Kogler 1996
Kogler 1996
Kogler 1996
PII: SO268-0033(96)00019-8
Abstract
Objective. The purpose of this investigation was to quantify the longitudinal arch support
properties of several types of foot orthosis.
Design. An in vitro method that simulated ‘static stance’ was used to determine arch
support capabilities, with plantar aponeurosis strain implemented as the performance
measure.
Background. A longitudinal arch support mechanism of an orthosis resists depression of
the foot’s arches by transferring a portion of the load to the medial structures of the foot.
Since the plantar aponeurosis is in tension when the foot is loaded, a quantifiable decrease
in strain should occur with an adequate orthotic arch control mechanism.
Methods. A differential variable reluctance transducer was surgically implanted in the
plantar aponeurosis of cadaveric donor limb feet (n = 7). Each specimen was mounted in an
electromechanical test machine which applied a load of up to 900 N axially to the tibia. The
test schedule was divided into seven test conditions: specimen barefoot; specimen with
shoe and specimen with shoe and five different orthoses.
Results. The University of California Biomechanics Laboratory Shoe Insert and two other
foot orthoses significantly decreased the strain in the plantar aponeurosis compared to the
barefoot control and were considered effective arch supports (P<O.O5). The functional foot
orthosis, stock orthosis, and test shoe did not effectively reduce plantar aponeurosis strain.
Significant variations of time required to achieve the specified load levels were recorded
among the test conditions, indicating the relative cushioning properties of the shoe/
orthosis systems.
Conclusions. The patterns of plantar aponeurosis strain observed in cadaveric tests
suggest that certain types of orthoses are more effective than others in the support of the
foot’s longitudinal arches. It is suggested that to support the longitudinal arches of the foot
effectively the medial surface contours of the orthosis must stabilize the apical bony
structure of the foot’s arch. Copyright @ 1996 Elsevier Science Ltd.
Relevance
Reducing tension in the plantar aponeurosis is an important treatment objective for orthotic
management of plantar fasciitis. Therefore it is of great clinical interest to know whether the
longitudinal arch support mechanism of specific foot orthoses have benefits with respect to
the loading of the plantar aponeurosis.
Key words: Foot orthoses, longitudinal arch support, plantar aponeurosis, plantar fasciitis,
biomechanics, shoes
there have been no specific studies that quantify strain Subj. Age sex 4 Height Body mass Leg mass
in the plantar aponcurosis to determine the functional NO. (VI /ml kg, !kgl
.---__-_ _..__ ___
control capabilities of foot orthoses. 1 56 F R 1.7 59.1 7.6
From a clinical perspective. it is important to know 1 56 M L 1.8 77.3 3.7
3 58 M L 1.7 80.9 4.0
how efficient an orthosis is in supporting the foot’s 4 51 M L 1.8 68.2 3.0
longitudinal arches for the relief of plantar fascia strain. 5 75 F L 1.6 55.5 2.9
6 51 M L 1.8 81.8 3.8
The aim of this study was to determine the arch support 7 51 M L 1.7 77.3 4.3
capabilities of several types of foot orthosis of various Mean 56.9 1 .J 71.4 3.5
designs. Plantar aponeurosis strain was used as a SD 8.5 0.1 10.7 0.6
Kogler et al: Longitudinal arch support mechanisms 245
The test schedule was divided into seven test con- --P--
ditions: specimen barefoot, specimen with shoe and
tests of five orthoses which combined specimen with
shoe and test orthosis. Five test runs were conducted
with each condition bringing the total number of
recorded test runs performed on each specimen to 35.
All specimens were subjected to the seven conditions in
a varied order utilizing a simple ‘Latin square test-
ing sequence’. This predetermined arrangement of
succession ensured that each condition was initiated at
a different stage within the schedule so that the effect of
order would be controlled. Specimens were randomly
assigned their position in the testing sequence square.
Between the different treatment conditions, legs
underwent an additional five cycles of loading to
eliminate ‘first time behaviour’ which represents initial
settling of the limb within the shoe and orthosis. The
shoe alignment plate and the mounting fixture ensured
that limb placement and position would be unchanged
as a specimen was prepared for each treatment con-
dition. With the locator pin removed, tibia1 rotation Figure 2. Diagramatic representation of the experimental set-up for
was permitted via the mounting post and compression testing the longitudinal arch support mechanism of foot orthoses.
