Orthoses Alter In Vivo Segmental Foot Kinematics During Walking in Patients With Midfoot Arthritis


      Rao S, Baumhauer JF, Tome J, Nawoczenski DA. Orthoses alter in vivo segmental foot kinematics during walking in patients with midfoot arthritis.


      To assess the effect of a 4-week intervention with a full-length carbon graphite (FL) orthosis on pain and function in patients with midfoot arthritis, and to identify alterations in in vivo foot kinematics accompanying FL use in patients with midfoot arthritis. These results have immediate application for enhancing patient care through effective orthotic recommendations.


      Experimental laboratory study supplemented by a case series.


      University based clinical research laboratory.


      Patients (n=30) with midfoot arthritis and age-, sex-, and body mass index–matched control subjects (n=20).


      Four-week intervention with FL orthoses.

      Main Outcome Measures

      Pain and function were assessed using the Foot Function Index–Revised (FFI-R). In vivo foot kinematics were quantified as peak and total range of calcaneal eversion, forefoot abduction, first metatarsal plantarflexion, and first metatarsophalangeal joint dorsiflexion during walking in 2 conditions: with FL orthoses and with shoes only. A paired t test and repeated-measures analysis of variance were used to assess statistical significance (α=.05) of change in FFI-R score and in vivo foot kinematics, respectively.


      Significant improvements in pain and function, discerned as lower FFI-R scores (P<.001), were noted after the 4-week intervention with FL orthoses. During walking, FL orthosis use resulted in decreased first metatarsophalangeal joint dorsiflexion (P=.024) and first metatarsal plantarflexion range of motion (P=.038), compared with the shoe-only condition.


      Orthotic intervention emphasizing a “stiffening” strategy of the first metatarsal and first metatarsophalangeal joint may be valuable in patients with midfoot arthritis and early degenerative changes.

      Key Words

      List of Abbreviations:

      ANOVA (analysis of variance), ES (effect size), FFI-R (Foot Function Index–Revised), FL (full-length carbon graphite (orthosis)), MDC90 (minimal detectable change at the 90% confidence interval), 3Q (three-quarter length (orthosis))
      To read this article in full you will need to make a payment


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Myerson M.S.
        • Cerrato R.A.
        Current management of tarsometatarsal injuries in the athlete.
        J Bone Joint Surg Am. 2008; 90: 2522-2533
        • Hardcastle P.H.
        • Reschauer R.
        • Kutscha-Lissberg E.
        • Schoffmann W.
        Injuries to the tarsometatarsal joint.
        J Bone Joint Surg Br. 1982; 64: 349-356
        • Arntz C.T.
        • Hansen Jr, S.T.
        Dislocations and fracture dislocations of the tarsometatarsal joints.
        Orthop Clin North Am. 1987; 18: 105-114
        • Richter M.
        • Wippermann B.
        • Krettek C.
        • Schratt H.E.
        • Hufner T.
        • Therman H.
        Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results.
        Foot Ankle Int. 2001; 22: 392-398
      1. Yu J, Cheung JT, Fan Y, Zhang Y, Leung AK, Zhang M. Development of a finite element model of female foot for high-heeled shoe design. Clin Biomech (Bristol, Avon) 2007;(23 Suppl 1):S31-8.

