Emerging Trends In Research With Orthoses And Biomechanics

Guest Clinical Editor: Cherri Choate, DPM

    “It is my feeling that these labs should be accessible to the clinicians in their communities,” explains Dr. Choate. “ … I foresee that future physicians will be able to refer patients for motion analysis studies and gain immediate and applicable information to affect patient care.”

   For example, Dr. Choate says the information from force plates may be helpful in treating various pathologies including diabetic foot ulcerations. Clinicians may also be able to obtain information that will help with shoe fit issues, offloading, orthotic problem solving and the linking of foot complaints to abnormal motions in the back, hips and knees, according to Dr. Choate.

    “Reliable, valid and non-invasive techniques of better assessing the foot-to-shoe interface (inside the shoe) will revolutionize our understanding of the nature and mechanism of foot pain, and its response to orthotic therapy,” opines Dr. Burns.

   Dr. Burns says technological advancements will range from clearer electromyography and fluoroscopy to the ultimate in functional magnetic resonance imaging (MRI). Dr. Davis also cites the emergence of imaging modalities such as MRI and dual fluoroscopy. As she notes, certain bony structures (such as the patella, talus and navicular) are not well suited to the placement of external markers. However, new imaging technologies can obviate the use of external markers by permitting the study of bony alignment during movement, which is not possible with current motion capture systems.

   Dr. Burns adds that we will continue to see advances with in-shoe pressure studies, particularly when it comes to measuring shear force. Refined measures of the foot and lower limb in very young children and how to interpret them will help target preventive orthotic therapy, according to Dr. Burns.

   Q: Which areas in lower extremity biomechanics will be the focus of future research?

   A: Dr. Burns notes the importance of pediatric research. He maintains that many areas require a more thorough biomechanical investigation. Dr. Burns says one key priority is the evidenced-based assessment of the growing foot and ankle in children, with particular focus on the predictors of foot pain, disability and deformity.

   Dr. Choate also notes that pediatric patients will be important in future research. She says studies by Mickle, Powell, Selby-Silverstein and Evans are starting to dispel myths about pediatric treatment modalities.1-5 Dr. Choate notes a worldwide awareness of the importance of early detection and the need for treatment algorithms for children. As she points out, early diagnosis and treatment may also lead to improved midlife outcomes for patients with select pathologies.

   In addition, Dr. Burns also advocates comparing the effects of AFOs and foot orthoses on motor function and walking ability in children with neuromuscular disorders.

   In the future, Dr. Davis says research will concentrate on new technologies like imaging and modeling to help understand normal and abnormal biomechanics. She claims that real-time motion analysis can provide more accurate biomechanical feedback to correct faulty biomechanics. Since the population is aging, she notes that preventing and treating OA may receive more emphasis in the literature.

   In regard to her own research, Dr. Davis is currently concentrating on the etiology and treatment for patellofemoral pain syndrome and stress fractures in runners.

   Dr. Nester notes the main focus of his research is detailing the biomechanical purpose of the small structures in the foot. While there is a good knowledge of the function of larger joints and the muscles of the legs and the plantar fascia, Dr. Nester says there is not as much awareness when it comes to the function of lower extremity ligaments, intrinsic muscles, etc.

   To this end, he is undertaking invasive and non-invasive in vivo research. He is also using dynamic cadaver simulations in collaboration with bioengineers in China. Finally, Dr. Nester is using foot modeling, which is in the early stages.

   Dr. Burns also believes the diabetic foot still requires broad investigation, application and innovation from a biomechanical perspective.

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