Posted on

Finally, an excuse for pregnant women to eat bacon and eggs

Press release:

If you’re pregnant and looking for an excuse to eat bacon and eggs, now you’ve got one: a new research study published in the January 2010 print issue of the FASEB Journal (http://www.fasebj.org) by a team of University of North Carolina researchers shows that choline plays a critical role in helping fetal brains develop regions associated with memory. Choline is found in meats, including pork, as well as chicken eggs.

“Our study in mice indicates that the diet of a pregnant mother, especially choline in that diet, can change the epigenetic switches that control brain development in the fetus” said Steven Zeisel, the senior scientist involved in the work and a senior member of the FASEB Journal‘s editorial board. “Understanding more about how diet modifies our genes could be very important for assuring optimal development.”

Continue reading “Finally, an excuse for pregnant women to eat bacon and eggs”
Posted on

How tendons become stiffer and stronger

Press release:

Tendons are what connect muscles to bones. They are relatively thin but have to withstand enormous forces. Tendons need a certain elasticity to absorb high loads, such as mechanical shock, without tearing. In sports involving sprinting and jumping, however, stiff tendons are an advantage because they transmit the forces that unfold in the muscles more directly to the bones. Appropriate training helps to achieve an optimal stiffening of the tendons.

Researchers from ETH Zurich and the University of Zurich, working at Balgrist University Hospital in Zurich, have now deciphered how the cells of the tendons perceive mechanical stress and how they are able to adapt the tendons to the demands of the body. Their findings have just been published in the journal Nature Biomedical Engineering [https://doi.org/10.1038/s41551-021-00716-x].

At the core of the newly discovered mechanism is a molecular force sensor in the tendon cells consisting of an ion channel protein. This sensor detects when the collagen fibres, that make up the tendons, shift against each other lengthwise. If such a strong shear movement occurs, the sensor allows calcium ions to flow into the tendon cells. This promotes the production of certain enzymes that link the collagen fibres together. As a result, the tendons lose elasticity and become stiffer and stronger.

Gene variant overreacts

Interestingly, the ion channel protein responsible for this occurs in different genetic variants in humans. A few years ago, other scientists found that a particular variant called E756del is clustered in individuals of West African ancestry. At that time, the importance of this protein for tendon stiffness was not yet known. One-third of individuals of African descent carry this gene variant, while it is rare in other populations. This gene variant protects its carriers from severe cases of the tropical disease malaria. Scientists assume that the variant was able to prevail in this population because of this advantage.

The researchers led by Jess Snedeker, Professor of Orthopaedic Biomechanics at ETH Zurich and the University of Zurich, have now shown that mice carrying this gene variant have stiffer tendons. They believe that tendons “overshoot” in their adaptive response to exercise due to this variant.

Major performance advantage

This also has direct effects on people’s ability to jump, as the scientists showed in a study with 65 African American volunteers. Of the participants, 22 carried the E756del variant of the gene, while the remaining 43 did not. To account for various factors that influence a person’s ability to jump (including physique, training, and general fitness), the researchers compared the performance during a slow and a fast jump. Tendons play only a minor role during slow jumping manoeuvres but are particularly important during fast jumps. With their study design, the scientists could isolate the effect of the gene variant on the jumping performance.

This showed that carriers of variant E756del performed 13 percent better on average. “It’s fascinating that a gene variant, which is positively selected due to an anti-malaria effect, at the same time is associated with better athletic abilities. We certainly did not expect to find this when we started the project,” says Fabian Passini, doctoral student in Snedeker’s group and first author of the study. It may well be that this gene variant explains in part why athletes hailing from countries with a high E756del frequency excel in world-class sports competitions, including sprinting, long-jumping and basketball. To date, there has been no scientific investigation into whether this gene variant is overrepresented among elite athletes. However, such a study would be of scientific interest, Passini says.

