TUTKIMUSTIIVISTELMIÄ LAATINUT PETRI VÄYRYNEN FYSIOTERAPEUTTI, ERIKOISTUNUT PODIATRIAAN TERVEYSTIETEIDEN MAISTERI PÄIVITETTY 30.11.2009 Vapaamuotoiset käännökset englanninkielisistä alkuperäistutkimuksista ovat allekirjoittaneen tekemiä. Mahdolliset kysymykset ja kommentit aiheeseen liittyen voi lähettää osoitteeseen: vayrynen@bluewin.ch. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch
Gait Posture. 2009 Nov;30(4):502-6. Basic gait and symmetry measures for primary school-aged children and young adults whilst walking barefoot and with shoes. Kävelyn perus- ja symmetriamittaukset ala-asteikäisillä lapsilla sekä nuorilla aikuisilla käveltäessä avojaloin ja kengät jalassa. Lythgo N, Wilson C, Galea M. Rehabilitation Sciences Research Centre, University of Melbourne, Australia. nlythgo@unimelb.edu.au This study investigated the basic spatio-temporal gait measures of 898 primary school-aged children (5-13 years) and 82 young adults (18-27 years). Participants completed 6-8 walks at preferred speed along a GAITRite walkway whilst barefoot and whilst wearing athletic shoes or runners. Outcome measures (non-normalized and normalized) were gait speed, cadence, step and stride length, support base, single and double support, stance duration, foot angle and associated symmetry measures. Non-normalized measures of speed, step and stride length, support base and foot angle increased with age whereas cadence reduced. Normalized measures remained unchanged with age in children whereas the young adults (both conditions) exhibited a 2.3% reduction in single support, a 5.1% increase in double support and a 2.6% increase in stance duration (p<0.0001). For the entire sample, shoes increased walking speed by 8 cm s(-1), step length by 5.5 cm, stride length by 11.1 cm and base of support by 0.5 cm. In contrast, foot angle and cadence reduced by 0.1 degrees and 3.9 steps min(-1) respectively. Shoes increased both double support (1.6%) and stance time (0.8%), whereas single support reduced by 0.8%. Symmetry remained unaffected by age. On average, measures of step and stride symmetry (combining both conditions) fell around 0.7 cm, whereas measures of symmetry for step and stance time, single and double support fell around 0.6%. Footwear significantly affected gait (p<0.0001). Gait may not be mature by age 13. Gait is symmetrical in healthy children and young adults but may change with pathology. TUTKIMUKSEN TARKOITUS: Tutkimuksessa tarkasteltiin 898 ala-asteikäisen (ikä 5-13 vuotta) sekä 82 nuoren aikuisen (ikä 18 27 vuotta) kävelyä GAITRite walkway-menetelmällä avojaloin sekä urheilukengillä. TULOKSET: Kengät vaikuttivat huomattavasti kävelyyn, sillä kävely ei ole täysin kypsynyt vielä 13 ikävuoteen mennessä. Kävely on terveillä lapsilla ja nuorilla aikuisilla symmetristä, mutta luonnollinen kävely voi muuttua patologisten tekijöiden seurauksena. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 2
Journal of Biomechanics. 2009 Sep 18;42(13):2081-8. The influence of footwear on foot motion during walking and running. Kenkien vaikutus jalkaterän toimintaan kävelyn ja juoksun aikana. Morio C, Lake MJ, Gueguen N, Rao G, Baly L. Oxylane Research, Department of Movement Sciences, 59665 Villeneuve d'ascq Cedex, France. cedric.morio@oxylane-group.com There are evidences to suggest that wearing footwear constrains the natural barefoot motion during locomotion. Unlike prior studies that deduced foot motions from shoe sole displacement parameters, the aim of this study was to examine the effect of footwear motion on forefoot to rearfoot relative motion during walking and running. The use of a multi-segment foot model allowed accurate both shoe sole and foot motions (barefoot and shod) to be quantified. Two pairs of identical sandals with different midsole hardness were used. Ten healthy male subjects walked and ran in each of the shod condition. The results showed that for barefoot locomotion there was more eversion of the forefoot and it occurred faster than for shod locomotion. In this later condition, the range of eversion was reduced by 20% and the rate of eversion in late stance by 60% in comparison to the barefoot condition. The sole constrained both the torsional (eversion/inversion) and adduction range of motion of the foot. Interestingly, during the push-off phase of barefoot locomotion the rate and direction