Welcome Readers! My name is Adam Kelly, ATC and I am going
to be your guest
blogger today! I am the author over at Eat.Run.Rehabilitate. Dr. E asked
me to write this post up as he is busy with the arrival of another little one
at home. I want to congratulate him on the newest addition to his family!
I am currently finishing up my final semester of graduate
school and that means finishing up my research study and thesis. Dr. E asked
that a write up a post to share a little bit about my study with all of you. So
where do I begin? Let’s begin at the bottom…aka the feet. I’ve always been very
interested in lower extremity function, mechanics, and injury.
During my undergraduate studies I became aware of a very
novel and unique silicon insert for spreading and separating the toes. Similar
in function to the inserts used for pedicures but vastly different in design,
this insert was marked to be worn within shoes and during weight-bearing
activities. I became very interested in this product and once I got to graduate
school I knew that I would like to potentially study it.
I soon found out that this would be a novel research idea.
The premise of this product is to promote and reintroduce a wider foot splay
and more natural biomechanical alignment. A large portion of society has
terribly deformed foot structure due to poor footwear selection, design, and
fit. Here is a picture of two different sets of feet…one is from a person that
has never worn footwear (B) and another from a human that had been habitually
wearing conventional footwear for most of their life(A).
What impacts do these differences in foot structure have?
What foot looks stronger, more robust, and healthier to you? While initial
review of foot (B) may appear foreign to many of us it definitely appears to be
the more natural of the two. The human foot should we widest at the toes and
not the metatarsals.
My literature review found that plenty of research had been
done on full-foot orthotics, textured insoles and textured surfaces to
investigate their effects on balance. Most studies theorized potential benefit
from influencing the afferent input of the somatosensory system and/or potentially
influencing structures and biomechanical alignment. So why not investigate what
this product could do to dynamic balance, and certain measures of foot
structure and mobility. So here is what I did:
Study Design:
3 randomized groups with equal parts men and women. Healthy
participants aged 21-29 with no previous history of lower extremity surgery,
peripheral artery disease, diabetes, neurological deficits, vertigo, concussion
or other potential ailments to equilibrium. Participants must have been physically
active for at least 30 minutes of light physical activity at least 3 times a
week. Participants also were excluded if they had suffered a significant lower
extremity injury in the last 6 months that had removed from physical activity
for at least three days or significantly altered ADL’s.
My three groups:
- Intervention Group #1: Foot-Toe Orthosis and Control Shoe
- Intervention Group #2: Control Shoe Only
- Control Group: No Intervention
This was a 4 week study with both acute and follow-up
measurements taken. What measures did we want to look at? Well, we wanted a
valid and reliable measure of dynamic balance. Upon reviewing the literature
regarding the star excursion balance test (SEBT) and the Y-balance test (YBT) we
decided that the YBT would be the most reliable, clinically relevant, and time
efficient measure of balance. We are also looking at various measures of the
foot such as hallux valgus angle, static arch height, and both great toe
flexion and extension range of motion.
Our Procedures?
We had subjects come in after being included and randomized
for baseline testing of the YBT, and for baseline measures of the feet. Those
randomized into the foot-toe orthosis group were then fitted for the insert and
were measured again using the YBT for any potential acute effects of wearing
the orthosis. Subjects were then fitted for shoes if placed into either of the
first two groups and were given a log book for hours of use and comfort of
wear. After four weeks- subjects returned for follow up testing of the YBT
(with and without the insert) and the aforementioned measures of foot structure
and mobility. Subjects spent the first week habituating to the shoes and
inserts by increasing wear time by 30 minute incremental segments and weeks 2-4
wearing the products for a minimum of four hours a day. Subjects also attempted
to wear the inserts at night while sleeping.
The Control Shoe
We decided that if we were going to be spreading the toes of
all of our subjects and testing the effects of doing this then we had better
well make sure they all had shoes would accommodate this product. We spoke with
the manufacturer of the toe-orthosis and they put us in contact with the
creater of Lems Shoes. Lems produces
minimalist shoes with wide toe-boxes, void of any arch support or cushion, and
is flat from heel to toe. Introducing our subjects to a shoe like this could
have a potential influence on our results so that is the reason for our control
and shoe only groups to help control these variables. It is also interesting
because it means that our study will also be investigating the potential
effects of introducing a minimalist shoe for 4 weeks on the various measures.
Hypothesis and
Preliminary Findings?
Based upon the previous research regarding influencing
balance via cutaneous receptors, mechanoreceptors of the feet and potentially
biomechanical alignment I was inclined to believe that this product would have
a positive relationship with our selected measures. Please take note that our
data is not 100% complete, and is not yet peer reviewed. Therefore, PLEASE take
these findings with a heavy grain of salt. So far, our pilot data has showed
that all of our measures have been very reliable with ICC’s ranging from .833 -
.982. Additionally, we found a statistically significant (n=50 legs, p=.003)
increase in the Y-balance test scores when comparing the baseline to acute
effects scores(r=.92818). There is still much more data to collect, manuscript
writing, and critiquing to be done for this study but it is a very exciting
time for me.
What have your experiences been with foot health &
deformities, balance, and injury? Do any of you have experience with using
splints, manual therapy or exercise to address potential issues?
I just want to thank Dr. E for inviting me to share my
research study with all of you. Congratulations to him on the baby girl once
again. Thanks for reading and as Dr. E Would say….”Keep it Eclectic”…or
something like that.
Edit: I want to thank Adam Kelly for letting me catch up on
some much needed rest with my wonderful family, yet keep the regular, quality
content flowing as the readers are used to! Looking forward to your study’s
completion and the results!
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