ISABEL DE CAMARGO NEVES SACCO

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Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina - Docente
LIM/54 - Laboratório de Bacteriologia, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • conferenceObject
    CHRONIC EFFECTS OF A FLEXIBLE AND MINIMALIST FOOTWEAR ON CLINICAL, FUNCTIONAL AND GAIT BIOMECHANICAL ASPECTS IN THE KNEE OSTEOARTHRITIS: A SINGLE-BLIND RANDOMIZED CLINICAL TRIAL
    (2012) TROMBINI-SOUZA, F.; MATIAS, A.; YOKOTA, M.; SCHAINBERG, C.; FULLER, R.; SACCO, I. C.
    Purpose: Recent studies have shown that the acute use of shoes that mimic barefoot gait decrease substantially knee loads while walking in elderly with knee osteoarthritis (OA). Probably due to methodological difficulties to implement this type of conservative treatment during extended period, the effectiveness of minimalist footwear has not been evaluated yet in elderly patients with knee OA. The purpose is to describe a randomized clinical trial protocol for evaluating the therapeutic effect of a minimalist (flexible, non-heeled) and inexpensive footwear on clinical, functional, and biomechanical gait in elderly women with knee OA. Methods: Fifty six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) will be randomized in blocks and allocated in the intervention group that will use a flexible non-heeled shoes- Moleca® forat least 6 hours daily or in the control group, which could not use these shoes or be under physical therapy or acupuncture treatment throughout these sis months. The use of Paracetamol 500 mg every six hour was allowed for both groups in case of pain. Moleca® (Calçados Beira Rio S.A., Novo Hamburgo, RS, Brazil) is a women's double canvas flexiblefl at walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. The mean weight is 172±19.6 g, ranging from 142 to 193 g depending on the size. Both groups will be followed during 6 months. They will be assessed at baseline condition, after 3 months (intervention group) and after 6 months of baseline condition(end of intervention, both groups). All the assessments will be performed by a physiotherapist that is blind to which group thepatient was allocated. The main outcome assessmentis the pain WOMAC score and the secondary outcomes are other WOMAC scores pain assessment (visual analogue scale - VAS), Lequesne index, Six-Minute Walk Test, and biomechanical gait analysis by means of 6 infrared cameras and a multi-component force plate to determine the knee adduction moment during gait. At baseline, all patients receive a diary to record the hours of daily use of footwear intervention. Every two weeks, the same physiotherapist carries phone calls to all patients in order to verify adherence to treatment and the correct filling this diary. Theinter group andinter-moments will be performed by repeated measures analysis of variance (α=0.05). This Trial was approved by the local Ethics Committee and was registered in ClinicalTrials.gov Identifier: NCT01342458. Results: Six hundred thirty-four elderly women have been contacted so far and 20 have already been allocated in the intervention group (9) and in the control (11). Five patients from intervention group have already completed all 3 assessments and finished the protocol. The preliminary results have shown that the elderly women of the intervention group have used the Moleca® shoe for an average monthly of 7 hours and 24 minutes (±3:47), corresponding to approximately 50% of the home-work hours of the day. Conclusion: This is the first randomized clinical trial protocol to assess the chronic effect of a minimalist footwear on the clinical, functional and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca® shoes for 6 months provides pain relief, reduction of the knee adduction moment while walking and improves joint function in elderly women with knee OA, and therefore can be considered as another inexpensive option for conservative OA treatment. The authors are pleased to acknowledge the financial support of State of São Paulo Research Foundation - FAPESP (processes: 2011/01640-8, 2011/03300-0, 2011/03069-6).
  • 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
  • article 35 Citação(ões) na Scopus
    Effect of a rocker non-heeled shoe on EMG and ground reaction forces during gait without previous training
    (2012) SACCO, Isabel C. N.; SARTOR, Cristina D.; CACCIARI, Licia P.; ONODERA, Andrea N.; DINATO, Roberto C.; PANTALEAO JR., Elcio; MATIAS, Alessandra B.; CEZARIO, Fernanda G.; TONICELLI, Lucas M. G.; MARTINS, Maria Cecilia S.; YOKOTA, Mariane; MARQUES, Paulo Eduardo C.; COSTA, Paulo Henrique C.