of forefoot torsion varied between individuals. However, most subjects displayed a forefoot inversion direction of motion while shod. Therefore, this experiment showed that the shoes not only restricted the natural motion of the barefoot but also appeared to impose a specific foot motion pattern on individuals during the push-off phase. These findings have implications for the matching of footwear design characteristics to individual natural foot function. TUTKIMUKSEN TARKOITUS: Tutkitusti on todettu, että liikuttaessa kengät jalassa, muuttaa kenkien käyttö jalkojen luonnollista (avojaloin) toimintaa. TULOKSET: Tutkimus osoitti, että kengät eivät rajoita vain jalkaterien luonnollista toimintaa vaan kengillä on taipumus muuttaa myös ponnistusvaiheessa tapahtuvaa askeleen liikekaavaa. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 3
Journal of Orthopaedic Research. 2009 Mar;27(3):318-24. Shoes influence lower limb muscle activity and may predispose the wearer to lateral ankle ligament injury. Kengät vaikuttavat alaraajan lihasaktiivisuuteen ja voivat altistaa käyttäjänsä nilkan ulkoreunan nivelsiteiden vammoille. Kerr R, Arnold GP, Drew TS, Cochrane LA, Abboud RJ. Institution of Motion Analysis & Research, Orthopaedic & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, Scotland, United Kingdom. Lateral ankle ligaments are injured by hyperinversion of the foot. Foot position is controlled by the lower limb muscles. Awareness of foot position is impaired by wearing shoes. We aimed to determine the influence of wearing shoes upon muscle activity. Sixty-two healthy subjects underwent the same measurements, barefoot and with standardized shoes in a random order. Electromyography (EMG) was recorded from the peroneus longus muscle in response to sudden and unanticipated inversion of the ipsilateral foot. Following foot inversion, the EMG signal showed an initial peak muscle contraction followed by a sustained smaller contraction. Both changes were significantly greater in shoes compared to the barefoot condition for all tested degrees of inversion. Muscle contraction following sudden inversion of the foot was significantly greater when wearing shoes. This greater muscular contraction may be an intrinsic mechanism to oppose the increased moment created by the inverted foot/shoe condition, and hence, may counter balance the increased tendency to injure the lateral ankle ligaments created by wearing shoes. (c) 2008 Orthopaedic Research Society. TUTKIMUKSEN TARKOITUS: Nilkan ulkoreunan nivelsiteet vaurioituvat ulospäin suuntautuvan nyrjähdyksen seurauksena. Alaraajan lihakset kontrolloivat jalkaterän asentoa. Tietoisuus jalkaterän asennosta heikkenee käytettäessä kenkiä. TULOKSET: Lihasten supistuminen äkillisen jalkaterän ulospäin kääntymisen seurauksena oli huomattavasti suurempi käytettäessä kenkiä. Tämä suurentunut lihasaktiviteetti saattaa olla eräs kehon sisäinen mekanismi, joka lisää jalkaterän ulospäin suuntautuvaa momenttia heikentäen samalla tasapainoa. Näillä muutoksilla on taipumus lisätä nilkan ulospäin suuntautuvia nyrjähdyksiä käytettäessä kenkiä. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 4
International Journal of Sports Medicine. 2008 Jun;29(6):512-8. Barefoot-shod running differences: shoe or mass effect? Avojaloin-jalkinein juoksun erot: kengän vai painon vaikutus? Divert C, Mornieux G, Freychat P, Baly L, Mayer F, Belli A. LAMIH, Université de Valenciennes, Valenciennes, France. caroline.divert@univ-valenciennes.fr The higher oxygen consumption reported when shod running is compared to barefoot running has been attributed to the additional mass of the shoe. However, it has been reported that wearing shoes also modified the running pattern. The aim of this study was to distinguish the mass and shoe effects on the mechanics and energetics when shod running. Twelve trained subjects ran on a 3-D treadmill ergometer at 3.61 m. s (-1) in six conditions: barefoot, using ultra thin diving socks unloaded, loaded with 150 g, loaded with 350 g, and two shoe conditions, one weighing 150 g and another 350 g. The results show that there was a significant mass effect but no shoe effect for oxygen consumption. Stride frequency, anterior-posterior impulse, vertical stiffness, leg stiffness, and mechanical work were significantly higher in barefoot condition compared to shod. Net