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- Author or Editor: Michael Raymond Pierrynowski x
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The etiology of running-related injuries remains unknown; however, an implicit theory underlies much of the conventional research and practice in the prevention of these injuries. This theory posits that the cause of running-related injuries lies in the high-impact forces experienced when the foot contacts the ground and the subsequent abnormal movement of the subtalar joint. The application of this theory is seen in the design of the modern running shoe, with cushioning, support, and motion control. However, a new theory is emerging that suggests that it is the use of these modern running shoes that has caused a maladaptive running style, which contributes to a high incidence of injury among runners. The suggested application of this theory is to cease use of the modern running shoe and transition to barefoot or minimalist running. This new running paradigm, which is at present inadequately defined, is proposed to avoid the adverse biomechanical effects of the modern running shoe. Future research should rigorously define and then test both theories regarding their ability to discover the etiology of running-related injury. Once discovered, the putative cause of running-related injury will then provide an evidence-based rationale for clinical prevention and treatment.
Background: Foot orthoses are commonly dispensed for musculoskeletal complaints of the foot and lower limb. Few randomized clinical trials evaluate the clinical effectiveness of foot orthoses.
Methods: In this randomized clinical trial with a crossover design, 42 participants wore custom orthoses and prefabricated inserts in their regular footwear for 4 weeks each, consecutively. Twenty-seven participants received prefabricated inserts first and 13 received custom orthoses first. A numeric pain rating scale (possible score, 0–10) was used to measure participant pain.
Results: Statistically and clinically important decreases in pain were reported after 3 weeks by participants wearing custom orthoses first (−1.39 pain units, t 12 = 2.70, P = .02). Participants who wore prefabricated inserts first reported no statistically significant change in pain. When the alternative intervention was introduced, participants now wearing prefabricated inserts had greater pain after 1 and 2 weeks (1.1 pain units, t 12 = 3.09, P = .01 and 0.9 pain units, t 12 = 2.65, P = .02, respectively). Participants now wearing custom orthoses did not demonstrate significantly lower pain at any week compared with the second baseline but did have significantly lower pain scores compared with their initial baseline scores (−0.81 pain units, t 12 = 2.31, P = .03).
Conclusion: Full-contact custom-made foot orthoses provide symptomatic relief after 3 weeks of use for patients with lower-extremity musculoskeletal pain if they are prescribed as the initial treatment. (J Am Podiatr Med Assoc 98(5): 357–363, 2008)
Background: Specific kinematic and kinetic outcomes have been used to detect biomechanical change while wearing foot orthoses; however, few studies demonstrate consistent effects. We sought to observe changes in walking economy in patients with musculoskeletal pain across 10 weeks while wearing custom-made foot orthoses and prefabricated shoe inserts.
Methods: In this crossover randomized controlled trial, 40 participants wore custom-made orthoses and prefabricated inserts for 4 weeks each, consecutively. The path length ratio was used to quantify walking economy by comparing the undulating path of a point in the pelvis with its direct path averaged across multiple strides.
Results: For the prefab-custom group (n = 27), significant decreases in path length ratio (improved economy of gait) were noted at the initial introduction of prefabricated inserts (P = .02) and custom orthoses (P = .02) but maintained a trend toward improved economy only while wearing custom orthoses (P = .08). For the custom-prefab group (n = 13), there was worsening of the path length ratio that was significant after removing the custom-made orthoses for 4 weeks (P = .01).
Conclusion: For patients with lower-extremity musculoskeletal pain, immediate improvements in economy of gait can be expected with both interventions. It seems, however, that only the custom-made orthoses maintain economy of gait for 4 weeks. Patients who begin wearing custom-made orthoses and then wear prefabricated insoles can expect a decrease in economy of gait. (J Am Podiatr Med Assoc 98(6): 429–435, 2008)
Background: We examined the ability of foot care professionals to consistently capture the forefoot-to-rearfoot angular relationship of a single-cast foot.
Methods: Eleven Canadian certified pedorthists each cast a single foot twice using the plaster of Paris and foam box techniques. Three independent raters subsequently measured the resultant casts. Statistical analysis of the data provided generalizability coefficient estimates (ρ2) of the intracaster, intercaster, and rater reliabilities.
Results: Intracaster reliabilities were excellent when the plaster and foam box techniques were used (ρ2 = 0.831 and 0.939, respectively). The casters were more intrareliable when foam was used (F = 2.755, P = .003). Intercaster reliabilities were poor for both techniques (ρ2 = 0.410 and 0.425). Although, intrarater reliability was excellent (ρ2 = 0.882), interrater reliability was poor (ρ2 = 0.418).
Conclusion: Although plaster of Paris casting is widely perceived by the foot care community as the gold standard, other casting techniques may prove to be equally reliable. (J Am Podiatr Med Assoc 98(1): 14–18, 2008)