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Biomechanical Analysis of the Effect of Orthotic Shoe Inserts

A Review of the Literature

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Abstract

Physical activity is increasingly recognised as an important component of primary disease prevention. Overuse injuries are common sequelae of exercise and sporting activities in general, and of running in particular, frequently resulting in cessation of activity. It has been proposed that there is a link between foot shape, foot function and the occurrence of injury. As a means of treatment and prevention of further injury, orthoses and shoe inserts are widely prescribed in the belief that they can alter the pattern of lower extremity joints’ alignment and movement. Although this is an assumption widely made in the treatment of many joint conditions, the manner through which this treatment could be effective is not clear.

This article aims to examine the literature to gain an improved understanding of the present state of knowledge regarding the effect of foot shape and orthotic use on foot kinematic and plantar pressure characteristics.

The effects of foot type on the occurrence of lower limb injury during sporting activities and different aspects of biomechanics are reviewed, and the effects of applying orthoses on injury treatment and prevention and on various aspects of biomechanics of the lower limb joints are discussed.

Further research is required, firstly to establish the casual effect of foot type and function on the risk of lower extremity overuse injury, and secondly to document the specific effect of orthotic therapy on injury treatment and prevention. Specifically, more prospective studies are necessary to investigate the long term effect of orthotic intervention.

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References

  1. Root ML, Orien WP, Weed JH. Normal and abnormal function of the foot. Los Angeles (CA): Clinical Biomechanics Corp, 1977

    Google Scholar 

  2. James SL, Bates BT, Ostering LR. Injuries to the runners. Am J Sports Med 1987; 6: 40–50

    Article  Google Scholar 

  3. Brody DM. Techniques in the evaluation and treatment of the injured runner. Orthop Clin North Am 1982; 13: 541–58

    PubMed  CAS  Google Scholar 

  4. Adelaar RS. The practical biomechanics of running. Am J Sports Med 1986; 14: 497–500

    Article  PubMed  CAS  Google Scholar 

  5. Sullivan D, Warren RF, Pavlov H, et al. Stress fracture in 51 runners. Clin Orthop 1984; 187: 188–92

    PubMed  Google Scholar 

  6. Cowan D, Jones B, Robinson J. Medial longitudinal arch height and risk of training-associated injury [abstract]. Med Sci Sports Exerc 1989; 21 Suppl.: S60

  7. Simkin A, Leichter I, Giladi M, et al. Combined effect of foot structure and an orthotic device on stress fracture. Foot Ankle 1989; 10 (6): 25–9

    PubMed  CAS  Google Scholar 

  8. Gross ML, Davlin LB, Evanski PM. Effectiveness of orthotic shoe inserts in the long-distance runner. Am J Sports Med 1991; 19 (4): 409–12

    Article  PubMed  CAS  Google Scholar 

  9. D’Ambrosia RD. Orthotic devices in running injuries. Clin Sports Med 1985; 4: 611–8

    PubMed  Google Scholar 

  10. Kippen C, Smith R. Biomechanics: a glossary of biomechanical terms. Available from: http://www.curtin.edu.au/cumin/dept/physio/podiatry/glossary [Accessed 2000 Apr 26]

  11. Cavanagh PR, Roger MM. Pressure distribution underneath the human foot. In: Perren SM, Schneider E, editors. Biomechanics: current interdisciplinary research. Dordrecht: Martinus Nijhoff Publishers, 1985: 85–95

    Chapter  Google Scholar 

  12. Kaufman KR, Brodine SK, Shaffer RA, et al. The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med 1999 Sep–Oct; 27 (5): 585–93

    PubMed  CAS  Google Scholar 

  13. Ilahi OA, Kohl III HW. Lower extremity morphology and alignment and risk of overuse injury. Clin J Sports Med 1998; 8 (1): 38–42

