Full length articleInfluence of foot posture on immediate biomechanical responses during walking to variable-stiffness supported lateral wedge insole designs
Section snippets
Background
Lateral wedge insoles (LWI) are shoe-worn inserts that can alter walking biomechanics to conservatively manage knee osteoarthritis (OA). Specifically, LWI target reductions in the external knee adduction moment (KAM) – a surrogate measure of medial tibiofemoral compressive load [1]. Reducing the KAM is a primary goal of biomechanical interventions for knee OA, and a recent systematic review and meta-analysis reported that walking with LWI produces standardized mean differences between -0.20 and
Participants and foot posture groups
Healthy adults were recruited from the university and surrounding community via electronic and print media, and word of mouth. Participants were screened for, and excluded from, participation if they had any history of neurological conditions that may impair gait. In the twelve months prior to participation, participants were also free of any musculoskeletal pain or injury, and did not use orthotic insoles during this time. The six-item foot posture index (FPI) assessment [7] was used to
Results
Table 1 summarizes participant characteristics separated by foot posture groups, and Appendix 1 in Supplementary material summarizes frontal plane knee and ankle gait biomechanical outcomes.
Discussion
The current investigation explored novel designs of LWI and whether different foot postures would exhibit different biomechanical responses to these insoles. Five orthotic insole conditions – three of which included a LWI – were compared against a flat control insole. A reduction in the KAM was found only with the standalone LWI and one of the supported-LWI (WEDG + V-ARCH). The supported-LWI (WEDG + V-ARCH), however, minimized the increase in ankle/subtalar eversion moment compared to the LWI
Conclusions
The findings from this study suggest that supinated foot types respond differently than neutral and pronated foot types to various LWI designs, and subsequently may be less likely to respond biomechanically to these interventions. Supported-LWI using arch-support with a variable-stiffness design may be superior to a uniform-stiffness design for concurrently reducing magnitudes of the KAM while mitigating the increase in ankle/subtalar eversion moment compared to a LWI alone.
CRediT authorship contribution statement
Calvin T.F. Tse: Conceptualization, Methodology, Writing - review & editing, Investigation, Formal analysis, Writing - original draft, Visualization. Michael B. Ryan: Conceptualization, Methodology, Writing - review & editing, Supervision, Funding acquisition. Michael A. Hunt: Conceptualization, Methodology, Writing - review & editing, Supervision, Funding acquisition.
Declaration of Competing Interest
CT and MR are employed by Kintec Footwear + Orthotics, however, these authors do not receive any direct benefit from this research that could potentially bias these results. The authors declare no other profession or financial affiliations which would bias the results of this study.
Acknowledgments
The authors would like to thank Kintec Footwear + Orthotics for conducting the pedorthic assessments and for the fabrication of study orthotics. The authors would also like to thank Natasha Krowchuk for assistance in the data collection process. Study funding and salary support was provided by the Natural Sciences and Engineering Research Council of Canada, Canadian Institutes of Health Research, and the Michael Smith Foundation for Health Research.
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