Search Results (74)

Background: An important role in postural control is played by the plantar proprioceptive inputs, as they contribute to the sensorimotor integration of the Tonic Postural System (TPS). Although plantar stimulation is an excellent strategy for improving balance, evidence remains limited. Therefore, the aim of this pilot study was to examine the acute effects of plantar proprioceptive training on dynamic balance performance and ankle range of motion (ROM). Methods: In this randomized controlled trial, 26 physically active young adults were divided into an experimental group (EG; n = 13) and a control group (CG; n = 13). The EG performed plantar proprioceptive training including walking on a reflexology mat and balance exercises on a proprioceptive pad. The CG remained lying supine on a couch for the same amount of time as the experimental intervention. The Y-Balance Test (YBT) was used to assess dynamic balance, while the ankle ROM (i.e., dorsiflexion and plantarflexion) was measured using an inertial sensor. All measurements were taken before (T0) and immediately after (T1) the experimental or control condition. Results: Improvements in the YBT were found in the EG from T0 to T1 for both right (p = 0.002; SE = 1.24) and left (p = 0.015) foot, but no changes from T0 to T1 were observed in the CG for both right and left foot (p > 0.05). No changes were observed for ankle ROM in both groups (p > 0.05). Conclusions: These preliminary results suggest that plantar proprioceptive training can provide acute improvements in dynamic balance with no significant changes in ankle ROM. The findings support a potential role of plantar stimulation in postural control mechanisms. Full article

Introduction: Although gait alterations associated with excess body weight have been widely studied, most available evidence comes from laboratory-based analyses, which limit ecological validity and the translation of findings into clinical practice. This study addresses this gap by examining gait biomechanics across BMI categories using portable sensor-based insoles that allow gait assessment in real-world conditions. Methods: A cross-sectional study including 96 adults categorized as normal weight (NW), overweight (OW), or obese (OB) was conducted. Gait biomechanics were recorded using PODOSmart^® intelligent insoles, which capture spatiotemporal and angular parameters during natural walking. Foot health, quality of life and comorbildities were evaluated throught valeted questionnarires. Differences between groups were analyzed using ANOVA and chi-square tests. Age and sex, known to influence gait, were comparable across BMI groups and were considered in the interpretation of the results. Results: Overall, the participants in the OB group exhibited reduced stride length, gait speed, and swing time, increased double-support time, and greater pronation–supination and progression angles than OW and NW participants. Partial eta-squared values (η²p) were predominantly medium to large, reinforcing the robustness of these between-group differences (e.g., double-support time, p > 0.001; η²p = 0.19). Individuals with obesity reported poorer general and foot health and more difficulty finding suitable footwear. BMI was also significantly associated with hypertension, dyslipidemia, arthritis, and depression (all p <0.05), whereas diabetes, cardiopathies, knee pain, and fatigue andwalking or social activity limitations showed no significant differences. Conclusions: By using portable gait analysis technology in ecological conditions, this study provides novel evidence of clinically meaningful gait impairments across BMI groups. Higher BMI is associated with clinically relevant gait impairments, poorer perceptions of foot and general health, and a higher prevalence of several comorbidities. Full article

This study aimed to establish normative in-shoe plantar foot temperature patterns across three static postures—lying, sitting, and standing—in healthy individuals, providing a clinically relevant baseline for interpreting in-shoe thermograms in diabetic or peripheral arterial disease (PAD) populations. A single-center prospective study included 20 healthy adults (40 limbs; 22–74 years) who underwent vascular and neurological screening prior to data collection. Plantar temperature was continuously recorded using Tarsos^® Smart Insoles with 21 embedded sensors per foot during three consecutive 10 min phases: supine, sitting, and standing. Data were analyzed for regional differences across the toes, metatarsals, arch, and heel using statistical and visual methods. Distinct posture-related temperature patterns were observed. The arch consistently exhibited the highest temperatures, while the toes remained cooler across all phases. Supine positioning resulted in relatively uniform temperature increases, whereas sitting and standing demonstrated more-stable but region-specific patterns, with slower rates of temperature change and more pronounced regional variation. Compared with barefoot thermography, the in-shoe condition showed greater heat retention and reduced evaporative cooling, highlighting the importance of context-specific baseline data. These findings demonstrate the influence of posture on plantar thermal distribution in the in-shoe environment and support the use of embedded monitoring systems for continuous assessment where surface thermography is not feasible. Full article