The findings about the force sensor and the mechanism by which tendons can adapt to physical demands are also important for physiotherapy. “We now have a better understanding of how tendons work. This should also help us treat tendon injuries better in future,” Snedeker says. In the medium term, it may also be possible to develop drugs that dock onto the newly discovered tendon force sensor. These could one day help to heal tendinopathies and other connective tissue disorders.

Posted on

Vitamin D deficiency may impair muscle function

Press release:

Vitamin D deficiency may impair muscle function due to a reduction in energy production in the muscles, according to a mouse study published in the Journal of Endocrinology. Vitamin D deficient mice were found to have impaired muscle mitochondrial function, which may have implications for muscle function, performance and recovery. This may suggest that preventing vitamin D deficiency in older adults could help maintain better muscle strength and function and reduce age related muscle deterioration, but further studies are needed to confirm this.

Vitamin D is a hormone well known to be important for maintaining bone health and preventing rickets and osteoporosis. In recent years, vitamin D deficiency has been reported to be as prevalent as 40% in European populations and linked to increased risk for several conditions, including COVID-19, cancer and diabetes. Although these studies report association rather than causation, the benefits of vitamin D supplementation are now a major subject of health debate. Multiple studies have also linked low vitamin D levels to poor muscle strength, particularly in older people. Skeletal muscle enables us to move voluntarily and perform everyday activities. It is essential that they have enough energy to power these movements. Specialised organs in cells, called mitochondria, convert nutrients in to energy to meet this demand. Previous studies indicate that impaired muscle strength in people with vitamin D deficiency may be linked to impaired muscle mitochondrial function. Determining the role of vitamin D in muscle performance of older people is also difficult, as they may suffer from a number of pre-existing health conditions that can also affect their vitamin D status. Therefore, previous studies have been unable to determine how vitamin D may directly affect muscle performance.

Dr Andrew Philp and his team at the Garvan Institute of Medical Research in Australia, and collaborating universities, used a mouse model to determine the effects of diet-induced vitamin D deficiency on skeletal muscle mitochondrial function in young, male mice. Mice were either fed a diet with normal quantities of vitamin D, or with no vitamin D to induce deficiency, for a period of 3 months. A typical vitamin D level for humans is 40-50 nmol.L-1, and acute vitamin D deficiency is diagnosed when levels drop below 12 nmol.L-1. On average, the mice in this study had vitamin D levels of 30 nmol.L1, with diet-induced vitamin D deficiency leading to levels of just 3 nmol.L-1. Although this level was more extreme than typically observed in people, it is still within the clinically-recognised range. Tissue and blood samples were collected monthly to quantify vitamin D and calcium concentrations and to assess markers of muscle mitochondrial function and number. After 3 months of diet-induced vitamin D deficiency skeletal muscle mitochondrial function was found to be impaired by up to 37%. This was not due to a reduced number of mitochondria or a reduction in muscle mass.

“Our results show there is a clear link between vitamin D deficiency and oxidative capacity in skeletal muscle. They suggest that vitamin D deficiency decreases mitochondrial function, as opposed to reducing the number of mitochondria in skeletal muscle.” Dr Philp comments. “We are particularly interested to examine whether this reduction in mitochondrial function may be a cause of age related loss in skeletal muscle mass and function.”

These findings suggest that vitamin D deficiency may impair mitochondrial function and reduce the amount of energy produced in the muscles, which may lead to poor muscle function. Therefore, preventing vitamin D deficiency in older people may help maintain muscle performance and reduce the risk of muscle related diseases, such as sarcopenia. However, further studies that investigate the direct effect of vitamin D deficiency on muscle function and strength are necessary to confirm this.

Whilst this study indicates that vitamin D deficiency can alter mitochondrial function in skeletal muscle, Dr Philp and his team were unable to determine precisely how this process occurred. Therefore, their future work aims to establish how vitamin D deficiency alters mitochondrial control and function in skeletal muscle.

