Effects of restriction of forefoot rocker functions by immobilisation of metatarsophalangeal joints on kinematics and kinetics during walking

Effects of Shoe‐Stiffening Inserts on Lower Extremity Kinematics in Individuals With First Metatarsophalangeal Joint Osteoarthritis

“…From heel lift until toe‐off, the first MTP joint dorsiflexes as the ankle joint plantarflexes, and this synergistic pattern of movement allows the body to progress forwards over the stationary foot (21). Our observation of decreased ankle joint plantarflexion during propulsion when the shoe‐stiffening insert was worn is similar to the findings of Hall and Nester (10), Zhang et al (12), and Takahashi et al (13), who noted that the ankle joint was less plantarflexed during propulsion when healthy participants wore stiff insoles designed to limit first MTP joint motion.…”

“…At the knee, we found that maximum flexion in stance phase increased when the shoe-stiffening inserts were worn. Hall and Nester (10), Zhang et al (12), and Takahashi et al (13) made similar observations in healthy participants, with Hall and Nester (10) suggesting that increased knee flexion may be a consequence of increased tension in the gastrocnemius muscle caused by increased ankle joint dorsiflexion. However, as we did not observe any increase in ankle joint dorsiflexion during midstance (the point in the gait cycle at which maximum knee flexion occurs), this suggestion cannot explain our findings.…”

“…Furthermore, few studies have examined the effects of shoe-stiffening inserts on the function of proximal joints (10,(12)(13)(14), which is an important consideration given that altered gait patterns may be responsible for adverse effects such as knee pain (16).…”

“…Shoe‐stiffening inserts are thin, semirigid insoles placed inside the shoe with the objective of decreasing dorsal compression within the first MTP joint by reducing the magnitude of dorsiflexion during the propulsive phase of gait (8). Investigation of the biomechanical effects of shoe‐stiffening inserts, however, is limited to studies of healthy individuals (9–13) or individuals with midfoot OA (14,15) and has not been undertaken in those with first MTP joint OA. Furthermore, few studies have examined the effects of shoe‐stiffening inserts on the function of proximal joints (10,12–14), which is an important consideration given that altered gait patterns may be responsible for adverse effects such as knee pain (16).…”

“…Investigation of the biomechanical effects of shoe‐stiffening inserts, however, is limited to studies of healthy individuals (9–13) or individuals with midfoot OA (14,15) and has not been undertaken in those with first MTP joint OA. Furthermore, few studies have examined the effects of shoe‐stiffening inserts on the function of proximal joints (10,12–14), which is an important consideration given that altered gait patterns may be responsible for adverse effects such as knee pain (16).…”