246 C/in. Biomech. Vol. 11, No. 5. 1996
Table 2. Mean (SD) for percent strain at different test loads. (n = 7) Values to orthoses increases with increasing load. In other
below dotted line indicate foot orthoses that had efficient longitudinal
arch support mechanisms. Their values were statistically different from words, there is a complementary relationship between
all other tests (PC 0.05). the effect for subject and orthoses on time to load. In
Test load values
general, the planned comparison tests of time to load
225 N 450 N 675 N 900 N
indicate that barefoot loaded quickest and FO no. 2
took the longest time to load. Furthermore, FO no. 5
Test condition
FO no. I* 2.88 (2.01) 3.98 (2.18) 4.71 (2.30) 5.29 (2.41)
and shoe performed similarly as did FO no. 3 and
Shoe 2.50 (1.78) 3.66 (1.83) 4.50 (1.89) 5.20 (1.95) FO no. 4 while FO no. 1 performed in a similar way to
Fo no. 4’ 2.31 (1.78) 3.51 (1.89) 4.35 (1.98) 5.03 (2.05)
Barefoot 1.31 (1.46) 2.62 (I .78) 3.54 (2.02) 4.29 (2.20)
FO no. 4. More detailed comparisons can be seen in
Table 3.
FO no. 5’ -2.64 (2.88) -2.13 (3.15) -1.62 (3.34) -1.16 (3.51)
FO no. 2* -2.76 (3.53) -1.56 (3.17) -0.74 (3.02) -0.66 (2.96)
The results of the repeated measures analysis
FO no. 3* -3.58 (3.39) -2.39 (3.28) -1.59 (3.25) -0.98 (3.24) indicate that the effect of treatment was not significant
*with shoe at 225 N, but was significant for loads 450, 675, and
900 N (P< 0.01). To determine specifically which
mean of the five replicates. Descriptive information treatments differed from one another, paired t tests
was also collected and statistical significance was set at were performed between each pair of orthoses. This
the 5% level (P < O.OS), although, given the pilot resulted in 15 paired follow-up tests being performed at
nature of this work, the 10% level was also entertained each load separately. These results indicate in general
(P < 0.10). The primary analysis was conducted as a that the pattern of performance was similar to that of
Latin Square Analysis of Variance (ANOVA) consisting the raw data seen in Table 2.
of subject, treatment (orthoses), and order for both
strain and time; follow-up comparisons were performed Discussion
with Duncan’s multiple range testX2. Additional
analysis consisted of converting percent strain to a In this investigation, several types of foot orthosis were
measure x that reflects the strain value that occurred evaluated on cadaveric donor limbs to determine the
with each orthosis as a function of the barefoot efficiency of their respective longitudinal arch support
condition, x = (f-h)lb) 100, where f and b are mechanisms. Strain in the plantar aponeurosis was
respectively the strain readings corresponding to the employed as a performance measure to quantify the
foot orthosis (or shoe) and barefoot conditions. This integrity of the arch of each foot. Orthoses which
complementary procedure resulted in a one factor produced a statistically significant decrease (P~0.05)
repeated measures analysis of variance with six levels in plantar aponeurosis strain compared to the barefoot
being performed for each load separately. Follow-up control were considered effective as an arch support.
