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12 pages, 548 KiB  
Article
The Role of Postural Assessment, Therapeutic Exercise and Foot Orthoses in Haemophilic Arthropathy: A Pilot Study
by Dalila Scaturro, Sofia Tomasello, Vincenzo Caruso, Isabella Picone, Antonio Ammendolia, Alessandro de Sire and Giulia Letizia Mauro
Life 2025, 15(8), 1217; https://doi.org/10.3390/life15081217 - 1 Aug 2025
Viewed by 260
Abstract
Haemophilic arthropathy is caused by repeated joint bleeding episodes, primarily affecting knees, ankles and elbows. Conservative options should be considered prior to surgery, as well as postural evaluation, since any functional overload promotes the development of new bleeding. The aim of this study [...] Read more.
Haemophilic arthropathy is caused by repeated joint bleeding episodes, primarily affecting knees, ankles and elbows. Conservative options should be considered prior to surgery, as well as postural evaluation, since any functional overload promotes the development of new bleeding. The aim of this study is to verify the use of foot orthoses in combination with postural rehabilitation, assessing the incidence of spontaneous haemarthroses and haematomas. In total, 15 patients were enrolled and randomly divided into two groups: 8 in group A, composed of patients who were prescribed foot orthoses and a 20-session rehabilitation program, and 7 in group B, composed of patients who were instructed to use foot orthoses only. All patients were evaluated at baseline (T0), at 3 months (T1—end of the rehabilitation program), and at 12 months (T2), using the following scales: Functional Independence Score in Haemophilia (FISH), Haemophilia Joint Health Score (HJHS) and Numerical Rating Scale (NRS). During the 12 months between the first and the last assessment, no patient in group A developed hemarthroses or hematomas, while one case of hemarthrosis was recorded in group B. The HJHS improved significantly (≤0.05) in group A at both T1 and T2, while in group B it improved significantly only in T2. As for FISH, it showed significant improvements in both groups at T1 and T2. NRS showed a significant reduction only at T2 in both groups (p-value T0–T1 0.3 in group A e 0.8 in group B). No patient reported any adverse effects from the use of orthotic insoles. The combination of postural rehabilitation, the use of foot orthoses and pharmacological prophylaxis could improve functioning and joint status in patients affected by haemophilic arthopathy, delaying or preventing new hemarthroses by improving the distribution of joint loads and the modification of musculoskeletal system’s characteristics. Full article
(This article belongs to the Special Issue Novel Therapeutics for Musculoskeletal Disorders)
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13 pages, 3980 KiB  
Article
Simulation–Driven Design of Ankle–Foot Orthoses Using DoE Optimization and 4D Visualization
by Marta Carvalho and João Milho
Biomechanics 2025, 5(3), 55; https://doi.org/10.3390/biomechanics5030055 - 1 Aug 2025
Viewed by 98
Abstract
Background/Objectives: The simulation of human movement offers transformative potential for the design of medical devices, particularly in understanding the cause–effect dynamics in individuals with neurological or musculoskeletal impairments. This study presents a simulation-driven framework to determine the optimal ankle–foot orthosis (AFO) stiffness [...] Read more.
Background/Objectives: The simulation of human movement offers transformative potential for the design of medical devices, particularly in understanding the cause–effect dynamics in individuals with neurological or musculoskeletal impairments. This study presents a simulation-driven framework to determine the optimal ankle–foot orthosis (AFO) stiffness for mitigating the risk of ankle sprains due to excessive subtalar inversion during high-impact activities, such as landing from a free fall. Methods: We employed biomechanical simulations to assess the influence of translational stiffness on subtalar inversion control, given that inversion angles exceeding 25 degrees are strongly correlated with injury risk. Simulations were conducted using a musculoskeletal model with and without a passive AFO; the stiffness varied in three anatomical directions. A Design of Experiments (DoE) approach was utilized to capture nonlinear interactions among stiffness parameters. Results: The results indicated that increased translational stiffness significantly reduced inversion angles to safer levels, though direction–dependent effects were noted. Based on these insights, we developed a 4D visualization tool that integrates simulation data with an interactive color–coded interface to depict ”safe design” zones for various AFO stiffness configurations. This tool supports clinicians in selecting stiffness values that optimize both safety and functional performance. Conclusions: The proposed framework enhances clinical decision-making and engineering processes by enabling more accurate and individualized AFO designs. Full article
(This article belongs to the Section Injury Biomechanics and Rehabilitation)
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29 pages, 2673 KiB  
Article
Process Parameters Optimization and Mechanical Properties of Additively Manufactured Ankle–Foot Orthoses Based on Polypropylene
by Sahar Swesi, Mohamed Yousfi, Nicolas Tardif and Abder Banoune
Polymers 2025, 17(14), 1921; https://doi.org/10.3390/polym17141921 - 11 Jul 2025
Viewed by 450
Abstract
Nowadays, Fused Filament Fabrication (FFF) 3D printing offers promising opportunities for the customized manufacturing of ankle–foot orthoses (AFOs) targeted towards rehabilitation purposes. Polypropylene (PP) represents an ideal candidate in orthotic applications due to its light weight and superior mechanical properties, offering an excellent [...] Read more.
