FRANCIS TROMBINI DE SOUZA
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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.
conferenceObject EFFECTIVENESS OF LONG-TERM USE OF MINIMALIST FOOTWEAR ON PAIN AND FUNCTION IN KNEE OSTEOARTHRITIS(2013) GOLDENSTEIN-SCHAINBERG, Claudia; FULLER, Ricardo; MATIAS, Alessandra; YOKOTA, Mariane; BUTUGAN, Marco; TROMBINI-SOUZA, Francis; SACCO, Isabel- Attenuation of foot pressure during running on four different surfaces: asphalt, concrete, rubber, and natural grass(2012) TESSUTTI, Vitor; RIBEIRO, Ana Paula; TROMBINI-SOUZA, Francis; SACCO, Isabel C. N.The practice of running has consistently increased worldwide, and with it, related lower limb injuries. The type of running surface has been associated with running injury etiology, in addition other factors, such as the relationship between the amount and intensity of training. There is still controversy in the literature regarding the biomechanical effects of different types of running surfaces on foot-floor interaction. The aim of this study was to investigate the influence of running on asphalt, concrete, natural grass, and rubber on in-shoe pressure patterns in adult recreational runners. Forty-seven adult recreational runners ran twice for 40 m on all four different surfaces at 12 +/- 5% km . h(-1). Peak pressure, pressure-time integral, and contact time were recorded by Pedar X insoles. Asphalt and concrete were similar for all plantar variables and pressure zones. Running on grass produced peak pressures 9.3% to 16.6% lower (P < 0.001) than the other surfaces in the rearfoot and 4.7% to 12.3% (P < 0.05) lower in the forefoot. The contact time on rubber was greater than on concrete for the rearfoot and midfoot. The behaviour of rubber was similar to that obtained for the rigid surfaces - concrete and asphalt - possibly because of its time of usage (five years). Running on natural grass attenuates in-shoe plantar pressures in recreational runners. If a runner controls the amount and intensity of practice, running on grass may reduce the total stress on the musculoskeletal system compared with the total musculoskeletal stress when running on more rigid surfaces, such as asphalt and concrete.
- Inexpensive footwear decreases joint loading in elderly women with knee osteoarthritis(2011) TROMBINI-SOUZA, Francis; KIMURA, Aline; RIBEIRO, Ana Paula; BUTUGAN, Marco; AKASHI, Paula; PASSARO, Anice C.; ARNONE, Antonio C.; SACCO, Isabel C. N.Recent literature has highlighted that the flexibility of walking barefoot reduces overload in individuals with knee osteoarthritis (OA). As such, the aim of this study was to evaluate the effects of inexpensive, flexible, non-heeled footwear (Moleca (R)) as compared with a modern heeled shoes and walking barefoot on the knee adduction moment (KAM) during gait in elderly women with and without knee OA. The gait of 45 elderly women between 60 and 70 years of age was evaluated. Twenty-one had knee OR graded 2 or 3 according to Kellgren and Lawrence's criteria, and 24 who had no OA comprised the control group (CG). The gait conditions were: barefoot, Moleca (R), and modern heeled shoes. Three-dimensional kinematics and ground reaction forces were measured to calculate KAM by inverse dynamics. For both groups, the Moleca (R) provided peak KAM and KAM impulse similar to barefoot walking. For the OA group, the Moleca (R) reduced KAM even more as compared to the barefoot condition during midstance. On the other hand, the modern heeled shoes increased this variable in both groups. Inexpensive, flexible, and non-heeled footwear provided loading on the knee joint similar to a barefoot gait and significant overload decreases in elderly women with and without knee OA, compared to modern heeled shoes. During midstance, the Moleca (R) also allowed greater reduction in the knee joint loads as compared to barefoot gait in elderly women with knee OA, with the further advantage of providing external foot protection during gait.
article 28 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)- Long-term use of minimal footwear on pain, self-reported function, analgesic intake, and joint loading in elderly women with knee osteoarthritis: A randomized controlled trial(2015) TROMBINI-SOUZA, Francis; MATIAS, Alessandra B.; YOKOTA, Mariane; BUTUGAN, Marco K.; GOLDENSTEIN-SCHAINBERG, Claudia; FULLER, Ricardo; SACCO, Isabel C. N.Background: Efforts have been made to retard the progressive debilitating pain and joint dysfunction in patients with knee osteoarthritis. We aimed to evaluate the therapeutic effect of a low-cost minimalist footwear on pain, function, clinical and gait-biomechanical aspects of elderly women with knee osteoarthritis. Methods: Throughout a randomized, parallel and controlled clinical trial, fifty-six patients with medial knee osteoarthritis were randomly allocated to an intervention (n = 28) or control group (n = 28), and assessed at baseline and after three and six months. The intervention involved wearing Moleca footwear for at least 6 h/day, 7 days/week, over 6 months. The pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index was the primary outcome. The secondary outcomes were the other subscales, Lequesne score, distance walked in 6 min, knee oedema and effusion, knee adduction moment and paracetamol intake. Intention-to-treat analysis was performed using two-way casewise ANOVA (< .05) and Cohen's d coefficient. Findings: Intervention group showed improvement in pain (effect size: 1.41, p < .001), function (effect size: 1.22, p = .001), stiffness (effect size: 0.76, p = .001), Lequesne score (effect size: 1.07, p < .001), and reduction by 21.8% in the knee adduction moment impulse (p = .017) during gait wearing Moleca (R). The analgesic intake was lower in the intervention group. Interpretation: The long-term use of Moleca (R) footwear relieves pain, improves self-reported function, reduces the knee loading while wearing Moleca (R), refrains the increase of analgesic intalce in elderly women with knee ostearthritis and can be considered as a conservative mechanical treatment option.
