Do commonly used postoperative orthopaedic shoes help off-load the forefoot?

Purpose: The aim of the experiment presented in this study was to determine the pressure distribution within the forefoot depending on the type of orthopaedic footwear used. Methods: The study included 27 women aged 20 to 25. The Zebris FDM-2 dynamographic platform was used in foot pressure measurements. The load distribution was measured in three types of orthopaedic footwear: MedSurg, MedSurgPro and OrthoWedge. The full gait cycle was recorded. The Cavanagh masks were applied to the load distribution results processed into a graphic form. The data were analysed using Statistica v.13.1. Results: In the forefoot area, i.e. the metatarsal bones and toes 1–5, the lowest loads were reported in the shoes that off-load the forefoot (0.2 N/cm2, p < 0.001). In the area of the first to fifth metatarsal bones and the hallux, the highest load was observed in the rocker shoe, accounting for 19.7 N/cm2 (p < 0.001). For comparison, high pressure in the flat shoe was found in the area of toes 2 to 5 (p < 0.001). Conclusions: In the area of the metatarsal and toe bones, the pressure exerted was highest in the commonly used rocker shoe. The flat shoe provides an even and uniform load in all areas of the forefoot, while this type of shoe does not significantly reduce the pressure forces on the forefoot. The shoe that was the most effective in off-loading was the forefoot off-loading shoe (OrthoWedge). Barefoot walking puts less load on the forefoot compared to the flat and rocker shoes used after orthopaedic procedures.

Effectiveness of Mechanical Treatment for Plantar Fasciitis: A Systematic Review

Context: Plantar fasciitis is one of the most common foot injuries. Several mechanical treatment options, including shoe inserts, ankle-foot orthoses, tape, and shoes are used to relieve the symptoms of plantar fasciitis. Objectives: To investigate the effectiveness of mechanical treatment in the management of plantar fasciitis. Evidence Acquisition: The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. A systematic search was performed in PubMed, CINAHL, Embase, and Cochrane up to March 8, 2018. Two independent reviewers screened eligible articles and assessed risk of bias using the Cochrane Collaboration’s risk of bias tool. Evidence Synthesis: A total of 43 articles were included in the study, evaluating 2837 patients. Comparisons were made between no treatment and treatment with insoles, tape, ankle-foot orthoses including night splints and shoes. Tape, ankle-foot orthoses, and shoes were also compared with insoles. Follow-up ranged from 3 to 5 days to 12 months. Cointerventions were present in 26 studies. Conclusions: Mechanical treatment can be beneficial in relieving symptoms related to plantar fasciitis. Contoured full-length insoles are more effective in relieving symptoms related to plantar fasciitis than heel cups. Combining night splints or rocker shoes with insoles enhances improvement in pain relief and function compared with rocker shoes, night splints, or insoles alone. Taping is an effective short-term treatment. Future studies should aim to improve methodological quality using blinding, allocation concealment, avoid cointerventions, and use biomechanical measures of treatment effects.

Effect of Different Placement of Heel Rockers on Lower-Limb Joint Biomechanics in Healthy Individuals

Background: Rocker shoes are commonly prescribed to healthy and pathologic populations to decrease stress on the lower limbs. An optimal rocker shoe design must consider both toe and heel rockers. Heel rockers are as effective as toe rockers in relieving foot plantar pressures. However, most studies have focused on the position of toe rockers. The aim of this study was to assess the effect of different heel rocker apex placements on lower-limb kinetics and kinematics. Methods: Eighteen healthy females participated in this study. Three pairs of rocker shoes with rocker apex positions anterior to the medial malleolus (shoe A), at the medial malleolus (shoe B), and posterior to the medial malleolus (shoe C) were fabricated and then compared with a flat shoe (shoe D). Kinetic and kinematic data were collected, and lower-extremity joint ranges of motion and moments were calculated. Results: Ankle range of motion was increased by shoe C (P = .04) during initial contact and by shoe A (P = .02) during single-limb support. Peak knee moment was significantly larger for shoes A and B (P &lt; .05) during single-limb support. Conclusions: Results showed that forward and backward shifting of the heel rocker apex could change the knee moment and ankle joint range of motion in the stance phase of gait. Therefore, placement of the heel rocker in a rocker-bottom shoe can be manipulated to promote the desired lower-limb motion, at least in healthy individuals.