    Unstable shoes have been designed to promote ""natural instability"" and during walking they should simulate barefoot gait, enhancing muscle activity and, thus, attributing an advantage over regular tennis shoes. Recent studies showed that, after special training on the appropriate walking pattern, the use of the Masai Barefoot Technology (MBT) shoe increases muscle activation during walking. Our study presents a comparison of muscle activity as well as horizontal and vertical forces during gait with the MBT, a standard tennis shoe and barefoot walking of healthy individuals without previous training. These variables were compared in 25 female subjects and gait conditions were compared using ANOVA repeated measures (effect size:0.25). Walking with the MBT shoe in this non-instructed condition produced higher vertical forces (first vertical peak and weight acceptance rate) than walking with a standard shoe or walking barefoot, which suggests an increase in the loads received by the musculoskeletal system, especially at heel strike. Walking with the MBT shoe did not increase muscle activity when compared to walking with the standard shoe. The barefoot condition was more effective than the MBT shoe at enhancing muscle activation. Therefore, in healthy individuals, no advantage was found in using the MBT over a standard tennis shoe without a special training period. Further studies using the MBT without any instruction over a longer period are needed to evaluate if the higher loads observed in the present study would return to their baseline values after a period of adaptation, and if the muscle activity would increase over time.
  • article 23 Citação(ões) na Scopus
    Reliability of medial-longitudinal-arch measures for skin-markers based kinematic analysis
    (2019) CARAVAGGI, Paolo; MATIAS, Alessandra B.; TADDEI, Ulisses T.; ORTOLANI, Maurizio; LEARDINI, Alberto; SACCO, Isabel C. N.
    The medial-longitudinal arch (MLA) is perhaps the most important feature characterizing foot morphology. While current skin-markers based models of the MLA angle used in stereophotogrammetry allow to estimate foot arch shape and deformation, these do not always appear consistent with foot anatomy and with standard clinical definitions. The aim of this study was to propose novel skin-markers based measures of MLA angle and investigate their reliability during common motor tasks. Markers on the calcaneus, navicular tuberosity, first metatarsal head and base, and on the two malleoli were exploited to test eight definitions of MLA angle consistent with foot anatomy, both as angles between two 3-dimensional vectors and as corresponding projections on the sagittal plane of the foot. The inter-trial, inter-session and inter-examiner reliability of each definition was assessed in multiple walking and running trials of two volunteers, tested by four examiners in three sessions. Inter-trial variability in walking was in the range 0.7-1.2 deg, the inter-session 2.8-7.5 deg, and the inter-examiner in the range 3.7-9.3 deg across all MLA definitions. The Rizzoli Foot Model definition showed the lowest inter-session and inter-examiner variability. MLA measures presented similar variability in walking and running. This study provides preliminary information on the reliability of MLA measurements based on skin markers. According to the present study, angles between 3-dimensional vectors and minimal marker sets should be preferred over sagittal-plane projections. Further studies should be sought to investigate which definition is more accurate with respect to the real MLA deformation in different loading conditions.
  • article 10 Citação(ões) na Scopus
    Recognition of Foot-Ankle Movement Patterns in Long-Distance Runners With Different Experience Levels Using Support Vector Machines
    (2020) SUDA, Eneida Yuri; WATARI, Ricky; MATIAS, Alessandra Bento; SACCO, Isabel C. N.