comparisons were performed with paired t-tests. Two groups of orthoses were statistically distinct, one
with effective longitudinal arch support mechanisms
and the other with devices that provided only nominal
Results reductions in plantar aponeurosis strain. Though
Results of the Latin Square, performed at each load variations in performance were anticipated, the
separately, indicate a non-significant effect of order for magnitudes of the differences were unexpected. The
time to load and a significant effect of order for per cent orthotic design characteristics that contributed to the
strain, which only accounts for approximately 10% of resultant data were of clinical interest. Test devices
the variability in the full model. Further examination of were critically examined to determine what influence
the means suggests that the use of a testing sequence
designed to control for order will probably be beneficial h I I I I I
their individual features have on the loading of the characterized by the concurrent gross motions of hind-
plantar aponeurosis. foot adduction-pronation-plantar flexion and forefoot
Three of the orthoses studied significantly reduced abduction-supination-dorsiflexion’ The primary bony
the amount of strain in the plantar aponeurosis displacements that occur with medial longitudinal arch
compared IO the control: the UC-BL, (FO no. 5). the depression are an amalgamation of: calcaneal plantar
soft accommodative orthosis (FO no. 2), and the semi- flexion and pronation; posterior migration of the talus
rigid orthosis (FO no, 3) (P<O.OS). The findings on the calcaneus; plantar displacement of the navicular
favour the orthotic principles stated by Campbell and and cuneiforms; dorsal compression and plantar
Inman which cmphasizc decreased tension in the widening of the cuneonavicular and cuneometatarsal
plant;ir aponcurosis for treatment of plantar fasciitis’. joints; dorsiflexion of the metatarsals; and anterior
In contrasr the functional orthosis (FC) no. 3), the migration of the metatarsals with posterior displace-
srock devirt iF0 no. 1‘I and the shot alone showed ment of the calcaneus’. We theorize that to decrease
slight incrcnscs in strain compared to the barefoot the arch-flattening moments in the foot, the longi-
condition though the increa>cs wcrc not statistically tudinal arch support mechanism of an orthosis must
significant. Ir is unclear it these occurrences were the support the apical bony structures of the foots arch: the
r-esult of a ‘bowstring’ effect to the plantar aponeurosis base of the first metatarsal, medial cuneiform, and the
described by Campbell and Inman’ or an arch lengthen- talus via the navicular and sustentaculum tali of the
mg rcsponsc While the ‘howstring’ effect may bc ;I calcaneus (Figure 5). This concept is in agreement with
rcasonahle assumption with regard to the foot orthoses KabP. Zamosky”‘. and Hayward’” who recognized
(t’o !I(:. 4 J’C) no I ). ~hc response from the shot is the importance of applying orthosis-ground reaction
rw ijuitc -!a apparcrrr One explanation for the forces in this region, noting that the longitudinal arch
pcrformartcc (of the shoe may be related to its elevated should be placed at the highest medial point near the
heel hcigh: !f the plantar aponcurosis does function talonavicular joint. Niggj” studied the placement of the
4milar Lo the tie-rod component of ;I ‘truss‘ as some medial longitudinal arch support mechanism and
authors h:\v~.; suggested” ‘.’ “.‘.‘. theoretically tension reported that if it is placed in the posterior part of the
would increase as the shorter posterior strut (composed midfoot under the sustentaculum tali of the calcaneus
of the calcancus and talus) is elevated. The shank initial pronation could be reduced. Orthotic restraint in
prrjfiic: of the shoe ma? ;Ilso play a role. When the foot this region reduces the dorsiflexion moments of the
is housed \slrhin tht: shot. there in a mild cur\‘c just medial tarsal metatarsal joints. plantar flexion moment
antct-ior to tht. calcaneus which is the point of transiiion of the calcaneus and the valgus moment at the subtalar
from the heel platform to the metatarsal heads. During joint. In contrast a longitudinal arch support mechanism
load transmission this gradual curvt: could disrupt the that confines support to only distal arch structures, the
functional pcAtion of the plantar aponeurosis altering distal shaft of the metatarsals and distal portion of the
it\ normal loading pattern. Additional tests are ncedcd calcaneus. will produce a dorsiflexion moment at the
tct Jcterminc. rhe influence of these t’actors on the load tarsal metatarsal joints and plantar flexion moments at
bearing characteristics oi the plantar aponcurosis. the talo-navicular joint which translate into an arch-
Accepted theorie\ of foot function proposed by flattening effect. This may explain why the shallow
wvcral authors provides ;I fundamental basis for it
discussion oI the biomechanics of longitudinal arch
support mechanisms. Acting as ;I functional unit. the
foot can srructurally t-emodel itself to alter its loading
~%ittL’FIi lir>t h Mac(~‘onaill~” ;md Sarratian.‘-” ha\72
charactcriycd the foot in this manner. comparing it to a
‘rwisted plate in which the arch is clevatcd when the
*foot plate I i\ twisted and deprcsscd when untwisted.
An ijrthosi> ian also change the cjricntation of the
ft~:.)t \ positiim and loading response. through pre-
scribed changes in its surface geometry. The arch
support ~t”gion of an orthosis. fol- example, closelv
resembles rhc ‘twisted foot piate’ model’5.ii. t~cncc. as
the foot assimilates to the shape ot this orthotic intcr-
f;:cc. its loadingc pattern is modified. In this situation.
tension in the plantar aponeurosis decreases since the
‘trush mechanism’ is deactivated’-‘. An effective arch
%upporl mechanism is capable of redirecting the loads
t’rom plantar soft tissues to the apical bony structures 01
the foot’s medial longitudinal arch (Figure 5).
