ANA PAULA RIBEIRO
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- The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners(2011) RIBEIRO, Ana Paula; TROMBINI-SOUZA, Francis; TESSUTTI, Vitor D.; LIMA, Fernanda R.; JOAO, Silvia M. A.; SACCO, Isabel C. N.Background: Plantar fasciitis is the third most frequent injury in runners. Despite its high prevalence, its pathogenesis remains inconclusive. The literature reports overload as the basic mechanism for its development. However, the way that these plantar loads are distributed on the foot surface of runners with plantar fasciitis and the effects of pain on this mechanical factor has not yet been investigated. Therefore, the aim of this study was to evaluate and compare the plantar pressure distributions during running in runners with symptom or history of plantar fasciitis and runners without the disease. Methods: Forty-five recreational runners with plantar fasciitis (30 symptomatic and 15 with previous history of the disease) and 60 runners without plantar fasciitis (control group) were evaluated. Pain was assessed by a visual analogue scale. All runners were evaluated by means of the Pedar system insoles during running forty meters at a speed of 12(5%) km/h, using standard sport footwear. Two-way ANOVAS were employed to investigate the main and interaction effects between groups and plantar areas. Findings: No interaction effects were found for any of the investigated variables: peak pressure (P=0.61), contact area (P=0.38), contact time (P=0.91), and the pressure-time integral (P=0.50). Interpretation: These findings indicated that the patterns of plantar pressure distribution were not affected in recreational runners with plantar fasciitis when compared to control runners. Pain also did not interfere with the dynamic patterns of the plantar pressure distributions.
- Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial(2022) RIBEIRO, Ana Paula; SOUZA, Brenda Luciano de; JOAO, Silvia Maria AmadoBackround: Calcaneal spurs are described as bony outgrowths arising on medial calcaneal, where inappropriate footwear can promote disease progression. Objective: Investigate the effectiveness of mechanical treatment with customized insole and minimalist flexible footwear during gait training program in women with calcaneal spur. Methods: Design: A single-blinded, randomized and controlled trial. Setting: Biomechanics laboratory. Participants: Forty-three women, 29 with calcaneal spur and 14 control. Intervention: Gait training program with use of the minimalist flexible footwear (MFG n = 15, age: 48.9 +/- 9.4, height: 1.61 +/- 0.1, BMI: 32.1 +/- 7.0) and customized insole on footwear (COIG n = 14, age: 50.3 +/- 5.8, height: 1.62 +/- 0.1, BMI: 32.2 +/- 4.3) and control (CG n = 14, age: 47.8 +/- 8.6, height: 1.63 +/- 0.1, BMI: 27.5 +/- 4.5), followed of the evaluations: baseline (T0) and after three (T3) and six (T6) months. Duration of the intervention was of the six months consecutive for at least 42 h per week (six hours a day, seven days a week). Outcome primary were calcaneus pain (visual analogue scale), Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br) and 6-min walk test (6MWT). Secondary was plantar pressure distribution by a pressure platform system during gait and static index foot posture (FPI). Statistical analysis: analysis of variance for repeated measure and between groups were used to detect treatment-time interactions (alpha = 5%). Effect size with D Cohen's also was used between T0 and after six (T6) months of intervention. Results: The MFG and COIG were effective at reducing pain after six months (MFG: 2.5-4.5 CI, p = 0.001; COIG: 1.5-3.5 CI, p = 0.011). The FFI and FHSQ-Br showed improvements with MFG and COIG after T6 (MFG: 13.7-15.4 CI, p = 0.010; COIG: 11.3-15.0 CI, p = 0.001). The 6MWT increased with MFG (589.3-622.7 CI) and COIG (401.3-644.7 CI) and foot pronation was decreased after T3 and T6 MFG (FPI Right: 4.2-5.4 CI; Left: 3.6-5.4 CI) COIG (FPI Right: 3.4-6.8 CI; Left: 3.3-5.7 CI). The contact area reduced on forefoot and rearfoot with MFG and GOIG and midfoot and rearfoot with MFG. Maximum force was reduced on foot with MFG after T3 and T6. The peak pressure was reduced on the forefoot with MFG and COIG and on midfoot and rearfoot with MFG. Conclusions: The mechanical treatment with customized insole and minimalist flexible footwear during gait training program during six months in women with calcaneal spur reduced the calcaneus pain, increased function and health feet and reduced plantar load on the rearfoot, midfoot and forefoot. However, the footwear alone was more effective than when combined customized insole, given the greater efficacy on clinical and biomechanical aspects.