efficiency, which has metabolic and mechanical components, decreased in the shod condition. The mechanical modifications of running showed that the main role of the shoe was to attenuate the foot-ground impact by adding damping material. However, these changes may lead to a decrease of the storage and restitution of elastic energy capacity which could explain the lower net efficiency reported in shod running. TUTKIMUKSEN TARKOITUS: Kengillä juoksu lisää hapenkulutusta verrattuna avojaloin juoksemiseen. Tämän arvellaan johtuvan kenkien painosta. Lisäksi aikaisemmat tutkimukset ovat osoittaneet, että kenkien käyttö muuttaa juoksun luonnollista kaavaa. TULOKSET: Mekaaninen juoksun modifointi osoitti, että kenkien merkittävin rooli oli alentaa alustasta välittyvää iskua, lisäämällä vaimennusta. Nämä muutokset saattavat kuitenkin johtaa elastisen energia kapasiteetin varastoitumisen sekä palautumisen vähenemiseen, mikä selittänee alentuneen netto tehokkuuden kengillä juostessa. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 5
Gait Posture. 2008 Jan;27(1):51-9. Foot motion in children shoes: a comparison of barefoot walking with shod walking in conventional and flexible shoes. Jalan liikkuvuus lasten kengissä: vertailututkimus käveltäessä avojaloin sekä perinteisillä ja joustavilla kengillä. Wolf S, Simon J, Patikas D, Schuster W, Armbrust P, Döderlein L. Department of Orthopedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany. Sebastian.Wolf@ok.uni-hd.de The increased prevalence for flatfoot and hallux valgus in modern societies may be the consequence of inadequate footwear in childhood. Based on the assumption that barefoot walking represents the best condition for the development of a healthy foot the objective of this study was to monitor the influence of commercial footwear on children's foot motion during walking. Furthermore, an attempt was made to reduce this influence by changing the physical properties of standard footwear. Children's barefoot motion pattern was monitored by a marker-based optical 3D-tracking method using a multi-segment foot model. In the study's first stage, barefoot walking was compared to walking with a commercial product. In the second stage it was compared to both, the pattern with the commercial product and with the shoe modified on the basis of the findings of the first stage of the study. Eighteen children (8.2+/-0.7 years old) with no foot deformity and with the same shoe size were recruited for this study. It was found that tibio-talar ROM increased in the commercial shoe (26.6 degrees ) compared to the barefoot condition (22.5 degrees, p=0.001) whereas the medial arch changes for push-off were diminished since the variation in arch length was reduced from 9.9% (barefoot) to 5.9% (shoe, p<0.001). Further, ROM in foot torsion along the long foot axis was reduced from 9.8 degrees (bare) to 4.7 degrees (shoe, p<0.001). These parameters could be improved with more flexible footwear. The present study shows that slimmer and more flexible children's shoes do not change foot motion as much as conventional shoes and therefore should be recommended not only for children in this age but for healthy children in general. TUTKIMUKSEN TARKOITUS: Lisääntynyt lättäjalkaisuuden sekä vaivaisenluun esiintyminen nyky-yhteiskunnassa saattaa johtua epäsopivien kenkien käytöstä lapsuudessa. Perustuen oletukselle, että avojaloin liikkuminen edustaa parasta tilaa terveiden jalkojen kehittymiselle, oli tämän tutkimuksen tarkoituksena monitoroida tavallisten kenkien vaikutusta lasten jalkojen toimintaan kävelyn aikana. TULOKSET: Tutkimus osoitti, että ohutpohjaiset ja joustavat lasten kengät eivät muuta jalkaterän luonnollista toimintaa siinä määrin mitä tavalliset kengät tekevät. Tämän vuoksi ohutpohjaisia ja joustavia kenkiä voidaan suositella kaiken ikäisille lapsille, joilla ei ole vakavia jalkaterien virheasentoja. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 6
