File
Ribeiro AP1, Maria Amado João S2
1University Santo Amaro, Post Graduation, Health Science Department and Physiotherapy, São Paulo, Brazil, 2University of Sao Paulo, Physical Therapy, Speech and Occupational Therapy Department, Sao Paulo, Brazil
Background: Calcaneus spur (CS) are most common musculoskeletal injuries, which contribute to work incapacity and locomotion in 75-89% of patients with plantar heel pain. Repetitive microtrauma is important in the pathogenesis of calcaneal spurs and inadequate footwear can result in worsening and progression of the disease. Conservative treatment by customized insole has shown effectiveness in short-term to calcaneus pain reduce. Recent studies, not specific to CS, have shown short and long-term benefits of minimalist footwear to reduced force overload in degenerative diseases.
Purpose: Investigate the therapeutic effect, of inexpensive and minimalist footwear and customized insole during gait in women with CS.
Methods: A randomized, parallel and controlled clinical trial with blind assessor was conducted. Twenty women with CS were randomized and allocated to the intervention groups (49.8±6.0 yr, 84.3±13.0 kg, 1.60±0.1 m) and twenty women to control group (49.8±9.0 yr, 66.7±7.0 kg, 1.61±0.1 m). The intervention groups were: minimalist footwear group-MFG (n=10 CS), customized insole on minimalist footwear group- CIG (n=10 CS) and control-GC group (n=20). Groups both were assessed at baseline condition and after three months. The footwear or insole use for three months, for at least six hours a day, seven days a week (42 hours weekly) were adopted as interventions. The primary outcomes were the foot pain verified by the visual analogue scale (VAS) and the feet disability domains by Foot Function Index (FFI) and Foot Health Status Questionnaire (FHSQ-Br). The secondary outcomes were the plantar pressure (rearfoot, midfoot and forefoot) evaluated by pressure platform system during gait.
Results: The intervention with minimalist footwear (MFG) was more effective in women with CS, due to the great improvement foot pain (pre: 9.8±0.7 and post: 2.8 ± 2.3, p=0.001), feet functionality (FFI score pre: 71.8±13.3 and post: 20.6±8.9, p=002; FSHQ-Br score pre: 94.4±4.8 and post: 30.0±9.6, p= 0.001) and peak pressure reduction on rearfoot (medial pre: 287.0±41.7 and post: 259.6±38.4, p=0.001; lateral pre: 271.3±41.3 and post: 245.6±38.0, p=0.001) and forefoot (pre: 319.8±32,1 and post: 270.4±29.4, p=0.001), when compared to CIG and CG (p 0.01).
Conclusion(s): The use of inexpensive and minimalist footwear can be recommended as a conservative mechanical treatment effective in reducing calcaneus pain, increased foot function and reduction plantar overload on the rearfoot in women with CS in relation the customized insole.
Implications: Greater emphasis should be placed on footwear education as a treatment strategy by physiotherapist and its appropriate selection according to the disease different stages (Acute - plantar fasciitis: inflammatory and chronic: degenerative with spurs of calcaneus).
Keywords: calcaneus spur, footwear, insole
Funding acknowledgements: The National Council of the Scientific and Technological Development (CNPq) provided support for Ana Paula Ribeiro´s scholarship (458700/2014-2).
Purpose: Investigate the therapeutic effect, of inexpensive and minimalist footwear and customized insole during gait in women with CS.
Methods: A randomized, parallel and controlled clinical trial with blind assessor was conducted. Twenty women with CS were randomized and allocated to the intervention groups (49.8±6.0 yr, 84.3±13.0 kg, 1.60±0.1 m) and twenty women to control group (49.8±9.0 yr, 66.7±7.0 kg, 1.61±0.1 m). The intervention groups were: minimalist footwear group-MFG (n=10 CS), customized insole on minimalist footwear group- CIG (n=10 CS) and control-GC group (n=20). Groups both were assessed at baseline condition and after three months. The footwear or insole use for three months, for at least six hours a day, seven days a week (42 hours weekly) were adopted as interventions. The primary outcomes were the foot pain verified by the visual analogue scale (VAS) and the feet disability domains by Foot Function Index (FFI) and Foot Health Status Questionnaire (FHSQ-Br). The secondary outcomes were the plantar pressure (rearfoot, midfoot and forefoot) evaluated by pressure platform system during gait.
Results: The intervention with minimalist footwear (MFG) was more effective in women with CS, due to the great improvement foot pain (pre: 9.8±0.7 and post: 2.8 ± 2.3, p=0.001), feet functionality (FFI score pre: 71.8±13.3 and post: 20.6±8.9, p=002; FSHQ-Br score pre: 94.4±4.8 and post: 30.0±9.6, p= 0.001) and peak pressure reduction on rearfoot (medial pre: 287.0±41.7 and post: 259.6±38.4, p=0.001; lateral pre: 271.3±41.3 and post: 245.6±38.0, p=0.001) and forefoot (pre: 319.8±32,1 and post: 270.4±29.4, p=0.001), when compared to CIG and CG (p 0.01).
Conclusion(s): The use of inexpensive and minimalist footwear can be recommended as a conservative mechanical treatment effective in reducing calcaneus pain, increased foot function and reduction plantar overload on the rearfoot in women with CS in relation the customized insole.
Implications: Greater emphasis should be placed on footwear education as a treatment strategy by physiotherapist and its appropriate selection according to the disease different stages (Acute - plantar fasciitis: inflammatory and chronic: degenerative with spurs of calcaneus).
Keywords: calcaneus spur, footwear, insole
Funding acknowledgements: The National Council of the Scientific and Technological Development (CNPq) provided support for Ana Paula Ribeiro´s scholarship (458700/2014-2).
Topic: Orthopaedics; Orthopaedics
Ethics approval required: Yes
Institution: School of Medicine, University of Sao Paulo
Ethics committee: Human Research Board, School of Medicine, University of Sao Paulo
Ethics number: 1.074.141/2015
All authors, affiliations and abstracts have been published as submitted.
