AbstractThe aim of this study was to investigate whether ischemic pain tolerance changed in patients who had successfully undergone treatment for chronic cervical myofascial pain syndrome (MPS). In a controlled study, patients with the diagnosis of MPS were assessed for pain intensity using a visual analogue scale (VAS), number of trigger points, range of motion (ROM) in cervical region, and ischemic pain threshold and tolerance using a modified tourniquet technique. Patients were randomly allocated into two groups. The first group was treated with connective tissue massage and the second with vapocoolant spray and stretch technique. No difference was found between the groups as regards to the assessed parameters except VAS, which was higher in the group treated with the spray and stretch technique. Following treatment, although there was a significant decrease in pain intensity and number of trigger points, and an increase in ROM in both groups, there was no difference in ischemic pain threshold or toler...

Home-based general versus center-based selective rehabilitation in patients with posterior tibial tendon dysfunction

OBJECTIVE The aim of this study was to compare the effect of home-based and supervised center-based selective rehabilitation in patients with Grade 1 to 3 posterior tibial tendon dysfunction (PTTD). METHODS The study included 49 subjects diagnosed with PTTD and referred to physiotherapy by an orthopedic surgeon. Subjects were randomly assigned into a home-based rehabilitation (21 cases; mean age: 33.56 ± 17.59) group or center-based rehabilitation (28 cases; mean age: 28.57 ± 14.74 years). The patients in the home-based rehabilitation group followed a home program of cold application, strengthening exercises for the posterior tibial and intrinsic muscles, and stretching in the subtalar neutral position. The patients in the center-based rehabilitation group followed a selective, supervised treatment consisting of the home protocol plus re-education of the non-functional tibialis posterior, proprioceptive neuromuscular facilitation methods, electrical stimulation, joint mobilization and taping techniques. Both groups received appropriate orthotics. All subjects were assessed before and after treatment for pain, muscle strength, foot function index (FFI) scores and specific tests for PTTD. RESULTS Statistical analysis showed significant differences between pre- and post-treatment results for pain, first metatarsophalangeal angle, forefoot abduction angle, FFI scores and foot and ankle muscle strengths in the center-based group and for the tibialis posterior muscle strength in the home-based group (p<0.05). Intergroup comparison, however, showed no differences between the groups at the end of the treatment program with the exception of posterior tibial muscle strength (p<0.05). CONCLUSION Home- and center-based forms of rehabilitation seem to be equally effective in relieving pain and improving functional outcome in patients with Grade 1 to 3 PTTD. A patient-selective, supervised program may provide a better improvement in tibialis posterior strength than home-based rehabilitation.

Foot biomechanics and initial effects of infrapatellar strap on gait parameters in patients with unilateral patellofemoral pain syndrome

BACKGROUND There is limited information on the relationship between plantar foot pressure and patellofemoral pain syndrome (PFPS). In addition, there is not enough research on the effects of an infrapatellar strap on PFPS. OBJECTIVE The aim of this study was to evaluate the immediate effects of an infrapatellar strap on dynamic pedabarography in patients with unilateral PFPS. METHODS Clinical case control study design. 18 females subjects with unilateral PFPS were included in the study. Gait parameters were tested using pedabarography during barefoot walking with and without an infrapatellar strap. RESULTS There were no statistically significant differences in gait trials comparing infrapatellar strap to no strap (P>0.05). In addition, a significant difference (P=0.043) in the % forefoot surface on the involved side demonstrated that body weight is transferred to medial aspect of the foot. DISCUSSION Although our results show a difference between the forefoot surface % of the affected and unaffected sides of subjects with PFPS there was no indication that an infrapatellar strap had any immediate effect on this parameter. CONCLUSION It is not clear whether PFPS is a cause or effect of abnormal gait. Further research is warranted to investigate the long-term effects of wearing an infrapatellar strap and associated altered foot biomechanics due to PFPS.

Orthotic management of the lower limb in children with hereditary motor sensory neuropathy (HMSN)

The lower limbs of 55 paediatric patients, with the diagnosis of hereditary motor sensory neuropathy (HMSN) referred to the Orthotics and Biomechanics Department of Hacettepe University, were assessed for appropriate orthotic intervention. Since in the natural history of HMSN symptoms and complaints are variable there is a wide range of interventions possible. The biomechanics of deforming forces and the consequential incidence of deformities in these 55 children, its orthotic implications and the efficacy of orthotic applications are discussed in detail.

Effects of hallux valgus deformity on rear foot position, pain, function, and quality of life of women.

