Jor Abu, Lau Noelle W K, Daryabor Aliyeh, Koh Mark W P, Lam Wing-Kai, Hobara Hiroaki, Kobayashi Toshiki
Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; Department of Leather Engineering, Faculty of Mechanical Engineering, Khulna University of Engineering & Technology, Khulna, Bangladesh.
Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
Gait Posture. 2024 Mar;109:240-258. doi: 10.1016/j.gaitpost.2024.02.003. Epub 2024 Feb 7.
Foot orthoses (FOs) are often prescribed by clinicians to treat foot and ankle conditions, prevent running injuries, and enhance performance. However, the lack of higher-order synthesis of clinical trials makes it challenging for clinicians to adopt an evidence-based approach to FOs' prescriptions.
Do FOs with different modifications alter lower extremity running kinematics and kinetics?
A systematic search of seven databases was conducted from inception to February 2023. The analysis was restricted to healthy adults without foot musculoskeletal impairments and studies that compared the FOs effects with the controls. The methodological quality of the 35 studies that met the eligibility criteria was evaluated using the modified Downs and Black checklist. The random effects model estimated the standardized mean difference (SMD) with 95% confidence intervals and effect sizes. Sub-group analyses based on FOs type were performed to assess the potential effects of the intervention.
Our findings indicated that both custom and off-the-shelf arch-support FOs reduced peak plantar pressure at the medial heel (SMD=-0.35, and SMD=-1.03), lateral heel (SMD=-0.50, and SMD=-0.53), and medial forefoot (SMD=-0.20, and SMD=-0.27), but increased plantar pressure at the mid-foot (SMD=0.30, and SMD=0.56). Compared with the controls, significant increases (SMD=0.36) in perceived comfort were found with custom FOs. A reduction (SMD=-0.58) in initial ankle inversion was found when a raised heel cup was integrated with arch-support FOs. A medial post integrated with arch support exhibited a reduced ankle (SMD=-1.66) and tibial (SMD=-0.63) range of motion. Custom FOs, however, unfavorably affected the running economy (SMD=-0.25) and perceived exertion (SMD=0.20).
Although FOs have been reported to have some positive biomechanical effects in healthy populations without musculoskeletal impairments or running-related issues, they need to be optimized and generalized to achieve better running performance and prevent injury.
临床医生常开具足部矫形器（FOs）来治疗足踝疾病、预防跑步损伤并提高运动表现。然而，由于缺乏对临床试验的高阶综合分析，临床医生难以采用基于证据的方法来开具FOs处方。
不同改良的FOs是否会改变下肢跑步的运动学和动力学？
从数据库建立至2023年2月，对七个数据库进行了系统检索。分析仅限于无足部肌肉骨骼损伤的健康成年人以及比较FOs与对照组效果的研究。使用改良的唐斯和布莱克检查表评估了符合纳入标准的35项研究的方法学质量。随机效应模型估计了标准化平均差（SMD）及其95%置信区间和效应量。基于FOs类型进行亚组分析以评估干预的潜在效果。
我们的研究结果表明，定制和现成的足弓支撑FOs均降低了足跟内侧（SMD = -0.35和SMD = -1.03）、足跟外侧（SMD = -0.50和SMD = -0.53）以及前足内侧（SMD = -0.20和SMD = -0.27）的足底压力峰值，但增加了足中部的足底压力（SMD = 0.30和SMD = 0.56）。与对照组相比，定制FOs的舒适度显著提高（SMD = 0.36）。当足跟杯与足弓支撑FOs结合时，初始踝关节内翻减少（SMD = -0.58）。与足弓支撑相结合的内侧支柱使踝关节（SMD = -1.66）和胫骨（SMD = -0.63）的活动范围减小。然而，定制FOs对跑步经济性（SMD = -0.25）和自觉用力程度（SMD = 0.20）有不利影响。
尽管据报道FOs在无肌肉骨骼损伤或与跑步相关问题的健康人群中具有一些积极的生物力学效应，但仍需对其进行优化和推广，以实现更好的跑步表现并预防损伤。
