Physiotherapy - Research Publications
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ItemEffect of high and low-supportive footwear on female tri-planar knee moments during single limb landing(BMC, 2018-09-10)BACKGROUND: Higher landing-related external knee joint moments at later stages of female pubertal development likely contribute to a higher incidence of non-contact anterior cruciate ligament (ACL) injury. Athletic footwear may provide a potential strategy to alter higher knee moments. METHODS: Thirty-one late/post-pubertal girls (Tanner stage IV-V, menarche and growth spurt attained) performed a single limb drop lateral jump in three footwear conditions (barefoot, low support shoes and high support shoes), in which peak knee abduction moment (KAbM), flexion moment (KFM) and internal rotation moments (KIRM) were measured. Repeated measures ANOVA and ANCOVA were used to test for a main effect of footwear with and without foot posture index (FPI) as a covariate (p < 0.05) with post-hoc test carried out via Fisher's Least Significant Difference (LSD). RESULTS: A main effect of footwear condition was observed for peak KFM (p < 0.05), but not KAbM or KIRM, in both unadjusted and adjusted models. Post-hoc analysis demonstrated that both high- and low-support shoes increased peak KFM compared with barefoot (p < 0.001). CONCLUSION: Our findings indicate commercially available high- and low-supportive footwear increase peak KFM, but do not effect KAbM or KIRM while landing among late/post-pubertal girls. This suggests that these styles of footwear are inadequate at reducing higher knee moments in an at-risk cohort.
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ItemDifferences and mechanisms underpinning a change in the knee flexion moment while running in stability and neutral footwear among young females(BMC, 2019-01-08)BACKGROUND: Higher peak external knee flexion moments (KFM) during running has been observed in healthy people wearing athletic footwear compared to barefoot, which may increase risk of knee pathologies such as patellofemoral pain. Currently, no studies have examined whether stability and neutral style athletic shoes influence the peak KFM differently, or explored the underlying biomechanical mechanisms by which footwear alters peak KFM in young females. METHODS: Lower limb biomechanics of sixty girls aged between 10 and 25 years old were collected while running in footwear (both stability and neutral) and barefoot. The external peak KFM, sagittal plane kinematics, sagittal plane knee ground reaction force (GRF) lever arm and sagittal plane resultant GRF magnitude were analysed by repeated measures Analysis of Variance. Linear mixed models were fit to identify predictors of a change in peak KFM, and to determine if the effects of these predictors differed between footwear conditions. RESULTS: The peak KFM was higher wearing both shoe styles compared to barefoot (p < 0.001), while no between-shoe differences were found (p > 0.05). Both shoes also increased kinematic variables at the hip, knee, and ankle (p < 0.05). When all these variables were entered into the mixed model, only a change in the knee-GRF lever arm was predictive of a change in peak KFM wearing shoes compared to barefoot (p < 0.001). CONCLUSION: These findings provide evidence that stability and neutral shoes increase peak KFM compared to barefoot, which is associated with a change in the knee-GRF lever arm rather than a change in lower limb kinematics. Future studies may consider manipulating footwear characteristics to reduce the knee-GRF lever arm in an effort to reduce peak KFM and the potential risk of patellofemoral pain.
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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.