Background
Ankle foot orthoses (AFOs) are commonly prescribed to individuals with Charcot‐Marie‐Tooth disease (CMT). The aim of this study was to evaluate patient reported satisfaction with orthotic ...devices and services in individuals with CMT to provide preliminary data for advancing AFO development and improving clinical care.
Methods
The Orthotics and Prosthetics Users Survey was distributed via e‐mail through the Inherited Neuropathy Consortium (INC) Contact Registry and includes 11 device‐specific questions and 10 service‐related questions. Participants were also asked open‐ended questions about their experiences with AFOs.
Results
Three hundred and fourteen individuals completed the survey. Over one‐third of participants provided negative responses, including dislike of AFO appearance, discomfort, abrasions or irritations, and pain. Ratings of orthotic services were generally positive.
Conclusions
Lower scores related to discomfort, abrasions and pain identified areas for AFO improvement. Continued research in these areas will be beneficial to informing and advancing AFO development and improving clinical care.
See article on pages 3–4 in this issue.
Individuals with myelomeningocele (MMC) present with neurological and orthopaedic deficiencies, requiring orthoses during walking. Orthoses for counteracting dorsiflexion may restrict activities such ...as rising from a chair.
How are sit-to-stand (STS) movements performed with ankle joint-restricted ankle-foot orthoses (AFO) and knee-ankle-foot orthoses with a free-articulated knee joint (KAFO-F)?
Twenty-eight adults with MMC, mean age 25.5 years (standard deviation: 3.5 years), were divided into an AnkleFree group (no orthosis or a foot orthosis) and an AnkleRestrict group (AFOs or KAFO-Fs). Study participants performed the five times STS test (5STS) while their movements were simultaneously captured with a three-dimensional motion system. Centre of mass (CoM) trajectories and joint kinematics were analysed using statistical parametric mapping.
The AnkleRestrict group performed the STS slower than the AnkleFree group, median 8.8 s (min, max: 6.9, 14.61 s) vs 15.0 s (min, max: 7.5, 32.2 s) (p = 0.002), displayed reduced ankle dorsiflexion (mean difference: 6°, p = 0.044) (74–81 % of the STS cycle), reduced knee extension (mean difference: 14°, p = 0.002) (17–41 % of the STS cycle), larger anterior pelvic tilt angle (average difference: 11°, p = 0.024) (12–24 % of the STS cycle), and larger trunk flexion angle (on average 4°, p = 0.029) (6–15 % of the STS cycle).
The differences between the AnkleFree and AnkleRestrict groups in performing the STS seem consistent with the participants functional ambulation: community ambulation in the AnkleFree group, and household and nonfunctional ambulation with less hip muscle strength in the majority of the AnkleRestrict group. No differences in the 5STS CoM trajectories or the kinematics were found with respect to the AFO and KAFO-Fs groups. Because orthoses are constructed to enable walking, the environment needs to be adjusted for activities in daily living such as the STS movement.
•Orthoses for walking require restricted ankle dorsiflexion in individuals with MMC.•A blocked ankle hampers forward movement altering sit-to-stand (STS) movements.•The effort required to perform STS in everyday activities should be acknowledged.•The findings highlight the importance of adjusting the environment with external support.
Introduction
Loss of ambulation in Duchenne muscular dystrophy presages scoliosis, respiratory failure, and death. Strategies to maintain ankle range of motion are employed, but little evidence ...exists to support these approaches and limited information is available concerning current practice.
Methods
In this study we assessed baseline bracing data from 187 boys participating in a multicenter, international clinical trial.
Results
Ankle‐foot orthoses (AFOs) were recommended for 54% of the boys, with nighttime static AFOs and nighttime dynamic AFOs utilized in 94% and 6% of these boys, respectively. Daytime static AFOs were recommended for 3 boys. Compliance with bracing recommendations was 54% for nighttime static braces and 67% for nighttime dynamic braces.
Discussion
The basis for the variation in recommended AFO use is unknown and requires further study. Long‐term follow‐up of boys may permit assessment of the effects of AFO use.
Foot pronation, as one of the prevalent foot abnormalities, can influence the biomechanics of the lower limbs. The use of various foot orthoses, including insoles and braces, is very common in ...eliminating this problem. The results obtained regarding the effect of orthoses on pain and biomechanics of individuals with foot pronation are different. The present review study was conducted to evaluate the effects of foot orthoses and shoes on the biomechanics of the lower limbs and balance in individuals with foot pronation. The articles were searched in Persian and Latin languages during 2004-22 in the databases of PubMed, Web of Science (WOS), Scopus, Islamic Science Citation (ISC), and Google Scholar search engine. Moreover, the types of the searched studies were original research, review studies, and clinical trials. Using keywords of Foot pronation, Foot orthoses, Medical soles, and Motion-control shoes, 52 relevant articles were selected, and 22 articles regarding the effects of orthoses and shoes on foot pronation were finally analyzed. Eight articles also reported that reducing forces imposed on the joints, absorbing shock, preventing pronation-related running injuries, and improving muscle activity occurred when using orthosis. Furthermore, 4 articles reported improving sports performance in athletes, reducing the ground reaction forces, and changing the frequency of muscle activity. Finally, 2 articles showed that motion-control shoes prevented intensifying the injury due to increased fatigue and subsequently increased mechanical loading during running. The results of the present study demonstrated that foot orthoses and motion-control shoes could have positive effects on balance, improving the activities of the lower limbs and reducing foot pronation and force imposed on the foot and lower limb joints.
