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Sand is an easy-to-access, cost-free resource that can be used to treat pronated feet (PF). Therefore, the aims of this study were to contrast the effects of walking on stable ground versus walking on sand on ground reaction forces (GRFs) and electromyographic (EMG) activity of selected lower limb muscles in PF individuals compared with healthy controls. Twenty-nine controls aged 22.2±2.5 years and 30 PF individuals aged 22.2±1.9 years were enrolled in this study. Participants walked at preferred speed and in randomized order over level ground and sand. A force plate was included in the walkway to collect GRFs. Muscle activities were recorded using EMG system. No statistically significant between-group differences were found in preferred walking speed when walking on stable ground (PF: 1.33±0.12 m/s; controls: 1.35±0.14 m/s; p = 0.575; d = 0.15) and sand (PF: 1.19±0.11 m/s; controls: 1.23±0.18 m/s; p = 0.416; d = 0.27). Irrespective of the group, walking on sand (1.21±0.15 m/s) resulted in significantly lower gait speed compared with stable ground walking (1.34±0.13 m/s) (p<0.001; d = 0.93). Significant main effects of \"surface\" were found for peak posterior GRFs at heel contact, time to peak for peak lateral GRFs at heel contact, and peak anterior GRFs during push-off (p<0.044; d = 0.27-0.94). Pair-wise comparisons revealed significantly smaller peak posterior GRFs at heel contact (p = 0.005; d = 1.17), smaller peak anterior GRFs during push-off (p = 0.001; d = 1.14), and time to peak for peak lateral GRFs (p = 0.044; d = 0.28) when walking on sand. No significant main effects of \"group\" were observed for peak GRFs and their time to peak (p>0.05; d = 0.06-1.60). We could not find any significant group by surface interactions for peak GRFs and their time to peak. Significant main effects of \"surface\" were detected for anterior-posterior impulse and peak positive free moment amplitude (p<0.048; d = 0.54-0.71). Pair-wise comparisons revealed a significantly larger peak positive free moment amplitude (p = 0.010; d = 0.71) and a lower anterior-posterior impulse (p = 0.048; d = 0.38) when walking on sand. We observed significant main effects of \"group\" for the variable loading rate (p<0.030; d = 0.59). Pair-wise comparisons revealed significantly lower loading rates in PF compared with controls (p = 0.030; d = 0.61). Significant group by surface interactions were observed for the parameter peak positive free moment amplitude (p<0.030; d = 0.59). PF individuals exhibited a significantly lower peak positive free moment amplitude (p = 0.030, d = 0.41) when walking on sand. With regards to EMG, no significant main effects of \"surface\", main effects of \"group\", and group by surface interactions were observed for the recorded muscles during the loading and push-off phases (p>0.05; d = 0.00-0.53). The observed lower velocities during walking on sand compared with stable ground were accompanied by lower peak positive free moments during the push-off phase and loading rates during the loading phase. Our findings of similar lower limb muscle activities during walking on sand compared with stable ground in PF together with lower free moment amplitudes, vertical loading rates, and lower walking velocities on sand may indicate more relative muscle activity on sand compared with stable ground. This needs to be verified in future studies.

ObjectivesTo test (i) if greater foot pronation (measured as midfoot width mobility) is associated with better outcomes with foot orthoses treatment, compared with hip exercises and (ii) if hip exercises are superior to foot orthoses, irrespective of midfoot width mobility.MethodsA two-arm parallel, randomised superiority clinical trial was conducted in Australia and Denmark. Participants (18–40 years) were included who reported an insidious onset of knee pain (≥6 weeks duration); ≥3/10 numerical pain rating, that was aggravated by activities (eg, stairs, squatting, running). Participants were stratified by midfoot width mobility (high ≥11 mm change in midfoot width) and site, randomised to foot orthoses or hip exercises and blinded to objectives and stratification. Success was defined a priori as much better or better on a patient-perceived 7-point scale at 12 weeks.ResultsOf 218 stratified and randomised participants, 192 completed 12-week follow-up. This study found no difference in success rates between foot orthoses versus hip exercises in those with high (6/21 vs 9/20; 29% vs 45%, respectively) or low (42/79 vs 37/72; 53% vs 51%) midfoot width mobility. There was no association between midfoot width mobility and treatment outcome (Interaction effect p=0.19). This study found no difference in success rate between foot orthoses versus hip exercises (48/100 vs 46/92; 48% vs 50%).ConclusionMidfoot width mobility should not be used to help clinicians decide which patient with patellofemoral pain might benefit most from foot orthoses. Clinicians and patients may consider either foot orthoses or hip exercises in managing patellofemoral pain.Trial registration numberACTRN12614000260628.