article 27 Citação(ões) na Scopus Changes in the Plantar Pressure Distribution During Gait Throughout Gestation(2011) RIBEIRO, Ana Paula; TROMBINI-SOUZA, Francis; SACCO, Isabel de Camargo Neves; RUANO, Rodrigo; ZUGAIB, Marcelo; JOAO, Silvia Maria AmadoBackground: The intention of this investigation was to longitudinally describe and compare the plantar pressure distribution in orthostatic posture and gait throughout pregnancy. Methods: A prospective longitudinal observational study was conducted with six pregnant women (mean +/- SD age, 32 +/- 3 years) with a mean +/- SD weight gain of 10.0 +/- 1.4 kg. Peak pressure, contact time, contact area, and maximum force in five plantar areas were evaluated using capacitive insoles during gait and orthostatic posture. For 1 year, the plantar pressures of pregnant women were evaluated the last month of each trimester. Comparisons among plantar areas and trimesters were made by analysis of variance. Results: For orthostatic posture, no differences in contact time, contact area, peak pressure, and maximum force throughout the trimesters were found. During gait, peak pressure and maximum force of the medial rearfoot were reduced from the first to third and second to third trimesters. Maximum force increased at the medial forefoot from the first to second trimester. Contact area increased at the lateral rearfoot from the second to third trimester and at the midfoot from the first to third trimester. Contact time increased at the midfoot and medial and lateral forefoot from the first to third trimester. Conclusions: Pregnant women do not alter plantar pressure during orthostatic posture, but, during gait, the plantar loads were redistributed from the rearfoot (decrease) to the midfoot and forefoot (increase) throughout pregnancy. These adjustments help maintain the dynamic stability of the pregnant woman during locomotion. (J Am Podiatr Med Assoc 101(5): 415-423, 2011)- Dynamic Patterns of Forces and Loading Rate in Runners with Unilateral Plantar Fasciitis: A Cross-Sectional Study(2015) RIBEIRO, Ana Paula; JOAO, Silvia Maria Amado; DINATO, Roberto Casanova; TESSUTTI, Vitor Daniel; SACCO, Isabel Camargo NevesAim/Hypothesis The etiology of plantar fasciitis (PF) has been related to several risk factors, but the magnitude of the plantar load is the most commonly described factor. Although PF is the third most-common injury in runners, only two studies have investigated this factor in runners, and their results are still inconclusive regarding the injury stage. Objective Analyze and compare the plantar loads and vertical loading rate during running of runners in the acute stage of PF to those in the chronic stage of the injury in relation to healthy runners. Methods Forty-five runners with unilateral PF (30 acute and 15 chronic) and 30 healthy control runners were evaluated while running at 12 km/h for 40 meters wearing standardized running shoes and Pedar-X insoles. The contact area and time, maximum force, and force-time integral over the rearfoot, midfoot, and forefoot were recorded and the loading rate (20-80% of the first vertical peak) was calculated. Groups were compared by ANOVAs (p<0.05). Results Maximum force and force-time integral over the rearfoot and the loading rate was higher in runners with PF (acute and chronic) compared with controls (p<0.01). Runners with PF in the acute stage showed lower loading rate and maximum force over the rearfoot compared to runners in the chronic stage (p<0.01). Conclusion Runners with PF showed different dynamic patterns of plantar loads during running over the rearfoot area depending on the injury stage (acute or chronic). In the acute stage of PF, runners presented lower loading rate and forces over the rearfoot, possibly due to dynamic mechanisms related to pain protection of the calcaneal area.
- Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis(2011) RIBEIRO, Ana Paula; TROMBINI-SOUZA, Francis; TESSUTTI, Vitor; LIMA, Fernanda Rodrigues; SACCO, Isabel de Camargo Neves; JOAO, Silvia Maria AmadoOBJECTIVE : To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF). INTRODUCTION: PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries. METHODS: Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries) and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images. RESULTS: There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners. CONCLUSIONS: Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms.
- y Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study(2016) RIBEIRO, Ana P.; SACCO, Isabel C. N.; DINATO, Roberto C.; JOAO, Silvia M. A.Background: The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined. Objective: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases. Method: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces. Results: The multiple regression analyses indicated that both the force-time integral (R-2=0.15 for acute phase PF; R-2=0.17 for chronic PF) and maximum force (R-2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R-2=0.18) and chronic (R-2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R-2=0.19) and chronic (R-2=0.40). Conclusion: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot.
- The influence of gender and body mass index on the FPI-6 evaluated foot posture of 10-to 14-year-old school children in Sao Paulo, Brazil: a cross-sectional study(2017) CARVALHO, Barbarah Kelly Goncalves de; PENHA, Patricia Jundi; PENHA, Naima Livia Jundi; ANDRADE, Rodrigo Mantelatto; RIBEIRO, Ana Paula; JOAO, Silvia Maria AmadoBackground: Adolescence is marked by changes to the body, including the feet. The Foot Posture Index (FPI-6) stands out from other foot type classification methods as valid, reliable, and multidimensional. However, the current literature differs according to age group, with little consolidation of normative data in school children, largely due to the influence of such factors as sex, age and body mass index (BMI). Thus, this study assesses foot posture in adolescents according to age, sex and BMI. Methods: The study evaluated 1.394 adolescents from Amparo and Pedreira regions in Sao Paulo, Brazil. Subjects were positioned barefoot on a wooden base and each foot was assessed by FPI-6 criteria. Each criterion was scored on a scale of -2 to +2, negative for supinated and positive for pronated posture. Initially the data were assessed for normality using the Shapiro-Wilk test and descriptive statistics were calculated. To investigate and compare the scores of FPI-6 with regards to age and body mass index, analysis of variance (ANOVA) was used, followed by post hoc Tukey. To compare the FPI-6 with regard to gender, an independent student t test was used. All data were analyzed using SPSS version 21.0 and the 5% significance level. Results: Boys had higher scores than girls (p = 0.037) for the right foot, and the group with normal BMI values scored higher than the obese group (p = 0.001). For the left foot, 11- and 13-year-olds differed (p = 0.024) with respect to age in general. The overweight and obese group scored lower than the normal BMI group (p = 0.039; p = 0.001, respectively). Conclusions: Overall, the feet in this study were classified as normal, with a tendency to pronation, particularly in boys. There were differences between the 11 and 13 year groups and, with regard to BMI, there were higher scores for the group with normal BMI. Therefore, a higher BMI in adolescence is not indicative of a pronated foot type.