Background/Objectives: Foot mobility is considered an intrinsic risk factor for lower-limb injury, yet commonly used pronated/neutral/supinated classifications rely on arbitrary cut-points. This study aimed to develop a data-driven framework for characterizing a continuous SSNDT–injury risk gradient and deriving clinically interpretable relative-risk bands that define practical injury risk zones along the sit-to-stand navicular drop test (SSNDT) continuum. Methods: Data from 137 physically active male students (274 feet) were analyzed. Intra-rater reliability of the sit-to-stand navicular drop test (SSNDT) was assessed using ICC(3,1). A quadratic mixed-effects logistic regression model was used to characterize the SSNDT–injury relationship and derive odds-ratio-based risk bands for interpretive and screening purposes. Results: SSNDT demonstrated good intra-rater reliability (ICC(3,1) = 0.82). Model comparison supported a non-linear, U-shaped association between SSNDT and injury risk, with a minimum risk value at approximately 5.5 mm. Bootstrap analysis supported a smooth continuous risk gradient. Four representative OR levels (1.2, 1.5, 1.8, and 2.0) were selected to define SSNDT-based interpretative risk bands. Injury prevalence showed an overall increasing trend across these zones, ranging from 4.2% in the Safe zone to 52.4% in the Extreme zone. Conclusions: SSNDT provides a robust, data-driven basis for quantifying foot-mobility–related injury risk along a continuous non-linear gradient and for deriving clinically interpretable relative-risk bands grounded in a validated model. The proposed framework avoids arbitrary cut-points and supports individualized risk screening. Full article

Background: Accurate assessment of pediatric foot biomechanics is challenging due to growth-related variability and limited quantitative tools. The supination and pronation angles of the ankle are critical for understanding lower limb alignment and pathological gait patterns. Objectives: This study introduces a novel digital pedoscopic system designed to enhance the quantitative evaluation of foot alignment and to demonstrate its clinical utility through clustering analysis of pediatric ankle angles. Methods: Thirty-five pediatric patients (mean age = 6.17 ± 4.54 years) with neurological or developmental disorders were evaluated using a semi-automated digital pedoscopic system to obtain quantitative measurements of ankle alignment. Key anatomical landmarks, including the heel, calf, and knee centers, were manually identified from posterior images, and the system automatically calculated ankle pronation and supination angles. K-means clustering analysis was applied to classify participants based on their biomechanical profiles. Results: A total of thirty-five pediatric patients were assessed, and the revised abstract now explicitly reports this sample size to improve clarity. Data-driven k-means clustering of bilateral rearfoot angles identified three clearly defined alignment subgroups—neutral, pronated, and supinated—each exhibiting characteristic distribution patterns and degrees of inter-individual variability. These findings highlight the system’s ability to quantitatively distinguish biomechanical phenotypes within a heterogeneous pediatric population. Visualization through scatter, box, and violin plots demonstrated distinct cluster-specific distributions and inter-individual variability in rearfoot alignment, demonstrating the feasibility of objective biomechanical stratification in pediatric populations. Conclusions: The digital pedoscopic imaging system provides a reliable and reproducible approach for quantitative assessment of foot alignment in children. Clustering analysis enables stratification of biomechanical subtypes, supporting individualized rehabilitation strategies and longitudinal monitoring in pediatric clinical practice. Full article

Aims: Structural lower limb-length discrepancies (LLLD) have been classically associated with the etiology of low back pain. However, their biomechanical effects on lower-limb muscle activity during running remain unclear. This pilot crossover study aimed to evaluate the influence of orthotic interventions—designed to compensate for LLLD and modify foot biomechanics—on the electromyographic (EMG) activity of the contralateral tensor fasciae latae (TFL) in healthy runners. Methods: A total of 41 recreational male and female runners (mean age 32.27 ± 6.09) with structural LLLD were recruited and classified as neutral (Ng), supinated (SPg), or pronated (PRg) based on their foot posture. Surface EMG activity of the TFL in the longer leg was recorded with specific surface electrodes while participants ran on a treadmill at a constant speed of 9 km/h for 3 min. Each subject randomly wore standard orthoses with 5 mm pronating (PRO), supinating (SUP) wedges or orthoses with a heel lift (TAL) to compensate for the shorter leg, alongside the baseline condition (SIN). Results: Perfect reliability (close to 1) was obtained for all measurements. A statistically significant reduction in TFL EMG activity was recorded in the Ng group: SIN 105.64 ± 50.6%MVC vs. PRO 100.16 ± 48.61%MVC (p < 0.05), and SIN vs. TAL 93.49 ± 15.88%MVC (p < 0.001). A significant reduction was also observed in the PRg group: SIN 91.82 ± 40.75%MVC vs. TAL 80.08 ± 31.75%MVC (p < 0.05). Conclusion: Orthotic compensation for LLLD and foot pronation modifications produced measurable changes in TFL EMG activity during running. These findings provide mechanistic insight into the interaction between limb-length asymmetry, foot biomechanics, and proximal muscle activation in runners, and may inform future studies on overuse injuries such as iliotibial band syndrome. Full article