Gait Posture. 2008 Jan;27(1):152-5. Long distance running increases plantar pressures beneath the metatarsal heads: a barefoot walking investigation of 200 marathon runners. Kestävyysjuoksu lisää jalkapohjassa jalkapöytäluiden kärkipäihin kohdistuvaa kuormitusta: avojaloin tehty kävelytutkimus 200 maraton juoksijalle. Nagel A, Fernholz F, Kibele C, Rosenbaum D. Movement Analysis Lab., Orthopaedic Department, University Hospital of Muenster, Domagkstr 3, 48149, Muenster, Germany. anagel@uni-muenster.de BACKGROUND: The growing popularity of endurance sports activities is associated with a growing number of metatarsal stress fractures in recreational runners. Excessive foot loading has been suggested as a potential cause for these problems [Bennell, K, Matheson G, Meeuwisse W, Brukner P. Risk factors for stress fractures. Sports Med 1999;28(2):91-122]. Therefore, the question arises whether long distance running affects foot loading characteristics like ground reaction forces and peak pressure in specific areas of the foot. PURPOSE: To investigate the effects of long distance running on plantar pressure patterns before and after a marathon race. STUDY DESIGN: Repeated measurements of recreational runners before and after a marathon race. METHODS: Two hundred participants of the third Muenster marathon, 2004, were measured before and after the race with plantar pressure measurements during barefoot walking on a capacitive platform. The ratio between forefoot and toe loading was calculated to assess a suggested loading shift between these areas. RESULTS: The results of the whole group of participants revealed a significant difference in foot loading characteristics before and after the race. Post-race peak pressure and impulse values were higher in the forefoot regions and reduced under the toes. CONCLUSIONS: The increased peak pressure under the metatarsal heads after the race indicates a load shift from the toes to the metatarsal heads. This suggests an increased loading of the metatarsal bones and could explain the increased incidence of metatarsal stress fractures in long distance runners. TUTKIMUKSEN TARKOITUS: Ihmisten kiinnostus kestävyystyyppiseen liikuntaan on lisääntynyt. Samanaikaisesti ovat lisääntyneet myös jalkapöytäluiden rasitusmurtumat. Lisääntynyttä jalkaterien kuormitusta pidetään yhtenä syynä murtumien lisääntymiseen. Mittaukset suoritettiin avojaloin ennen ja jälkeen maratoonin. TULOKSET: Juoksun jälkeen kuormituksen painehuippu siirtyy pois varpailta, kohti jalkapöytäluiden kärkipäitä. Tämän kuormitusmuutoksen arvioidaan johtavan jalkapöytäluiden kuormituksen lisääntymiseen, mikä saattaa selittää kestävyysjuoksijoiden lisääntyneet rasitusmurtumat. SELVENNYKSENÄ AIKAISEMMISTA TUTKIMUKSISTA: Perinteisessä juoksukengässä kanta on (keskimäärin 1,5 cm) korotettuna etuosaan verrattuna. Tämä korotus pakottaa lisääntynyttä kuormitusta päkiälle. Samanaikaisesti juoksukengän kärki on irti alustalta. Tämä rakenne (kengän käynti) tarkoittaa, että kävelyn/juoksun keskitukivaiheessa varpaat ovat irti alustalta ja niiden askelta tasapainottava vaikutus heikkenee, mikä edelleen lisää päkiään kohdistuvaa kuormitusta. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 7
Gait Posture. 2007 Jan;25(1):94-8. Influence of footwear midsole material hardness on dynamic balance control during unexpected gait termination. Kengän välipohjamateriaalin kovuuden vaikutus dynaamisen tasapainon hallintaan kävelyssä tapahtuvien odottamattomien muutosten seurauksena. Perry SD, Radtke A, Goodwin CR. Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ont., Canada N2L-3C5. sperry@wlu.ca The purpose of this study was to determine the influence of different midsole hardnesses on dynamic balance control during unexpected gait termination. Twelve healthy young female adults were asked to walk along an 8-m walkway, looking straight ahead. During 25% of the trials, they were signaled (via an audio buzzer) to terminate gait within the next two steps. The four experimental conditions were: (1) soft (A15); (2) standard (A33); (3) hard (A50); (4) barefoot. Center of mass (COM) position relative to the lateral base of support (BOS), center of mass-center of pressure (COM-COP) difference and vertical loading rate were used to evaluate the influence of midsole material on dynamic balance control. The results were a decrease in the medial-lateral range of COM with respect to the lateral BOS, a reduction in the maximum COM-COP difference and an increase in the vertical loading rate due to the presence and hardness level of the midsole material when compared to the barefoot condition. The primary outcomes of this study have illustrated the influence of midsole hardness as an impediment to dynamic balance control during responses