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Late Rearfoot Eversion and Lower-limb Internal Rotation Caused by Changes in the Interaction between Forefoot and Support Surface

Thales R. Souza Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

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Rafael Z. Pinto Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

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Renato G. Trede Department of Mechanical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

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Renata N. Kirkwood Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

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Antônio E. Pertence Department of Mechanical Engineering, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

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Sérgio T. Fonseca Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

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Background: The influence of distal mechanical factors that change the interaction between the forefoot and the support surface on lower-limb kinematics is not well established. This study investigated the effects of the use of lateral wedges under the forefoot on the kinematics of the lower extremity during the stance phase of walking.

Methods: Sixteen healthy young adults participated in this repeated-measures study. They walked wearing flat sandals and laterally wedged sandals, which were medially inclined only in the forefoot. One wedged sandal had a forefoot lateral wedge of 5° and the other wedged sandal had a forefoot lateral wedge of 10°. Kinematic variables of the lower extremity, theoretically considered clinically relevant for injury development, were measured with a three-dimensional motion analysis system. The variables were evaluated for three subphases of stance: loading response, midstance, and late stance.

Results: The 5° laterally wedged sandal increased rearfoot eversion during midstance and the 10° laterally wedged sandal increased rearfoot eversion during mid- and late stances, in comparison to the use of flat sandals. The 10° laterally wedged sandal produced greater internal rotation of the shank relative to the pelvis and of the hip joint, during the midstance, also compared to the use of flat sandals.

Conclusions: Lateral wedges under the forefoot increase rearfoot eversion during mid-and late stances and may cause proximal kinematic changes throughout the lower-extremity kinetic chain. Distal mechanical factors should be clinically addressed when a patient presents late excessive rearfoot eversion during walking. (J Am Podiatr Med Assoc 99(6): 503–511, 2009)

Corresponding author: Thales R. Souza, MSc, Department of Physical Therapy, Universidade Federal de Minas Gerais, Av. Antonio Carlos 6627, Belo Horizonte, MG, 31270-010 Brazil. (E-mail: thalesrsouza@gmail.com)