Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand.
Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand.
Gait Posture. 2022 Sep;97:174-183. doi: 10.1016/j.gaitpost.2022.07.259. Epub 2022 Aug 2.
Orthotic wedges with medial posting of the forefoot and rearfoot have been shown to be effective in controlling excessive foot pronation in people with plantar fasciitis (PF), however the best prescription remains unclear.
The aim of this study was to determine the biomechanical effects of two designs of orthotic wedges within a shoe on the hip, knee, rearfoot, and forefoot kinematics in individuals with PF.
Thirty-five participants with PF were recruited. They were asked to walk under three randomized conditions; shod, shod with orthotic wedges with foot assessment technique 1 (W1), and shod with orthotic wedges from a new assessment technique (W2). Biomechanical outcomes included lower limb and multi-segment foot kinematics in each subphase of the stance gait, including contact phase, midstance phase, and propulsive phase.
Compared with shod, the W1 significantly increased rearfoot dorsiflexion, decreased peak forefoot dorsiflexion, and peak rearfoot eversion during the contact phase. In addition, W1 increased rearfoot inversion, decreased hallux dorsiflexion, and peak hallux dorsiflexion during the propulsive phase. For W2, the wedge significantly decreased peak knee internal rotation, decreased forefoot abduction, peak forefoot dorsiflexion, and peak rearfoot eversion during the contact phase. In addition, W2 increased rearfoot inversion, decreased hallux dorsiflexion, and decreased peak hallux dorsiflexion during the propulsive phase. When comparing W1 and W2, W1 showed greater rearfoot dorsiflexion during the contact phase.
These findings suggest that the use of forefoot varus wedges, and the combination of forefoot and rearfoot varus wedges, can change the lower limb kinematics, the multi-segment foot kinematics estimated using markers fixed to the shoe, and the relative length of the plantar fascia which can be associated with a reduction in pain and symptoms during walking.
在前足和后足内侧贴附矫正楔形物已被证明可有效控制足底筋膜炎（PF）患者过度的足内旋，但最佳处方仍不清楚。
本研究旨在确定鞋内两种矫形楔形物设计对 PF 患者髋关节、膝关节、后足和前足运动学的生物力学影响。
招募了 35 名 PF 患者。要求他们在三种随机条件下行走；穿鞋、穿鞋并使用足部评估技术 1（W1）的矫形楔形物、穿鞋并使用新评估技术（W2）的矫形楔形物。生物力学结果包括每个站立步态亚相的下肢和多节段足部运动学，包括接触相、中间相和推进相。
与穿鞋相比，W1 在接触相时显著增加了后足背屈，降低了前足足背屈峰值和后足外翻峰值。此外，W1 在推进相时增加了后足内翻，降低了大脚趾背屈和大脚趾背屈峰值。对于 W2，楔形物显著降低了峰值膝关节内旋、减小了前足外展、前足足背屈峰值和后足外翻峰值在接触相时。此外，W2 增加了后足内翻，降低了大脚趾背屈，降低了推进相时的大脚趾背屈峰值。比较 W1 和 W2 时，W1 在接触相时表现出更大的后足背屈。
这些发现表明，使用前足内翻楔形物和前足与后足内翻楔形物的组合，可以改变下肢运动学、使用固定在鞋上的标记估计的多节段足部运动学以及足底筋膜的相对长度，这可能与减轻行走时的疼痛和症状有关。