Posted on

Icing muscle injuries may delay recovery

Press release from Kobe University:

A study using a mouse model of eccentric contraction (*1) has revealed that icing injured muscles delays muscle regeneration. The discovery was made by a research group including Associate Professor ARAKAWA Takamitsu and then PhD. Student KAWASHIMA Masato from Kobe University’s Graduate School of Health Sciences, and Chiba Institute of Technology’s Associate Professor KAWANISHI Noriaki et al. In addition, the researchers illuminated that this phenomenon may be related to pro-inflammatory macrophages’ (*2, 3, 4) ability to infiltrate damaged cells. This research raises questions as to whether or not severe muscle injuries (such as torn muscles) should be iced.

These research results were published online as one of the Journal of Applied Physiology‘s Articles in Press on March 25, 2021.

Main points

  • The research results revealed that applying an ice pack to a severe muscle injury resulting from eccentric contraction may prolong the time it takes to heal.
  • The cause of this phenomenon is that icing delays the arrival of pro-inflammatory macrophages, which are responsible for the phagocytosis (*5), or removal, of damaged tissue. Furthermore, this makes difficult for the macrophages to sufficiently infiltrate the damaged muscle cells.

Research Background

Skeletal muscle injuries encompass a range of damage to muscles; from a microcellular level to a severe level. These injuries include not only those that happen during sports or schools’ physical education lessons but also external injuries that occur as a result of accidents and disasters.

‘RICE treatment’ is a common approach for skeletal muscle injuries, regardless of the extent of the injury. This acronym stands for Rest, Ice, Compression and Elevation and is often used in physical education, sports and even medicine. Ice is commonly applied regardless of the type of muscle injury, yet little is known about the long-term effects of icing.

Ice is used to suppress inflammation, however, inflammation in response to tissue injury is one of the body’s healing mechanisms. This has come to be understood as a vital response for tissue regeneration. In other words, suppressing inflammation with ice may also inhibit the body’s attempt to repair itself.

Experiments investigating the effect of icing muscles after injury have produced conflicting results. Some have reported that it delays muscle regeneration while others have stated that it doesn’t inhibit this process. However, none of the research up until now has investigated the effects of icing using an injury model that mimics common sports injuries caused by muscle contraction.

Using a mouse model of eccentric contraction injury, the current research team decided to observe the effects of post-injury icing. In this mouse model, injuries were induced to resemble severe torn muscles.

Research Methodology and Results

Eccentric contraction was induced by electrically stimulating the leg muscles of the mice and then exerting a stronger force during this stimulation to make the leg muscles move in the opposite direction. After this, the muscles were harvested. Icing was performed by placing polyurethane bags of ice on top of the skin over three 30 minute sessions per day, with each session being 2 hours apart. This was continued until two days after the injury. The icing was based on the usual clinically recommended method.

The researchers investigated the regenerated skeletal muscle two weeks after injury, comparing the icing group with the non-icing group. A significantly higher percentage of smaller regenerated muscle fibers were found in cross-sections from the icing group, with a greater number of medium to large fibers in the non-icing group (Figure 1). In other words, this revealed that skeletal muscle regeneration may be delayed as a result of icing.

Next, the researchers periodically took samples of muscle from the icing and non-icing groups of animals in order to investigate what was happening in the regeneration process up until this point.

In the regeneration process, inflammatory cells gather at the site of the injury, remove the debris from the damaged muscle and then begin to build new muscle. However, the results revealed that it is harder for inflammatory cells to enter the injured muscle cells if ice is applied (Figure 2).

Macrophages are typical of the inflammatory cells that enter the injured muscle. These consist of pro-inflammatory macrophages, which phagocyte damaged tissue thus causing inflammation, and anti-inflammatory macrophages (*6), which suppress the inflammatory reaction and promote repair. It is thought that pro-inflammatory macrophages change their characteristics, becoming anti-inflammatory. The results of this research team’s experiments showed that icing delays the arrival of pro-inflammatory macrophages at the site of the injury (Figure 3).

These results indicate the possibility that macrophages are unable to sufficiently phagocyte the damaged muscle when ice is applied after severe muscle injuries caused by eccentric contraction, consequently delaying the formation of new muscle cells.

