Emerging Trends In Research With Orthoses And Biomechanics
As podiatry continues to emphasize evidenced-based medicine more and more, some of the leaders in biomechanics research share their thoughts on current studies and speculate about how future research with orthoses may eventually alter the way podiatrists practice.
Q: What orthotic-related research projects have your completed or are you currently in the midst of studying?
A: Cherri Choate, DPM, is working with Paul Scherer, DPM, and Howard Hillstrom, PhD, and his research group at the Hospital for Special Services in New York City. She says Stride Rite Shoes has formed a research team in an attempt to design the next generation of children’s shoes based on clinical data. The goal of her study is to determine if and how different types of shoe designs impact pediatric gait.
“Although the study is still in the stage of data collection, the long-term applications could be very important in understanding the development of the foot and its relationship to shoe gear,” says Dr. Choate. “After many years of treating pediatric feet primarily by speculation, the results should help us develop evidence-based protocols for treating pediatric foot pathology with shoes and orthotic devices.”
Christopher Nester, BSc, PhD, and his group recently finished a two-year project to develop a mass-produced insole (the salfordinsole™) that has the durability and biomechanical performance of a custom-made orthosis. Testing proved the insoles reduced foot pronation, according to Dr. Nester.
Irene Davis, PhD, PT, has studied the effect of inverted orthotics on rearfoot mechanics during running. Other projects include assessing the effect of orthoses on rearfoot control and shock attenuation during running, and how orthoses affect forefoot and rearfoot strike in runners. She has also investigated the effect of wedged orthoses in patients with knee osteoarthritis (OA).
Joshua Burns, PhD, B App Sc (Pod) Hons, is involved in designing and evaluating foot orthoses and footwear for the treatment of pain in a variety of conditions including cavus foot, the neuroischemic diabetic foot, rheumatoid arthritis and lower limb injuries in triathlon athletes. He notes having a particular interest in the orthotic management of children and adults with neuromuscular disorders like Charcot-Marie-Tooth disease and Duchenne muscular dystrophy.
Dr. Burns is also working on the development and validation of clinically relevant outcome measures. He says establishing these measures can help accurately and reliably capture the beneficial effects (e.g. plantar pressure, gait analysis, functional performance) of foot orthoses from a biomechanical perspective.
Q: What technological advancements do you foresee making an impact in biomechanics research?
A: Dr. Nester asserts the integration of imaging and motion technologies will provide unique insight into the biomechanical behavior of the foot and ankle. One will be able to track structures in detail during activities and movements, and create patient specific visual and computational models. He says this will provide excellent research tools as well as useful visual aids in clinical practice to help educate patients.
As Dr. Choate notes, the gold standard for gait analysis in the global research community is the six-camera, three-dimensional motion analysis system. When one uses this system in conjunction with force plates, gait mats and videography, she says physicians can obtain a tremendous amount of data in both clinical and research scenarios. Although relying on static measurement data is of limited value, Dr. Choate says the new systems and dynamic values, including temporal information, should lead to “significant advancements” in the study of lower extremity mechanics.
In the near future, Dr. Choate says the profession should address the issue of access to technology such as gait labs. As she notes, the high cost and high maintenance of gait labs means there are only a handful of fully functioning motion analysis labs available globally.