ASICS FOOTWEAR REVIEW: CHARCOT FOOT GT-4000 2

Charcot Foot GT-4000 2

Thanks to Asics for this latest footwear review from Anthony Ng.

Charcot foot is a significant foot complication of Diabetes which involves a direct inflammatory response affecting bones, soft tissues and joints of the foot and ankle. The pathophysiology is unknown however, Charcot’s tends to develop from trauma, increased weight bearing along with neuropathy.

Charcot foot is a significant foot complication of Diabetes which involves a direct inflammatory response affecting bones, soft tissues and joints of the foot and ankle. The pathophysiology is unknown however, Charcot’s tends to develop from trauma, increased weight bearing along with neuropathy.

If healthcare professionals are unable to identify the condition at the acute phase to prevent the foot changes, it will result in significant deformation primarily occurring at the Lisfranc joints, STJ or mid tarsal region of the foot. The damage to the foot skeletal shape can be of a gross foot deformity, resulting in vast valgus malalignment, notably arch collapse with a rocker bottom appearance. This often results in increased stiffening of the foot, along with associated ligament changes altering the natural forces of gait which will lead to further lower limb complications.

The best strategy is to avoid this condition from occurring and diagnose early for prophylaxis. If Charcot’s foot has already occurred and settled, the deformity of the foot structures will need to be continually supported. If you have any suspicion of a patient whom you deem will develop this condition, the treatment is more therapeutic to stop, prevent or preserve the foot from deteriorating. Surgical intervention is recommended for the most serve foot disfigurements where all other non-surgical options are exhausted.

As the deformity mainly occurs at the Lisfranc joints, STJ and MTJ there will be the tendency for the foot to move medially. ASICS has engineered the new GT-4000 version 2, which provides the stiffening strength required at the rear and midportion of the shoe to help support those foot structures during the forces of plantar loading.

The GT-4000 uppers and correct midsole shore densities helps correct alignment and influences the pressure distribution to prevent subsequent disorganization of the foot from further deformity and provide those at risk with supportive footwear before this condition can eventuate. The strong midfoot truss offers reduced torsional twisting to increase stabilization and strength occurring around the mid tarsal region. This will provide the desirable control and help support those associated with a rocker bottom deformity.

This condition is associated with a lack of absorbency. Shock attenuation is required to provide comfort for those interlocking joints and bones throughout the gait cycle. The chosen foam offers durability and effective energy return providing comfort.

The ideal pitch profile will not create additional trans ferred forces as the unstable foot moves through gait. The 2E width fit adds extra depth and girth to accommodate structural changes that may have occurred or provide the space for any accommodative custom fabricated devices. CONTINUED ON NEXT PAGE >>

Finding the correct footwear can be difficult, the GT-4000 provides some of the ideal requirements for this condition. GT-4000: Solid rigid constructed rear, with a durable dual-density midsole offers the desirable support thought out the medial and lateral longitudinal arch which extends through to the propulsive phase. Other conditions that this shoe may be benefit include: Amputation to hallux: is associated with the structures of the midfoot to move medially. Altered pressure distribution occurs during the initial phase of propulsion causing the foot to move in a valgus direction, ultimately affect the timing of the gait cycle. The GT-4000 encompasses a strong extended midfoot component which improves sagittal alignment.

Flexible flatfoot with hallux Valgus: Notable weakening of foot muscles, causes ineffective transfer of energy which alters the timing of the foot during dynamic gait; this often makes normal push-off impossible. Ineffective sagittal plane motion causes increase foot deformity resulting in Hallux Valgus (HAV). Support required from distal midfoot to proximal forefoot. Posterior Tibial Dysfunction: Normally related to adults with an acquired flat foot deformity. resulting in tendon degeneration/ elongation changes. The presentation of a valgus deformity will require a supportive constructive shoe to improve foot alignment in providing a more positive ergonomic ride.

Pronation: Able to effectively control kinematics of pronation and reducing tibial rotation. Capable of replacing the need for orthotic therapy.

STJ Ligament Injury : Usually associated with a major traumatic sprain. Irritation occurs over the anterior ankle, with loss of strength in dorsiflexion. Supportive footwear to regain ankle hold and control.

Anthony Ng

B.Sc (Pod), B.Ed, Dip Tch

Survey Request

Physios - we need your help to understand how you manage middle-aged and older adults with chronic hip pain. We value your perspective as a physio working in clinical practice. We want to know what you think is most important when managing patients with chronic hip pain. Your views can inform the design of clinically relevant studies that aim to improve the health of people with chronic hip pain. This is a one-off online survey that will take approximately 20 to 40minutes to complete. By completing this survey you can enter the draw to win an Apple iPad Air. Follow this link https:// melbourneuni.au1.qualtrics.com/jfe/form/SV_8iCXMECS5Z8HsYR to participate. This study is being Co-ordinated by Mr Travis Haber and Dr Michelle Hall at the Centre for Health, Exercise and Sports Medicine (CHESM) at the University of Melbourne, email Travis thaber@student.unimelb.edu.au if you have any questions.

Is there an association between external workload and lower-back injuries in cricket fast bowlers? A systematic review.