Comment from Associate Professor Arakawa

In sports, the mantra of immediately applying ice to an injury is commonplace, regardless of the injury’s severity. However, the mechanism that we illuminated through this research suggests that not icing a severe muscle injury may lead to faster recovery. The idea of immediately cooling any type of injury is also entrenched in schools’ physical education classes. I hope that in the future, the alternative option of speeding up recovery by not cooling severe muscle injuries will become known.

However, even though icing may disrupt the recovery process for severe muscle injuries, there is no denying the possibility that there are degrees of mild muscle injuries that can be iced. The next issue is to work out where to draw the line. We are now in the middle of investigating what effect icing has on slight muscle injuries.

Next, we will continue to investigate how icing should be carried out according to the extent of the muscle injury. We aim to contribute guidelines that will enable people in sports and clinical rehabilitation to make accurate judgements about whether or not to ice an injury.

Posted on

Pink drinks can help you run faster and further, study finds

Press release:

A new study led by the Centre for Nutraceuticals in the University of Westminster shows that pink drinks can help to make you run faster and further compared to clear drinks.

The researchers found that a pink drink can increase exercise performance by 4.4 per cent and can also increase a ‘feel good’ effect which can make exercise seem easier.

The study, published in the journal Frontiers in Nutrition, is the first investigation to assess the effect of drink colour on exercise performance and provides the potential to open a new avenue of future research in the field of sports drinks and exercise.

During the study participants were asked to run on a treadmill for 30 minutes at a self-selected speed ensuring their rate of exertion remained consistent. Throughout the exercise they rinsed their mouths with either a pink artificially sweetened drink that was low in calories or a clear drink which was also artificially sweetened and low in calories.

Both drinks were exactly the same and only differed in appearance – the researchers added food dye to the pink drink to change the colour.

The researchers chose pink as it is associated with perceived sweetness and therefore increases expectations of sugar and carbohydrate intake.

Previous studies have also shown that rinsing the mouth with carbohydrates can improve exercise performance by reducing the perceived intensity of the exercise, so the researchers wanted to assess whether rinsing with a pink drink that had no carbohydrate stimulus could elicit similar benefits through a potential placebo effect.

The results show that the participants ran an average 212 metres further with the pink drink while their mean speed during the exercise test also increased by 4.4 per cent. Feelings of pleasure were also enhanced meaning participants found running more enjoyable.

Future exploratory research is necessary to find out whether the proposed placebo effect causes a similar activation to the reward areas of the brain that are commonly reported when rinsing the mouth with carbohydrates.

Talking about the study, Dr Sanjoy Deb, corresponding author on the paper from the University of Westminster, said: “The influence of colour on athletic performance has received interest previously, from its effect on a sportsperson’s kit to its impact on testosterone and muscular power. Similarly, the role of colour in gastronomy has received widespread interest, with research published on how visual cues or colour can affect subsequent flavour perception when eating and drinking.

“The findings from our study combine the art of gastronomy with performance nutrition, as adding a pink colourant to an artificially sweetened solution not only enhanced the perception of sweetness, but also enhanced feelings of pleasure, self-selected running speed and distance covered during a run.”

Posted on

Where did the toning shoes go?

They did not go anywhere, they are just not a prominent today as they once were.

The toning shoes (or more likely called the unstable footwear today) were that category of footwear that made extraordinary promises that were not and have not been supported by the evidence. The shoes tend to have a rocker under the sole that makes them unstable. Because of this instability, the muscles work harder and the gait is different. It was claimed that this could cure cellulite (it can’t) and increases your exercise to give you a tone up (again unsubstantiated by the actual evidence). All this resulted in litigation and fines from regulatory agencies for false advertising.

All that did not mean that the category of footwear did not have some use. The very nature of toning shoes is that they have some sort of rocker on the sole which can be quite useful for people with osteoarthritis in the first metatarsophalangeal joint. The change is gait reportedly help some people with postural and low back problems, and can also make worse some people, so some trial and error was needed to see if they can help. More research needs to be done to see who they can best help and what the indications may be.

