Vanity sizing for shoes as women’s feet get fatter
London - it is a discovery that might leave high-heel fans feeling a little flat.
Sky-high shoes could be to blame for flat feet, according to a study.
Scientists claim that high heels are the reason women are more likely to develop the agonising condition than men - and say their risk is increased further if they spend a lot of time standing up.
But before you resign yourself to a lifetime of sensible footwear, the researchers also say they are close to finding a cure.
The scientists, from the University of East Anglia, believe that flat feet come about when tendons in the feet are weakened by proteins that occur naturally in the body.
This causes the arch of the foot to fall, which can lead to excruciating pain and difficulties walking.
And they say their discovery could lead to the development of new drugs to combat these proteins, called enzymes, and stop them weakening the tendons.
Around 3.5 percent of the British population are thought to be affected by flat feet.
The condition is more common in women over 40, but it also runs in families and many sufferers are born with it.
Dr Graham Riley, who carried out the study, said that high heels did not properly support the feet, which caused the tendons to weaken. He also warned that women who wore heels were particularly at risk if they spent large chunks of the day standing up.
High heels alter posture and increase pressure on the ball of the foot. Repeated wear is already known to strain the hips, knees and thighs, as well as increasing the risk of conditions such as osteoarthritis, hammer toe, back problems, bunions and corns.
At the moment, flat feet can be treated by wearing insoles or supportive devices inside the shoe. In some cases, patients have surgery to reshape their feet.
Despite the breakthrough, the scientists say it will be at least a decade before drugs for the condition are available.
But they claim that in future treatments could be developed for other common conditions of the feet such as Achilles tendonitis, which causes heel pain.
Dr Riley, whose study is published in the Annals of the Rheumatic Diseases journal, added: “Our study may have important therapeutic implications since the altered enzyme activity could be a target for new drug therapies in the future.
“We have shown that similar changes also take place in other painful tendon conditions such as Achilles tendonitis, so this advance may ultimately result in an effective alternative to surgery for many patients.”
Professor Alan Silman, medical director of Arthritis Research UK, said: “Foot problems are an important and not sufficiently recognised cause of pain and disability in the elderly.
“Ageing changes to the supporting tendons contribute to these problems and this research represents a first step to successfully unravelling some of the complex biochemistry that regulates tendon disorders.”
Showing posts with label adult flatfoot disorder. Show all posts
Showing posts with label adult flatfoot disorder. Show all posts
Sunday, February 12, 2012
Tuesday, January 24, 2012
Assessing PTTD: Linking the kinetic chain
Many studies of posterior tibial tendon dysfunction (PTTD), or adult acquired flatfoot disorder, have focused on foot kinematics and benefits of bracing for pain relief and increased ambulation. But new findings from the University of Southern California in Los Angeles suggest clinicians also look higher along the kinetic chain when determining an effective treatment.
A September 2011 Journal of Orthopedic & Sports Physical Therapy study by USC researchers revealed women with PTTD performed significantly fewer single leg heel raises and repeated sagittal and frontal plane nonweight-bearing leg lifts; had at least 27% less hip abduction endurance; showed nearly 40% less hip extensor endurance; and reported a 50% increase in pain after a six minute walk test when compared with age-matched controls. Hip torque and calf muscle strength were also dramatically inferior, and, most interestingly, weakness was apparent in the involved and uninvolved limbs of participants with PTTD.
“The hip deficits that appeared bilaterally were surprising, as our hypothesis was that the hip deficits would be on the same side as the PTTD,” said Lisa M. Noceti-DeWit, DPT, ATC, adjunct instructor of clinical physical therapy at USC. Noceti-DeWit coauthored the study with university colleagues, including Kornelia Kulig, PhD, PT, a Catherine Worthingham fellow. “At this point, our research team is not yet able to speculate why the hip deficits are bilateral. We do feel that clinicians should assess hip strength in women with PTTD and provide appropriate intervention if deficits are found.”
Hip weakness may not be specific to women with PTTD, but reflective of general deconditioning or changes in motor control for a variety of reasons, explained Jeff Houck, PT, PhD, associate professor of physical therapy at New York’s Ithaca College, where he specializes in clinical biomechanics and orthopedics.
“One might ask about knee strength in these patients. If it is also lower, it would indicate more general deconditioning,” Houck said.
General strengthening approaches combined with functional exercises may be helpful, especially from a general health perspective, Houck suggested.
“However, the impact on clinical management of tendinopathy is not determined, therefore the weakness may not be specific to PTTD, but rather a secondary effect,” he said.
Women are three times as likely as men to be diagnosed with PTTD, and the disorder is most frequently found in women in their 50s. PTTD appears to peak during perimenopause, prompting research into female hormonal indicators, including estrogen receptors. A Pennsylvania State College of Medicine study, published in the December 2010 Foot & Ankle International, found no significant gender-related differences in estrogen expression in diseased posterior tibial tendons and no differences in estrogen receptors in diseased tibial tendons versus controls of healthy posterior tibial or flexor digitorum longus tendons. Larger studies may yet explain the role of estrogen in the overall health of tendons and connective tissues.
