SLR - October 2016 - Brett Chatman
Reference: Rachmawati, MR, Tulaar AB, Immanuel S, Purba A, Mansyur M, Haryadi RD, Hadisoebroto I, Husni A, and Ibrahim N. Correcting of pronated feet reduce skeletal muscle injury in young women with biomechanical abnormalities. Anat Cell Biol. 2016 Mar;49(1): 15–20.Scientific Literature Review
Reviewed By: Brett Chatman, DPM
Residency Program: MedStar Washington Hospital Center
Podiatric Relevance: A podiatrist’s role is to analyze one’s foot structure and note any biomechanical abnormalities, especially during the gait cycle. Flexible flat feet are a common abnormality that is frequently observed and, if painful, is a deformity that most podiatrists seek to improve. Typical treatment begins with foot orthotics to help improve gait. The authors of this article aimed to demonstrate that correction of pronated feet by foot orthotics will reduce skeletal muscle injury through the analysis of CK-MM markers.
Methods: This study was a double-blind clinical trial that analyzed adult women who had biomechanical abnormalities consisting of pronated feet accompanied by functional leg length disparities. The subjects were split into two groups; the first group was given athletic shoes with orthotics, and the second was group given athletic shoes without orthotics. Each patient had weightbearing radiographs taken in her athletic shoes with/without the orthotics to show the difference in the position of the talus. Inclusion criteria consisted of women aged 20 to 29 who were willing to participate in the exercise tests and have their blood drawn. Exclusion criteria were for patients with a history of lower-limb trauma, neurologic problems, those who exercise three times per week or those who have high risk factors for CK-MM in their blood plasma. Blood samples were taken from each subject from the median cubital vein, and the CK-MM concentration was analyzed by electrophoresis between 24 and 72 hours after the walking test.
Results: Among the 177 young women aged 20 to 29 years selected, only 37 of the subjects (21 percent) met the inclusion criteria, of which 10 subjects were dropped out, and finally there were 27 subjects (15 percent) who were willing to follow the entire series of examinations in this study. Randomized allocation was performed using a computer program, 14 subjects entered the treatment group and 13 subjects entered the control group. The ANOVA repeated test analyzed the differences in the CK-MM concentrations and revealed significant differences after those walking tests. It was noted in both the treatment and control group that the CK-MM concentrations after the first walking test were higher than before the walking test (P=0.007). The unpaired t test showed that the elevation of the CK-MM concentrations after the first, second and third walking test was higher significantly in the control group (P≤0.05) than in the treatment group. Thus, there was a physiologic adaptation on those who used the foot orthoses in the treatment group. This result indicates that the pronated feet corrected by foot orthoses will improve the series of biomechanical abnormalities and will decrease eccentric contraction, reduce the pressure in muscle tissues and reduce the amount of muscle injury while walking.
Conclusions: This article took an analysis of flat feet correction to a molecular level and showed that the elevation of CK-MM concentrations was lower in subjects who received orthotic correction for pronated feet. The foot orthoses for correcting the pronated feet on the young women with biomechanical abnormalities is able to reduce the degree of skeletal muscle injury after walking activity and lead to a better quality of life. This study proved that the subjects who have biomechanical abnormalities not corrected by foot orthoses had higher degrees of muscle injury than the subjects who were corrected by foot orthoses. After analyzing the results of this article, I will be more attentive to the correction of flat feet at an earlier visit in the younger age group due to the interesting findings of this study.