- The Effect of Short and Long-Term Therapeutic Treatment with Insoles and Shoes on Pain, Function, and Plantar Load Parameters of Women with Plantar Fasciitis: A Randomized Controlled Trial(2022) RIBEIRO, Ana Paula; JOAO, Silvia Maria AmadoBackground and Objectives: Plantar fasciitis (PF) is a prevalent musculoskeletal disease, with inflammation at the origin of the plantar fascia, that affects sedentary people, particularly middle-aged women. Foot pain and functional limitations lead patients to seek treatment. Investigate the therapeutic effect of conservative treatment combining a custom insole with minimalist flexible shoes and the shoes alone in a gait-training protocol, in the short and long term, in women with PF. Materials and Methods: Design: A randomized, controlled, and single-blind trial. Setting: Biomechanics laboratory. Participants: 36 women, 26 with acute PF and 10 controls. Intervention: Gait-training protocol wearing the minimalist shoes alone (SG, n = 12, age: 46.4 +/- 9.6, height: 1.60 +/- 0.2, BMI: 28.8 +/- 4.2), with a custom insole in the shoes (CIG, n = 14, age: 48.9 +/- 9.8, height: 1.60 +/- 0.1, BMI: 26.7 +/- 5.6), and control (CG, n = 10, age: 46.1 +/- 10.7, height: 1.61 +/- 0.2, BMI: 26.4 +/- 4.8). Evaluations were performed at baseline (T0) and after three (T3) and six (T6) months. The intervention had a duration of six months (six hours a day, seven days a week). Primary outcomes were rearfoot pain (visual analogue scale), the Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br), and 6 min walk test (6MWT). The secondary outcomes were plantar pressure distribution during gait, measured by the pressure platform, and foot posture. Results: The CIG was effective for reducing pain and improving the FPI after T6 compared to CG. The FPI, FHSQ-Br and 6MWT demonstrated improvements after T6 in both the CIG and SG, compared to the CG. After T6, contact area (rearfoot) and maximum force (forefoot) reduced with CIG. Maximum force (midfoot and rearfoot) reduced with CIG and SG, as did peak pressure (forefoot and midfoot) in relation to CG. Conclusions: A customized insole associated with minimalist flexible shoes during a gait-training protocol can be recommended as a more effective treatment than minimalist flexible shoes alone over the short and long term, for reduction in calcaneus pain, increased function and foot health, and improved walking through reduced plantar load in women with PF.
- POSTURAL ASSESSMENT OF LUMBAR LORDOSIS AND PELVIC ALIGNMENT ANGLES IN ADOLESCENT USERS AND NONUSERS OF HIGH-HEELED SHOES(2011) PEZZAN, Patricia Angelica de Oliveira; JOAO, Silvia Maria A.; RIBEIRO, Ana Paula; MANFIO, Eliane FatimaObjective: The aims of this study were (1) to analyze the influence of wearing high-heeled shoes on lumbar lordosis and pelvic inclinations among adolescents aged between 13 and 20 years were users and nonusers of high-heeled shoes and (2) to correlate these postural angles with age. Methods: Fifty adolescents from the nonuser group (NUG) of high-heeled shoes and 50 from the user group (UG) were evaluated. Postural assessments were obtained by photogrammetry under 2 conditions-barefoot and with high-heeled shoes-and analyzed using the evaluation postural software. The measured angles included lumbar lordosis and the horizontal alignment of the pelvis. Descriptive analyses were carried out, with a significance level of 5%. Results: With high-heeled use, the NUG demonstrated rectification of the lumbar spine and pelvic retroversion, whereas the UG demonstrated hyperlordosis and pelvic anteversion. When barefoot, smaller lumbar lordosis angles for both groups were observed. However, the pelvic angles were lower for the UG group and higher for the NUG. The studied angles showed high reliabilities. Age was correlated with lumbar lordosis angles for the NUG in the barefoot condition and with pelvic alignments in both conditions for the UG. Conclusion: For the subjects in this study, the use of high-heeled shoes is correlated with increased lumbar lordosis and pelvic anteversions. Lumbar lordosis angles are correlated with age for the NUG when barefoot. (J Manipulative Physiol Ther 2011;34:614-621)