Corey Perrett, Peter Lamb, Melanie Bussey, PhD

Physical Therapy in Sport https://doi.org/10.1016/j.ptsp.2019.11.007

By Pip Sail

Introduction:

The prevalence of injuries to fast bowlers is over 20% compared with the next most commonly injured position, batsmen7.4%, (Orchard, Kountouris, and Sims). During each delivery bowlers exert significant vertical and horizontal ground reaction forces (Bayne, Elliot, Campbell & Alderson 2016) and experience substantial shear force through the lumbo-pelvic region (Crewe, Campbell, Elliot & Alderson 2013). The repetitive nature of this substantial load combination has been associated with this prevalence, particularly in the lower-back and more significantly for the sport, lower-back injuries have been associated with the highest number of playing days lost (Frost & Chalmers 2012). Lower-back pain injury in cricketers has been associated with both intrinsic and extrinsic risk factors (Olivier et al.,2016). Intrinsic factors are diverse, including, but not limited to:mixed action (Portus, Mason, Elliott, Pfitzner & Done,2004), trunk muscle asymmetries (Engstrom, Walker, Kippers, & Mehnert, 2007), and reduced lumbar proprioception (Olivier, Stewart, & McKinon, 2014). Workload is reported as the primary extrinsic factor for injury (Olivier et al.,2016) in fast bowlers. The association between workload and injury is complex: high workload may increase Injury risk by 2.1x (Hulin et al., 2013) and low workload by 1.4x (Dennis, Farhar, Goumas, & Orchard,2003). Workload is said to have a dual risk threshold. This dual risk threshold indicates that bowlers need to have a workload high enough to facilitate positive training adaptations compatible to the demands of the task but low enough to minimise the risk of stress related injuries (Hulin et al.,2013) Workload has been defined in terms of internal and external load. Internal workload refers to the perceived effort or physiological demand of each delivery on the internal structures of the body (Hulin

et al.,2013). External is defined by the total bowling volume (Hulin et al., 2013). The product of these represents the total workload.

Because of the ‘dual’ risk threshold the timeframe of the workload becomes important. The ratio between an acute workload (about a week) and a chronic workload (on average, 4 weeks) becomes a potential risk factor for injury (Hulin et al., 2013; McNamara et al.,2017;Windt & Gabbett, 2018)

Since there is plausible mechanism for workloads causing injury, the hypothesis for this paper is, that external workloads are associated with lower-back injuries in cricket fast bowlers.

Method:

Literature search using 4 sets of key words: (1) cricket; (2) bowl,bowler,fast,pace,seam,medium; (3) spine, lumbar, lower-back, disc, fracture, stress, spondylosis, spondylolisthesis;

(4) workload, work, load, effort, demand, overuse, internal, external.

Inclusion:

Type of study-cohort or cross-sectional that included a measure of external workload AND an outcome measure of lower-back injury in cricket fast-bowlers Type of participants-cricket fast bowlers; no restriction in terms of age, sex,skill level or handedness

Results:

Only eight were found to meet the inclusion criteria: Four of these were a mixture of retrospective and prospective cohort studies, (Alway et al., 2019 Orchard et al.,2002, 2015;Orchard and James 2003) each reflecting on some previously recorded data. The other four were entirely prospective cohorts (Bayne et al., 2016; Davies et al,.2008; Dennis et al., 2005,2008) which followed participants for a period of time. The study follow-up ranged from 6 months to the length of the season in the prospective cohort studies. The retrospective cohorts examine data from multiple seasons. The diagnostic pathway also differed with 2 utilising MRI and 4 using clinical diagnosis via physical examination. In general, the risk of bias across the studies was high. Only those studies that used imaging to validate the injury diagnosis (Bayne et al., 2016;Dennis et al., 2005) could be said to be clear of measurement bias in terms of the injury diagnosis; however, neither of these studies used a valid, reliable method of workload measure, so the risk of measurement bias was high in all the studies.

Table 3

Discussion:

Based on the existing quality of evidence the hypothesis can not be supported. The risk bias scores across 8 studies was 6-11 from 15 and consequently, the level of evidence to determine whether external workload could accurately predict lower-back injuries in cricket fast bowlers was low. One problematic issue across studies was the risk measurement bias when diagnosing lower back injuries. A validation of initial diagnosis through MRI would be considered gold standard, and thus reduce the risk of bias in the study. Had the examined studies used valid measures for injury and/or workload, their strength of evidence would have been greater, improving effectiveness of the study. The review highlights a need for valid and reliable methods for measuring both workload and lowerback injuries in order to be able to link the two. Although imaging is expensive, time consuming and to an extent less practical than a physio or doctor, it is the best way to determine whether an injury exists and if so to what extent. Knowing this for certain is essential to determine the cause of injury.

Designing studies to improve the measurement of workload remains a significant challenge. While it has been recognised that workload can be categorised as either acute, chronic, or both as well as internal or external (Hulin et al 2013), understanding what these workloads are and how to measure them remains unclear.

Conclusion:

This review found that there is very little strength to any association between external workload and lower -back injury in fast bowlers, due to biases within the injury and workload measurements in the existent literature. Accurate measurement and a better understanding of workload will help uncover whether there is an association between workload and lower-back injuries. A full set of references is available on request.