Eichelberger P1, Lambelet D1, Chavaillaz N1, Krause F2, Baur H1
1Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Bern, Switzerland, 2University Hospital Bern, Inselspital, Department of Orthopedic Surgery, Bern, Switzerland
Background: Foot orthoses are commonly used in the management of foot complaints. While certain studies explored effects on multi-segment foot kinematics, the knowledge about the influence on midfoot kinematics measured by cranio-caudal and medio-lateral navicular translation is limited.
Purpose: The study aimed to evaluate the effects of wearing sandals and sandals with medial longitudinal arch supporting orthoses on the navicular kinematics during the stance phase of walking.
Methods: Navicular kinematics were measured in 22 healthy participants while walking barefoot (BF) and in sandals with (SO) and without (S) orthoses, which provided medial longitudinal arch support. Effects of the footwear intervention on the cranio-caudal and medio-lateral navicular position with respect to bipedal upright stand, navicular displacement and velocity throughout the stance phase were explored by statistical parametric mapping.
Results: Cranio-caudal and medio-lateral navicular displacement showed generally consistent patterns of caudally dropping and medially bulging during loading response, mid- and terminal stance followed by cranially rising and laterally shifting during push-off. Maximum caudal displacement was 6.2, 6.9 and 7.2 mm (BF, S, SO) between 76% and 78% stance and not significantly affected by the shoe conditions. However, there was a tendency for a more flattened arch in late terminal stance due to shoes with orthoses when looking at the cranio-caudal navicular position. Maximum medial displacement was 4.3, 5.4 and 7.0 mm (BF, S, SO) between 72% and 76% stance and was significantly increased by shoes with orthoses compared to barefoot walking. This was due to a more lateral position during loading response and a more medial position towards the end of terminal stance. Up to 1.8 mm less caudal displacement occurred from initial contact to 65% stance with orthoses compared to barefoot walking and walking in shoes but the effect was only significant when comparing shoes with and without orthoses. Shoes with and without orthoses restricted the arch rise during push-off up to 3 mm and 4 mm, respectively. Shoes with orthoses increased the medial displacement between 1.5 mm and 5.9 mm during the second half of stance. Both shoe conditions led up to 22.5 mm/s reduced rates of caudal and medial displacement during early loading response and up to 54.5 mm/s reduced rates of cranial and lateral displacement during push-off.
Conclusion(s): The study found that walking in shoes with foot orthoses affected midfoot kinematics. The tendency of increased caudal arch drop and medial arch drift might be a consequence of reduced muscular stabilization due the footwear intervention or because the sandals provided not enough support for the orthoses to fulfill the intended requirements. However, foot orthoses delayed the arch drop during the first half of stance. Shoes possibly restricted dorsal extension in the metatarsal-phalangeal joints during push-off and consequently prevented the windlass mechanism from passively rising the medial longitudinal arch.
Implications: Instead of reducing assessments to features, like range of motion, the whole stance phase should be considered when analyzing effects of footwear. Studies combining biomechanical measurements with patient outcomes are needed to further explore the effectiveness of foot orthoses.
Keywords: midfoot motion, foot orthoses, walking
Funding acknowledgements: This study was supported by a grant from the Swiss National Science
Foundation (SNSF), Project 140928.
Purpose: The study aimed to evaluate the effects of wearing sandals and sandals with medial longitudinal arch supporting orthoses on the navicular kinematics during the stance phase of walking.
Methods: Navicular kinematics were measured in 22 healthy participants while walking barefoot (BF) and in sandals with (SO) and without (S) orthoses, which provided medial longitudinal arch support. Effects of the footwear intervention on the cranio-caudal and medio-lateral navicular position with respect to bipedal upright stand, navicular displacement and velocity throughout the stance phase were explored by statistical parametric mapping.
Results: Cranio-caudal and medio-lateral navicular displacement showed generally consistent patterns of caudally dropping and medially bulging during loading response, mid- and terminal stance followed by cranially rising and laterally shifting during push-off. Maximum caudal displacement was 6.2, 6.9 and 7.2 mm (BF, S, SO) between 76% and 78% stance and not significantly affected by the shoe conditions. However, there was a tendency for a more flattened arch in late terminal stance due to shoes with orthoses when looking at the cranio-caudal navicular position. Maximum medial displacement was 4.3, 5.4 and 7.0 mm (BF, S, SO) between 72% and 76% stance and was significantly increased by shoes with orthoses compared to barefoot walking. This was due to a more lateral position during loading response and a more medial position towards the end of terminal stance. Up to 1.8 mm less caudal displacement occurred from initial contact to 65% stance with orthoses compared to barefoot walking and walking in shoes but the effect was only significant when comparing shoes with and without orthoses. Shoes with and without orthoses restricted the arch rise during push-off up to 3 mm and 4 mm, respectively. Shoes with orthoses increased the medial displacement between 1.5 mm and 5.9 mm during the second half of stance. Both shoe conditions led up to 22.5 mm/s reduced rates of caudal and medial displacement during early loading response and up to 54.5 mm/s reduced rates of cranial and lateral displacement during push-off.
Conclusion(s): The study found that walking in shoes with foot orthoses affected midfoot kinematics. The tendency of increased caudal arch drop and medial arch drift might be a consequence of reduced muscular stabilization due the footwear intervention or because the sandals provided not enough support for the orthoses to fulfill the intended requirements. However, foot orthoses delayed the arch drop during the first half of stance. Shoes possibly restricted dorsal extension in the metatarsal-phalangeal joints during push-off and consequently prevented the windlass mechanism from passively rising the medial longitudinal arch.
Implications: Instead of reducing assessments to features, like range of motion, the whole stance phase should be considered when analyzing effects of footwear. Studies combining biomechanical measurements with patient outcomes are needed to further explore the effectiveness of foot orthoses.
Keywords: midfoot motion, foot orthoses, walking
Funding acknowledgements: This study was supported by a grant from the Swiss National Science
Foundation (SNSF), Project 140928.
Topic: Human movement analysis; Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: Ethics committee of the canton of Bern
Ethics committee: Ethics committee of the canton of Bern
Ethics number: 052/15
All authors, affiliations and abstracts have been published as submitted.
