gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)

23.10. - 26.10.2018, Berlin

Comparison of two different forefoot off-loader shoes and their influence on pelvic position and spinal posture

Meeting Abstract

  • presenting/speaker Roman Michalik - Uniklinik RWTH Aachen, Klinik für Orthopädie, Aachen, Germany
  • Tim Classen - Uniklinik RWTH Aachen, Klinik für Orthopädie, Aachen, Germany
  • Valentin Quack - Uniklinik RWTH Aachen, Klinik für Orthopädie, Aachen, Germany
  • Ben Rohof - Uniklinik RWTH Aachen, Klinik für Orthopädie, Aachen, Germany
  • Björn Rath - Uniklinik RWTH Aachen, Klinik für Orthopädie, Aachen, Germany
  • Hanno Schenker - Uniklinik RWTH Aachen, Klinik für Orthopädie, Aachen, Germany
  • Markus Tingart - Uniklinik RWTH Aachen, Klinik für Orthopädie, Aachen, Germany
  • Marcel Betsch - Uniklinik RWTH Aachen, Klinik für Orthopädie, Aachen, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocPT25-654

doi: 10.3205/18dkou791, urn:nbn:de:0183-18dkou7911

Veröffentlicht: 6. November 2018

© 2018 Michalik et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Forefoot off-loader shoes (FOS) are a common tool in the post-operative treatment of forefoot surgery. The purpose of these shoes is to unload the operated region of the foot in order to allow early mobilization and rehabilitation after e.g. hallux valgus, hallux rigidus or claw toe surgeries. Because of the design of these shoes they can lead to leg length discrepancies (LLD), which can result in clinical symptoms such as low back pain and pelvic obliquity. However, little is known about the actual biomechanical effects of different designs of FOS on the pelvic position and spinal posture. Purpose of this study was to analyse and compare the effects of two different designs of forefoot unloader shoes on pelvis and spine.

Methods: This study was approved by the local ethics committee and all subjects gave their written and oral consent to participate in this study. Two FOS (Darco: OrthoWedge & Relief Dual) were evaluated in this study during upright standing and during walking on a treadmill (3 km/h). Changes of the pelvic position and spinal posture were measured with a surface topography system (Formetric 4D motion, Diers International GmbH). All data were checked for Gaussian distribution by the Chi-square test and presented as means with standard deviations. Statistical analysis was performed with SAS (SAS Institure Inc., NC, USA) using student T-tests.

Results and conclusion: As expected, both FOS (Darco: OrthoWedge & Relief Dual) resulted in significant changes of the pelvic obliquity (p<0.000) and pelvic torsion (p<0.0001), while standing in the neutral position. The two shoes also led to changes in the spinal posture, as shown by an increase in lateral deviation, surface rotation and trunk inclination (p<0.0001), independent of the type of shoe. Interestingly, when comparing both shoes, we did only find a significant difference for pelvic obliquity (p<0.0001) and trunk imbalance (p<0.037) between the two tested shoes. During walking on a treadmill, both FOS also had a significant influence on the pelvic obliquity, surface rotation, lateral deviation and trunk inclination (all: p<0.0001). However, only minor differences in surface rotation (p=0.047) and pelvic obliquity (p<0.0001) were found between the two shoes while walking.

As expected, our results showed that FOS lead to significant changes in pelvic position and spinal posture during standing and while walking. Most FOS create a LLD, which is responsible for the effects on the musculoskeletal apparatus. Because of that companies and physicians recommend to wear a special support shoe on the contralateral side to compensate for the LLDs. However, most patients refuse to wear the support shoes, and can therefore be negatively affected by FOS. Our results also show that the design of the shoe plays only a minor role regarding the body posture.