Flexible flatfoot (FFF) cause biomechanical and sensorimotor disorders of the foot and ankle complex and reduce of postural stability. Postural stability is an important movement skill that affects ...the performance of taekwondo (TKD) athletes and can lead to fall injuries. The purpose of this study is the effect 12-week application of foot orthosis (FOs) on dynamic balance in TKD athletes with FFF.
In this trial, 30 girls of the TKD athletes with FFF were recruited. They were randomly assigned to experimental and control groups (15 subjects in each group). The experimental group used FOs with medial longitudinal arch support for 12 weeks, and the control group did not have any intervention. The outcome measures include navicular drop and balance in three directions: anterior-posterior, medial-lateral and overall stability. Covariance analysis was used to compare the results between two groups.
The covariance results showed that the experimental group compared to the control group with a high effect size had a significant difference in reducing of navicular drop (P = 0.000, ηp2 =0.512), anterior-posterior sway (P = 0.000, (ηp2 =0.397) medial-lateral sway (P = 0.019, ηp2 = 0.186) and overall stability sway (P = 0.008, ηp2 = 0.232).
The FOs with medial longitudinal arch support leads to FFF correction and provides mechanical stability of the foot and ankle complex. Also, the impulses sent from plantar receptors are increased and a better understanding of postural sway is transmitted to the central nervous system and balance strategies are improved.
•Postural stability is influenced by foot posture.•The flexible flatfoot there is a mechanical instability in the foot bones.•The foot orthosis in flexible flatfoot increases the dynamic balance.•The foot orthosis prevents lower limb injuries caused by flexible flat foot.
•Tips and tricks for fabrication of the relative motion (RM) orthoses•Fabrication simplification•Ideas for immediate clinical use
Relative Motion (RM) orthoses are an extremely important and ...beneficial intervention in hand rehabilitation. They can be used for a variety of hand conditions including for positioning, protection, alignment and exercise. In order to achieve the intended goals of this orthotic intervention, the clinician must pay attention to detail during its fabrication. The purpose of this manuscript is to offer some simple and practical fabrication tips for hand therapists who want to include the use of RM orthoses to manage these different clinical conditions. Photos are provided to reinforce some of the key concepts.
The main aim of this review is to report the effect of different types of in-shoe and barefoot wedges on the distribution of the plantar loading of the human foot. We hypothesise that frontal plane ...wedges modify this parameter.
A systematic review was performed, using the PubMed, CINAHL, Prospero and Scopus databases, consulted from their date of first publication to May 2020. Only observational (cross-over studies), randomised controlled trials (RCTs) and quasi-experimental studies addressing the effects of in-shoe and barefoot frontal plane wedges on plantar loading were included. All articles were subjected to quality assessment, using the Newcastle-Ottawa scale for the observational (cross-over) studies, TREND for quasi-experimental studies and the Cochrane Collaboration’s tool for the RCTs.
Eleven papers were included in the final review. Four were cross-over studies, other four were quasi-experimental studies and three were RCTs. These eleven studies included 320 patients, with ages ranging from 20 to 60 years. Regarding the risk of bias, most of the observational studies and RCTs had a moderate level of quality. Conclusions: The results suggest that lateral wedges are more effective, producing a lateral shift of the centre of pressure and increasing the pressure. Regarding the impact on the peak impact force there seems to be less consensus among the published data.
•The frontal plane wedges cause a redistribution of the plantar pressure.•Lateral wedges produces a lateral shift of the gait line.•Varus wedges produces a medial shift of this biomechanical feature.•The vertical ground reaction forces no clear conclusions can be drawn.
●A systematic review was performed on studies utilizing 3D printed orthoses for musculoskeletal conditions of the elbow, wrist, hand and digits in clinical settings.●The 10 studies included in this ...systematic review report on actual patient use of 3D printed orthoses.●The 3D printing process of orthoses for the upper extremity remains complex and under-utilized.●There is a need for more clinical trials to study the benefits of 3D printed orthoses compared with custom made low temperature thermoplastic orthoses for patients in the hand therapy setting.
Systematic Review
3D printed orthoses are emerging as a possible option in the field of hand therapy to fabricate conventional casts and orthoses. It is unknown how this technology is currently being used to treat upper extremity musculoskeletal conditions, and if 3D orthoses are comparable to custom- made low temperature thermoplastic orthoses fabricated by hand therapists.
The primary aim of this review was to investigate the utilization, effectiveness and feasibility of 3D printed technology to manufacture custom orthoses for musculoskeletal conditions of the upper extremity.
Studies describing 3D printed orthoses or casts used in treatment with patients were included following a comprehensive literature search using CINAHL, PubMed, Medline, ProQuest, and EBSCO databases. The selected studies had to address musculoskeletal conditions of the elbow, wrist, hand and/or digits that would typically be immobilized with a cast or brace or orthotic or orthosis.
Ten studies met the inclusion criteria. Study designs included case studies, case series, and 1 randomized clinical trial. 3D printed orthoses/casts appear to be comfortable, provide adequate immobilization, and have pleasing aesthetics. However, expensive equipment, lack of appropriate software and scanning tools and lack of highly skilled clinicians are all factors preventing the implementation of 3D printed orthoses into current clinical practice.
3D printed orthoses appear to be effective at immobilization of a limb, aesthetically pleasing, and utilize lightweight and well -ventilated materials. However, the feasibility of implementing 3D printing technology in hand therapy settings remains challenging in part due to the resources required.
While 3D printing shows promise, the high cost of equipment, lack of training and skill of clinicians and the long time required for production are all factors that need to be improved to make 3D printing a viable option in the hand therapy setting.
PDF