    Article  CAS  Google Scholar 

  14. Stergiou N, Bates BT. The relationship between subtalar and knee joint function as a possible mechanism for running injuries. Gait Posture 1997; 6 (3): 177–85

    Article  Google Scholar 

  15. Cowan DN, Jones BH, Robinson JR. Foot morphologic characteristics and risk of exercise-related injury. Arch Fam Med 1993; 2: 273–7

    Article  Google Scholar 

  16. Wen DY, Puffer JC, Schmalzried TP. Lower extremity alignment and risk of overuse injuries in runners. Med Sci Sports Exerc 1997; 29 (10): 1291–8

    Article  PubMed  CAS  Google Scholar 

  17. Wen DY, Puffer JC, Schmalzried TP. Injuries in runners: a prospective study of alignment. Clin J Sport Med 1998; 8 (3): 187–94

    Article  PubMed  CAS  Google Scholar 

  18. Cureton TK, Wickens JS, Haskell PE. The validity of footprint as a measure of vertical height of the arch and functional efficiency of the foot. Res Q 1935; 6: 70–80

    Google Scholar 

  19. Subotnick SI. The flat foot. Physician Sports Med 1981; 9: 85–91

    Google Scholar 

  20. Subotnick SI. The biomechanics of running: implications for prevention of foot injuries. Sports Med 1985; 2: 144–53

    Article  PubMed  CAS  Google Scholar 

  21. Matheson GO, Clement DB, McKenzie DC, et al. Stress fracture in athletes: a study of 320 cases. Am J Sports Med 1987; 15: 46–58

    Article  PubMed  CAS  Google Scholar 

  22. Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: aetiology and treatment. Am J Sports Med 1984; 12: 178–84

    Article  Google Scholar 

  23. Bahlsen A. The aetiology of running injuries: a longitudinal, perspective study [thesis]. Calgary (AB): University of Calgary, 1988

    Google Scholar 

  24. Viitasalo JT, Kvist M. Some biomechanical aspects of the foot and ankle in the athletes with and without shin splints. Am J Sports Med 1983; 11: 125–30

    Article  PubMed  CAS  Google Scholar 

  25. Gehlsen GM, Seger A. Selected measures of angular displacement, strength, and flexibility in subjects with and without shin splints. Res Q 1983; 1: 478–85

    Google Scholar 

  26. Messier SP, Pittala KA. Etiologic factors associated with selected running injuries. Med Sci Sports Exerc 1988; 20 (5): 501–5

    PubMed  CAS  Google Scholar 

  27. Marshal P. The rehabilitation of overuse foot injuries in athletes and dancers. Clin Sports Med 1988; 7 (1): 175–91

    Google Scholar 

  28. Hamill J, Bates BT, Knutzman KM. Relationship between selected static and dynamic lower extremity measures. Clin Biomech 1989; 4: 217–25

    Article  Google Scholar 

  29. Kernozek TW, Ricard MD. Foot placement angle and arch type: effects on rearfoot motion. Arch Phys Med Rehabil 1990; 71: 988–91

    PubMed  CAS  Google Scholar 

  30. Nawoczenski DA, Saltzman CL, Cook TM. The effect of foot structure on the three-dimensional kinematic coupling behaviour of the leg and rear foot. Phys Ther 1998; 78 (4): 404–16

    PubMed  CAS  Google Scholar 

  31. Moseley L, Smith R, Hunt A, et al. Three-dimensional kinematics of the rearfoot during the stance phase of walking in normal adult males. Clin Biomech 1996; 11: 39–45

    Article  Google Scholar 

  32. Lundberg A, Svensson O, Bylund C, et al. Kinematics of the ankle/foot complex, part 2: pronation and supination. Foot Ankle 1989; 9 (5): 248–53

    PubMed  CAS  Google Scholar 

  33. Inman VI. The joints of the ankle. Baltimore (MD): Williams & Wilkins, 1976

    Google Scholar 

  34. Nachbauer W, Nigg BM. Effects of arch height of the foot on ground reaction forces in running. Med Sci Sports Exerc 1992; 24 (11): 1264–9

