Physiotherapy - Research Publications
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ItemEffect of knee unloading shoes on regional plantar forces in people with symptomatic knee osteoarthritis - an exploratory study(BMC, 2018-06-26)BACKGROUND: Knee 'unloading' footwear can reduce the external knee adduction moment in people with knee osteoarthritis, yet effects of these shoes on regional plantar forces are unknown. We evaluated the effects of unloading shoes on in-shoe regional plantar forces, and whether measures of foot posture and/or mobility moderate these effects in people with symptomatic knee osteoarthritis. METHODS: In this exploratory study 21 participants underwent testing while wearing knee unloading shoes (ASICS GEL-Melbourne OA) and conventional shoes in random order. Peak total forces were compared across conditions for: lateral heel, medial heel, lateral forefoot, and medial forefoot. Arch index, centre of pressure position and medial-lateral heel peak force ratio were also evaluated. Foot posture, foot mobility magnitude and navicular drop were separately added to the mixed linear model to investigate if these modified the effect of footwear on outcomes. RESULTS: Unloading shoes significantly increased lateral heel and lateral forefoot force (12.9 and 20.2% respectively, all P < 0.001), with concurrent decreases in the medial heel (8.9%, P = 0.001) and medial forefoot (9.9%, P = 0.005). Unloading shoes significantly shifted the centre of pressure anteriorly (4.7%, P < 0.001) and laterally (5.6%, P = 0.034), but did not affect the arch index (8.7%, P = 0.093). Foot posture, foot mobility magnitude and navicular drop did not moderate the effect of footwear on outcomes. CONCLUSION: Compared to conventional shoes, unloading shoes caused a lateral shift in foot pressure and force patterns. Although these effects were not moderated by foot posture, FMM or navicular drop, variability in the individual increases in lateral heel force suggests participant characteristics other than foot posture may play a role. TRIAL REGISTRATION: ACTRN12613000851763. Registered 02 August 2013.
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ItemFootwear for self-managing knee osteoarthritis symptoms: protocol for the Footstep randomised controlled trial(BMC, 2018-07-18)BACKGROUND: Knee osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability globally, and abnormal knee loading is central to disease pathogenesis. Clinical guidelines recommend clinicians provide advice regarding appropriate footwear for people with knee OA, yet there is little research comparing the effects of different footwear on knee OA symptoms. Research suggests that wearing flat flexible shoes is associated with lower knee joint loads compared to stable supportive shoe styles. This two-arm pragmatic, comparative effectiveness randomised controlled trial will compare the effects of daily use of flat flexible shoes and stable supportive shoes on knee OA clinical outcomes, over 6 months. METHODS: 164 people with symptomatic medial tibiofemoral OA of moderate to severe radiographic severity (Kellgren and Lawrence Grade 3 & 4) will be recruited from the community. Following baseline assessment, participants will be randomly allocated to receive either i) flat flexible shoes or; ii) stable supportive shoes. Participants will choose two different pairs of shoes from a selection that fulfil the criteria in their allocated shoe class. Limited disclosure will blind participants to group allocation. Participants will be instructed to wear their allocated shoes daily for 6 months (minimum of 6 h/day), after which participants will be reassessed. The primary outcomes are knee pain severity on walking (measured by numerical rating scale) and self-reported physical function (measured by the Western Ontario and McMaster Universities Osteoarthritis Index), assessed at baseline and 6 months. Secondary outcomes include additional measures of knee pain, function, sport and recreation participation and quality-of-life (measured using subscales of the Knee Osteoarthritis Outcome Score), as well as pain at other sites (measured by numerical rating scale), self-reported global ratings of change in pain and physical function (measured by 7-point rating scale), and physical activity levels (measured by Physical Activity Scale for the Elderly). DISCUSSION: This study will determine whether daily wear of flat flexible shoes improves clinical outcomes in the management of knee OA, compared to stable supportive shoes. Findings will assist clinicians in providing evidence-based advice regarding appropriate footwear for people with knee OA to self-manage symptoms. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry reference: ACTRN12617001098325 . Registered 28/07/2017.
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ItemPlug-in-Gait calculation of the knee adduction moment in people with knee osteoarthritis during shod walking: comparison of two different foot marker models(BMC, 2017-02-04)BACKGROUND: Understanding how kinematic multi-segment foot modelling influences the utility of Plug-in-Gait calculations of the knee adduction moment (KAM) during shod walking is relevant to knee osteoarthritis (OA). Multi-segment foot markers placed on the skin through windows cut in to the shoe provide a more accurate representation of foot mechanics than the traditional marker set used by Plug-in-Gait, which uses fewer markers, placed on the shoe itself. We aimed to investigate whether Plug-in-Gait calculation of the KAM differed when using a kinematic multi-segment foot model compared to the traditional Plug-in-Gait marker set. METHODS: Twenty people with medial knee OA underwent gait analysis in two test conditions: i) Plug-in-Gait model with its two standard foot markers placed on the shoes and; ii) Plug-in-Gait with the heel marker virtualised from a modified-Oxford Foot Model where 8 ft markers were placed on the skin through windows cut in shoe uppers. Outcomes were the peak KAM, KAM impulse and other knee kinetic and kinematic variables. RESULTS: There were no differences (P > 0.05) in any gait variables between conditions. Excellent agreement was found for all outcome variables, with high correlations (r > 0.88-0.99, P < 0.001), narrow limits of agreement and no proportional bias (R2 = 0.03-0.14, P > 0.05). The mean difference and 95% confidence intervals for peak KAM were also within the minimal detectable change range demonstrating equivalence. CONCLUSIONS: Plug-in-Gait calculations of the KAM are not altered when using a kinematic multi-segment foot marker model with skin markers placed through windows cut in to the shoe, instead of the traditional marker set placed on top of shoes. Researchers may be confident that applying either foot model does not change the calculation of the KAM using Plug-in-Gait.
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ItemUnloading shoes for osteoarthritis of the knee: protocol for the SHARK randomised controlled trial(BIOMED CENTRAL LTD, 2014-02-21)BACKGROUND: Knee osteoarthritis (OA) is a common and disabling condition. Abnormalities in knee loading play an important role in disease pathogenesis, yet there are few non-surgical treatments for knee OA capable of reducing knee load. This two-arm randomised controlled trial is investigating the efficacy of specially-designed unloading shoes for the treatment of symptoms in people with knee OA. METHODS/DESIGN: 164 people with symptomatic medial tibiofemoral joint OA will be recruited from the community and randomly allocated to receive either unloading shoes or control shoes. Unloading shoes have a specially-designed triple-density midsole where the medial side is softer than normal and the lateral side harder as well as a lateral wedge between the sole and sock-liner. Control shoes are standard athletic shoes and do not contain these features. Participants will be blinded to shoe allocation and will be instructed to wear the shoes as much as possible every day for 6 months, for a minimum of 4 hours per day. The primary outcomes are knee pain (numerical rating scale) and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index) measured at baseline and 6 months. Secondary outcomes include additional measures of knee pain, knee stiffness, participant global ratings of change in symptoms, quality-of-life and physical activity. CONCLUSIONS: The findings from this study will help determine whether specially-designed unloading shoes are efficacious in the management of knee OA. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry reference: ACTRN12613000851763.