[Purpose] To investigate the relationship between hallux valgus (HV) deformity and the position of rearfoot joints, and its effects on the quality of life, pain, and related functional status of women with bilateral hallux valgus (HV). [Subjects and Methods] The subjects were 27 right-dominant women. Demographic data, HV angle, weight-bearing and non-weight-bearing subtalar pronation (SP), and navicular height were recorded. Visual Analog Pain Scale, Foot Function Index (FFI), and the American Orthopaedic Foot and Ankle Society (AOFAS) first metatarsophalangeal- interphalangeal (MTP-IP) and AOFAS Mid foot (MF) Scales, and SF-36 were also used. [Results] HV angle, weight-bearing SP, and pain intensity of the left foot were higher. HV angle of left foot was correlated with all sub-scales of FFI, the pain parameter of AOFAS MTP-IP, and pain and total scores of AOFAS-MF Scale. HV angle of the left foot correlated with physical role, pain, and social function sub-domains of SF-36. Right HV angles were correlated with right foot pain and non-weight-bearing SP. [Conclusion] Increasing HV angle and pathomechanical changes in the rear foot are correlated, resulting in increasing pain and thus decreasing functional status as well as decreasing quality of life. Although all the participants were right-dominant, their left foot problems were more prominent.

Analysis of age and gender related differences in pressure pain threshold and pressure pain tolerance levels

AbstractThe purpose of this study was to investigate age and gender differences in pressure pain threshold (PPTh) and pressure pain tolerance (PPTo). PPTh and PPTowere assessed be means of a pressure algometer in 40 young subjects (20 men, 20 women; mean age 26.22 ± 4.69 years) and 60 old subjects (30 men, 30 women; mean age 73.43±7.16 years) in four different points of the body. When the data from all four sites were added and averaged the older subjects showed a significantly higher value of PPTh and a lower value of PPTo. PPTh was lower in older females than in older males. There was the same tendency in the younger group although it did not reach statistical significance. PPTo was significantly higher in males, both in the older and younger groups.

Effects of Body Mass Index on Mechanical Properties of the Plantar Fascia and Heel Pad in Asymptomatic Participants

Background: Musculoskeletal foot disorders have a high incidence among overweight and obese individuals. One of the important factors causing this high incidence may be plantar fascia and heel pad (HP)–related mechanical changes occurring in these individuals. The aim of the present study was to investigate the plantar fascia and HP stiffness and thickness parameters in overweight and obese individuals and compare these values with those of normal-weight individuals. Methods: This study was carried out in 87 (52 female, 35 male) healthy sedentary individuals between the ages of 19 and 58 years (34 ± 11 years). Participants were subsequently categorized according to body mass index (BMI) as normal weight (18.5 kg/m2 < BMI < 25 kg/m2) or overweight and obese (BMI ≥25 kg/m2). Plantar fascia and HP thickness and stiffness were measured with an ultrasonography device using a linear ultrasonography probe. Results: Overweight and obese individuals had higher HP thickness (P < .001), plantar fascia thickness (P = .001), heel pad microchamber layer (MIC) stiffness (P < .001), and heel pad macrochamber layer (MAC) stiffness (P < .001), whereas they had lower plantar fascia stiffness (P < .001) compared with the individuals with normal weight. BMI had a moderate correlation with HP thickness (P < .001, r = 0.500), plantar fascia thickness (P = .001, r = 0.536), MIC stiffness (P < .001, r = 0.496), and MAC stiffness (P < .001, r = 0.425). A negative and moderate correlation was found between BMI and plantar fascia stiffness (P < .001, r = –0.439). Conclusion: Increased BMI causes a decrease in the stiffness of plantar fascia and an increase in the thickness of the plantar fascia as well as the thickness and stiffness of HP. Increased body mass could cause changes in the mechanical properties of HP and plantar fascia. Level of Evidence: Level 3, comparative study.

The short -term effects of an exercise programme as an adjunct to an orthosis in neuromuscular scoliosis.

The purpose of this study was to investigate the effects of a 4 week physiotherapy programme on patients who were given a spinal orthosis for neuromuscular scoliosis. This study was planned as a single group pre- and post-intervention repeated measures design. All patients were given a polyethylene spinal orthosis with an anterior opening. Fifteen (15) patients with neuromuscular diseases and a mean age of 12.46 years were evaluated. An exercises programme consisting of postural training, muscle strengthening and stretching exercises with special emphasis on respiratory exercises was given as an adjunct to orthotic treatment. The degree of impairment in forced vital capacity was 17.56% upon wearing an orthosis, it decreased to 9.28% following therapy (p < 0.05). There was also a statistically significant increase in muscle strength, balance duration and a significant decrease in limitation of range of motion. The results of the study imply that the conservative treatment of neuromuscular scoliosis should include an exercise programme as an adjunct to an orthosis, both to reduce the compromising effect of an orthosis on respiratory function and to support the patients physical capacities.