Nowadays, Fused Filament Fabrication (FFF) 3D printing offers promising opportunities for the customized manufacturing of ankle–foot orthoses (AFOs) targeted towards rehabilitation purposes. Polypropylene (PP) represents an ideal candidate in orthotic applications due to its light weight and superior mechanical properties, offering an excellent balance between flexibility, chemical resistance, biocompatibility, and long-term durability. However, Additive Manufacturing (AM) of AFOs based on PP remains a major challenge due to its limited bed adhesion and high shrinkage, especially for making large parts such as AFOs. The primary innovation of the present study lies in the optimization of FFF 3D printing parameters for the fabrication of functional, patient-specific orthoses using PP, a material still underutilized in the AM of medical devices. Firstly, a thorough thermomechanical characterization was conducted, allowing the implementation of a (thermo-)elastic material model for the used PP filament. Thereafter, a Taguchi design of experiments (DOE) was established to study the influence of several printing parameters (extrusion temperature, printing speed, layer thickness, infill density, infill pattern, and part orientation) on the mechanical properties of 3D-printed specimens. Three-point bending tests were conducted to evaluate the strength and stiffness of the samples, while additional tensile tests were performed on the 3D-printed orthoses using a home-made innovative device to validate the optimal configurations. The results showed that the maximum flexural modulus of 3D-printed specimens was achieved when the printing speed was around 50 mm/s. The most significant parameter for mechanical performance and reduction in printing time was shown to be infill density, contributing 73.2% to maximum stress and 75.2% to Interlaminar Shear Strength (ILSS). Finally, the applicability of the finite element method (FEM) to simulate the FFF process-induced deflections, part distortion (warpage), and residual stresses in 3D-printed orthoses was investigated using a numerical simulation tool (Digimat-AM®). The combination of Taguchi DOE with Digimat-AM for polypropylene AFOs highlighted that the 90° orientation appeared to be the most suitable configuration, as it minimizes deformation and von Mises stress, ensuring improved quality and robustness of the printed orthoses. The findings from this study contribute by providing a reliable method for printing PP parts with improved mechanical performance, thereby opening new opportunities for its use in medical-grade additive manufacturing. Full article
(This article belongs to the Special Issue Latest Progress in the Additive Manufacturing of Polymeric Materials)
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17 pages, 341 KiB  
Article
Study of Force Changes Based on Orthotic Elements Under the First Ray
by Marina Ballesteros-Mora, Pedro V. Munuera-Martínez, Natalia Tovaruela-Carrión, Antonia Sáez-Díaz and Javier Ramos-Ortega
Appl. Sci. 2025, 15(14), 7708; https://doi.org/10.3390/app15147708 - 9 Jul 2025
Viewed by 278
Abstract
The first ray plays a fundamental role in foot biomechanics, particularly in stabilizing the medial longitudinal arch and enabling efficient weight transfer during the mid-stance and propulsion phases of gait. When dorsiflexed—a condition known as metatarsus primus elevatus—especially in its flexible form, this [...] Read more.