When the foot is sub,rected to the load of body- Figure 5. Plantar aspect of the bones ofthe right foot showing primary
weight in quiet standing Its longitudinal arches flatten support region for the longitudinal arch support mechanism of a foot
orthosis. Partial circle indicates the position of the vertices of the orthotic
and clongatr’“. The combined movements are generally support.
Kogler et al: Longitudinal arch support mechanisms 249
tarsal plantar flexion during the acceleration phase of was fabricated out of a soft material and the other a
gait3c~.‘-r
1 To accomplish this the width of the orthosis is rigid. An explanation for this occurrence may be that
narrowed medially and additional plaster is often the soft material ‘bottomed out’ relatively quickly,
applied to the rncdial aspect of the positive cast to allow limiting its cushioning effect. Another probable
for plantar flexion of the tirst metatarsal. If our suppo- influence to loading time is the surface geometry of the
sition 3s valid. that an effective longitudinal arch orthoses. We noted with the strain data that surface
supper?. mechanism must support the apical bony contours of an orthosis contributed to changes in foot
structures of rhc foot’s arch.. the design criterion of the loading patterns. It seems reasonable to assunie that if
tunctionat foot cbrthosis limits its arch support abilities. an orthosis can modify the way the foot accepts a load,
This observation is in agreement with Anthony who variations in loading time may occur. It was hard to
state\ ‘when ;i functional foot orthosis is prescribed and discern the contribution of the longitudinal arch
fabricated ctrrrcctly it dock not support the medial support mechanism of the orthosis to the loading titnc.
fongitudinai arch of the foot““‘. Two of the principles Of the three orthoses which had effective arch
assoLiated with the design 01 the prefabricated orthosis supports, the UC-BI, shoe insert (FO no. 5) loaded
jF0 no.>.1:i arc elevation c>f the heel and plantal approximately two tenths of a second (0.2 s) faster
Compression j )r medial structures to change the (at 900 N) than the other two devices which had the
manner in which the plantar aponcurosis is oriented longest loading times. Though rationalization of the
during loading ~l‘hc rcsuitr from our data challcngc differences in loading time proved to be difficult, the
these: concepts :+incc strain in the plantar aponeurosis results illustrate that orthoses obviously influence the
mcreascd compared to the barefoot control and alt loading time and that the changes can be quite
other test conditions (Tablt* 2) significant. Additional studies are needed to identify
‘I’hc three orthoscs (FO no. 2. I;0 no. 3. FO no. 5) the importance of material properties and surface
that dccrcasrll strain in the ptantar aponeurosis geometry to loading time. Theoretically ptantar
lyplcall! generated nefati\c strain VdLlCS. thus aponeurosis strain reduction and increased loading
indicating their orthotic control capabilities. This is of time appear to be positive design features for treatment
consequence uhen one examines the relationship of of plantar fasciitis. Since the benefits of these qualities
this occurrence to the designated zero position of the cannot be singled out as the key elements for successful
Strai3; trnnsducct Since the plantar aponeurosis management, combinations of several orthotic pro-
experience5 ijn!y ~1portion of the toad bearing forces cedures would be advisable to increase the chances for
applied to the toot’-‘. tensiie forces are rclativcly 1ow a positive clinical result.