    Running practice could generate musculoskeletal adaptations that modify the body mechanics and generate different biomechanical patterns for individuals with distinct levels of experience. Therefore, the aim of this study was to investigate whether foot-ankle kinetic and kinematic patterns can be used to discriminate different levels of experience in running practice of recreational runners using a machine learning approach. Seventy-eight long-distance runners (40.7 +/- 7.0 years) were classified into less experienced (n= 24), moderately experienced (n= 23), or experienced (n= 31) runners using a fuzzy classification system, based on training frequency, volume, competitions and practice time. Three-dimensional kinematics of the foot-ankle and ground reaction forces (GRF) were acquired while the subjects ran on an instrumented treadmill at a self-selected speed (9.5-10.5 km/h). The foot-ankle kinematic and kinetic time series underwent a principal component analysis for data reduction, and combined with the discrete GRF variables to serve as inputs in a support vector machine (SVM), to determine if the groups could be distinguished between them in a one-vs.-all approach. The SVM models successfully classified all experience groups with significant crossvalidated accuracy rates and strong to very strong Matthew's correlation coefficients, based on features from the input data. Overall, foot mechanics was different according to running experience level. The main distinguishing kinematic factors for the less experienced group were a greater dorsiflexion of the first metatarsophalangeal joint and a larger plantarflexion angles between the calcaneus and metatarsals, whereas the experienced runners displayed the opposite pattern for the same joints. As for the moderately experienced runners, although they were successfully classified, they did not present a visually identifiable running pattern, and seem to be an intermediate group between the less and more experienced runners. The results of this study have the potential to assist the development of training programs targeting improvement in performance and rehabilitation protocols for preventing injuries.
  • conferenceObject
    LOW COST MINIMALIST SHOE AS A MECHANICAL TREATMENT FOR ALGO-FUNCTIONAL ASPECTS AND ANALGESIC MEDICINE INTAKE IN ELDERLY WOMEN WITH KNEE OSTEOARTHRITIS
    (2014) TROMBINI-SOUZA, F.; MATIAS, A.; YOKOTA, M.; SCHAINBERG, C.; FULLER, R.; SACCO, I. C.
  • article 2 Citação(ões) na Scopus
    Predictive Effect of Well-Known Risk Factors and Foot-Core Training in Lower Limb Running-Related Injuries in Recreational Runners: A Secondary Analysis of a Randomized Controlled Trial
    (2022) SUDA, Eneida Yuri; WATARI, Ricky; MATIAS, Alessandra B.; TADDEI, Ulisses T.; SACCO, Isabel C. N.
    Background: Running carries the risk of several types of running-related injuries (RRIs), especially in the lower limbs. The variety of risk factors and the lack of strong evidence for several of these injury risks hinder the ability to draw assertive conclusions about them, hampering the implementation of effective preventive strategies. Because the etiology of RRIs seems to be multifactorial, the presence of RRI risk factors might influence the outcome of therapeutic strategies in different ways. Thus, further investigations on how risk and protective factors influence the incidence and prevention of RRIs should be conducted. Purpose: To investigate the predictive effect of well-known risk factors and 1 protective factor-foot-core training-on the incidence of lower limb RRIs in recreational runners. Study Design: Cohort study; Level of evidence, 2. Methods: Middle- and long-distance recreational runners (N = 118) were assessed at baseline and randomly allocated to either an intervention group (n = 57) or a control group (n = 61). The intervention group underwent an 8-week (3 times/wk) foot-core training program. Participants were followed for a year after baseline assessment for the occurrence of RRIs. Logistic regression with backward elimination of variables was used to develop a model for prediction of RRI in recreational runners. Candidate predictor variables included age, sex, body mass index, years of running practice, number of races, training volume, training frequency, previous RRI, and the foot-core exercise training. Results: The final logistic regression model included 3 variables. As previously shown, the foot-core exercise program is a protective factor for RRIs (odds ratio, 0.40; 95% CI, 0.15-0.98). In addition, older age (odds ratio, 1.07; 95% CI, 1.00-1.14) and higher training volume (odds ratio, 1.02; 95% CI, 1.00-1.03) were risk factors for RRIs. Conclusion: The foot-core training was identified as a protective effect against lower limb RRI, which can be negatively influenced by older age and higher weekly training volume. The predictive model showed that RRIs should be considered a multivariate entity owing to the interaction among several factors. Registration: NCT02306148 (ClinicalTrials.gov identifier).