Background: Arthrodesis of the first metatarsophalangeal joint (MTP1) is a common intervention for hallux rigidus (HR). The procedure eliminates MTP1 motion but results in significant pain relief and high satisfaction rates, although MTP1 is eliminated. Less evidence is available regarding the effects on gait and the presence of compensatory mechanisms. The aim of this study is to investigate the effects of MTP1 arthrodesis on gait and patient-reported outcome measures (PROMs) compared with preoperative functioning and healthy individuals. Methods: In this prospective study, 10 patients (10 feet) with HR who underwent MTP1 arthrodesis were evaluated before and after surgery and compared with 15 healthy controls (30 feet). Gait analysis was performed with a motion capturing system using the multi-segment Oxford foot model. Spatiotemporal parameters and kinematics were quantitatively analyzed. PROMs were evaluated using validated questionnaires including the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) scale, the Numeric Pain Rating Scale (NPRS), and the Manchester–Oxford Foot Questionnaire (MOXFQ). Results: MTP1 joint motion was reduced in HR and further reduced after MTP1 arthrodesis compared with healthy controls. Furthermore, intersegmental ROM analysis revealed increased forefoot frontal plane motion (pronation and supination) in HR compared with healthy controls. This was also observed after MTP1 arthrodesis, while additionally increased frontal plane motion in the hindfoot (inversion and eversion) was observed compared with HR and healthy controls. PROM evaluation revealed improved AOFAS-HMI (from 55.7 to 79.1 points, p = 0.002) and NPRS (from 5.7 to 1.5 points, p = 0.004) scores after surgery. Additionally, improvements in the MOXFQ score (from 51.0 to 20.0 points, p = 0.002) were observed. Conclusions: Due to the loss of sagittal hallux motion, foot and ankle kinematics are changed in HR patients and after MTP1 arthrodesis compared with healthy controls. Loss of MTP1 motion results in increased frontal plane motion of the forefoot in HR, and increased frontal plane motion of the fore- and hindfoot after MTP1 arthrodesis. Additionally, substantial improvements in PROMs were recorded after surgery. Full article

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

(1) Background: Plantar heel pain (PHP), a common overuse foot injury, significantly impacts runners. While the mechanical role of the plantar fascia during gait is established, its effect on foot function during running, particularly foot joint coupling, remains unclear. This study investigated foot joint coupling during running in runners with and without PHP using statistical parametric mapping (SPM). (2) Methods: Thirteen uninjured runners (seven m, six f; age = 30.5 ± 5.9 years; BMI = 23.5 ± 3.0 kg/m²) and thirteen runners with PHP (six m, seven f; age = 29.0 ± 8.0 years; BMI = 23.1 ± 2.0 kg/m²) performed running trials at 4.0 m/s. A seven-segment foot model that defined six functional articulations (rearfoot, medial and lateral midfoot, medial and lateral forefoot, first metatarsophalangeal) was used to quantify foot kinematics, vector coding was used to calculate joint coupling between adjacent foot segments, and SPM was used to analyze joint stance phase coupling angles. (3) Results: There were statistically significant differences in rearfoot frontal plane–medial midfoot frontal plane joint coupling between runners with and without PHP from 69 to 70% stance phase (mean difference = 39.41°) and at 76% stance (mean difference = 47.89°). The differences were indicative of greater medial midfoot eversion rotation relative to rearfoot complex inversion in the PHP group. (4) Conclusions: The difference in the rearfoot complex and medial midfoot frontal plane coupling occurred during the propulsion phase of the running stance when the foot should be transitioning to a more supinated position, which may reflect compromised supination due to plantar fascia degeneration. Full article

Previous studies on gender differences in running biomechanics have predominantly been limited to joint angles and have not investigated a potential influence of footwear condition. This study shall contribute to closing this gap. Lower body biomechanics of 37 recreational runners (19 f, 18 m) were analysed for eight footwear and two running speed conditions. Presenting the effect size Cliff’s Delta enabled the interpretation of gender differences across a variety of variables and conditions. Known gender differences such as a larger range of hip movement in female runners were confirmed. Further previously undiscovered gender differences in running biomechanics were identified. In women, the knee extensors are less involved in joint work. Instead, compared to men, the supinators contribute more to deceleration and the hip abductors to acceleration. In addition to differences in extent, women also show a temporal delay within certain variables. For the foot, ankle and shank, as well as for the distribution of joint work, gender differences were found to be dependent on footwear condition, while sagittal pelvis and non-sagittal hip and thigh kinematics are rather consistent. On average, smaller gender differences were found for an individual compared to a uniform running speed. Future studies on gender differences should consider the influence of footwear and running speed and should provide an accurate description of the footwear condition used. The findings of this study could be used for the development of gender-specific running shoes and sports and medical products and provide a foundation for the application of smart wearable devices in gender-specific training and rehabilitation. Full article

