Kinematic, kinetic and electromyographic response to customized foot orthoses in patients with tibialis posterior tenosynovitis, pes plano valgus and rheumatoid arthritis

Abstract

Objective: To describe the effect of customized foot orthoses (FOs) on the kinematic, kinetic and EMG features in patients with RA, tibialis posterior (TP) tenosynovitis and associated pes plano valgus.

Methods: Patients with RA and US-confirmed tenosynovitis of TP underwent gait analysis, including three-dimensional (3D) kinematics, kinetics, intramuscular EMG of TP and surface EMG of tibialis anterior, peroneus longus, soleus and medial gastrocnemius. Findings were compared between barefoot and shod with customized FO conditions.

Results: Ten patients with RA with a median (range) disease duration of 3 (1-18) years were recruited. Moderate levels of foot pain and foot-related impairment and disability were present with moderately active disease states. Altered timing of the soleus (P = 0.05) and medial gastrocnemius (P = 0.02) and increased magnitude of tibialis anterior (P = 0.03) were noted when barefoot was compared with shod with FO. Trends were noted for reduced TP activity in the contact period (P = 0.09), but this did not achieve statistical significance. Differences in foot motion characteristics were recorded for peak rearfoot eversion (P = 0.01), peak rearfoot plantarflexion (P < 0.001) and peak forefoot abduction (P = 0.02) in the shod with FOs compared with barefoot conditions. No differences in kinetic variables were recorded.

Conclusion: This study has demonstrated, for the first time, alterations in muscle activation profiles and foot motion characteristics in patients with RA, pes plano valgus and US-confirmed TP tenosynovitis in response to customized FOs. Complex adaptations were evident in this cohort and further work is required to determine whether these functional alterations lead to improvements in patient symptoms.

Keywords: electromyography; foot orthoses; kinematics; rheumatoid arthritis; tibialis posterior.

Fig. 1

Motion time curves for key kinematic variables barefoot and shod with FO during stance. Data are presented as the mean (1 s.d.). Grey shaded area represents barefoot and black lines represent shod with FO. (a) Rearfoot frontal plane motion; (b) rearfoot sagittal plane motion; (c) forefoot transverse plane motion; (d) forefoot sagittal plane motion.

Fig. 2

Ensemble EMG activity for lower limb muscles barefoot and shod with FO during stance. Barefoot represented by grey shaded area; black lines represent shod with FO. All data presented as mean (±1 s.d.). (a) Tibialis posterior; (b) medial gastrocnemius; (c) peroneus longus; (d) soleus; (e) tibialis anterior.