The first ray plays a fundamental role in foot biomechanics, particularly in stabilizing the medial longitudinal arch and enabling efficient weight transfer during the mid-stance and propulsion phases of gait. When dorsiflexed—a condition known as metatarsus primus elevatus—especially in its flexible form, this structure disrupts load distribution, impairs propulsion, and contributes to various clinical symptoms. Despite its clinical importance, the biomechanical impact of orthotic elements placed beneath the first ray remains underexplored. This study aimed to quantify the variations in medio-lateral (Fx), antero-posterior (Fy), and vertical (Fz) force vectors generated during gait in response to different orthotic elements positioned under the first ray. A quasi-experimental, post-test design was conducted involving 22 participants (10 men and 12 women) diagnosed with flexible metatarsus primus elevatus. Each participant was evaluated using custom-made insoles incorporating various orthotic elements, while gait data were collected using a dynamometric platform during the mid-stance and propulsion phases. Significant gait-phase-dependent force alterations were observed. A cut-out (E) reduced medio-lateral forces during propulsion (p < 0.05), while a kinetic wedge (F) was correlated with late-stance stability (r = −0.526). The foot posture index (FPI)/body mass index (BMI) mediated the vertical forces. The effect sizes reached 0.45–0.42 for antero-posterior force modulation. Phase-targeted orthoses (a cut-out for propulsion, a kinetic wedge for late stance) and patient factors (FPI/BMI) appear to promote biomechanical efficacy in metatarsus primus elevatus, enabling personalized therapeutic strategies. Full article
(This article belongs to the Special Issue Advances in Foot Biomechanics and Gait Analysis, 2nd Edition)
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16 pages, 1185 KiB  
Article
Iliotibial Band Behavior Assessed Through Tensor Fasciae Latae Electromyographic Activity with Different Foot Orthoses in Recreational Runners According to Foot Type: A Cross-Sectional Study
by Ruben Sanchez-Gomez, Álvaro Gómez Carrión, Ismael Ortuño Soriano, Paola Sanz Wozniak, Ignacio Zaragoza García, Fatma Ben Waer, Cristina Iona Alexe and Dan Iulian Alexe
J. Funct. Morphol. Kinesiol. 2025, 10(3), 237; https://doi.org/10.3390/jfmk10030237 - 23 Jun 2025
Viewed by 443
Abstract
Background: Iliotibial band syndrome (ITBS) through the tensor fascia latae (TFL) is a well-known pathology among runners whose etiology is not completely clear, nor is the effectiveness of plantar insoles for different types of feet known well enough for them to be considered [...] Read more.
Background: Iliotibial band syndrome (ITBS) through the tensor fascia latae (TFL) is a well-known pathology among runners whose etiology is not completely clear, nor is the effectiveness of plantar insoles for different types of feet known well enough for them to be considered a possible approach for this issue. Objective: to understand how foot type and foot orthotics may influence the electromyographic (EMG) activity of the TFL. Methods: A total of 41 healthy recreational runners (mean age 32.66 ± 3.51) were recruited for the present cross-sectional study, categorizing them as neutral (NEUg = 15), supinators (SUPg = 15), and pronators (PROg = 11) according to the foot postural index, over a period of 11 months. The EMG of the TFL was measured using a surface electromyograph device while they ran on a treadmill at a constant speed of 9 km/h for 3 min, randomly using supinating (SUP), pronating (PRO), or heel lift (TAL) insoles of 5 mm each one, compared to the baseline condition (SIN). The intraclass correlation coefficient (ICC) was performed to check the reproducibility of the tests, pairwise comparisons with Bonferroni adjustment were made, and to test the differences between measurements, the Friedman test was performed. Results: The Shapiro–Wilk test indicated a normal distribution of the sample (p > 0.05). Almost all obtained results showed a “perfect reproducibility” close to one; a significant statistical increase was observed in the mean EMG values from NEUg (87.58 ± 4.81 mV) to SUPg (97.17 ± 4.3 mV) (p < 0.05) during SIN+ basal condition. Additionally, there was a statistical reduction from SIN (87.58 ± 4.81 mV) vs. PRO (74.69 ± 3.77 mV) (p < 0.001) in NEUg and from SIN (97.17 ± 4.3 mV) vs. PRO (90.96 ± 4 mV) (p < 0.001) in SUPg. Conclusions: The SUPg exhibited increased activation of TFL fibers compared to the NEUg, likely due to the biomechanical demands associated with a supinated foot type. In contrast, the use of PRO appeared to promote relaxation of the TFL fibers by inducing internal rotation of the lower limb. Based on these preliminary results from a cross-sectional study in a healthy population, it is recommended to assess foot type when addressing ITBS and to consider the use of PRO as a complementary therapeutic strategy alongside conventional treatments. Full article
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11 pages, 963 KiB  
Article
Effect of Anti-Pronation Athletic Tape Types: A Randomized Crossover Trial on Ankle Strength, Gait Parameters, and Balance Control Ability in Women with Flexible Flat Feet
by Sang-Young Park and Seong-Gil Kim
Appl. Sci. 2025, 15(12), 6858; https://doi.org/10.3390/app15126858 - 18 Jun 2025
Viewed by 491
Abstract
Athletic Tape is widely used as an immediate and cost-effective intervention for flexible flat feet, offering a practical alternative to orthotic devices and exercise therapies. This study aimed to compare the effects of low-dye and anti-pronation taping (elastic and inelastic) on ankle strength, [...] Read more.
