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The CurePPaC Study analysing non-surgical treatment strategies to Cure Pes Planovalgus associated Complaints

English title The CurePPaC Study analysing non-surgical treatment strategies to Cure Pes Planovalgus associated Complaints
Applicant Baur Heiner
Number 140928
Funding scheme Project funding (Div. I-III)
Research institution Fachbereich Gesundheit Berner Fachhochschule
Institution of higher education Berne University of Applied Sciences - BFH
Main discipline Rehabilitation
Start/End 01.04.2013 - 31.03.2016
Approved amount 293'561.00
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All Disciplines (2)

Discipline
Rehabilitation
Surgery

Keywords (5)

conservative therapy; foot-function-index; foot orthoses; gait analysis; neuromuscular control

Lay Summary (German)

Lead
Eine Knick-Senkfuss-Fehlstellung geht oft mit einer Fehlfunktion der fussgewölbestabilisierenden Muskulatur einher. Im frühen Stadium können konservative Therapien angewandt werden. Dazu werden Fussorthesen, oder auch ein Kräftigungstraining empfohlen. Bisher gibt es jedoch noch kaum guten Studien, die wissenschaftliche Belege für diese Massnahmen liefern. Die vorliegende Studie prüft deshalb in einer randomisierten kontrollierten Studie die klinischen und funktionellen Effekte dieser Therapien.
Lay summary

Der Knick-Senkfuss ist eine häufige Fehlstellung bei der sich das Längsgewölbe des Fusses absenkt. Gleichzeitig sind die Muskulatur und die zugehörige Sehne, die das Gewölbe stützt, meist degenerativ verändert und abgeschwächt. Die Patientinnen und Patienten sind durch Schmerzen erheblich eingeschränkt. Es wird angenommen, dass in frühen Stadien eine konservative Therapie mit Fussorthesen (Entlastung durch mechanische Unterstützung des Fussgewölbes) und/oder kräftigenden Übungen der betroffenen Muskulatur erfolgreich sein kann. Allerdings gibt es kaum aussagekräftige Studien, die den Erfolg dieser Massnahmen wissenschaftlich belegen. Eine Studie (Kulig et al. Phys Ther 2009) deutet auf den Erfolg von Fussorthesen und einer Kräftigungstherapie hin, wenngleich nicht geprüft wurde, ob einfaches Zuwarten gegebenenfalls auch zu einer Verbesserung der Symptome führt. Zudem hat bisher noch keine Studie umfangreiche Veränderungen in der Funktion (Bewegungsmuster) der Patientinnen und Patienten) in alltagsrelevanten Situationen (Gehen, Treppensteigen) geprüft. Der undifferenzierte Einsatz vielfältiger konservativer Therapiemassnahmen führt zu hohen Kosten. Das Wissen über einen gezielten und sinnvollen Einsatz wissenschaftlich geprüfter Massnahmen kann somit einen optimierten Mitteleinsatz im Gesundheitswesen führen. Die vorliegende Studie (CurePPaC Studie) prüft in einer „kontrollierten randomisierten Studie“ sowohl die klinischen Effekte für die Patientinnen und Patienten (Mögliche Verbesserung der Symptome) als auch mögliche Veränderungen im Bewegungsverhalten (Analyse der zugrundeliegenden Mechanismen).

Direct link to Lay Summary Last update: 04.02.2013

Lay Summary (English)

Lead
Pes planovalgus is often accompanied by a dysfunction of the posterior tibial tendon. Early stages of this entity are thought to be treated with non-surgical therapy options like foot orthoses and/or strengthening exercises of the posterior tibial muscle. The randomized-controlled trial investigates the clinical benefit as well as changes in biomechanical function possibly induced by the proposed therapies.
Lay summary

Pes planovalgus is a common foot deformity characterized by a flattening of the foot’s longitudinal arch and is accompanied by a dysfunction of the posterior tibial tendon. Early stages of this pathology are thought to be treated with non-surgical therapy options like foot orthoses (relief of tendon stress by mechanical unloading of the arch) or strengthening exercises. Recent literature clearly states the urgent need for high quality studies to evaluate the proposed non-surgical treatments. There is only one high quality study available that shows benefits of orthoses therapy and exercise (Kulig et al. Phys Ther 2009) without testing against a "wait-and-see" strategy. No study to date evaluated functional changes pre-post in dynamic movement pattern of daily living like gait or stair climbing. The widespread use of several non-surgical treatment strategies lead to extensive health care expenses. An optimized therapeutic strategy could eventually lead to more efficient health care expenditures. The presented proposal addresses this latest knowledge and aims to analyze non-surgical treatment strategies to Cure Pes Planovalgus associated Complaints in the CurePPaC Study.