    PubMed  CAS  Google Scholar 

  35. Cavanagh PR, Lafortune MA. Ground reaction forces in distance running. J Biomech 1980; 13: 397–406

    Article  PubMed  CAS  Google Scholar 

  36. Nigg BM, Bahlsen AH, Luethi SM, et al. The influence of running velocity and midsole hardness on external impact forces in heel-toe running. J Biomech 1987; 20: 951–9

    Article  PubMed  CAS  Google Scholar 

  37. Nigg BM, Herzog W, Redd LJ. Effects of viscoelastic shoe inserts on vertical impact forces in heel-toe running. Am J Sports Med 1988; 16: 70–6

    Article  PubMed  CAS  Google Scholar 

  38. McCulloch M, Brunt D, Vander Linden D. The effect of foot orthotics and gait velocity on lower limb kinematics and temporal events of stance. J Orthop Sports Phys Ther 1993; 17 (1): 2–10

    PubMed  Google Scholar 

  39. Lafortune MA, Cavanagh PR, Sonner HJ, et al. Three-dimensional kinematics of the human knee during walking. J Biomech 1992; 25 (4): 347–57

    Article  PubMed  CAS  Google Scholar 

  40. Nigg BM, Nachbauer W, Cole G. Effects of arch height of the foot on angular motion of the lower extremities in running. J Biomech 1993; 26 (6): 909–16

    Article  PubMed  CAS  Google Scholar 

  41. Busseuil C, Freychat P, Guedj EB, et al. Rearfoot-forefoot orientation and traumatic risk of running. Foot Ankle Int 1998; 19 (1): 32–7

    PubMed  CAS  Google Scholar 

  42. Freychat P, Belli A, Carret JP, et al. Relationship between rearfoot and forefoot orientation and ground reaction forces during running. Med Sci Sports Exerc 1996; 28 (2): 225–32

    Article  PubMed  CAS  Google Scholar 

  43. Ogon M, Aleksiev AR, Pope MH, et al. Does arch height affect impact loading at the lower back level in running? Foot Ankle Int 1999; 20 (4): 263–6

    PubMed  CAS  Google Scholar 

  44. Sneyers CJL, Lysens R, Feys W, et al. Influences of malalignment of foot on the plantar pressure pattern in running. Foot Ankle Int 1995; 16 (10): 624–32

    PubMed  CAS  Google Scholar 

  45. Scranton PE, McMaster JH. Momentary distribution of forces under the foot. J Biomech 1986; 9: 45–8

    Article  Google Scholar 

  46. Walker M, Fan HJ. Relationship between foot pressure pattern and foot type. Foot Ankle Int 1998; 19 (6): 379–83

    PubMed  CAS  Google Scholar 

  47. Clarke TE. The pressure distribution under the foot in barefoot walking [thesis]. State College (PA): Penn State University, 1980

    Google Scholar 

  48. Mann RA, Baxter DC, Lutter LD. Running symposium. Foot Ankle 1981; 1: 190–224

    PubMed  CAS  Google Scholar 

  49. Donatelli R. Abnormal biomechanics of the foot and ankle. J Orthop Sports Phys Ther 1987; 9: 11–6

    PubMed  CAS  Google Scholar 

  50. Close JR, Inman VT. The function of the subtalar joint. Clin Orthop 1967; 50: 159–79

    PubMed  CAS  Google Scholar 

  51. Engsberg JR, Andrew JG. Kinematic analysis of the talocalcaneal/talocrural joint during running support. Med Sci Sports Exerc 1987; 19: 275–84

    PubMed  CAS  Google Scholar 

  52. Engsberg JR, Grimston S, Wackwitz J. Predicting talocalcaneal joint orientation from talocalcaneal/talocrural joint orientation. J Orthop Res 1988; 6 (5): 749–57

