Oliver Ludwig

Background/Objectives: Pes planovalgus is one of the most common misalignments in children. In this study the established biomechanical foot orthoses (BMFO) are being compared with a more recent treatment: sensorimotor foot orthoses (SMFO). SMFO are a more recent treatment and aim to correct malalignment by specifically modulating muscle activity rather than relying solely on passive mechanical support, as is the case with BMFO. Methods: Thirty-two children and adolescents aged six to six-teen participated in this study. After randomized group allocation, the rearfoot angle was analyzed by two-dimensional gait analysis in the SMFO-group (n=18) and the BMFO group (n=14) under three conditions: without foot orthoses (baseline), with foot orthoses (immediate) and after four weeks of use. Results: (1) SMFO and BMFO significantly improved the rearfoot angle immediately after application, (2) the achieved correction was maintained over four weeks in both groups, and (3) despite baseline differences, the superior rate of improvement in the SMFO-group resulted in comparable rearfoot alignment between SMFO and BMFO at the four-week follow-up. Conclusions: Based on the results, it can be concluded that SMFO and BMFO are comparable methods for treating pes planovalgus in children and adolescents.

Background: Preventive team testing showed an above-average number of pes cavus among soccer players. This raised the question of whether wearing relatively small soccer shoes - as it is often the case for soccer players - shoes might be responsible and cause a kind of foot compression and a muscular-induced pes cavus. Methods: This cross-sectional study included 198 male youth and adult soccer players (age: 18.6±5.8 years, height: 176.3±14.8 cm, body mass: 69.9±11.5 kg). The delta between shoe and foot length was compared with arch index (AI) and normalised truncated navicular height (NTNH) and especially for those whose shoes were too small. Results: The data confirms that among soccer players, 34% had a pes cavus, only 15% were free of pes planus or pes cavus and 27% wore shoes that were too small. Contrary to the authors hypothesis, the NTNH revealed a general relationship with the delta between foot length and shoe length. Players with shoes that were too small had a significantly higher arch (AI = 0.24) than players with adequate shoe size (AI = 0.25), but on average, the arch was still in the range of a normal foot. No correlation was found between the magnitude of the delta and the AI value for the subgroup of players whose shoes that were too small. Conclusions: The data confirm the increased prevalence of pes cavus among soccer players, but could not confirm the authors’ hypothesis that this may be caused by wearing shoes that are too small.

Background: The alignment of a person’s body segments depends on their innate anatomy and neuromuscular status. Sagittal posture assessments provide valuable information on correctable deficits, which can be used to prevent possible health issues or injuries. Methods: This article provides practical guidance on how to perform a basic photometric sagittal posture analysis in a reproducible manner, which reference points should be used, and which errors should be avoided. For this purpose, based on the current literature, four important evidence-based parameters for evaluation are defined, and literature-based reference values are given for the assessment of posture. Conclusions: When done correctly, the sagittal posture analysis is a valuable tool in the fields of medicine and sports.

Analyzing the posture of athletes is an important preventive diagnostic tool, especially because some posture parameters appear to be associated with risk of muscle injury and complaints. So far, it is unclear how these parameters change during the day under sport-related stress. In this pilot study, the posture parameters of pelvic tilt, body lean, trunk lean, and pelvic displacement were analyzed in 20 soccer players (16.61 ± 0.28 years, 179.38 ± 6.40 cm, 70.35 ± 7.79 kg, playing in the German Youth Academy League) at three points in time on one day, in each case with habitual posture and active posture with eyes open and closed. Intensive sporting activities took place between the measurement points. A repeated two-factor ANOVA was calculated for each posture parameter with the factors of measurement time and posture. Cohen’s d was determined as a measure of the effect size, and the intra-class correlation coefficient was calculated for the three measurement times. Only pelvic tilt and body lean remained stable throughout the day. We therefore recommend using both parameters to assess the posture of athletes, especially because studies show that they can be associated with possible complaints and injuries. However, since the examined posture parameters change significantly depending on whether a habitual or actively tense posture is adopted, particular attention must be paid to reproducible postures and clear instructions to the test subjects.