The purpose of this study was to determine the effect of systematic corrective exercises on the static and dynamic balance of students with pronation distortion syndrome. In this randomized controlled clinical trial study, 30 volunteers were selected and randomly divided into the control and experimental groups (15 subjects per group). The experimental group performed systematic corrective exercises for 12 weeks, while the control group performed the routine exercise. Static and dynamic balance was evaluated before and after the interventions. The data were analyzed using independent and paired -tests ( < 0.05). The results showed significant improvement ( < 0.05) in the static and dynamic balance in the experimental group, but not in the control group. A significant difference was evident between the experimental and control groups in terms of static and dynamic balances, in static balance including Flamingo balance test (42.26 ± 5.35 vs. 10.13 ± 1.92) stabilometr (1.23 ± 0.48 vs. 3.71 ± 1.02), and in dynamic balance including star excursion balance test (anterior direction 82.4 ± 6.2 vs. 66.7 ± 6.9, Posterior-internal direction 87.8 ± 4.7 vs. 69.6 ± 6.3, posterior-external direction 86.06 ± 6.93 vs. 67.2 ± 6.2), stabilometr (3.8 ± 0.6 vs. 11.18 ± 1.8) ( < 0.05 for all variables). It can be concluded that systematic corrective exercises improve static and dynamic balance in students with pronation distortion syndrome and it could be recommended as modalities for these people.

The link between gait parameters and foot abnormalities in association with low back pain is not well understood. The objective of this study was to investigate the effects of excessive foot pronation as well as the association of LBP with excessive foot pronation on the GRF components during shod walking. Forty-five subjects were equally divided into a control group, a group of subjects with pronated feet only, and another group with pronated feet and LBP. Ground reaction forces were analyzed during shod walking. Foot pronation without low back pain was associated with increased lateral-medial ground reaction force, impulse, and time to peak of all reaction forces in heel contact phase (p<0.03). In low back pain patients with pronated foot, greater vertical reaction forces (p=0.001) and loading rate, and time to peak on propulsion force were observed compared to pronated foot without low back pain group. Impulse in posterior-anterior reaction force was smaller in the able-bodied group with normal foot than in the other groups (p<0.05). Positive peak of free moments of the LBP group was significantly greater than that in other groups (p<0.05). In conclusion, foot pronation alone was not associated with elevated vertical ground reaction forces. While, low back pain patients with foot pronation displayed higher vertical ground reaction force as well as higher loading rate. Present results reveal that gait ground reaction force components in low back pain patients with pronated foot may have clinical values on the prognosis and rehabilitation of mechanical LBP patients.

This study evaluated the effect of the lacertus fibrosus on the biceps brachii moment arms to determine the lacertus importance in forearm strength. The work proceeded from the null hypothesis that the lacertus fibrosus has no effect on flexion/extension and supination/pronation. Ten fresh-frozen cadaveric specimens were mounted in an elbow simulator to measure tendon excursion, elbow flexion/extension (FE) and forearm pronation/supination (PS) angles. FE moment arms were calculated throughout FE excursion at multiple, constant PS angles and PS moment arms were measured throughout PS excursion at multiple, constant FE angles. Tests included the lacertus intact, the superficial lacertus transected, and the entire lacertus transected along with any connections to surrounding tissue. The intact lacertus increased the FE moment arm of the biceps with the elbow in less than 40° flexion and decreased the FE moment arm with the elbow in greater than 80° flexion, where the decrease could exceed 50%, depending on the flexion angle. The intact lacertus decreased the PS supination moment arm at all flexion angles; the intact lacertus even caused the biceps to act as a pronator at full elbow extension. The intact lacertus assists in early elbow flexion and the lacertus hinders elbow flexion at greater than 80° flexion. The lacertus hinders the biceps function of supination, especially in a supinated position. Injury of the lacertus without direct biceps tendon damage can be tested best at the ends of the flexion ROM and at higher supination angles. Lacertus syndrome may be more quickly diagnosed with provocative tests that isolate the lacertus function.

Excessive pronation and increased pronation velocity of the foot due to excessive Subtalar Joint (STJ) motion have been discussed as major intrinsic factors for the pathophysiology of overuse running injuries. A possible strategy to reduce these risk factors is the use of the supinator muscles acting eccentrically during the support phase of running. We hypothesised that STJ-specific strength training of the supinator and pronator muscles would be more effective in reducing rearfoot motion compared to traditional plantarflexor and dorsiflexor exercises. Twenty healthy male (20–35 years) recreational runners performed machine-based Subtalar Training (ST) with the right foot and machine-based plantar-/ dorsiflexor taining around the Talocrural joint (TT) with the left over a period of ten weeks. STJ muscle strength and shank muscle volume were measured in pre- and posttest. Furthermore, rearfoot motion during overground running (3.3 m/s) was analysed. The multifactorial analyses showed significant increases in muscle strength and volume (p < 0.001). Interaction effects (time x group) revealed higher strength increases for ST (p < 0.001) and higher muscle volume increase in the deep supinator muscles (p < 0.05) for ST. The analyses of rearfoot motion showed significant changes after the treatment indicated by a higher inversion angle at touchdown (p < 0.01) and reduced eversion velocity in mid-stance (p < 0.01). Both effects were higher after ST (p < 0.01; time x group interaction). Machine-based subtalar-specific strength training represents a potential prevention strategy for male runners to enhance the function of the supinator muscles, to stabilise rearfoot motion during running and, therefore, to reduce lower limb injury risk.