Direct link to Lay Summary Last update: 04.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Cranio-caudal and medio-lateral navicular translation are representative surrogate measures of foot function in asymptomatic adults during walking.
Eichelberger Patric, Pohl Johannes, Jaspers Theo, Ferraro Matteo, Krause Fabian, Baur Heiner (2018), Cranio-caudal and medio-lateral navicular translation are representative surrogate measures of foot function in asymptomatic adults during walking., in PloS one, 13(12), 0208175-0208175.
Intra- and interday reliability of the dynamic navicular rise, a new measure for dynamic foot function: A descriptive, cross-sectional laboratory study
Blasimann Angela, Eichelberger Patric, Lutz Nicole, Radlinger Lorenz, Baur Heiner (2018), Intra- and interday reliability of the dynamic navicular rise, a new measure for dynamic foot function: A descriptive, cross-sectional laboratory study, in The Foot, 37(Dec), 48-53.
The influence of gait and speed on the dynamic navicular drop - A cross sectional study on healthy subjects.
Pohl J, Jaspers T, Ferraro M, Krause F, Baur H, Eichelberger P (2018), The influence of gait and speed on the dynamic navicular drop - A cross sectional study on healthy subjects., in Foot (Edinburgh, Scotland), 36, 67-73.
A minimal markerset for three-dimensional foot function assessment: measuring navicular drop and drift under dynamic conditions
Eichelberger Patric, Blasimann Angela, Lutz Nicole, Krause Fabian, Baur Heiner (2018), A minimal markerset for three-dimensional foot function assessment: measuring navicular drop and drift under dynamic conditions, in J Foot Ankle Res, 11, 15.
Analysis of accuracy in optical motion capture - A protocol for laboratory setup evaluation
Eichelberger Patric, Ferraro Matteo, Minder Ursina, Denton Trevor, Blasimann Angela, Krause Fabian G., Baur Heiner (2016), Analysis of accuracy in optical motion capture - A protocol for laboratory setup evaluation, in Journal of Biomechanics, 49(10), 2085-2088.
Non-surgical treatment of pain associated with posterior tibial tendon dysfunction: study protocol for a randomised clinical trial
Blasimann Angela, Eichelberger Patric, Brülhart Yvonne, El-Masri Isam, Flückiger Gerhard, Frauchiger Lars, Huber Martin, Weber Martin, Krause Fabian G., Baur Heiner (2015), Non-surgical treatment of pain associated with posterior tibial tendon dysfunction: study protocol for a randomised clinical trial, in Journal of Foot and Ankle Research, 8(37), 1-11.

Collaboration

Group / person Country
Types of collaboration
Siloah Bern, Klinik für Orthopädie und Traumatologie - orthosiloah Switzerland (Europe)
- Research Infrastructure
Praxis für Fusschirurgie Bern Switzerland (Europe)
- Research Infrastructure
Spital STS AG Thun, Klinik für Orthopädie, Traumatologie und Sportmedizin Switzerland (Europe)
- Research Infrastructure
Inselspital / Universitätsspital Bern, Department of Orthopaedic Surgery Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Sonnenhofspital Bern, Fuss- und Sprunggelenkchirurgie Switzerland (Europe)
- Research Infrastructure
Salemspital Bern, Praxis für Fuss- und Sprunggelenkschirurgie Switzerland (Europe)
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
European Society for Movement Analysis in Adults and Children, 26th Annual Meeting Poster The influence of gait and speed on the dynamic navicular drop - a cross-sectional study on healthy subjects. 06.09.2017 Trondheim, Norway Eichelberger Patric;
World Congress of the World Confederation of Physical Therapy (WCPT) Poster Navicular Rise: a possibility to describe dynamic foot function during stance? A descriptive, cross- sectional laboratory study 02.07.2017 Capetown, South Africa Baur Heiner; Blasimann Angela; Eichelberger Patric;
World Congress of the World Confederation of Physical Therapy (WCPT) Poster Coupling of navicular mobility and foot length change during walking 02.07.2017 Capetown, South Africa Baur Heiner; Eichelberger Patric; Blasimann Angela;
World Congress of the World Confederation of Physical Therapy (WCPT) Poster The influence of gait and speed on the dynamic navicular drop - a cross-sectional study on healthy subjects. 02.07.2017 Capetown, South Africa Baur Heiner; Blasimann Angela; Eichelberger Patric;
FOOT International (EFAS, DAF, I-FAB) Poster A marker set for clinically focused 3D dynamic foot function assessment 23.06.2016 Berlin, Germany Eichelberger Patric; Baur Heiner; Blasimann Angela;
25th World Congress of the International Society of Biomechanics (ISB) Talk given at a conference Performance optimization and error estimation of an optical motion capture setup for measuring small displacements on the foot within a full body measurement volume 12.07.2015 Glasgow, Great Britain and Northern Ireland Blasimann Angela; Baur Heiner;
World Congress of the World Confederation of Physical Therapy (WCPT) Talk given at a conference Reliability of a new foot model for dynamic navicular drop measurement 01.05.2015 Singapore, Singapore Eichelberger Patric; Baur Heiner;
World Congress of the World Confederation of Physical Therapy (WCPT) Poster Non-surgical treatment of Pes Planovalgus associated pain – a systematic review 01.05.2015 Singapore, Singapore Baur Heiner; Blasimann Angela;
13th international symposium on 3D analysis of human movement (3D AHM - a subdivision of the International Society of Biomechanics) Talk given at a conference Analysis of measurement accuracy of optical 3D motion measurements. A protocol for precise and fast lab setup evaluation 14.07.2014 Lausanne, Switzerland Eichelberger Patric; Baur Heiner;
Physioswiss Congress (bi-anual National Physiotherapy Conference) Poster Konservative Interventionen bei Tibialis posterior-Sehnendysfunktion bezogen auf das Outcome Schmerz 13.06.2014 Bern, Switzerland Blasimann Angela; Baur Heiner;
Physioswiss Congress (bi-anual National Physiotherapy Conference) Poster Optische 3D Messung kleinräumiger Relativbewegungen am Fuss 13.06.2014 Bern, Switzerland Eichelberger Patric; Brühlhardt Yvonne; Blasimann Angela; Baur Heiner;