to gait termination. In conclusion, the present study suggests that variations in midsole material and even the presence of it, impairs the dynamic balance control system. TUTKIMUKSEN TARKOITUS: Tarkoitus oli tutkia kenkien eri kovuisten välipohjamateriaalien vaikutusta dynaamisen tasapainon hallintaan kävelyssä tapahtuvien odottamattomien muutosten seurauksena. TULOKSET: Tutkimuksen tärkein havainto oli, että välipohjamateriaalin kovuus heikentää dynaamisen tasapainon hallintaa odottamattomissa kävelyssä tapahtuvissa muutoksissa. Tutkimuksen perusteella välipohjamateriaalin kovuuden vaihtelu tai ylipäätään välipohja heikentävät dynaamisen tasapainon hallinnan kontrollointia. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 8
Foot Ankle International. 2009 Oct;30(10):986-91. Sensitivity mapping of the human foot: thresholds at 30 skin locations. Jalkaterän tuntoalueiden kartoittaminen: (ärsytys)kynnys 30 ihoalueelle. Hennig EM, Sterzing T. Biomechanics Laboratory, Sports and Movement Sciences, University of Duisburg-Essen, Gladbecker Str. 182, 45141 Essen, Germany. ewald.hennig@uni-due.de BACKGROUND: Mechanoreceptors in the skin provide sensory input for the central nervous system about foot placement and loading. This information is used by the brain to actively control or regain balance and is important to establish memory traces for subsequent movement. A sensitivity map of the human foot could help to understand the mechanisms of the foot as a sensory organ for movement adjustment and balance control. MATERIALS AND METHODS: Touch and vibration perception threshold values from 30 plantar and dorsal foot locations were determined in more than 40 women and men between 20 and 35 years. Semmes Weinstein monofilaments and a vibrotactile neurothesiometer were used for skin sensitivity threshold detection. RESULTS: Large sensitivity differences were present between the 30 different foot sites. Gender effects were not present for touch but women had better sensitivities for vibration (p < 0.01), especially on the dorsal aspect of the foot. Age, in our cohort of 20- to 35-year-olds, did not have an influence on vibration or touch sensitivity. The heel had the highest detection thresholds for touch but was very sensitive for vibration stimuli. Compared to the dorsum, the plantar foot was substantially more sensitive, especially for vibration detection. CONCLUSION: The results suggest that primarily the fast adapting plantar mechanoreceptors are important in assisting balance control during human locomotion. CLINICAL RELEVANCE: The sensitivity map of the foot will help in understanding the function of the foot as a sensory organ and could be useful in creating footwear for better balance control and for the design of comfortable shoes. TUTKIMUKSEN TARKOITUS: Ihon mekanoreseptorit välittävät keskushermostolle tietoa jalkaterien asennosta ja kuormittumisesta. Aivot käyttävät tätä tietoa aktiiviseen tasapainon kontrolloimiseen, lisäksi tieto on tärkeä tiettyjen liikekaavojen muistijäljen kehittymiselle. TULOKSET: Erityisesti jalkapohjassa sijaitsevat mekanoreseptorit ovat tärkeitä tasapainon kontrolloinnin avustajia ihmisen liikkuessa. Jalan tuntoaistimusalueiden tunteminen helpottaa ymmärtämään jalkaterän toimintaa sensorisena elimenä. Tieto saattaa olla avuksi kehiteltäessä kenkiä, jotka parantavat tasapainon hallintaa. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 9
British Journal of Sports Medicine. 2009 Apr;43(4):288-92. Biomechanical variables associated with Achilles tendinopathy in runners. Biomekaaniset vaihtelut, jotka ovat yhteydessä juoksijoiden akillesjänteiden kiputiloihin. Azevedo LB, Lambert MI, Vaughan CL, O'Connor CM, Schwellnus MP. Institute of Sports and Exercise Science, University of Worcester, Worcester, UK. l.azevedo@tees.ac.uk OBJECTIVE: The aim of this study was to investigate the kinetics, kinematics and muscle activity in runners with Achilles tendinopathy. DESIGN: Case-control study. SETTING: Biomechanics laboratory. PARTICIPANTS: 21 runners free from injury and 21 runners with Achilles tendinopathy performed 10 running trials with standardised running shoes. Injured runners were diagnosed clinically according to established diagnostic criteria. Uninjured runners had been injuryfree for at least 2 years. Main outcome measurements: During each trial, kinetic and