Department of Sport Biomechanics, Faculty of Educational Science and Psychology, University of Mohaghegh Ardabili Iran.
Department of Health and Sport Medicine, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
J Biomech. 2024 Nov;176:112345. doi: 10.1016/j.jbiomech.2024.112345. Epub 2024 Sep 25.
This systematic review with meta-analysis aimed to investigate the effects of foot orthoses (FO) application on lower limb joint angles and moments in adults with flexible flat-feet during walking. The following five databases were systematically searched from inception until March 2024: Scopus, PubMed, EMBASE, PEDro, and Cochrane Central Register of Controlled Trials (CENTRAL). Between-group standardized mean differences (SMDs) with 95% confidence intervals were computed using a random-effects model. Study heterogeneity was assessed using the I-index. Twenty-four studies were identified and meta-analyzed. Studies were then categorized according to the applied flat-feet assessment method: (1) foot posture index (FPI-6) or clinical observation; (2) foot print arch index or radiography; (3) arch height index (including navicular drop, the arch height index, navicular height normalized to foot length [NNHT]); (4) forefoot varus method; (5) rearfoot eversion or resting calcaneal stance position (RCSP). The meta-analysis showed significant effects of FO application during walking on peak rearfoot eversion (ten studies: moderate SMDs), peak ankle dorsiflexion (five studies: small SMDs), and eversion (seven studies: moderate SMDs). This meta-analysis indicated significant effects of FO application on peak ankle eversion moment (five studies: small SMDs) and peak knee adduction moment (six studies: small SMDs). We observed greater effects of FO application on walking mechanics in the studies that used the FPI-6 method for the assessment of foot posture. Since previous research showed particularly high test-retest reliability measures for the FPI-6 method, we recommend to uniformly use this type of foot posture measure in future studies.
本系统评价和荟萃分析旨在研究在成年人行走时，使用足部矫形器（FO）对扁平足患者下肢关节角度和力矩的影响。我们系统地检索了以下五个数据库，从建库开始到 2024 年 3 月：Scopus、PubMed、EMBASE、PEDro 和 Cochrane 对照试验中心注册库（CENTRAL）。使用随机效应模型计算组间标准化均数差值（SMD）及其 95%置信区间。采用 I 指数评估研究异质性。确定了 24 项研究并进行了荟萃分析。然后根据应用的扁平足评估方法对研究进行分类：（1）足弓指数（FPI-6）或临床观察；（2）足印弓指数或 X 线摄影；（3）足弓高度指数（包括舟骨下降、足弓高度指数、足长的舟骨高度[NNHT]）；（4）前足旋前法；（5）跟骨外翻或休息跟骨站立位（RCSP）。荟萃分析显示，FO 在行走时的应用对峰值跟骨外翻（10 项研究：中度 SMDs）、峰值踝关节背屈（5 项研究：小 SMDs）和外翻（7 项研究：中度 SMDs）有显著影响。本荟萃分析表明，FO 在峰值踝关节外翻力矩（5 项研究：小 SMDs）和峰值膝关节内收力矩（6 项研究：小 SMDs）的应用上有显著影响。我们观察到，在使用 FPI-6 方法评估足姿的研究中，FO 的应用对行走力学有更大的影响。由于之前的研究显示 FPI-6 方法具有特别高的复测可靠性，因此我们建议在未来的研究中统一使用这种类型的足姿测量方法。
