Payen Eléna, Acien Maxime, Isabelle Pier-Luc, Turcot Katia, Begon Mickaël, Abboud Jacques, Moisan Gabriel
Department of Anatomy, Université du Québec à Trois-Rivières, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques, Université du Québec à Trois-Rivières, Canada.
Department of Anatomy, Université du Québec à Trois-Rivières, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques, Université du Québec à Trois-Rivières, Canada.
Gait Posture. 2025 May;118:17-24. doi: 10.1016/j.gaitpost.2025.01.022. Epub 2025 Jan 21.
Foot orthoses (FOs) are commonly prescribed to reduce pain and improve function in individuals with musculoskeletal disorders, including those with chronic metatarsalgia (CM). Reducing the mechanical overload under the metatarsal heads during locomotion is the central point of the treatment for CM. Medially wedged FOs (MWFOs) with a metatarsal pad could further reduce pressure loading under the metatarsal heads and modify foot and ankle biomechanics compared to standard FOs (SFOs).
Do MWFOs further decrease the peak plantar pressure under the metatarsal heads in individuals with CM compared to SFOs? What are the effects of these FOs on foot and ankle 3D kinematics and kinetics in individuals with CM?
Twenty-three individuals (17 females and 6 males) with CM were recruited in this cross-sectional descriptive study. Participants walked during three conditions: (1) Shod, (2) SFOs, and (3) MWFOs. Peak plantar pressure, midfoot and ankle angles and moments were calculated and compared across conditions with repeated measure ANOVAs using statistical parametric mapping.
SFOs and MWFOs reduced plantar pressure under the metatarsal heads, ankle plantarflexion angle, and midfoot plantarflexion moment compared to shod. SFOs and MWFOs increased plantar pressure under the medial midfoot. MWFOs reduced plantar pressure under the 1st-2nd-3rd metatarsal heads during the second part of the stance phase and increased plantar pressure under the medial midfoot compared to SFOs. MWFOs also decreased midfoot dorsiflexion and inversion angles, ankle eversion angle, and ankle inversion moment compared to shod.
MWFOs were more effective than SFOs in reducing peak pressure under the 1st-2nd-3rd metatarsal heads and modifying lower limb biomechanics during walking. This reduction implies a pressure transfer from the metatarsal heads to the medial midfoot. These findings are promising to find the FOs model most suitable to reduce pain and improve physical function in individuals with CM.
足部矫形器（FOs）通常用于减轻患有肌肉骨骼疾病的个体的疼痛并改善其功能，包括慢性跖痛症（CM）患者。减少运动过程中跖骨头下方的机械过载是CM治疗的核心要点。与标准足部矫形器（SFOs）相比，带有跖骨垫的内侧楔形足部矫形器（MWFOs）可进一步降低跖骨头下方的压力负荷，并改变足踝生物力学。
与SFOs相比，MWFOs是否能进一步降低CM患者跖骨头下方的足底峰值压力？这些足部矫形器对CM患者的足踝三维运动学和动力学有何影响？
在这项横断面描述性研究中招募了23名患有CM的个体（17名女性和6名男性）。参与者在三种条件下行走：（1）穿鞋，（2）SFOs，（3）MWFOs。使用统计参数映射通过重复测量方差分析计算并比较各条件下的足底峰值压力、中足和踝关节角度及力矩。
与穿鞋相比，SFOs和MWFOs降低了跖骨头下方的足底压力、踝关节跖屈角度和中足跖屈力矩。SFOs和MWFOs增加了中足内侧的足底压力。与SFOs相比，MWFOs在站立期的第二部分降低了第1 - 2 - 3跖骨头下方的足底压力，并增加了中足内侧的足底压力。与穿鞋相比，MWFOs还降低了中足背屈和内翻角度、踝关节外翻角度以及踝关节内翻力矩。
MWFOs在降低第1 - 2 - 3跖骨头下方的峰值压力以及改变行走过程中的下肢生物力学方面比SFOs更有效。这种降低意味着压力从跖骨头转移到了中足内侧。这些发现有望找到最适合减轻CM患者疼痛并改善其身体功能的足部矫形器模型。