lower limb kinematic data were measured using a strain gauge force plate and six infrared cameras respectively. Electromyographic (EMG) data from six muscles (tibialis anterior (TA), peroneus longus (PE), lateral gastrocnemius (LG), rectus femoris (RF), biceps femoris (BF) and gluteus medius (GM)) were measured with a telemetric EMG system. RESULTS: Knee range of motion (heel strike to midstance) was significantly lower in injured runners than in uninjured runners. Similarly, preactivation (integrated EMG (IEMG) in 100 ms before heel strike) of TA was lower for injured runners than uninjured runners. RF and GM IEMG activity 100 ms after heel strike was also lower in the injured group. However, impact forces were not different between the two groups. CONCLUSION: Altered knee kinematics and reduced muscle activity are associated with Achilles tendinopathy in runners. Rehabilitation exercises or other mechanisms (e.g. footwear) that affect kinematics and muscle activity may therefore be beneficial in the treatment of runners with Achilles tendinopathy. TUTKIMUKSEN TARKOITUS: Tarkoituksena oli tutkia kinetiikkaa, kinematiikkaa sekä lihasaktiviteettia akillesjänteen kiputiloista kärsivillä juoksijoilla. JOHTOPÄÄTÖKSET: Heikentynyt polven kinematiikka sekä alentunut lihasvoima ovat yhteydessä juoksijoilla esiintyviin akillesjänteen kiputiloihin. Kuntoutus tai muut toimenpiteet (esimerkiksi kengät), jotka vaikuttavat kinematiikkaan sekä lihasaktiivisuuteen voivat olla hyödyllisiä hoidettaessa akillesjänteen kiputiloja. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 10
Foot and Ankle Surgery. 2008;14(4):180-9. Children sport shoes--a systematic review of current literature. Lasten urheilukengät systemaattinen katsaus ajankohtaiseen kirjallisuuteen. Walther M, Herold D, Sinderhauf A, Morrison R. Department of Foot and Ankle Surgery, Orthopaedic Hospital Munich-Harlaching, Munich, Germany. info@markus-walther.com OBJECTIVE: The child's foot is clearly distinct from the adult foot in its functional anatomy and ability to cope with pressure. This requires special considerations in the development of a children's sport shoe. METHODS: Medical and sport science databases were thoroughly searched for studies pertaining to the anatomy and biomechanics of children's feet during their development. With the data found, a list of requirements for the children's shoe was compiled. RESULTS: Small children should have a sports shoe, which is as flexible as their own foot. The small impact forces during their sports activities make extra cushioning superfluous. During school age the connective tissue gains stability. The growing amount of sports activities, much of which is performed on hard indoor surfaces, enhances the need for cushioning. At the same time there is a growing necessity for adequate mechanical stimuli to help the muscles and bones develop. The strength of the connective tissue and the flexibility of the joints reach adult levels by the age of 15. In small shoes, the displacement of proportions can lead to improper positioning of the flex zone and thereby causing harmful stress on the foot. Cushioning elements are often oversized. Considering the wide range of anatomy in the child's foot, it is advisable to produce children's shoes in different widths. CONCLUSION: The child's foot differs in anatomy and function from the adult foot. Children sport shoes should meet the child specific requirement. TUTKIMUSESTA: Lapsen jalka eroaa aikuisen jalasta sekä toiminnalliselta anatomialtaan että kyvyltään sietää painetta. Nämä seikat vaativat erityistä huomiota suunniteltaessa urheilukenkiä lapsen jaloille sopiviksi. Esimerkiksi pienten lasten tulisi käyttää urheilukenkiä, jotka ovat yhtä joustavia kuin heidän jalkansakin. Pienet, alustalta välittyvät iskut eivät tarvitse erityistä iskunvaimennusta. Kouluiässä supistuvan kudoksen stabiliteetti paranee, sillä lisääntynyt liikunta, usein kovilla alustoilla suoritettuina, vaatii lisääntynyttä iskunvaimennusta. Samanaikaisesti esiintyy kasvavaa tarvetta sopivalle mekaaniselle ärsykkeelle, mikä auttaa lihaksia ja luita kehittymään. Supistuvan kudoksen voima sekä nivelten liikkuvuus saavuttavat aikuisten tason noin 15 vuotiaana. Liian pienet kengät aiheuttavat muutoksia jalkojen toiminnassa ja voivat johtaa haitallisiin muutoksiin. Usein iskua vaimentavat elementit ovat lasten kengissä ylimitoitettuja. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 11