Houck suggested clinicians be cautious when employing ankle foot orthoses in women with PTTD unless the devices allow some ankle plantar flexion. His studies have shown more restrictive devices may lead to compensatory gait alterations that further weaken the ankle plantar flexors.
“The hip compensation to adapt to a decreased push off may be a stronger hip flexor contraction, resulting in a pull off rather than a push off. The further weakening of the ankle plantar flexors may aggravate the overall condition,” Houck said.
This overemphasis on hip flexion could help explain the reduced hip extensor endurance associated with PTTD in the USC study.
Changes in subtalar motion may also affect hip mechanics in patients with PTTD, Houck added.
“Subtalar inversion/eversion fine-tunes standing balance, and the hip abductors and adductors are major players in maintaining balance. Therefore, losing control at the subtalar joint as a result of PTTD may require some compensations at the hip. This may manifest as lower single leg stance time or increased trunk movements during single leg stance,” he said.
Future targeted studies exploring connections beyond the foot and ankle may elucidate whether existing hip weakness predisposes women to PTTD, or whether PTTD through its various stages complicates movement affecting both hips.
By Christina Hall Nettles
A September 2011 Journal of Orthopedic & Sports Physical Therapy study by USC researchers revealed women with PTTD performed significantly fewer single leg heel raises and repeated sagittal and frontal plane nonweight-bearing leg lifts; had at least 27% less hip abduction endurance; showed nearly 40% less hip extensor endurance; and reported a 50% increase in pain after a six minute walk test when compared with age-matched controls. Hip torque and calf muscle strength were also dramatically inferior, and, most interestingly, weakness was apparent in the involved and uninvolved limbs of participants with PTTD.
“The hip deficits that appeared bilaterally were surprising, as our hypothesis was that the hip deficits would be on the same side as the PTTD,” said Lisa M. Noceti-DeWit, DPT, ATC, adjunct instructor of clinical physical therapy at USC. Noceti-DeWit coauthored the study with university colleagues, including Kornelia Kulig, PhD, PT, a Catherine Worthingham fellow. “At this point, our research team is not yet able to speculate why the hip deficits are bilateral. We do feel that clinicians should assess hip strength in women with PTTD and provide appropriate intervention if deficits are found.”
Hip weakness may not be specific to women with PTTD, but reflective of general deconditioning or changes in motor control for a variety of reasons, explained Jeff Houck, PT, PhD, associate professor of physical therapy at New York’s Ithaca College, where he specializes in clinical biomechanics and orthopedics.
“One might ask about knee strength in these patients. If it is also lower, it would indicate more general deconditioning,” Houck said.
General strengthening approaches combined with functional exercises may be helpful, especially from a general health perspective, Houck suggested.
“However, the impact on clinical management of tendinopathy is not determined, therefore the weakness may not be specific to PTTD, but rather a secondary effect,” he said.
Women are three times as likely as men to be diagnosed with PTTD, and the disorder is most frequently found in women in their 50s. PTTD appears to peak during perimenopause, prompting research into female hormonal indicators, including estrogen receptors. A Pennsylvania State College of Medicine study, published in the December 2010 Foot & Ankle International, found no significant gender-related differences in estrogen expression in diseased posterior tibial tendons and no differences in estrogen receptors in diseased tibial tendons versus controls of healthy posterior tibial or flexor digitorum longus tendons. Larger studies may yet explain the role of estrogen in the overall health of tendons and connective tissues.
Houck suggested clinicians be cautious when employing ankle foot orthoses in women with PTTD unless the devices allow some ankle plantar flexion. His studies have shown more restrictive devices may lead to compensatory gait alterations that further weaken the ankle plantar flexors.
“The hip compensation to adapt to a decreased push off may be a stronger hip flexor contraction, resulting in a pull off rather than a push off. The further weakening of the ankle plantar flexors may aggravate the overall condition,” Houck said.
This overemphasis on hip flexion could help explain the reduced hip extensor endurance associated with PTTD in the USC study.
Changes in subtalar motion may also affect hip mechanics in patients with PTTD, Houck added.
“Subtalar inversion/eversion fine-tunes standing balance, and the hip abductors and adductors are major players in maintaining balance. Therefore, losing control at the subtalar joint as a result of PTTD may require some compensations at the hip. This may manifest as lower single leg stance time or increased trunk movements during single leg stance,” he said.
Future targeted studies exploring connections beyond the foot and ankle may elucidate whether existing hip weakness predisposes women to PTTD, or whether PTTD through its various stages complicates movement affecting both hips.
By Christina Hall Nettles
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