Abstract

Summary of research planIntroduction: Pes planovalgus or flatfoot-associated complaints are frequent symptoms, which are thought to be caused by the foot deformity itself. Concurrently, the multifactorial weakness of the M. tibialis posterior and its tendon (trauma, systemic disease, chronic tendon degeneration by overuse) can lead to a flattening of the medial longitudinal arch of the foot. Affected patients suffer from functional impairment and pain. Less severe cases are eligible for non-surgical treatment. Foot orthoses are considered to be the first line approach. Furthermore strengthening of the arch- and ankle-stabilizing muscles are thought to contribute to an active compensation of the deformity. There is only limited evidence concerning the numerous therapy approaches since high quality studies are missing. One excellent report shows clear benefits by the use of foot orthoses and strengthening exercises without comparing to a “wait-and-see”-policy. Beside the fact that evidence-based guidelines for therapy have yet to be developed, no data is available showing functional benefits that accompany the therapy process. This would give further insight into mechanisms behind non-surgical management strategies and how patients benefit functionally from therapy. Purpose: The purpose of this randomized longitudinal intervention study is the evaluation of the therapeutic benefit of three different non-surgical treatment regimens (newly developed foot orthoses FON, current best practice foot orthoses, FOC, foot orthoses and accompanying eccentric exercises FOE) in patients with Pes planovalgus and accompanying complaints. Furthermore the analysis of possible functional changes in gait mechanics (kinematics and kinetics) and neuromuscular control (electromyographic analysis) will contribute to a superior understanding of functional changes that accompany non-operative management. The purpose of the study is to optimize non-surgical management in patients suffering from Pes planovalgus associated pain leading to an efficient use of health care system’s financial resources. Methods: 60 patients with Pes planovalgus associated complaints (clinical diagnosis with plain weight bearing radiographs), M. tibialis posterior dysfunction) are included in the study. Functional impairment is evaluated pre and post intervention by the Foot-Function-Index (FFI, German version). Anthropometric data recording is followed by preparation of subject’s foot anatomical landmarks with retroflective markers and superficially detectable muscles of the ankle joint complex are prepared with SEMG electrodes. The 3D kinematic data allows inter alia the calculation of segmental angels of the lower extremity and measurement of navicular drop. The neuromuscular activity is analyzed in the time (on-off pattern) and amplitude domain (gait cycle specific phases). Procedure: Potential participants are recruited via the Outpatient Clinic of the Department of Orthopaedic Surgery of the Inselspital, University Hospital, Bern. After initial screening, subjects are randomized to one of three intervention groups. FON and FOC subjects wear custom-made foot orthoses only. FOE-subjects wear individually accustomed foot orthoses and they will perform a combined monitored and home training program to progressively strengthen the M. tibialis posterior and accompanying ankle stabilizing muscles with eccentric exercises. Subjects are measured pre and post intervention (12 weeks). Measurements include the primary outcome measure Foot-Function-Index (FFI, German version: total score) followed by basic anthropometric measures. Subject preparation allows then the measurement of 10 trials on a walkway and on stairs with embedded force plates in barefoot condition. An average step cycle out of 10 trials is calculated and biomechanical outcome measures are extracted. A re-test allows the calculation of intervention effects by one-factor ANOVA (factor: therapy group) for repeated measures.
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