Objective: To evaluate the morphofunctional alterations in the foot and their association with functionality, considering aspects such as disability, pain, and limitations in daily activities in patients with fibromyalgia syndrome (FMS). Methods: A case–control study was conducted in patients with FMS (case group) and without FMS (control group), matched by age and sex. Foot posture was assessed using the foot posture index (FPI), along with the presence of hallux valgus (HV), trigger points, hyperkeratosis, and dorsiflexion of the first metatarsophalangeal joint and ankle. Foot functionality was evaluated using the foot function index (FFI) questionnaire. Results: A total of 100 women with FMS and 100 women without FMS, with a mean age of 61.97 ± 9.26 years, were recruited. HV (p < 0.001), hyperkeratosis (p < 0.001), pronated and supinated foot (p < 0.001), as well as limitations in dorsiflexion of the first metatarsophalangeal joint (p < 0.001) and the ankle with the knee flexed (p < 0.001) and extended (p < 0.001), along with the activity of the flexor hallucis brevis (p = 0.006), adductor hallucis (p = 0.006), and dorsal interosseous (p = 0.002) muscles, were significantly associated with the FFI, being higher in individuals with FMS, indicating greater impairment of foot functionality in these patients. Multivariate analysis revealed a statistical association between FMS and low educational level (OR = 2.57, 95% CI 1.05–5.72), the presence of another rheumatic disease (OR = 5.07, 95% CI 2.34–11), and the presence of any active trigger point (OR = 11.15, 95% CI 3.97–31.31). Conclusions: The study highlights the relationship between morphofunctional foot alterations, specifically the presence of active myofascial trigger points, and functionality in patients with FMS. Full article

Morphological and functional asymmetry of the lower limbs is a well-recognized factor contributing to musculoskeletal injuries among athletes across different levels. However, limited research exists on evaluating foot mobility asymmetry as a potential predictor of such injuries. This study aimed to (1) assess the frequency of foot mobility asymmetries among amateur athletes, (2) investigate the predictive value of foot mobility asymmetry (measured via navicular height drop) for injury risk, and (3) explore the relationship between foot type and injury occurrence. A cross-sectional sampling method was employed to select 45 physically active male amateur athletes (runners and team sports practitioners) from a university. Injury history was retrospectively recorded, and a modified navicular drop test was conducted to classify foot arch height. The predictive power of navicular height drop asymmetry was analyzed using ROC curves, and the relationship between foot type (neutral and defective combinations—pronated or supinated) and injury occurrence was examined using chi-square tests for independence. Multiple logistic regression was applied to calculate injury risk odds ratios across different foot type subgroups. The results revealed a significant frequency (51.1%) of participants with at least one defective foot, including 31.1% with one neutral and one defective foot and 20% with both feet defective. Navicular height drop asymmetry emerged as a valuable predictor of injuries, with a 36% asymmetry identified as the cut-off for increased injury risk (AUC = 0.832, 95% CI: 0.691–0.973, p < 0.001). A significant relationship was found between foot type and injury occurrence. Only one out of 22 participants with neutral feet (4.55%) experienced an injury, compared to 9 out of 14 (64.29%) with one neutral and one defective foot and 5 out of 9 (55.56%) with both feet defective. These differences were statistically significant (χ² = 16.24, p < 0.001, Cramer’s V = 0.60). The odds ratio for injury risk was 37.8 (p = 0.016) for those with asymmetry (one neutral and one defective foot) and 26.3 (p = 0.102) for those with both feet defective, compared to participants with both feet neutral. In clinical practice, these findings suggest that routine screenings for physically active individuals should incorporate foot mobility asymmetry assessment. However, it is essential to integrate this factor with other risk indicators. For individuals exhibiting high asymmetry, general foot defect correction programs may be beneficial, but injury prevention strategies should adopt a more comprehensive approach, focusing on overall fitness and tailored interventions for high-risk individuals. Full article