    Article  PubMed  CAS  Google Scholar 

  53. Areblad M, Nigg BM, Ekstrand J, et al. Three-dimensional measurement of rearfoot motion during running. J Biomech 1990; 23 (9): 933–40

    Article  PubMed  CAS  Google Scholar 

  54. Kilmartin TE, Wallace WAW. The scientific basis for the use of biomechanical foot orthoses in the treatment of lower limb sports injuries: a review of the literature. Br J Sports Med 1994; 28 (3): 180–4

    Article  PubMed  CAS  Google Scholar 

  55. Bates BT, Ostering LR, Mason B, et al. Foot orthotic devices to modify selected aspects of lower extremity mechanics. Am J Sports Med 1979; 7: 338–42

    Article  PubMed  CAS  Google Scholar 

  56. Lutter LD. Foot-related knee problems in the long distance runner. Foot Ankle 1980; 1: 112–6

    PubMed  CAS  Google Scholar 

  57. Donatelli R, Hurlbert C, Conaway D, et al. Biomechanical foot orthotics: a retrospective study. J Orthop Sports Phys Ther 1988; 10 (6): 205–12

    PubMed  CAS  Google Scholar 

  58. Sperryn PN, Reestan L. Podiatry and the sports physician: an evaluation of orthoses. Br J Sports Med 1983; 7: 129–34

    Article  Google Scholar 

  59. Scherer PR. Heel spur syndrome: pathomechanics and nonsurgical treatment. Biomechanics Graduate Research Group for 1988. J Am Podiatr Med Assoc 1991 Feb; 81 (2): 68–72

    PubMed  CAS  Google Scholar 

  60. Blake RL, Denton JA. Functional foot orthoses for athletic injuries: a retrospective study. J Am Podiatr Med Assoc 1985; 75 (7): 359–62

    PubMed  CAS  Google Scholar 

  61. Hamill J, Derrick TR. Orthoses: foot/custom. The mechanics of foot orthoses for runners. Biomechanics 1996; 3 (2). Available from: http://www.biomech.coin/db_area/archives/1996/9602 orthcusttxt.bio.html [Accessed 2000 Apr 26]

  62. Nigg BM, Morlock M. The influence of lateral heel flare of running shoes on pronation and impact forces. Med Sci Sports Exec 1987; 19 (3): 294–302

    CAS  Google Scholar 

  63. Rodgers M, Leveau B. Effectiveness of foot orthotic devices used to modify pronation in runners. J Orthop Sports Phys Ther 1982; 4 (2): 86–90

    PubMed  CAS  Google Scholar 

  64. Taunton J, Clement D, Smart G, et al. A triplanar electrogoniometer investigation on running mechanism in runners with compensatory overpronation. Can J Appl Sports Sci 1985; 10 (3): 104–15

    CAS  Google Scholar 

  65. Novick A, Kelley D. Position and movement changes of the foot with orthotic intervention during the loading response of gait. J Orthop Sports Phys Ther 1990; 11 (7): 301–12

    PubMed  CAS  Google Scholar 

  66. Smith R, Sima WF, Reischl S. Can we meaningfully measure the flat foot? A multiexaminer comparison of radiographic and structural measurement [abstract]. 1993 American Orthopedic Foot and Ankle Society Summer Meeting; 1993 Jul 22–25; Ashville (NC), 4

  67. Eng JJ, Pierrynowski MR. The effects of soft orthotics on three-dimensional lower limb kinematics during walking and running. Phys Ther 1994; 74 (9): 836–44

    PubMed  CAS  Google Scholar 

  68. Leung AK, Mak AF, Evans JH. Biomedical gait evaluation of the immediate effect of orthotic treatment for flexible flat foot. Prosthet Orthot Int 1998; 22 (1): 25–34

    PubMed  CAS  Google Scholar 

  69. De Wit B, De Clercq D, Lenoir M. The effect of varying midsole hardness on impact forces and foot motion during foot contact in running. J Appl Biomech 1995; 11 (4): 395–406