Athletic Tape is widely used as an immediate and cost-effective intervention for flexible flat feet, offering a practical alternative to orthotic devices and exercise therapies. This study aimed to compare the effects of low-dye and anti-pronation taping (elastic and inelastic) on ankle strength, gait parameters, and balance control in women with flexible flat feet. Thirty women were evaluated under four conditions: no taping, low-dye taping, elastic anti-pronation taping, and inelastic anti-pronation taping. Each condition was tested at 3-day intervals. Outcome measures included ankle muscle strength, step length, stride length, balance control ability assessed using the Romberg and limits of stability tests. Repeated-measures analysis of variance and post hoc least significant difference analyses were used to determine statistical significance. Additionally, effect sizes (η2) were calculated for the primary outcomes. Dorsiflexion strength significantly improved with elastic taping (p < 0.05). Step length increased with both elastic and inelastic taping, whereas stride length improved only with elastic taping. All taping methods significantly reduced the limits of stability compared with the no-taping condition (p < 0.05). Athletic Tape interventions, especially elastic anti-pronation taping, may reduce excessive foot pronation and improve ankle strength and gait performance in women with flexible flat feet. Full article
(This article belongs to the Special Issue Advanced Physical Therapy for Rehabilitation)
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22 pages, 3223 KiB  
Article
An EMG-Based GRU Model for Estimating Foot Pressure to Support Active Ankle Orthosis Development
by Praveen Nuwantha Gunaratne and Hiroki Tamura
Sensors 2025, 25(11), 3558; https://doi.org/10.3390/s25113558 - 5 Jun 2025
Viewed by 780
Abstract
As populations age, particularly in countries like Japan, mobility impairments related to ankle joint dysfunction, such as foot drop, instability, and reduced gait adaptability, have become a significant concern. Active ankle–foot orthoses (AAFO) offer targeted support during walking; however, most existing systems rely [...] Read more.
As populations age, particularly in countries like Japan, mobility impairments related to ankle joint dysfunction, such as foot drop, instability, and reduced gait adaptability, have become a significant concern. Active ankle–foot orthoses (AAFO) offer targeted support during walking; however, most existing systems rely on rule-based or threshold-based control, which are often limited to sagittal plane movements and lacking adaptability to subject-specific gait variations. This study proposes an approach driven by neuromuscular activation using surface electromyography (EMG) and a Gated Recurrent Unit (GRU)-based deep learning model to predict plantar pressure distributions at the heel, midfoot, and toe regions during gait. EMG signals were collected from four key ankle muscles, and plantar pressures were recorded using a customized sandal-integrated force-sensitive resistor (FSR) system. The data underwent comprehensive preprocessing and segmentation using a sliding window method. Root mean square (RMS) values were extracted as the primary input feature due to their consistent performance in capturing muscle activation intensity. The GRU model successfully generalized across subjects, enabling the accurate real-time inference of critical gait events such as heel strike, mid-stance, and toe off. This biomechanical evaluation demonstrated strong signal compatibility, while also identifying individual variations in electromechanical delay (EMD). The proposed predictive framework offers a scalable and interpretable approach to improving real-time AAFO control by synchronizing assistance with user-specific gait dynamics. Full article
(This article belongs to the Special Issue Sensor-Based Human Activity Recognition)
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10 pages, 1124 KiB  
Article
Energetics of a Novel 3D-Printed Custom Ankle Foot Orthosis in a Population of Individuals with Foot Drop: A Pilot Study
by Paolo Caravaggi, Giulia Rogati, Massimiliano Baleani, Roberta Fognani, Luca Zamagni, Maurizio Ortolani, Alessandro Zomparelli, Franco Cevolini, Zimi Sawacha and Alberto Leardini
Appl. Sci. 2025, 15(11), 5885; https://doi.org/10.3390/app15115885 - 23 May 2025
Viewed by 634
Abstract
Passive Dynamic Ankle–Foot Orthoses (PD-AFOs) are medical devices prescribed to individuals with foot drop, a condition characterized by weakness of the ankle dorsiflexor muscles. PD-AFOs can store and release energy during the stance phase of the gait cycle, while supporting the foot in [...] Read more.