when a ioad corresponding to the limb mass (Table 1) is There arc several limitations associated with the
t~ccd to determine the initial tcngth of the transducer. in vitro test method described herein, and it is
4 rcasonablc !f! \,i~*u analoyq to-.thc loading situation important to understand these limitations when making
created with the described reference length acquisition any clinical inferences from these results. The relatively
method. might be that of restful sitting. If one accepts ‘static‘ method of testing did not account for the
this equivocaticrn. the data suggest that longitudinal dynamics of the windlass mechanism and the influence
;rrch support mechanisms in foot orthoses can act as ;I of the plantar flexors on plantar aponeurosis strain. It
cubstitutc for the function of the plantar aponeurosis as seems reasonable to assume that during the various
a structural member during ‘static’ situations (e.g. yuict phases of gait, tensile forces in the plantar fascia arc
standing). This theor\: is supported by the mean values constantly changing. Therefore our results do not
in Table 2 and the &ain patterns in Figure 3 which address the ability of a longitudinal arch support
show that evthn at higher loads the orthoses held strain mechanism to modify tension during walking or
&cl:) below KY<). This ha\ important clinical impti- running. While measurements of strain in the ptantar
cations when plantar aponeurosis strain reduction is the aponeurosis have proved to be of value in the asscss-
desired treatment objecti\-c ment of longitudinal arch support mechanisms there
Significann variations (f’~O.05) of the time to are many other factors which may be equally as
achieve the required loads wcrc recorded among the meaningful. Foot-ankle kinematics. changes in ground
test orthoses (Table 3). The results showed a great
degree of overlap in some of the statistical groupings. Table 3. Mean (SD) for time to achieve prescribed loads. (n : 7) Results of
making it difficult to associate orthotic traits with time Duncan’s multiple range test show that all grouped values (a, b, c. d. e)
were statistically significant from one another (PiO.05)
to load performance. The hardness of material may be
one of several factors that influences loading time. The Test load values
-__..__ ---
extended loading period of the viscoclastic orthosis 225 N 450 N - 675 N 900 N
reaction forces, interface pressures, and centre-of- fascial strain. Phys Sports Med 1977; 5(11) 68-73
pressure measurements are a few other parameters that 5 Awbry BJ, Bernardone JJ, Connolly TJ. Prospective
could provide a more complete picture of the functional evaluation of invasive and noninvasive treatment
protocols for plantar fasciitis. Rehabil R&D Prog Report
properties of arch supports. Further studies are also 1989;26:49-50
necessary on pes cavus and pes planus feet since the 6 D’Ambrosia RD. Conservative management of
biomechanical function of these foot types may yield metatarsal and heel pain in the adult human foot.
different results. Orthopedics 1987; 10: 137-42
7 Goulet MJ. Role of soft orthosis in treating plantar
fasciitis-Suggestion from the field. Phys Ther 1984; 64:
Conclusions 1.544
8 Riddle DL, Freeman DB. Management of a patient with a
The patterns of plantar aponeurosis strain observed in diagnosis of bilateral plantar fasciitis and achilles
cadaveric tests, suggest that certain types of orthoses tendonitis. A case report. Phys Ther 1988; 68: 1913-16
are more effective than others in the support of the 9 Riegler HF. Orthotic devices for the foot. Orthop Rev
foot’s longitudinal arches. Of the five orthoses tested, 1987; 16: 293-303
10 Taunton JE, Clement DB, McNicol K. Flantar fasciitis in
three had longitudinal arch support mechanisms that runners. Can J Appl Sport Sci 1982; 7: 41-4
significantly reduced tension in the plantar aponeurosis, 11 Andrews JR. Overuse syndromes of the lower extremity.
while two did not show any substantial changes Clin Sports Med 1983; 2: 137-48
compared to the barefoot situation. These latter results 12 Blake RL, Denton JA. Functional foot orthoses for
imply that some of the orthotic designs prescribed by athletic injuries: a retrospective study. JAm Podiatr Med
Assoc 1985;75:359-62
clinicians for plantar fasciitis, may not fulfil the treat-
13 Clancy WG. Runners injuries. Fart two. Evaluation and
ment objective of decreased strain in the plantar treatment of specific injuries. Am J Sports Med 1980; 8:
aponeurosis as previously speculated. We theorize that 287-9
to control the foot’s longitudinal arch the medial 14 Doxey GE. Clinical use and fabrication of molded
surface contours of the orthosis must stabilize the apical thermoplastic foot orthotic devices. Phys Ther 1985; 65:
1679-82
bony structures of the arch. Hence, it is probably 15 Ferguson H, Raskowsky M, Blake RL, Denton JA. TL-61
advantageous to position the foot so that its medial arch versus Rohadur orthoses in heel spur syndrome. J Am
is elevated during negative impression procedures to Podiatr MedAssoc 1991: 81: 439-42
maximize orthotic control. The material properties of 16 James SL, Bates BT, Osternig LR. Injuries to runners.