Do not write the toning shoes off just because of the litigation and embarrassing celebratory endorsements they used to have. They do have their uses.

Posted on

Study shows significant benefit of PolarCap® in recovery from sports-related concussions

Press release:

–PolarCool AB (publ), a Swedish medical device company focusing on treatment of sports-related traumatic brain injury (TBI) and whiplash, today announced that it has submitted a 510(k) pre-market notification to the U.S. Food and Drug Administration (FDA) for the PolarCap® System.

This submission follows publication of statistically significant clinical results in the scientific journal Concussion, showing clear benefit for use of the PolarCap® System in the treatment of concussions among players of 15 elite Swedish Ice-Hockey teams in the Swedish Hockey Leagues (SHL).

The incidence of sports-related concussions is a significant national health concern in Sweden, as it is here in the U.S., and there is growing evidence that repetitive traumatic brain injury can cause long-term changes in brain structure and function. This is of particular concern in the field of contact sports, such as ice hockey, where available treatment options are limited.

“With this important FDA submission, we are paving the way for the first-ever sports-related TBI treatment model,” said Martin Waleij, PolarCool Chairman of the Board. “Supported by robust clinical evidence enabling players to safely return to play much earlier, our 510(k) submission is the first step in the FDA review process. We look forward to this review and are confident that speedy clearance for the PolarCap® System is on the horizon.”

The study, led by investigators from Lund University at Skåne University Hospital in Lund, Sweden, Luleå University of Technology in Luleå, and BrainCool AB, represents the largest study population focused on sports-related concussion treatment in Sweden or the U.S., and shows statistical benefits of therapeutic cooling using the PolarCap® System head and neck cooling technology.

“Publication of these study results in the journal Concussion marks a significant milestone for sports medicine around the globe,” said Erik Andersson, Chief Executive Officer of PolarCool, maker of the PolarCap® System that was used in the Lund study. “We are eager to proceed with larger studies and to partner with academic medical centers and professional sports organizations to further validate the benefits of this medical cooling technology–with the ultimate goal of improving both short- and long-term safety for players of all contact sports.”

The Swedish Hockey League, the players organization SICO and PolarCool are actively collaborating to improve player safety. Two PolarCap® Systems are available at all games and the league is working to establish a standardized acute treatment method concussion injuries.

“It is very positive that we can constitute that the introduction of the Polar Cap has meant fewer long time absences among players that were treated by cooling directly after a concussion, with this treatment we have another tool to use (against head injuries),” said SHL Sports Director & Vice CEO Johan Hemlin in a recent SHL press release.

Fifteen teams from elite ice-hockey leagues for males in Sweden were given the option to participate in the intervention group (receiving selective head-neck cooling after a sports-related concussion) or the control group (standard sports-related concussion management). Selective head-neck cooling was initiated at a mean of 12.3 ± 9.2 min after the concussion in 29 players, and 52 SRC controls received standard management. Results showed significant benefits of cooling in treating concussions with a median time to return to play for the players who underwent cooling of 7 days, versus 12 days for those who did not. The study also shows promising reduction in the proportion of long-term absence, which can be as long as three weeks or more, among treated players.

Posted on

Sever’s Disease of the Heel in Child Athletes

The commonest reason for pain in the heel in adults is a condition called plantar fasciitis that make up to 90% of the cases. In regards to children, plantar fasciitis is actually very rare and the most frequent reason for pain in the heel in kids being a condition often called Sever’s Disease. This really is bad vocabulary becasue it is not a disease and the use of that phrase can certainly have pretty undesirable consequences. There’s also a trend away from the using terminology of disorders from getting named after individuals, typically the doctor which first described the problem. The better appropriate name for the problem is calcaneal apophysitis. It is a problem of the growing cartilage area at the back of the heel bone or calcaneus.

When we are born, many of the bones continue to be a delicate and flexible cartilage framework which the bone grows on. With the heel bone growth commences in the center and grows to take up the entire area of that cartilage material framework. Nevertheless, there exists still a cartilage growing region in the back of the calcaneus that development and growth continues to occur at. That small growth growth plate at the back of the calcaneus can be at risk from injury if strains on the heel bone tend to be excessive.