Current Opinion in Rheumatology. 2009 Mar;21(2):164-70. Advances in insoles and shoes for knee osteoarthritis. Tuet ja kengät, jotka ehkäisevät polven degeneratiivista (rappeuttavaa) niveltulehdusta. Hinman RS, Bennell KL. Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Victoria, Australia. ranash@unimelb.edu.au PURPOSE OF REVIEW: This review highlights recent research findings, including their clinical application, for insoles and footwear in knee osteoarthritis. In particular, it examines their effect on knee load, osteoarthritis symptoms and disease progression. RECENT FINDINGS: Increased joint loading increases the risk of osteoarthritis progression, but is amenable to change. Given the prevalence of medial compartment osteoarthritis, insoles and footwear largely aim to reduce the knee adduction moment, an indicator of medial compartment load. Lateral wedged insoles can reduce this moment but do not appear to slow disease progression. Although nonexperimental and quasiexperimental studies report favourable effects of lateral wedges on symptoms, clinical trials have not been confirmatory. Medial wedged insoles show promise in relieving symptoms of lateral compartment disease. Walking in shoes increases joint load compared with walking in barefeet. Shoes with a flat or low heel and that are flexible rather than stabilizing may be optimal; however, effects of off-the-shelf shoes on osteoarthritis symptoms are unknown. Promising shoe modifications include shoes that promote foot mobility and those with variable stiffness or laterally wedged soles. SUMMARY: Insoles and footwear offer great potential, as simple, inexpensivetreatment strategies for knee osteoarthritis. Further research is needed to evaluate efficacy and to determine which patient subgroups are most responsive. TUTKIMUKSESTA: Perinteiset kengät lisäävät nivelten kuormittumista verrattuna avojaloin liikkumiseen. Esimerkiksi joustavat kengät, jotka sallivat jalan liikkeet ja joissa ei ole korkoa tai korko on hyvin matala, alentavat mahdollisesti polven degeneratiivisen niveltulehduksen aiheuttamia oireita. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 12
Arthritis and Rheumatism. 2006 Sep;54(9):2923-7. Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis. Avojaloin liikkuminen alentaa alaraajojen nivelten kuormittumista polven degeneratiivisessa niveltulehduksessa. Shakoor N, Block JA. Section of Rheumatology, Rush Medical College, Chicago, Illinois 60612-3862, USA. najia_shakoor@rush.edu OBJECTIVE: To evaluate the effects that modern shoes have on gait and lower extremity joint loads in osteoarthritis (OA). METHODS: Gait analyses were performed on 75 subjects with knee OA while they were wearing their everyday walking shoes and while they were walking barefoot. The trials involved optoelectronic detection of external markers during ambulation over a multicomponent force plate, and were matched for speed. Comparisons were made of gait parameters and joint loading during trials in which the subjects walked while wearing shoes and while barefoot. RESULTS: Peak joint loads at the hips and knees significantly decreased during barefoot walking, with an 11.9% reduction noted in the knee adduction moment. Stride, cadence, and range of motion at the lower extremity joints also changed significantly, but these changes could not explain the reduction in the peak joint loads. CONCLUSION: Shoes may detrimentally increase loads on the lower extremity joints. Once factors responsible for the differences in loads between with-shoe and barefoot walking are better delineated, modern shoes and walking practices may need to be reevaluated with regard to their effects on the prevalence and progression of OA in our society. TUTKIMUKSESTA: Tarkoituksena oli tutkia perinteisten kenkien vaikutusta kävelyyn sekä alaraajojen nivelten kuormittumiseen degeneratiivisessa niveltulehduksessa. Lonkkien ja polvien kuormitushuiput alenivat merkitsevästi liikuttaessa avojaloin. Kengät sen sijaan näyttäisivät lisäävän haittaavasti alaraajojen nivelten kuormitusta. Tämän perusteella tulisi kenkien ja kävelyn vaikutusta arvioida uudelleen niveltulehdusten esiintymisessä sekä sairauden kehittymisessä. Tiivistelmän laatija: Petri Väyrynen, vayrynen@bluewin.ch 13