Background: Patellofemoral pain (PFP) significantly affects patients’ daily activities and consequently reduces their quality of life. Custom-made foot orthoses (FOs) are a common method of medical treatment that positively influences biomechanical factors such as the kinematics of the lower extremity and reduces pain perception in patients. However, there is a gap in research regarding the influence of different FO treatments on knee pain. Therefore, this study addresses the impact of biomechanical foot orthoses (BMFOs) and sensorimotor foot orthoses (SMFOs) on patients with foot deformity and PFP. Methods: A total of 26 participants (9 men, 17 women; 27.7 ± 10.7 years; 175.0 ± 0.1 cm; 75.7 ± 18.8 kg; BMI: 24.7 ± 5.6) took part in this randomized controlled clinical trial. In the pre-test, knee pain was evaluated using the Kujala Anterior Knee Pain Scale after the physician’s anamnesis and plantar pressure measurement. A 3-month intervention with SMFO and BMFO was performed, and weekly development was evaluated using 11-item visual analog scales (VASs). Repeated measures analyses of variance were used to assess differences between time of measurements (ToMs) and the interaction effect between ToMs and treatment groups (SMFO, BMFO). Results: Statistical analysis revealed no statistically significant interaction between ToMs and treatment groups but a significant main effect on Kujala anterior knee pain scores (M_Diff = 10.189; p = 0.014) and 12-week VAS (p = 0.001). Conclusions: The findings indicate that both treatment approaches effectively alleviated perceived knee pain in the PFP sample with foot deformity, with neither approach demonstrating superior efficacy. This trial was registered in the WHO International Clinical Trials Registry Platform (ICTRP) and German Clinical Trials Register (DRKS00035082).

Patellofemoral pain (PFP) significantly affects patients’ daily activities and consequently reduces their quality of life. Custom-made foot orthoses (FO) are a common method of medical treatment that positively influence biomechanical factors such as the kinematics of the lower extremity and reduce pain perception in patients. However, there is a gap in the research regarding the influence of different FO treatments on knee pain. Therefore, this study addresses the impact of biomechanical foot orthoses (BMFO) and sensorimotor foot orthoses (SMFO) on patients with foot deformity and PFP. A total of 26 participants (9 men, 17 women; 27.7 ± 10.7 years; 175.0 ± 0.1 cm; 75.7 ± 18.8 kg; BMI: 24.7 ± 5.6) took part in this randomized-controlled clinical trial. In the pre-test, knee pain was evaluated using the Kujala anterior knee pain scale after the physician’s anamnesis and plantar pressure measurement. A 3-month intervention with SMFO and BMFO was performed, and weekly development was evaluated using 11-item visual analog scales (VASs). Repeated measures analyses of variance were used to assess differences between time of measurements (ToMs) and the interaction effect between ToMs and treatment groups (SMFO, BMFO). Statistical analysis revealed no statistically significant interaction between ToMs and treatment groups but a significant main effect on Kujala anterior knee pain scores (MDiff = 10.189; p = .014) and 12-week VAS (p = .001). The findings indicate that both treatment approaches effectively alleviate perceived knee pain in the PFP sample with foot deformity, with neither approach demonstrating superior efficacy. This trial was retrospectively registered in the WHO International Clinical Trials Registry Platform (ICTRP) and German Clinical Trials Register (DRKS00035082).

Background: Individuals may exhibit altered foot pronation during gait when fatigue sets in. Therefore, a more evidence-based understanding of these fatigue-induced changes may be helpful for future gait analysis and return-to-play tests since fatigue can provide new insights that might explain a person’s complaints. Methods: A total of 25 healthy individuals (12♂, 13♀; 24.3 ± 2.7 years; 174.9 ± 9.09 cm; 70 ± 14.2 kg; BMI: 22.7 ± 2.8) participated in this controlled non-randomized study of unilateral fatigue of the right foot’s stabilizing muscles with regard to the pronation of the foot, measured by navicular drop (ND) in static (statND; standing) and dynamic (dynND; walking) states. The left foot served as the control. Surface electromyography was used to verify fatigue. Results: While the statND did not change, the dynND increased significantly by 1.44 ± 2.1 mm (=22.3%) after the foot-stabilizing muscles experienced fatigue. No correlation was found between the statND and dynND. Conclusions: Muscular fatigue can affect foot pronation. The dynND appears to be more representative of the loads in everyday life, whereby most studies use the statND.

Individuals may exhibit altered foot mechanics, in this case foot pronation, only when fatigue sets in. Therefore, a more evidence-based understanding of these fatigue-induced changes may be helpful for future gait analysis and return to play tests, since fatigue could provide new insights that might explain a person’s complaints. Methods: 25 healthy test persons (24.3±2.7 years, BMI: 22.7±2.8) participated in this controlled non-randomized study of unilateral fatigue of the right foot stabilizing muscles with regard to the pronation of the foot, measured by navicular drop (ND) in a static (statND) und dynamic (dynND) state. The left foot served as a control. Surface electromyography was used to verify fatigue. Results: While statND didn’t change, the dynND increased significantly by 1.44±2.1 mm (= 22.3 %) after fatigue of the foot stabilizing muscles. No correlation was found between statND and dynND. Conclusion: Muscular fatigue can affect foot pronation. The dynND appears to be more representative of the loads in everyday life, whereby most studies work with the statND.