The principle risk factors are a higher bodyweight, those that are taller and having an even more lively lifestyle including playing more sporting activity. Many additionally suggest that tighter calf muscles are a factor, but that’s not absolutely a regular observation. The disorder is far more common in the ages of 8 through 12 years. The growing plate of the heel bone combines with the rest of the bone tissue about the middle of the age of puberty, which means that no matter what happens it’s not possible to have got this issue past that age.

The signs and symptoms of Sever’s disease will usually start off as a slight ache in the back of the heel bone which gets even worse as time passes and it is more painful with a lot more exercise. The condition frequently becomes worse with a lot more exercise levels with soreness amounts definitely not exactly the same every day and differs depending on physical activity or sports participation amounts. A characteristic indication of this problem is pain on the sides in the back of the calcaneus when you press it between your fingers. There aren’t any xrays or any other imaging that can be used to help determine this and the diagnosis is dependant on the clinical findings.

The key approach to treating Sever’s disease will be education of the child and parents about the characteristics of the condition and its self-limiting character. Way of life as well as sport activity levels are going to need to be decreased so the stress on the developing area is lessened to bearable amounts. Cold therapy can be used following sporting activity in cases where the discomfort levels are higher. When the calf muscles are tight, then a stretching program are useful to improve the range of flexibility. A shock absorbing heel pad is frequently also very effective. Usually it is a matter of doing these therapies as well as managing the activity amounts and then wait for the condition to take its natural course and finally recover.

Posted on

Exercise can help support recovery of patients with lasting COVID symptoms, study finds

Press release:

Patients with lasting symptoms of COVID-19 who completed a six week, supervised rehabilitation programme demonstrated significant improvements in exercise capacity, respiratory symptoms, fatigue and cognition, according to researchers at the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre – a partnership between Leicester’s Hospitals, the University of Leicester and Loughborough University.

The study, which is published in the journal Chronic Respiratory Disease today (Friday 7 May 2021), followed thirty patients who took part in face-to-face exercise rehabilitation classes twice a week over a period of six weeks. The programme included aerobic exercise, such as walking or using a treadmill, strength training of the arms and legs, and educational discussions to support symptom management based upon the information on the Your COVID Recovery platform.

Researchers found a statistically significant improvement in exercise capacity, as measured by scores of distance travelled and ability to keep going without a rest using incremental and endurance shuttle-walking tests. They also found that fatigue improved by 5 points on the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue Scale over the six-week period. In addition, participants demonstrated improvement in their overall wellbeing and cognition, as measured by standardised clinical assessment tools.

Participants were referred through a hospital discharge follow-up telephone assessment, at a face-to-face COVID-19 clinic assessment, or via their GP. Individuals were offered the opportunity to take part if they displayed physical and/or psychological symptoms that were affecting their daily activities. Patients were excluded if they demonstrated acute symptoms, or were not medically stable (such as uncontrolled diabetes) or had only symptoms that were deemed unlikely to benefit from a pulmonary rehabilitation programme, such as loss of taste or smell.

Of the participants, there was an even split between men and women, with an average of 58 years. Eighty-seven per cent of participants were admitted to hospital with COVID-19, staying on average 10 days in hospital. Fourteen per cent required mechanical ventilation and were treated in an Intensive Care Unit. Four individuals had a pre-existing respiratory condition, such as asthma or chronic obstructive pulmonary disease (COPD).

Dr Enya Daynes, specialist pulmonary rehabilitation and research physiotherapist at Leicester’s Hospitals and lead author of the study, said: “We know that COVID-19 survivors present with a wide variety of symptoms and that a one-size-fits-all approach to managing these would not be appropriate. However, there are some overlap between the needs of COVID-19 survivors and patients who have accessed pulmonary rehabilitation [PR] for other conditions, such as COPD. So we modified our well-established PR course for COVID-19 survivors and measured their symptoms to assess whether the programme could be of potential benefit.