conferenceObject BENEFIC EFFECT OF THE USE OF FLEXIBLE AND MINIMALIST FOOTWEAR ON KNEE OSTEOARTHRITIS(2012) TROMBINI-SOUZA, Francis; YOKOTA, Mariane; MATIAS, Alessandra; GOLDENSTEIN-SCHAINBERG, Claudia; FULLER, Ricardo; SACCO, Isabel C. N.Objective(s): To analyze the therapeutic effect of chronic use of the flexible, nonheeled commercial shoe Moleca® on clinical aspects of women with knee osteoarthritis (OA). Material & Methods: Six women with an established diagnosis of knee OA according to ACR criteria were evaluated after assignment of approved informed consent. The intervention consisted of the use for a 6 month period of Moleca® footwear (RS, Brazil) for at least 6hours daily and for 7 days a week. This is a light (mean weight=172±19.6 g, range 142-193 g depending on size) double canvas flexible flat walking shoe nonheeled, with a 5-mm antislip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Assessment was done at baseline and 6 months later. All patients were screened and evaluated by a rheumatologist at baseline for clinical examination and x-rays. Subsequent procedures were performed by the same physiotherapist to assess pain (visual analogue scale–VAS), WOMAC index and knee adduction moment during gait calculated by inverse dynamics method using 6 infrared cameras and a multicomponent force plate. T-test was used to compare pre/post intervention effects and P<0.05 was considered significant. Results: Mean age of patients was 69±6 yrs, weight=65.9±12.1 kg, height=152±5 cm, BMI=28.6±4.9 kg/cm 2. Allwomen had knee OA grade 2 or 3 (Kellgren-Lawrence). Average use of Moleca® was 7:24±3:47 h monthly. Remarkably, 6 months after intervention, a reduction of 56.6% and 73.9% of VAS for pain at night and at the moment of assessment, respectively, was observed (P=0.048 and P=0.015). Total WOMAC score diminished 44.9% (p=0.001), WOMAC pain subscale decreased 55.2% (p=0.015), and WOMAC function index improved 43.6% (p=0.004). The first (p= 0.533) and the second (p=0.686) knee adduction moment peaks were alike, while significant reduction of 11.2% in knee loading (p=0.001) was achieved during midstance. Conclusion(s): We have demonstrated in this pilot study that elderly women with knee OA have a benefit effect on pain and function following a 6 month period of use of a specific flexible, nonheeled shoe. These preliminary results warrant further studies aiming to evaluate long term benefit of this intervention in a larger sample population.- 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.
conferenceObject Beneficial Effect Of Long-Term Use Of a Low-Cost Minimalist Footwear On Joint Load, Clinical, and Functional Aspects Of Elderly Women With Knee Osteoarthritis(2013) TROMBINI-SOUZA, Francis; MATIAS, Alessandra; YOKOTA, Mariane; BUTUGAN, Marco; PEREIRA, Ivye; GOLDENSTEIN-SCHAINBERG, Claudia; FULLER, Ricardo; SACCO, Isabel C. N.- Effectiveness of a long-term use of a minimalist footwear versus habitual shoe on pain, function and mechanical loads in knee osteoarthritis: a randomized controlled trial(2012) TROMBINI-SOUZA, Francis; FULLER, Ricardo; MATIAS, Alessandra; YOKOTA, Mariane; BUTUGAN, Marco; GOLDENSTEIN-SCHAINBERG, Claudia; SACCO, Isabel C. N.Background: Recent studies have shown an important reduction of joint overload during locomotion in elderly women with knee osteoarthritis (OA) after short- term use of minimalist shoes. Our aim is to investigate the chronic effect of inexpensive and minimalist footwear on the clinical and functional aspects of OA and gait biomechanics of elderly women with knee OA. Methods/Design: Fifty-six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) are randomized into blocks and allocated to either the intervention group, which will use flexible, non-heeled shoes-Moleca (R)-for six months for at least six hours daily, or the control group, which could not use these shoes. Neither group is undergoing physical therapy treatment throughout the intervention period. Moleca (R) is a women's double canvas, flexible, flat walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Both groups will be followed for six months and will be assessed at baseline condition, after three months, and after six months (end of intervention). All the assessments will be performed by a physiotherapist that is blind to the group allocation. The primary outcome is the pain Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. The secondary outcomes are global WOMAC score; joint stiffness and disability WOMAC scores; knee pain with a visual analogue scale; walking distance in the six-minute walk test; Lequesne score; amount and frequency (number of days) of paracetamol (500 mg) intake over six months; knee adduction moment during gait; global medical assessment score; and global patient auto-assessment score. At baseline, all patients receive a diary to record the hours of daily use of the footwear intervention; every two weeks, the same physiotherapist makes phone calls to all patients in order to verify adherence to treatment. The statistical analysis will be based on intention to treat analysis, as well as general linear models of analysis of variance for repeated measure to detect treatment-time interactions (alpha = 5%). Discussion: This is the first randomized, clinical trial protocol to assess the chronic effect of minimalist footwear on the clinical and functional aspects and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca (R) shoes for six months will provide pain relief, reduction of the knee adduction moment when walking, and improve joint function in elderly women with knee OA, and that the treatment, thus, can be considered another inexpensive and easy-to-use option for conservative OA treatment.