Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, 1-152 MEB 500 Newton Road, Iowa City, Iowa, USA.
Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, 1-152 MEB 500 Newton Road, Iowa City, Iowa, USA.
Gait Posture. 2024 Jun;111:191-195. doi: 10.1016/j.gaitpost.2024.04.032. Epub 2024 May 3.
Traumatic lower limb injuries can result in chronic pain. Orthotic interventions are a leading conservative approach to reduce pain, manage loading, and protect the foot. Robust carbon fiber custom dynamic orthoses (CDOs) designed for military service members have been shown to reduce foot loading. However, the effect of carbon fiber orthosis design, including designs widely used in the civilian sector, on foot loading is unknown.
Determine if carbon fiber orthoses alter foot loading during gait.
Loadsol insoles were used to measure peak forces and force impulse acting on the forefoot, midfoot, hindfoot, and total foot. Nine healthy, able-bodied individuals participated. Force impulse was quantified as cumulative loading throughout stance phase. Participants walked without an orthosis and with three carbon fiber orthoses of differing designs: a Firm stiffness CDO, a Moderate stiffness CDO, and a medial and lateral strut orthosis (MLSO).
There were significant main effects of orthosis condition on peak forefoot forces as well as forefoot and hindfoot force impulse. Peak forefoot forces were significantly lower in the Moderate and Firm CDOs compared to no orthosis and MLSO. Compared to walking without an orthosis, forefoot force impulse was significantly lower and hindfoot force impulse was significantly greater in all carbon fiber orthoses. Additionally, hindfoot force impulse in the Firm CDO was significantly higher than in the MLSO and Moderate CDO.
The three carbon fiber orthosis designs differed regarding foot loading, with more robust orthoses providing greater forefoot offloading. Orthosis-related changes in forefoot loading suggest that carbon fiber orthoses could reduce loading-associated pain during gait. However, increased hindfoot force impulse suggests caution should be used when considering carbon fiber orthoses for individuals at risk of skin breakdown with repetitive loading.
下肢创伤可导致慢性疼痛。矫形干预是减少疼痛、管理负荷和保护足部的主要保守方法。为军人设计的坚固碳纤维定制动态矫形器（CDO）已被证明可减少足部负荷。然而，碳纤维矫形器设计（包括在民用领域广泛使用的设计）对足部负荷的影响尚不清楚。
确定碳纤维矫形器是否会改变步态中的足部负荷。
使用 Loadsol 鞋垫测量前足、中足、后足和整个足部的峰值力和力脉冲。九名健康、健全的个体参与了研究。力脉冲被量化为整个站立阶段的累积负荷。参与者在不佩戴矫形器和佩戴三种不同设计的碳纤维矫形器的情况下行走：一种是坚固刚度 CDO，一种是中等刚度 CDO，一种是内侧和外侧支撑矫形器（MLSO）。
矫形器条件对峰值前足力以及前足和后足力脉冲有显著的主要影响。与不佩戴矫形器和 MLSO 相比，中、坚固 CDO 的前足峰值力显著降低。与不佩戴矫形器相比，所有碳纤维矫形器的前足力脉冲显著降低，后足力脉冲显著增加。此外，坚固 CDO 的后足力脉冲显著高于 MLSO 和中等 CDO。
三种碳纤维矫形器设计在足部负荷方面存在差异，更坚固的矫形器提供更大的前足减压。与碳纤维矫形器相关的前足负荷变化表明，碳纤维矫形器可能会减少与步态相关的疼痛。然而，后足力脉冲的增加表明，对于有因重复负荷而导致皮肤破裂风险的个体，在考虑使用碳纤维矫形器时应谨慎。