This study aimed to identify the clinical and biomechanical factors of subjects with excessive foot pronation who are not responsive (i.e., “non-responders”) to medially wedged insoles to increase knee adduction external moment. Ankle dorsiflexion range of motion, forefoot-shank alignment, passive hip stiffness, and midfoot passive resistance of 25 adults with excessive bilateral pronation were measured. Also, lower-limb angles and external moments were computed during walking with the participants using control (flat surface) and intervention insoles (arch support and 6° medial heel wedge). A comparison between “responders” (n = 34) and “non-responders” (n = 11) was conducted using discrete and continuous analyses. Compared with the responders, the non-responders had smaller forefoot varus (p = 0.014), larger midfoot passive internal torque peak (p = 0.005), and stiffness measured by the torsimeter (p = 0.022). During walking, non-responders had lower angle peaks for forefoot eversion (p = 0.001), external forefoot rotation (p = 0.037), rearfoot eversion (p = 0.022), knee adduction (p = 0.045), and external hip rotation (p = 0.022) and higher hip internal rotation angle peak (p = 0.026). Participants with small forefoot varus alignment, large midfoot passive internal torque, stiffness, small knee valgus, hip rotated internally, and foot-toed-in during walking did not modify the external knee adduction moment (“non-responders”). Clinicians are advised to interpret these findings with caution when considering the prescription of insoles. Further investigation is warranted to fully comprehend the response to insole interventions among individuals with specific pathologies, such as patellofemoral pain and knee osteoarthritis (OA).

This study aimed to determine whether hallux pronation influences the proximal to distal phalangeal articular angle (PDPAA) and evaluate its relationship with postoperative recurrence. We included 94 hallux valgus (HV) patients who underwent distal chevron metatarsal osteotomy (DCMO) alone (DCMO-only group, n  = 15) and DCMO with Akin osteotomy (DCMO + Akin group, n  = 79). Preoperative additional toe radiographs were taken under supination stress to position the pronated toe as a true anteroposterior orientation. The mean follow-up period was 12.9 months. The PDPAA on weightbearing radiograph did not significantly differ from the PDPAA corrected by supination stress (5.0 ± 7.0 vs. 4.7 ± 6.4 degrees, p  = 0.820). The DCMO-only group showed a higher recurrence rate than the DCMO + Akin group (33.3 vs. 7.6%, p  = 0.014). In the DCMO-only group, those with recurrence had significantly higher preoperative PDPAA values than those without recurrence (7.6 ± 5.9 vs. -0.2 ± 3.0 degrees; respectively, p  = 0.013). In conclusion, the PDPAA was not significantly influenced by the hallux pronation in patients with HV. For HV patients with a large preoperative PDPAA, additional Akin osteotomy should be considered to prevent recurrence.

ObjectivesThe aim of the study was to evaluate foot posture and the mechanical properties of extrinsic foot muscles in fibromyalgia.MethodsPatients with fibromyalgia (n = 86) and age- and gender-matched controls (n = 41) were included in the study. Foot Posture Index (FPI), Beighton and Brighton criteria were used to evaluate static foot posture, joint hypermobility, and benign joint hypermobility syndrome (BJHS), respectively. Tonus, elasticity, and stiffness of the extrinsic foot muscles including gastrocnemius medialis, tibialis anterior, and peroneus longus were measured by the MyotonPRO® device. Foot function, quality of life, and physical activity level were assessed by the Foot Function Index (FFI), Short Form-36 (SF-36), and the International Physical Activity Questionnaire-Short Form (IPAQ-SF), respectively.ResultsThe frequency of abnormal foot posture in the fibromyalgia and control groups was 68.6% versus 39%, respectively; and neutral foot posture was approximately twice as prevalent in the control group compared to the fibromyalgia group (p = 0.006). Pronated foot posture was the most common abnormality in fibromyalgia (61.6%) and observed in 85.5% of the patients with joint hypermobility and in 87.1% of those meeting BJHS criteria. The elasticity of peroneus longus at rest and the elasticity of tibialis anterior in the standing position were significantly different between the fibromyalgia group and the control group [1.08 (0.22) vs. 1.02 (0.25), p = 0.037 and 0.92 (0.29) vs. 0.87 (0.24), p = 0.011, respectively]. Regarding the fibromyalgia group, no difference was detected among foot posture groups in terms of myotonometric data.ConclusionsPronation foot posture is common in fibromyalgia with a much higher frequency in fibromyalgia patients with hypermobility. In daily clinical practice for fibromyalgia, particular attention should be given to foot alignment.

Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.