Do orthopaedic shoes improve local dynamic stability of gait? An observational study in patients with chronic foot and ankle injuries

BMC Musculoskeletal Disorders

Olivier Dériaz³  François Luthi²  Philippe Terrier¹ 

[1] Clinique romande de réadaptation, Collaborateur scientifique / Service de recherche, Avenue Grand-Champsec 90, Sion, CH, 1951, Switzerland;Dpt de l'appareil locomoteur, FBM/CHUV, UNIL, Lausanne, Switzerland;Clinique romande de réadaptation SuvaCare, Sion, Switzerland

关键词: Lyapunov exponents;    Ankle fractures;    Gait variability;    Footwear outcome;    Foot orthoses;   

Others  :  1133441
DOI  :  10.1186/1471-2474-14-94

 received in 2012-10-23, accepted in 2013-03-07,  发布年份 2013

【 摘 要 】

Background

Complex foot and ankle fractures, such as calcaneum fractures or Lisfranc dislocations, are often associated with a poor outcome, especially in terms of gait capacity. Indeed, degenerative changes often lead to chronic pain and chronic functional limitations. Prescription footwear represents an important therapeutic tool during the rehabilitation process. Local Dynamic Stability (LDS) is the ability of locomotor system to maintain continuous walking by accommodating small perturbations that occur naturally during walking. Because it reflects the degree of control over the gait, LDS has been advocated as a relevant indicator for evaluating different conditions and pathologies. The aim of this study was to analyze changes in LDS induced by orthopaedic shoes in patients with persistent foot and ankle injuries. We hypothesised that footwear adaptation might help patients to improve gait control, which could lead to higher LDS:

Methods

Twenty-five middle-aged inpatients (5 females, 20 males) participated in the study. They were treated for chronic post-traumatic disabilities following ankle and/or foot fractures in a Swiss rehabilitation clinic. During their stay, included inpatients received orthopaedic shoes with custom-made orthoses (insoles). They performed two 30s walking trials with standard shoes and two 30s trials with orthopaedic shoes. A triaxial motion sensor recorded 3D accelerations at the lower back level. LDS was assessed by computing divergence exponents in the acceleration signals (maximal Lyapunov exponents). Pain was evaluated with Visual Analogue Scale (VAS). LDS and pain differences between the trials with standard shoes and the trials with orthopaedic shoes were assessed.

Results

Orthopaedic shoes significantly improved LDS in the three axes (medio-lateral: 10% relative change, paired t-test p < 0.001; vertical: 9%, p = 0.03; antero-posterior: 7%, p = 0.04). A significant decrease in pain level (VAS score -29%) was observed.

Conclusions

Footwear adaptation led to pain relief and to improved foot & ankle proprioception. It is likely that that enhancement allows patients to better control foot placement. As a result, higher dynamic stability has been observed. LDS seems therefore a valuable index that could be used in early evaluation of footwear outcome in clinical settings.

【 授权许可】

   
2013 Terrier et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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