The Clinical Effect of Lateral Wedge on Hemiplegic Weight Bearing

Abstract

The purpose of this study was to investigate the influence of the lateral wedge on asymmetrical weight bearing and posture in hemiplegic gait. The subjects were 2-female and 4-male moderate stroke patients, average age 54 +/- 6 yr. The time from onset was 127 +/- 69.7 days. A 7 mm-thick wedged insole was applied to the affected side for a week. Before and after that, the vertical ground reaction force, single supporting period and side movement of the trunk were recorded during walking. As a result, we found that the vertical ground reaction ratio and single supporting period ratio of the affected side (affected/unaffected) were significantly increased (P < 0.05), and also that the lateral sway of the trunk was remarkably decreased (P < 0.05). Our results indicate that the application of the lateral wedge for a week improved asymmetrical weight bearing and gait ability in moderate hemiplegic patients. Also we believe that a randomly sampled comparison study should be performed in the near future.

Foot posture after stroke: frequency, nature and clinical significance

“…Although those with abnormal supination may benefit from a lateral wedge; those with abnormal pronation would require a medial wedge. Some studies have suggested using a lateral sole wedge on the affected or non-affected side to improve balance or other gait parameters, 26,27 but our data suggest that this may adversely affect the feet of many stroke patients. Research on healthy participants has shown that a lateral wedge may increase the velocity of muscle plantarflexor and invertor muscle lengthening.…”

Effect of Customized Insoles on Gait in Post-Stroke Hemiparetic Individuals: A Randomized Controlled Trial

“…Corrective insoles can change the pressure distribution on the sole to provide an appropriate base of support, maintain correct positioning of the foot to limit or facilitate the movement of the lower limbs as well as enhance shock absorption and stability to alleviate pain or other specific pathologies while standing or walking [17]. Previous research has demonstrated that lateral-wedged and heel-lift insoles had a positive effect by increasing the weight-bearing of the hemiplegic side and bilateral symmetry during standing, but these effects were not felt during ambulation [18,19]. Kusumoto et al confirmed that the insoles combined with a metatarsal pad promoted static and dynamic balance in patients with cerebral palsy [20].…”

Early Observations of the Effects of Lateral Wedge Orthoses on Lower Limb Muscle Length and Potential for Exacerbating Spasticity

“…5 The most widely used foot orthosis for patients with stroke is the lateral wedge orthosis which is prescribed to improve balance and gait and correct varus deformity. [6][7][8] Previous studies have demonstrated that wedgeshaped orthoses can influence electromyographic activity of lower limb muscles in the normal population. 9,10 If this is also the case in patients with neurological conditions, then orthotic design could positively or adversely affect muscle activity and consequently, function.…”

“…There is however, clinical and objective evidence that orthoses can modify foot and ankle biomechanics 4 and elicit neuromuscular responses 5 . The most widely used foot orthosis for patients with stroke is the lateral wedge orthosis which is prescribed to improve balance and gait and correct varus deformity 6–8 . Previous studies have demonstrated that wedge-shaped orthoses can influence electromyographic activity of lower limb muscles in the normal population 9,10 .…”