Effects of a corrective heel lift with an orthopaedic walking boot on joint mechanics and symmetry during gait

Severin, Anna C.; Gean, Richard P; Barnes, Sally G.; Queen, Robin M.; Butler, Robert J.; Martín, Robert D.; Barnes, C. Lowry; Mannen, Erin M.

doi:10.1016/j.gaitpost.2019.07.374

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…Similar to our presented data, they could not detect any significant changes in peak pressure and peak pressure integral. However, previous studies were able to show a reduction of gait asymmetries [ 30 ], significant improvements in the modified Oswestry low back pain disability questionnaire, and higher scores in the lower extremity functional scale [ 23 ] when an orthotic shoe lift was used.…”

Section: Discussionmentioning

confidence: 99%

Pedobarographic evaluation of five commonly used orthoses for the lower extremity

Ehrnthaller¹,

Rellensmann²,

Baumbach³

et al. 2022

Arch Orthop Trauma Surg

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Introduction Orthoses are designed to achieve immobilization or off-loading of certain regions of the foot. Yet, their off-loading capacity for the specific regions has not yet been studied. Therefore, the aim of this study was to analyze the plantar pressure distribution of five commonly applied orthoses for foot and ankle in a healthy population. Materials and Methods Five orthoses (postoperative shoe, forefoot relief shoe, short walker boot, high walker boot, and calcaneus fracture orthosis) were compared pedobarographically using insoles on a treadmill to a ready-made running shoe in eleven healthy subjects (median age 29 years). Peak pressure, maximum force, force–time integral, contact time, and contact area were evaluated separately for the forefoot, midfoot, and hindfoot. Results The forefoot relief shoe, the short- and high walker boot significantly reduced the peak pressure at the forefoot with no significant differences between these orthoses. None of the five orthoses off-loaded the midfoot, but the calcaneus fracture orthosis and the short walker boot instead increased midfoot load. For the hindfoot, the calcaneus fracture orthosis was the only device to significantly reduce the peak pressure. Conclusions This is the first study to investigate the specific off-loading capacities of different orthoses for specific foot regions in a healthy collective. The knowledge of absolute and relative load shifts for the different orthoses is of fundamental interest for targeted clinical decision-making of physicians.

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Section: Discussionmentioning

confidence: 99%

Pedobarographic evaluation of five commonly used orthoses for the lower extremity

Ehrnthaller¹,

Rellensmann²,

Baumbach³

et al. 2022

Arch Orthop Trauma Surg

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“…The use of a CAM boot for an orthopedic foot and ankle condition results in an LLD between the booted and nonbooted extremities. 12,24 LLDs can negatively impact patients' balance and cause pain in other joints and the low back. 2,11 Thus, limb-lengthening orthotics have been developed that attach to the plantar aspect of the contralateral shoe, lengthening the contralateral limb, and reducing the discrepancy between the effective lengths of the limbs.…”

Section: Discussionmentioning

confidence: 99%

Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot

Mehraban

Idarraga

et al. 2020

Foot & Ankle Orthopaedics

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Background: Patients are often made weightbearing as tolerated (WBAT) in a controlled ankle motion (CAM) boot for the management of various foot and ankle conditions. The CAM boot causes a leg length discrepancy (LLD) between the booted (longer) and contralateral (shorter) lower extremities. This discrepancy can potentially cause balance problems, undue strain on joints, and discomfort in patients. We hypothesized that a leg length–evening orthotic placed on the plantar aspect of the contralateral shoe improves balance among patients who are WBAT in a CAM boot. Methods: Patients made WBAT in a CAM boot were randomized to either the leg length–evening orthotic intervention group or to a control group in which patients wore a normal shoe of their choice. Patients were followed for 2 weeks and asked a series of questions pertaining to balance and pain experienced at their knees, hips, and back. Balance was the primary outcome and was scored from 0 (no difficulty with balance) to 10 (great difficulty with balance). Of 107 subjects enrolled and randomized, 95 (88.8%) completed the study, satisfying the a priori sample size requirement of 94 patients. There were no differences in baseline characteristics between groups ( P > .05 for each). Results: Intervention patients reported less difficulty with balance than control patients (intention-to-treat analysis: 2.0±1.5 vs 3.2±1.8, P = .001; as-treated analysis: 2.1±1.7 vs 3.0±1.7, P = .009). Intervention and control patients did not differ with respect to pain experienced at their knees, hips, or back, or in a composite total pain score ( P > .05 for each). Conclusion: This multicenter randomized controlled trial found that adding a limb length–evening orthotic to the plantar aspect of the contralateral shoe in a patient that is WBAT in a CAM boot improved patient-reported self-assessment of balance. The trial was powered to identify a difference in the primary outcome measure of balance and may have been insufficiently powered to identify differences in knee, hip, back, or total pain. Level of Evidence: Level II, prospective comparative study.

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“…Auch wenn die Unterschiede in der vorliegenden Arbeit nicht statistisch untersucht wurden, waren diese Veränderungen ebenfalls festzustellen (siehe Kapitel 3.4 und 3.5). Es erscheint plausibel, dass diese Veränderungen des Gangbildes für die Schmerzen verantwortlich sein könnten, da die Gelenke in ungewohnter Weise beansprucht werden und die Probanden auch in der vorliegenden Arbeit schon nach der relativ kurzen Gehzeit über Belastungen der Hüften und Knie berichteten Severin et al (2019). haben untersucht, inwiefern die durch einen orthopädischen Boot hervorgerufenen kinematischen Veränderungen durch eine kontralaterale Fersenerhöhung reversibel sind.…”

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“…Da die kontralateraleErhöhung in Studien mit CAM-Walker-Boot häufig nicht durchgeführt wird(Akizuki et al 2001;Gulgin et al 2018;Ready et al 2018;Zellers et al 2019a), liegt die Vermutung nahe, dass diese auch in der klinischen Praxis eine geringe Rolle spielt. ObwohlSeverin et al (2019) auch mit kontralateraler Fersenerhöhung veränderte Gangbilder beobachteten, sollte weitergehend untersucht werden, ob einige der negativen Folgen durch das Tragen eines CAM-Walker-Boots mit einer kontralateralen Fersenerhöhung abgemildert werden können.4.7 Bedeutung und Erweiterung der SimulationsmethodeDie in dieser Arbeit verwendete Simulationsmethode ist ein geeigneter Ansatz, um Informationen über die Muskelsehneneinheiten bei Probanden zu erhalten. Einfache Ganganalysen ermöglichen zwar die Berechnung von Gelenkmomenten, können jedoch keine Einblicke in die Muskelsehnenmechanik gewähren(Delp und Loan 2000;Reinbolt et al 2011).…”

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Biomechanische Analyse der Achillessehnenentlastung durch Unterschenkelorthetik

Förster¹

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Effects of a corrective heel lift with an orthopaedic walking boot on joint mechanics and symmetry during gait

Cited by 9 publications

References 24 publications

Pedobarographic evaluation of five commonly used orthoses for the lower extremity

Pedobarographic evaluation of five commonly used orthoses for the lower extremity

Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot

Biomechanische Analyse der Achillessehnenentlastung durch Unterschenkelorthetik

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