an orthosis influence the loading time of the foot. Am J Sports Med 1978; 6: 40-9
17 Lehrman WL. Overuse syndrome in runners. Am Fumify
Devices manufactured from viscoelastic materials Phys 1984; 29: 157
absorb a higher percentage of energy imparted to the 18 Roy S. How I manage plantar fasciitis. Phys Sports Med
foot compared to more rigid components which 1983; 11: 127-31
decrease the loading time. Finally, the methods 19 Scholl WM. The Human Foot. Foot Specialist Publishing
presented in this paper will be useful in evaluating co. 1931
20 Snider MF, Clancy WG, McBeath AA. Plantar fascial
future designs of longitudinal arch support mechanisms release for chronic plantar fasciitis in runners. Am J Sports
for orthoses as well as athletic shoes. Med 1983; 11: 215-19
21 Torg JS. Athletic footwear and orthotic appliances. Clin
Sports Med 1982; 1: 157-75
Acknowledgements
22 Torg JS, Pavlov H, Torg E. Overuse injuries in sport. The
The authors wish to thank Dr Steve Verhulst, Division foot. Clin Sports Med 1987; 6: 291-320
of Statistics and Consulting, Southern Illinois University 23 Hicks JH. The foot as a support. Acta Anat. 1955;25:
34-45
School of Medicine, for his assistance with the data 24 Hicks JH. The three weight bearing mechanisms of the
analysis. We also acknowledge Dr John N Bergmann of foot. In: Evans FG, ed. Biomechanical Studies of the
Bergmann Orthotic Laboratories for his consultation Musculo-skeletal System). Charles C. Thomas,
with the laser digitization of the foot orthoses, and Springfield, IL, 1961; 161-91
25 Sarrafian SK. Functional characteristics of the foot and
Franklin Veer for his assistance with the data analysis.
plantar aponeurosis under tibiotalar loading, Foot Ankle
This study was supported by a Central Research 1987; 8: 4- 18
Committee Award from Southern Illinois University 26 Wright DG, Rennels BS. A study of the elastic properties
School of Medicine, and by a grant from the Pedorthic of plantar fascia. J Bone Joint Surg 1964; 46: 482-92
Footwear Association Research Foundation. 27 Kogler GF, Solomonidis SE, Paul JF. In vitro method for
quantifying the effectiveness of the longitudinal arch
support mechanism of a foot orthosis. Clin Biomech 1995;
References 10: 245-52
28 Schuster RO. Neutral plantar impression cast-method
1 Kapandji IA. The Physiology of the Joints. Volume2 and rationale. J Am Podiatr Med Assoc 1976; 66: 422
Lower Limb. Churchill Livingstone, New York, 1985 29 Anthony RJ. The Manufacture and Use of the Functional
2 Campbell JW, Inman VT. Treatment of plantar fasciitis Foot Orthosis. Karger, Basel, Switzerland; 1991
and calcaneal spurs with the UC-BL shoe insert. Clin 30 Root ML, Weed JH, Orien WF. Normal and Abnormal
Orthop 1974; 103: 57-62 Function of the Foot. Vol. II. Clinical. Biomechanics
3 Kwong FK, Kay D, Voner RT, White MW. Flantar Corp. Los Angeles, CA, I977
fasciitis mechanics and pathomechanics of treatment. Clin 31 Michaud TC. Foot Orthoses and Other Forms of
Sports Med 1988; 7(l): 119-26 Conservative Foot Care. Williams and Wilkins, Baltimore,
4 Newel SG, Miller J. Conservative treatment of plantar MD, 1993
252 C/in. Biomech. Vol. 11, No. 5, 1996
32 Edwards AE. Experimental Design in Psychological -77 Zamosky I. Shoe modifications in lower extremity
Research. Rinehart, New York. 1960; 254-80 orthotics. Bull Prosth Res 1964 (Fall)
33 Lapidus PW. Kinesiology and anatomy of the tarsal 38 Hayward GJ. Orthopaedic canvas shoe. Utah, United
joints. C&n Orthop 1963; 30: 20-35 States Patent. 1975 (as quoted by Nigg”“)
34 Kim W, Voloshin AS. Role of the plantar fascia in the 39 Nigg BM. Biomechanics of Running Shoes. Champaign,
load bearing capacity of the human foot. .l Biomech 1995: IL: Human Kinetics. 1986
2%:1025--31 40 Cavanagh PR. The Running Shoe Book. Mountain View,
.75 MacConaill MA. The postural mechanism of the human CA: Anderson World Inc. 1980
foot. Proc R Ir Acad 1945; 14: 245-78 41 Kelso SF. Richie DH. Cohen IR, Weed JH, Root ML.
36 Rabl CRH. Orthopuedie desfusses. Stuttgart: Auflage. Direction and range of the 1st ray. J Am Pod&r Med
1044(as quoted by N&p? R.ssoc 1982; 72: 600- 605
I. Clinical studies
2. Bioengineering studies
1 Studies in other basic science areas
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