    Google Scholar 

  70. Dixon SJ, Collop A, Batt ME. The influence of different running surfaces on ground reaction forces and lower extremity kinematics in shod running. Med Science Sports Exec. In press

  71. Albert S, Rinoie C. Effect of custom orthotics on plantar pressure distribution in the pronated diabetic foot. J Foot Ankle Surg 1994; 33 (6): 598–604

    PubMed  CAS  Google Scholar 

  72. Root ML, Orion WP, Weed JH, et al. Biomechanical examination of the foot. Los Angles (CA): Clinical Biomechanics Corporation, 1971

    Google Scholar 

  73. Menz HB. Clinical hindfoot measurement: a critical review of the literature. Foot 1995; 5 (2): 57–64

    Article  Google Scholar 

  74. Astrom M, Arvidson T. Alignment and joint motion in the normal foot. J Orthop Sports Phys Ther 1995; 22 (5): 216–22

    PubMed  CAS  Google Scholar 

  75. McPoil TG, Hunt GC. Evaluation and management of foot and ankle disorders: present problems and future directions. J Orthop Sports Phys Ther 1995; 21 (6): 381–8

    PubMed  CAS  Google Scholar 

  76. Knutzen KM, Price A. Lower extremity static and dynamic relationship with rearfoot motion in gait. J Am Podiatr Med Assoc 1994; 84 (4): 171–80

    PubMed  CAS  Google Scholar 

  77. Crossley K, Bennell KL, Wrigley T, et al. Ground reaction forces, bone characteristics, and tibial stress fracture in male runners. Med Sci Sports Exerc 1999; 31 (8): 1088–93

    Article  PubMed  CAS  Google Scholar 

  78. Macera CA, Pate RR, Powell KE, et al. Predicting lower-extremity injuries among habitual runners. Arch Intern Med 1989; 149 (11): 2565–8

    Article  PubMed  CAS  Google Scholar 

  79. Walter SD, Hart LE, McIntosh JM, et al. The Ontario cohort study of running-related injuries. Arch Intern Med 1989; 149 (11): 2561–4

    Article  PubMed  CAS  Google Scholar 

  80. Valmassy R, Subotnick St. Orthoses. In: Subotnick SI, editor. Sports medicine of the lower extremity. 2nd ed. Philadelphia (PA): Churchill Livingstone, 1999: 465–79

    Google Scholar 

  81. Lucchetti L, Cappozzo A, Cappello A, et al. Skin movement artefact assessment and compensation in the estimation of knee-joint kinematics. J Biomech 1998; 31 (11): 977–84

    Article  PubMed  CAS  Google Scholar 

  82. Reinschmidt C, van den Bogert AJ, Lundberg A, et al. Tibiofemoral and tibiocalcaneal motion during walking: external vs skeletal markers. Gait Posture 1997; 6: 98–109

    Article  Google Scholar 

  83. Stacoff A, Reinschmidt C, Nigg BM, et al. Effects of foot ortheses on skeletal motion during running. Clin Biomech 2000; 15 (1): 54–64

    Article  CAS  Google Scholar 

  84. Nigg BM, Nurse MA, Stefanyshyn DJ. Shoe inserts and orthotics for sport and physical activities. Med Sci Sports Exerc 1999; 31 (7 Suppl.): S421–8

    Google Scholar 

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Acknowledgements

The authors extend great appreciation to the Ministry of Health and Medical Education, Islamic Republic of Iran and Shiraz University of Medical Sciences, Shiraz, Iran for the financial support of the studentship toward this project.

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Correspondence to Mohsen Razeghi.

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Razeghi, M., Batt, M.E. Biomechanical Analysis of the Effect of Orthotic Shoe Inserts. Sports Med 29, 425–438 (2000). https://doi.org/10.2165/00007256-200029060-00005

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