Passive Dynamic Ankle–Foot Orthoses (PD-AFOs) are medical devices prescribed to individuals with foot drop, a condition characterized by weakness of the ankle dorsiflexor muscles. PD-AFOs can store and release energy during the stance phase of the gait cycle, while supporting the foot in the swing phase. This study aimed at estimating the energetics of a novel fiberglass-reinforced polyamide custom PD-AFO in a population of mild foot drop patients. Eight PD-AFOs were designed and 3D-printed via selective laser sintering for eight participants with a unilateral foot drop condition. Lower limb kinematics and AFO flexion/extension were recorded during comfortable walking speed via skin marker-based stereophotogrammetry. The stiffness of each AFO was measured via an ad hoc experimental setup. The elastic work performed by the PD-AFO during gait was calculated as the dot product of the calf-shell resisting moment and the rotation angle. The average maximum energy stored by the calf-shell across all PD-AFOs was 0.013 ± 0.005 J/kg. According to this study, 3D-printed custom PD-AFOs made with fiberglass-reinforced polyamide can store some elastic energy, which is released to the ankle during push-off. Further studies should be conducted to assess the effect of this energy return mechanism in improving the gait of individuals with deficits of the ankle plantarflexor muscles. Full article
(This article belongs to the Special Issue 3D Printing Technologies in Biomedical Engineering)
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11 pages, 28340 KiB  
Article
Self-Adapting Foot Orthosis Inlay Facilitates Handling and Reduces Plantar Pressure Compared to Vacuum-Based Technology
by Alexander Milstrey, Carolin Horst, Stella Gartung, Ann-Sophie Weigel, Richard Stange and Sabine Ochman
J. Clin. Med. 2025, 14(10), 3384; https://doi.org/10.3390/jcm14103384 - 13 May 2025
Viewed by 412
Abstract
Background/Objectives: Orthoses are commonly used in the treatment of various foot and ankle injuries and deformities. An effective technology in foot orthoses is a vacuum system to improve the fit and function of the orthosis. Recently, a new technology was designed to [...] Read more.
Background/Objectives: Orthoses are commonly used in the treatment of various foot and ankle injuries and deformities. An effective technology in foot orthoses is a vacuum system to improve the fit and function of the orthosis. Recently, a new technology was designed to facilitate the wearing of the foot orthoses while maintaining function without the need for vacuum suction. Methods: A plantar dynamic pressure distribution measurement was carried out in 25 healthy subjects (13 w/12 m, age 23–58 y) using capacitive measuring insoles in two differently designed inlays within the VACOpedes® orthosis (Group A: vacuum inlay vs. Group B: XELGO® inlay) and a regular off-the-shelf shoe (Group C, OTS). The peak plantar pressure, mean plantar pressure and maximum force were analyzed in the entire foot and in individual regions of the medial and lateral forefoot, the midfoot and the hindfoot. Finally, the wearing comfort was compared using a visual analog scale from 1 to 10 (highest comfort). Results: The peak pressure of both inlays was significantly lower than in the OTS shoe (A: 230.6 ± 44.6 kPa, B: 218.0 ± 49.7 kPa, C: 278.6 ± 50.5 kPa; p < 0.001). In a sub-analysis of the different regions, the XELGO® inlay significantly reduced plantar pressure in the medial forefoot compared to the vacuum orthosis (A: 181.7 ± 45.7 kPa, B: 158.6 ± 51.7 kPa, p < 0.002). The wearing comfort was significantly higher with the XELGO® inlay compared to the vacuum inlay (A: 5.68/10, B: 7.24/10; p < 0.001). Conclusions: The VACOpedes® orthosis with a new XELGO® inlay showed at least equivalent relief in all pressure distribution measurements analyzed and greater relief in the forefoot area than the VACOpedes® orthosis with a vacuum inlay, as well as increased wearing comfort. Full article
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19 pages, 18176 KiB  
Article
Dual Transverse Arch Foot Orthosis Improves Gait Biomechanics in Females with Flexible Flatfoot
by Linjie Zhang, Qiaolin Zhang, Qian Liu, Xinyan Jiang, János Simon, Tibor Hortobágyi and Yaodong Gu
Bioengineering 2025, 12(4), 418; https://doi.org/10.3390/bioengineering12040418 - 14 Apr 2025
Viewed by 1030
Abstract
(1) Background: Flexible flatfoot is characterized by medial arch collapse, leading to musculoskeletal impairments. We examined the effects of single-arch foot orthosis (SFO) and dual-arch foot orthosis (DFO) on arch height, kinematics, and kinetics in young females during walking and jogging. (2) Methods: [...] Read more.