  • article 7 Citação(ões) na Scopus
    Impact of diabetic neuropathy severity on foot clearance complexity and variability during walking
    (2019) SUDA, Eneida Yuri; MATIAS, Alessandra Bento; BUS, Sicco A.; SACCO, Isabel C. N.
    Background: The control of foot trajectory during swing phase is important to achieve safe clearance with the ground. Complexity of a physiological control system arises from the interaction of structural units and regulatory feedback loops that operate to enable the organism to adapt to a non-static environment. Diabetic polyneuropathy (DPN) impairs peripheral feedback inputs and alters ankle control during gait, which might affect toe clearance (ToC) parameters and its complexity, predisposing DPN-subjects to tripping and falling. Research question: How do different DPN-severity degrees change ToC trajectory and minimum ToC, and its complexity during gait of diabetic subjects? Methods: 15 healthy controls and 69 diabetic subjects were assessed and classified into DPN-severity degrees by an expert fuzzy model: absent (n = 26), mild (n = 21) and severe (n = 22). Three-dimensional kinematics was measured during comfortable walking. ToC was the minimum vertical distance between the marker placed at the first metatarsal head and the ground during swing. Mean ToC, ToC standard deviation (SD) between trials, and sample entropy (SaEn) and standard deviation (SD) of ToC trajectory were calculated from the ToC temporal series. ANOVA and ANCOVA (with the walking speed as the covariate) and Bonferroni pairwise post-hoc tests (P < 0.05) were used to compare groups. Results: Mean ToC and ToC SD did not show differences between groups (ANCOVA F = 0.436; df = 3; P = 0.705; F = 1.719; df = 3; P = 0.170, respectively). ToC trajectory SD also did not show differences between groups (ANCOVA F = 3.98; df = 3; P = 0.755). Severe-DPN subjects showed higher ToC_Traj_SaEn than controls (ANCOVA F = 2.60; df = 3; P = 0.05). Significance: Severe-DPN subjects showed a more complex pattern of overall foot-ankle trajectory in swing phase in comparison to controls, although did not present lower minimum ToC values. The higher complexity of ToC might lead to an increase in the motor system output (more strategies, increase in variability), resulting in a more unstable system and selected motor strategies.
  • article 4 Citação(ões) na Scopus
    Effects of Foot-Core Training on Foot-Ankle Kinematics and Running Kinetics in Runners: Secondary Outcomes From a Randomized Controlled Trial
    (2022) MATIAS, Alessandra B.; WATARI, Ricky; TADDEI, Ulisses T.; CARAVAGGI, Paolo; INOUE, Rafael S.; THIBES, Raissa B.; SUDA, Eneida Y.; VIEIRA, Marcus F.; SACCO, Isabel C. N.
    This study investigated the effectiveness of an 8-week foot-core exercise training program on foot-ankle kinematics during running and also on running kinetics (impact loads), with particular interest in biomechanical outcomes considered risk factors for running-related injuries in recreational runners. A single-blind, randomized, controlled trial was conducted with 87 recreational runners randomly allocated to either the control (CG) or intervention (IG) group and assessed at baseline and after 8 weeks. The IG underwent foot-core training 3 times/week, while the CG followed a placebo lower-limb stretching protocol. The participants ran on a force-instrumented treadmill at a self-selected speed while foot-segment motion was captured simultaneously with kinetic measurements. After the intervention, there were statistically significant changed in foot biomechanics, such as: IG participants strike the ground with a more inverted calcaneus and a less dorsiflexed midfoot than those in the CG; at midstance, ran with a less plantarflexed and more adducted forefoot and a more abducted hallux; and at push-off, ran with a less dorsiflexed midfoot and a less adducted and more dorsiflexed hallux. The IG runners also had significantly decreased medial longitudinal arch excursion (p = 0.024) and increased rearfoot inversion (p = 0.037). The 8-week foot-core exercise program had no effect on impact (p = 0.129) and breaking forces (p = 0.934) or on vertical loading rate (p = 0.537), but it was positively effective in changing foot-ankle kinematic patterns.""
  • article 35 Citação(ões) na Scopus
    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.