“We found there were significant improvements in clinical outcomes of walking capacity and symptoms of fatigue, cognition and respiratory symptoms – factors that patients tell us most affect their quality of life.”

Professor Sally Singh, head of cardiac and pulmonary rehabilitation at Leicester’s Hospitals, professor at the University of Leicester and senior author of the paper, said: “This adapted rehabilitation programme for individuals following COVID-19 has demonstrated promising improvements in clinical outcomes. There were no drop-outs due to worsening symptoms and the high completion rate suggests that patients found it to be an acceptable treatment.

“There has been concern that rehabilitation may worsen or trigger symptoms of post-viral fatigue and that exercise therapy may exacerbate fatigue. The exercise element of this programme is progressed by staff experienced in delivering pulmonary and cardiac rehabilitation programmes in line with patient’s symptoms throughout the programme. Our results did not show that fatigue worsened among the group of patients on the study, and that many of their symptoms improved. This suggests an adapted pulmonary rehabilitation courses can be part of a spectrum of patient-centred and holistic approaches to treating the many different presentations of lasting COVID symptoms.”

The research team acknowledges that as a cohort study there is no control group of people with similar symptoms who did not embark on the modified pulmonary rehabilitation course to offer a comparison and that further studies with a larger patient population are needed to confirm their preliminary findings.

Posted on

The Richie Brace for a Progressive Flat Foot

A progressing deteriorating of a flat foot or fallen arch of the foot in an adult is oftentimes known as posterior tibial tendon dysfunction as well as adult acquired flatfoot and may have problematic consequences if not detected early and sorted out. This is often more frequent in older in addition to obese adults. The key issue is that the posterior tibial muscles which are the reason for supporting the arch of the feet are not very good at doing that, and so a gradual flattening of the foot occurs. In addition to a falling with the arch of the foot there is typically increasing pain and discomfort in the arch area of the foot and the rearfoot. As the adult acquired flat foot progresses, further walking gets increasingly tougher and it is extremely tireing.

There are actually commonly 4 stages involving posterior tibial tendon dysfunction that this problem progresses through with one being the initial phase and 4 being the final phase that only surgical treatment can deal with. There is certainly some difference of opinion with the classifications of this as their is variability between health professionals plus some reliability concerns. That being said, stage 1 is typically treated with foot supports along with exercises plus some medication for the pain and discomfort. Stage 2 usually needs a lot more aggressive and supportive foot orthoses, carrying on using the exercise routines as well as increasing levels of pain alleviation medicines may be required. Both stage one and two will benefit with high top supporting shoes. Long-term weight loss plans will also be going to be helpful. If this doesn’t stop the development and the foot is heading in the direction of a stage three, then there’s increasing probability that reconstructive foot surgery is likely to be needed. This is the reason it is so crucial that there be more intense conservative treatment of the foot when it’s still at stage 2 to halt the development.

An increasingly frequent treatment for posterior tibial tendon dysfunction while it progresses to stage two is the Richie Brace. This Richie Brace is now being commonly used and it has been demonstrated to be very effective at stopping the progress with this problem and avoiding the requirement for surgical treatment. Surgical interventions tend to be successful, but there is frequently a left over measure of impairment remaining as the surgery usually will require the fusing of some important joints and also the moving of muscles insertions to other parts of the foot. The Richie brace is a combination of an aggressively supportive bespoke foot orthotic plus an ankle foot orthoses with struts to support both sides of the joints at the ankle. The bespoke foot orthoses is made from a plaster cast or optical scan of the foot with the foot kept in a ideal position. The aim of the foot orthotic portion of the Richie Brace would be to try and support the foot in this corrected position. The struts which get included up the side of the ankle are hinged with the ankle joint to allow motion to happen at this joint. These struts are then held on by Velcro on the leg to help support and enhance the benefit of the foot orthotic. Generally if the progress of the problem can be ended making use of this, then surgery is commonly prevented.