Discussion
overpronation of the footA, edema, pain, lower-extremity injuries, overpronation
EDEMA, OBESE, HEAT, POSITIVE
The present findings supported most of the hypotheses that the customized insoles with medial wedge could change the kinematic variables of the rearfoot, forefoot, hallux, knee, and hip during the stance phase of walking. When compared with the customized insole without medial wedge, that with medial wedges demonstrated less knee motion in the transverse plane, less hallux motion in the sagittal, frontal and transverse planes than the other. A possible explanation for these findings may be related to the length of the customized insole. The present study used a three-quarter length customized insole, which uncovered the metatarsal heads of the forefoot. The addition of medial wedges, especially at the forefoot, to the customized insole could decrease overpronation at the subtalar jointIn addition, the present study demonstrated that the customized insole with medial wedge provided the least forefoot and hallux motions in the transverse plane during the contact phase, and the least rearfoot motion in the frontal plane during the midstance phase among the others. Since over movement of the foot in the frontal and transverse planes during the early phase of the stance is related to overpronation of the footA number of previous studies determined the kinematic changes of the medial wedge from the shod among persons with lower-extremity injuries, including patellofemoral osteoarthritisAfter the 3-month follow-up, the participants had significantly less pain intensity and higher foot function scores than at baseline. There was also significant reduction in the number of participants in the apparent group from the US findings, which included those with either plantar fascia thickness greater than 3.8 mm or hypo-echogenicity of the plantar fascia. Abnormal findings from ultrasonography represented perifascial fluid accumulation that caused plantar fascia edema in the symptomatic feetHowever, there was no significant difference regarding the plantar fascia thickness of the plantar fascia. Among 24 participants in the apparent US group, there were only 4 participants with plantar fascia thickness greater than 3.8 mm at baseline. After 3-month follow up, there were only 3 participants with that criteria from a total of 8 participants in the apparent US group. Obviously, an average thickness of the plantar fascia among participants is less than the diagnostic criteria for PFSome limitations should be concerned. For example, most participants in this study were obese, which could produce measurement error from skin movement. A pre-post experimental design was used to determine the clinical outcomes and US findings from the use of the customized insole with medial wedges. The control group should be included in further studies to compare such effects. And the therapist used a heat moulding method instead of a negative casting method. The present results could thus reflect the biomechanical effects of customized insole with only heat-moulding method and not other methods of production. However, several strengths must be acknowledged. The results could be generalized to PF population. Furthermore, this is the first study to determine the effects of customized insoles using joint kinematics and US diagnosis as objective outcomes among persons with PF. Although joint kinematics were only investigated as immediate effects, clinical outcome and US diagnosis were additionally determined as short-term effects. Positive outcomes from the present study supported the use of customized insoles with medial wedges as an effective conservative treatment in patients with PF. Further studies should use randomized controlled trials and extend the follow-up period. Joint kinetics and muscle activity should be additionally included to comprehensively investigate the biomechanical effects of the customized insole in individuals with PF.