Background: Foot morphology in children is a crucial factor influencing multiple aspects of their physical development. Between the ages of 5 and 10 years, the critical period of child development is when the movement and stability patterns are consolidated that can affect their long-term physical performance and quality of life. The aim of this study is to analyze how the type of foot influences different physical characteristics, laxity, strength, motor tests, and baropodometric variables in children aged 5 to 10 years. Methods: A cross-sectional study involving 196 children was conducted. Different physical characteristics, laxity, strength, motor tests, and baropodometric variables of the sample were analyzed for age and Foot Posture Index (FPI). Results: Differences in all variables were examined by age and FPI. Statistical analysis showed a moderate to high correlation (r > 0.6, p < 0.01) between FPI and the relaxed calcaneal stance position (RCSP) test. Some significant differences were also found in variables related to foot pronation and supination. These results provide valuable information for understanding differences in motor and functional development during childhood and pre-adolescence. Conclusions: The findings highlight the variability in physical and functional development between age and foot type groups, highlighting the importance of considering these differences in the assessment and management of foot-related conditions and biomechanics in childhood. Foot type significantly influences children’s growth and development. Full article

Background: Flatfeet in children are common, causing concern for parents due to potential symptoms. Technological advances, like 3D foot kinematic analysis, have revolutionized assessment. This review examined 3D assessments in paediatric idiopathic flexible flat feet (FFF). Methods: Searches focused on paediatric idiopathic FFF in PubMed, Web of Science, and SCOPUS. Inclusion criteria required 3D kinematic and/or kinetic analysis during posture or locomotion, excluding non-idiopathic cases, adult feet, and studies solely on pedobarography or radiographs. Results: Twenty-four studies met the criteria. Kinematic and kinetic differences between FFF and typical feet during gait were outlined, with frontal plane deviations like hindfoot eversion and forefoot supination, alongside decreased second peak vertical GRF. Dynamic foot classification surpassed static assessments, revealing varied movement patterns within FFF. Associations between gait characteristics and clinical measures like pain symptoms and quality of life were explored. Interventions varied, with orthoses reducing ankle eversion and knee and hip abductor moments during gait, while arthroereisis normalized calcaneal alignment and hindfoot eversion. Conclusions: This review synthesises research on 3D kinematics and kinetics in paediatric idiopathic FFF, offering insights for intervention strategies and further research. Full article

Background: The present study aimed to analyze and compare the efficacy of the anterolateral and posterolateral approaches for surgical treatment of supination–external rotation type IV ankle fractures. Methods: This retrospective study enrolled 60 patients (60 feet) with supination–external rotation type IV ankle fractures, including 30 patients (30 feet) treated by means of the anterolateral approach and 30 patients (30 feet) treated by means of the posterolateral approach. Postoperative clinical efficacy was compared between the groups based on operation time, intraoperative blood loss, postoperative complications, fracture healing time, visual analog scale scores, Short Form-36 Health Survey scores, and American Orthopedic Foot and Ankle Society scores. Comparisons between the two groups were performed using independent-samples t tests and analyses of variance. Intragroup differences were compared using paired t tests, and the x 2 test was used to compare categorical variables. Results: All 60 included patients completed follow-up ranging from 12 to 18 months (mean duration, 14.8 ± 3.5 months). Although baseline characteristics were similar in the two groups, there were significant differences in operation time (86.73 ± 17.44 min versus 111.23 ± 10.05 min; P < .001) and intraoperative blood loss (112.60 ± 25.05 mL versus 149.47 ± 44.30 mL; P < .001). Although fracture healing time (10.90 ± 0.66 weeks versus 11.27 ± 0.94 weeks; P = .087) was shorter in the anterolateral group than in the posterolateral group, the difference was not significant. Postoperative complications occurred in one and three patients in the anterolateral and posterolateral approach groups, respectively. Visual analog scale scores were significantly lower in the anterolateral group than in the posterolateral group (1.43 ± 0.50 versus 1.83 ± 0.75; P = .019), although there was no significant difference in Short Form-36 Health Survey scores between the groups (73.63 ± 4.07 versus 72.70 ± 4.04; P = .377). However, American Orthopedic Foot and Ankle Society scores were higher in the anterolateral group than in the posterolateral group (80.43 ± 4.32 versus 75.43 ± 11.32; P = .030). Conclusions: Both the anterolateral and posterolateral approaches can achieve good results in the treatment of supination–external rotation type IV ankle fractures. Compared with the posterolateral approach, the anterolateral approach is advantageous for the treatment of supination–external rotation type IV ankle fractures given its safety and ability to reduce trauma, clear field of view revealed, and allow for exploration and repair of the inferior tibiofibular anterior syndesmosis within the same incision. Full article