(1) Background: Flexible flatfoot is characterized by medial arch collapse, leading to musculoskeletal impairments. We examined the effects of single-arch foot orthosis (SFO) and dual-arch foot orthosis (DFO) on arch height, kinematics, and kinetics in young females during walking and jogging. (2) Methods: Healthy females (n = 19) with flexible flatfoot were tested under three conditions: regular shoes, SFO, and DFO. Motion capture and a 3D force plate gathered biomechanical data. We also used a high-speed dual fluoroscopic imaging system (DFIS) to assess dynamic foot morphology. Outcomes included normalized truncated navicular height, medial arch angle, angles and moments at the metatarsophalangeal, subtalar, ankle, knee, and hip joints. (3) Results: Both types of orthoses improved the normalized navicular height and reduced the medial arch angle, with DFO vs. SFO showing greater effects (p < 0.001). DFO vs. SFO was also more effective in limiting the range of motion (ROM) of the metatarsophalangeal joint and dorsiflexion (p < 0.001). Additionally, DFO reduced the ankle range of motion and the maximum knee flexion during walking. Both orthoses reduced subtalar plantarflexion moments during stance (p < 0.001) and modulated ankle plantarflexion moments throughout different phases of gait. DFO uniquely enhanced metatarsophalangeal plantarflexion moments during jogging (p < 0.001). (4) Conclusions: Dual vs. single transverse arch foot orthosis is more effective in improving gait biomechanics in females with flexible flatfoot. Longitudinal studies are needed to confirm these benefits. Full article
(This article belongs to the Special Issue Mechanobiology in Biomedical Engineering)
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20 pages, 4435 KiB  
Article
Biomechanical Strategies to Improve Running: Cadence, Footwear, and Orthoses—A Quasi-Experimental Study
by Yves Lescure, Marie Adelaide Nicolas, Eleonore Perrin, Enrique Sanchis-Sales, Eva Lopezosa-Reca, Corentin Travouillon and Gabriel Gijon-Nogueron
Sensors 2025, 25(8), 2414; https://doi.org/10.3390/s25082414 - 11 Apr 2025
Viewed by 1459
Abstract
Background: Running-related injuries are often associated with biomechanical inefficiencies, particularly in the sagittal and frontal planes. This study evaluates the effects of three interventions—reduced heel-to-toe drop (HTD) shoes, increased cadence, and inversion foot orthoses—on key kinematic parameters: ankle dorsiflexion, knee flexion, and hip [...] Read more.
Background: Running-related injuries are often associated with biomechanical inefficiencies, particularly in the sagittal and frontal planes. This study evaluates the effects of three interventions—reduced heel-to-toe drop (HTD) shoes, increased cadence, and inversion foot orthoses—on key kinematic parameters: ankle dorsiflexion, knee flexion, and hip adduction (measured at foot strike and at their respective peak joint angles during the stance phase). Methods: Nineteen recreational runners (ten males and nine females; mean ± SD: age 26.4 ± 4.3 years; height 174.2 ± 7.8 cm; weight 68.3 ± 9.6 kg; BMI 22.5 ± 2.1 kg/m2) participated in a 3D motion capture study under five experimental conditions: baseline (10 mm HTD, no cadence adjustment, no foot orthoses), full intervention (5 mm HTD, +10% cadence, orthoses), and three partial interventions: HTD combined with orthoses, HTD combined with increased cadence, and cadence increase alone. Kinematic changes were analyzed for statistical significance. Results: The full intervention significantly increased ankle dorsiflexion at foot strike (from 8.11° to 10.44°; p = 0.005) and reduced peak knee flexion (from 45.43° to 43.07°; p = 0.003). Cadence adjustments consistently produced improvements, while orthoses and HTD alone showed effects on ankle flexion only. Conclusions: Combining structural (HTD and orthoses) and dynamic (cadence) modifications optimizes running biomechanics, providing evidence-based strategies for injury prevention and performance enhancement. Full article
(This article belongs to the Special Issue Sensors for Human Posture and Movement)
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29 pages, 3703 KiB  
Article
Improving Social Acceptance of Orthopedic Foot Orthoses Through Image-Generative AI in Product Design
by Stefan Resch, Jakob Schauer, Valentin Schwind, Diana Völz and Daniel Sanchez-Morillo
Appl. Sci. 2025, 15(8), 4132; https://doi.org/10.3390/app15084132 - 9 Apr 2025
Cited by 1 | Viewed by 1230
Abstract
The lack of social acceptability for wearable devices such as orthopedic foot orthoses can lead to irregular usage and missed health benefits, as shown in prior studies. While AI-generated designs have been explored for prototyping aesthetic hand orthoses, their impact on social acceptability, [...] Read more.