        • Myerson M.S.
        • Fisher R.T.
        • Burgess A.R.
        • Kenzora J.E.
        Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment.
        Foot Ankle. 1986; 6: 225-242
        • Teng A.L.
        • Pinzur M.S.
        • Lomasney L.
        • Mahoney L.
        • Havey R.
        Functional outcome following anatomic restoration of tarsal-metatarsal fracture dislocation.
        Foot Ankle Int. 2002; 23: 922-926
        • Kuo R.S.
        • Tejwani N.C.
        • Digiovanni C.W.
        • et al.
        Outcome after open reduction and internal fixation of Lisfranc joint injuries.
        J Bone Joint Surg Am. 2000; 82: 1609-1618
        • Rao S.
        • Nawoczenski D.
        • Baumhauer J.
        Midfoot arthritis: nonoperative options and decision making for fusion techniques.
        Tech Foot Ankle Surg. 2008; 7: 188-195
        • Jung H.G.
        • Myerson M.S.
        • Schon L.C.
        Spectrum of operative treatments and clinical outcomes for atraumatic osteoarthritis of the tarsometatarsal joints.
        Foot Ankle Int. 2007; 28: 482-489
        • Clark H.
        • Rome K.
        • Plant M.
        • O'Hare K.
        • Gray J.
        A critical review of foot orthoses in the rheumatoid arthritic foot.
        Rheumatology (Oxford). 2006; 45: 139-145
        • Shrader J.A.
        Nonsurgical management of the foot and ankle affected by rheumatoid arthritis.
        J Orthop Sports Phys Ther. 1999; 29: 703-717
        • Janisse D.J.
        • Janisse E.
        Shoe modification and the use of orthoses in the treatment of foot and ankle pathology.
        J Am Acad Orthop Surg. 2008; 16: 152-158
        • Zifchock R.A.
        • Davis I.
        A comparison of semi-custom and custom foot orthotic devices in high- and low-arched individuals during walking.
        Clin Biomech (Bristol, Avon). 2008; 23: 1287-1293
        • Novick A.
        • Kelley D.L.
        Position and movement changes of the foot with orthotic intervention during the loading response of gait.
        J Orthop Sports Phys Ther. 1990; 11: 301-312
        • Branthwaite H.R.
        • Payton C.J.
        • Chockalingam N.
        The effect of simple insoles on three-dimensional foot motion during normal walking.
        Clin Biomech (Bristol, Avon). 2004; 19: 972-977
        • Nester C.J.
        • van der Linden M.L.
        • Bowker P.
        Effect of foot orthoses on the kinematics and kinetics of normal walking gait.
        Gait Posture. 2003; 17: 180-187
        • Nawoczenski D.A.
        • Ludewig P.M.
        The effect of forefoot and arch posting orthotic designs on first metatarsophalangeal joint kinematics during gait.
        J Orthop Sports Phys Ther. 2004; 34: 317-327
        • Woodburn J.
        • Barker S.
        • Helliwell P.S.
        A randomized controlled trial of foot orthoses in rheumatoid arthritis.
        J Rheumatol. 2002; 29: 1377-1383
        • Woodburn J.
        • Helliwell P.S.
        • Barker S.
        Changes in 3D joint kinematics support the continuous use of orthoses in the management of painful rearfoot deformity in rheumatoid arthritis.
        J Rheumatol. 2003; 30: 2356-2364
        • Nawoczenski D.A.
        • Ketz J.
        • Baumhauer J.F.
        Dynamic kinematic and plantar pressure changes following cheilectomy for hallux rigidus: a mid-term follow-up.
        Foot Ankle Int. 2008; 29: 265-272
        • Sammarco V.J.
        • Nichols R.
        Orthotic management for disorders of the hallux.
        Foot Ankle Clin. 2005; 10: 191-209
        • Cavanagh P.R.
        • Morag E.
        • Boulton A.J.
        • Young M.J.
        • Deffner K.T.
        • Pammer S.E.
        The relationship of static foot structure to dynamic foot function.
        J Biomech. 1997; 30: 243-250
        • Saltzman C.L.
        • Nawoczenski D.A.
        • Talbot K.D.
        Measurement of the medial longitudinal arch.
        Arch Phys Med Rehabil. 1995; 76: 45-49
        • Greisberg J.
        • Hansen Jr, S.T.
        • Sangeorzan B.
        Deformity and degeneration in the hindfoot and midfoot joints of the adult acquired flatfoot.
        Foot Ankle Int. 2003; 24: 530-534
        • Rao S.
        • Baumhauer J.F.
        • Tome J.
        • Nawoczenski D.A.
        Comparison of in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and matched asymptomatic control subjects.
        J Biomech. 2009; 42: 1054-1060
        • Budiman-Mak E.
        • Conrad K.J.
        • Roach K.E.
        The Foot Function Index: a measure of foot pain and disability.
        J Clin Epidemiol. 1991; 44: 561-570
        • SooHoo N.F.
        • Samimi D.B.
        • Vyas R.M.
        • Botzler T.
        Evaluation of the validity of the Foot Function Index in measuring outcomes in patients with foot and ankle disorders.
        Foot Ankle Int. 2006; 27: 38-42
        • SooHoo N.F.
        • Vyas R.
        • Samimi D.
        Responsiveness of the Foot Function Index, AOFAS clinical rating systems, and SF-36 after foot and ankle surgery.
        Foot Ankle Int. 2006; 27: 930-934
        • Budiman-Makb E.
        • Conrad K.
        • Stuck R.
        • Matters M.
        Theoretical model and Rasch analysis to develop a revised Foot Function Index.
        Foot Ankle Int. 2006; 27: 519-527
        • Umberger B.R.
        • Nawoczenski D.A.
        • Baumhauer J.F.
        Reliability and validity of first metatarsophalangeal joint orientation measured with an electromagnetic tracking device.
        Clin Biomech (Bristol, Avon). 1999; 14: 74-76
        • Ascension Technology Corp.
        Installation and operation guide.
        (Accessed November 4, 2008)
        • Houck J.R.
        • Tome J.M.
        • Nawoczenski D.A.
        Subtalar neutral position as an offset for a kinematic model of the foot during walking.
        Gait Posture. 2008; 28: 29-37
        • Davitt J.S.
        • Kadel N.
        • Sangeorzan B.J.
        • Hansen Jr, S.T.
        • Holt S.K.
        • Donaldson-Fletcher E.
        An association between functional second metatarsal length and midfoot arthrosis.
        J Bone Joint Surg Am. 2005; 87: 795-800
        • de P Magalhães E.
        • Davitt M.
        • Filho D.J.
        • Battistella L.R.
        • Bertolo M.B.
        The effect of foot orthoses in rheumatoid arthritis.
        Rheumatology (Oxford). 2006; 45: 449-453
        • Hall C.
        • Nester C.J.
        Sagittal plane compensations for artificially induced limitation of the first metatarsophalangeal joint: a preliminary study.
        J Am Podiatr Med Assoc. 2004; 94: 269-274
        • Powers C.M.
        • Heino J.G.
        • Rao S.
        • Perry J.
        The influence of patellofemoral pain on lower limb loading during gait.
        Clin Biomech (Bristol, Avon). 1999; 14: 722-728
        • Heino Brechter J.
        • Powers C.M.
        Patellofemoral stress during walking in persons with and without patellofemoral pain.
        Med Sci Sports Exerc. 2002; 34: 1582-1593
        • Davis I.S.
        • Zifchock R.A.
        • Deleo A.T.
        A comparison of rearfoot motion control and comfort between custom and semicustom foot orthotic devices.
        J Am Podiatr Med Assoc. 2008; 98: 394-403
        • Rao S.
        • Baumhauer J.F.
        • Becica L.
        • Nawoczenski D.A.
        Shoe inserts alter plantar loading and function in patients with midfoot arthritis.
        J Orthop Sports Phys Ther. 2009; 39: 522-531