The lack of social acceptability for wearable devices such as orthopedic foot orthoses can lead to irregular usage and missed health benefits, as shown in prior studies. While AI-generated designs have been explored for prototyping aesthetic hand orthoses, their impact on social acceptability, particularly for foot orthoses, remains unknown. The current state of research is limited, as no empirical evidence exists on whether AI-designed orthoses influence acceptance, nor has the role of customized generative pre-trained transformers (GPTs) and specific prompting strategies been examined in this context. To address these gaps, we conducted two mixed-methods studies to investigate (1) the impact of AI-generated orthosis designs on social acceptability compared to existing orthopedic products and development concepts and (2) how a customized GPT and different prompt keywords influence acceptance. Our results show that AI-generated designs significantly enhance social acceptance across orthotic categories. Furthermore, we found that personalized GPTs and targeted prompt keywords significantly influence user perception. Overall, our findings highlight the potential of using AI to create socially acceptable design solutions for wearable technology and offer new applications for future smart devices. We contribute to generative AI in product design and provide concrete recommendations for optimizing prompting strategies to enhance social acceptance. Full article
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15 pages, 1311 KiB  
Review
Hindfoot Valgus and First Ray Insufficiency: Is There Correlation?
by Gabriele Colò, Federico Fusini, Daniele Marcolli, Massimiliano Leigheb and Michele Francesco Surace
Surgeries 2025, 6(2), 26; https://doi.org/10.3390/surgeries6020026 - 27 Mar 2025
Viewed by 1738
Abstract
The first metatarsal has the greatest inclination of all metatarsals and carries about 40% of body weight during the static stance. The rearfoot and the first ray (FR) are two distinct structures, but they are strongly related to the latest studies in the [...] Read more.
The first metatarsal has the greatest inclination of all metatarsals and carries about 40% of body weight during the static stance. The rearfoot and the first ray (FR) are two distinct structures, but they are strongly related to the latest studies in the literature; however, their mutual involvement in the foot biomechanics appears not to be fully explored. Understanding their interdependence is essential to approaching the patient in his totality. This overview aims to analyze the current evidence from the latest studies that examine the correlation between FR insufficiency (FRI) and hindfoot valgus (HV), focusing on their biomechanical interaction, clinical implications, and treatment approaches. All analyzed studies showed that plantarflexion of the first metatarsophalangeal (MTP1) joint in correct alignment increased by 26% compared to a deviated articulation. In FRI, the “windlass” mechanism appears compromised, and FR lacks the necessary stability and plantarflexion; consequently, the medial arch collapses, and the foot moves into excessive pronation. On the other hand, in HV condition, the pulley system is significantly diminished, and peroneus longus contraction cannot stabilize the FR with resultant FRI and dorsal migration. A significant correlation was found between hindfoot alignment and first metatarsal rotation (86% of patients) and between HV and hallux valgus. Foot orthoses, physical therapy, and exercise programs, especially in the initial stages of symptomatic HV, provide satisfactory results in 67% to 90% of cases, improving foot alignment and pain relief in FRI patients. In more severe cases, surgical intervention to realign the hindfoot is indicated with a very low complication rate (1–4%), which can vary from 24% to 55% in stage 4 flatfoot. No study in the literature has been found to address both pathologies simultaneously from a treatment point of view, and, although not all HV patients are affected by FRI, most patients seem to benefit from surgical stabilization of the FR in 80% of individuals with symptomatic HV. However, despite a predominance of FRI among HV individuals, not all clinical studies have confirmed this correlation. Full article
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13 pages, 1122 KiB  
Article
Optimizing Running Mechanics, Effects of Cadence, Footwear, and Orthoses on Force Distribution: A Quasi-Experimental Study
by Marie Adelaide Nicolas-Peyrot, Yves Lescure, Eleonore Perrin, Magdalena Martinez-Rico, Corentin Travouillon, Gabriel Gijon-Nogueron and Eva Lopezosa-Reca
J. Funct. Morphol. Kinesiol. 2025, 10(1), 89; https://doi.org/10.3390/jfmk10010089 - 10 Mar 2025
Viewed by 2153
Abstract
Background: Running is a popular physical activity known for its health benefits but also for a high incidence of lower-limb injuries. This study examined the effects of three biomechanical interventions—cadence adjustments, footwear modifications, and foot orthoses—on plantar pressure distribution and spatiotemporal running [...] Read more.
Background: Running is a popular physical activity known for its health benefits but also for a high incidence of lower-limb injuries. This study examined the effects of three biomechanical interventions—cadence adjustments, footwear modifications, and foot orthoses—on plantar pressure distribution and spatiotemporal running parameters. Methods: A quasi-experimental, repeated-measures design was conducted with 23 healthy recreational runners (mean age 25, mean BMI 22.5) who ran at least twice per week. Five conditions were tested: baseline (C0), increased cadence (C1), orthoses (C2), low-drop footwear (C3), and a combination of these (C4). Data were collected on a Zebris treadmill, focusing on rearfoot contact time, peak forces, and stride length. Results: Increasing cadence (C1) reduced rearfoot impact forces (−81.36 N) and led to a shorter stride (−17 cm). Low-drop footwear (C3) decreased rearfoot contact time (−1.89 ms) and peak force (−72.13 N), while shifting pressure toward the midfoot. Orthoses (C2) effectively redistributed plantar pressures reducing rearfoot peak force (−41.31 N) without changing stride length. The combined intervention (C4) yielded the most pronounced reductions in peak forces across the rearfoot (−183.18 N) and forefoot (−139.09 N) and increased midfoot contact time (+5.07 ms). Conclusions: Increasing cadence and low-drop footwear significantly reduced impact forces, improving running efficiency. Orthoses effectively redistributed plantar pressures, supporting individualized injury prevention strategies. These findings suggest that combining cadence adjustments, footwear modifications, and orthoses could enhance injury prevention and running efficiency for recreational runners. Full article
(This article belongs to the Special Issue Biomechanical Analysis in Physical Activity and Sports)
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24 pages, 3260 KiB  
Systematic Review
An Evaluation of Orthotics on In-Toeing or Out-Toeing Gait
by Harshavardhan Bollepalli, Carter J. K. White, Jacob Dane Kodra and Xue-Cheng Liu
Healthcare 2025, 13(5), 531; https://doi.org/10.3390/healthcare13050531 - 28 Feb 2025
Viewed by 1672
Abstract
Background and Objectives: In-toeing and out-toeing gait are rotational deformities commonly observed in children with neuromuscular conditions. These gait abnormalities often result from internal tibial torsion, increased femoral anteversion, and metatarsus adductus. This study was conducted to create a comprehensive evaluation of [...] Read more.
Background and Objectives: In-toeing and out-toeing gait are rotational deformities commonly observed in children with neuromuscular conditions. These gait abnormalities often result from internal tibial torsion, increased femoral anteversion, and metatarsus adductus. This study was conducted to create a comprehensive evaluation of the effectiveness of lower extremity orthotics as a non-operative treatment option, given their regular use in clinical settings. The aim of this literature review was to understand the efficacy of various orthotic devices in correcting rotational deformities in the transverse plane, thereby improving ambulation stability and 3D joint motion. Materials and Methods: Literature published after 1 January 1990 was reviewed, utilizing databases such as CENTRAL (Wiley), CINAHL (EBSCO), Medline (OVID), Scopus (Elsevier), and Web of Science (Clarivate). In totality, 13 studies were included, evaluating 365 participants with neuromuscular conditions using various orthotic devices. Results: Among these studies, two were randomized control trials (Level 1), nine were quasi-experimental studies (Level 2), and two were case studies (Level 4). Quality assessment determined that 69% of the included studies had a low risk of bias, while 31% demonstrated a moderate risk. Compression garments and rotational systems showcased the greatest change in proximal lower extremity rotation at 19.73° ± 1.57 and 24.13° ± 8.49, respectively. The most significant difference in foot progression angle is through the use of rotational systems, 19° ± 26.87. Conclusions: In a short-term treatment, children with neuromuscular disorders exhibiting in-toeing or out-toeing gait may benefit from different types of orthoses. Compression garments may aid joint alignment and enhance proprioception, rotational systems correct alignment with precise adjustability, AFOs that achieve effective stabilization can deliver benefits in the transverse plane, and foot orthotics may be appropriate for mild gait abnormality management. Full article
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