***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The purpose of this study was to establish the effect of simple non moulded flat based insoles on three-dimensional foot motion during normal walking . Excessive foot pronation is considered a major contributing factor to lower limb injuries .  Moulded foot orthoses have been shown to decrease maximum foot eversion .  Simple insoles are widely used in clinical practice as an alternative to moulded orthoses . However , there has been little research into the kinematic effects of simple insoles . METHODS All subjects had an inverted rearfoot and forefoot position when the subtalar joint was placed in neutral , which was assessed by a  weight bearing goniometer .  Rotations of the whole foot about three orthogonal axes relative to the shank were estimated using a five camera motion analysis system . FINDINGS Biplanar insoles significantly ( P < 0.05 ) reduced maximum eversion by an average of 3.1 degrees when compared to the no insole condition . The cobra insole reduced maximum eversion by an average of 2.1 degrees when compared to the no insole condition . This difference approached statistical significance ( P = 0.058 ) . INTERPRETATION Biplanar and cobra insoles had no significant effect on maximum dorsiflexion , abduction or rate of eversion , when compared to the no insole condition . These results provide some limited support for the use of simple insoles to control for excessive foot pronation during walking OBJECTIVE To quantify the effects of posting and custom-molding of foot orthotics on lower extremity kinematics and kinetics during running . DESIGN Repeated measures . Background . Several kinematic and kinetic factors have been suggested to increase a runner 's risk for injuries . It has been speculated that foot orthotics can be used to reduce injury related complaints or even prevent running injuries by affecting these factors . METHODS Twenty one volunteers participated in this study . Kinematic and kinetic variables obtained during overground running for medial posting , custom-molding , and the combination of medial posting and custom-molding of foot orthotics were compared to a control condition . Repeated measures ANOVA and student t-tests were used to detect significant differences ( alpha=0.05 ) . RESULTS Posting of foot orthotics reduced maximum foot eversion and ankle inversion moment and increased vertical loading rate and maximum knee external rotation moment ( P<0.05 ) . Molding and posting and molding reduced vertical loading rate and ankle inversion moment and increased maximum foot inversion and maximum knee external rotation moment ( P<0.05 ) . CONCLUSIONS The effects of posting and molding of foot orthotics are extremely different and when combining posting and molding , the effects of molding appear to be dominant . It yet remains to be determined whether posting or molding is more beneficial with respect to overuse running injuries . RELEVANCE The potential of foot orthotics for reducing pain and injuries is convincing . The current study provides valuable information about the role of specific structural components of foot orthotics and contributes to the knowledge about the mechanism underlying the effect of foot orthotics in running OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE To determine the quantitative effects of a corrective rearfoot orthotic device on the vertical , anteroposterior , and mediolateral ground reaction forces ( GRFs ) during ambulation . DESIGN We conducted a prospect i ve , r and omized , single-blinded study of 25 subjects during ambulation with and without a rearfoot orthotic device .  MATERIAL AND METHODS Thirteen men and 12 women were enrolled in the study ; the inclusion criteria included asymptomatic pes planus ( 5 to 10 degrees of calcaneal eversion ) . Each subject walked across a st and ard force plate in 10 trials without an orthotic device . The force plate was used to quantify the effect of a semirigid functional rearfoot orthotic device on GRFs and the center of pressure versus a st and ard shoe with no device . The observer was blinded , trials were completed in r and om order , and the paired t test was used for statistical analysis . RESULTS No evidence suggested the presence of a significant difference in mediolateral GRFs and in the center of pressure exerted at 10 % , 20 % , 50 % , and 80 % of stance phase with and without the orthotic device . Significant reductions were noted in vertical GRFs per newton of body weight exerted at 10 % ( P = 0.0009 ) and 20 % ( P = 0.0383 ) of stance phase and in anteroposterior GRFs exerted at 10 % ( P = 0.0009 ) and 50 % ( P = 0.0033 ) of stance phase when ambulation was compared with and without the orthotic device . CONCLUSION These results indicate that a rearfoot orthotic device reduces vertical and anteroposterior GRFs in the early stages of the stance phase during the gait cycle . We found no evidence to suggest a significant difference at any of the percent stance phases when comparisons were made of mediolateral GRFs exerted with and without the orthotic device . These data are contrary to current hypotheses about use of orthotic devices , and further studies would be helpful to reproduce these findings and to determine whether these changes are related to clinical improvement in symptomatic pes planus OBJECTIVE To study the effects of foot orthotics on the mean electromyographic amplitude of proximal and distal lower extremity muscle groups during the first 50 % of the stance phase during treadmill running . DESIGN Repeated measures . SETTING Subjects were recruited from the general community . PARTICIPANTS Twelve recreational runners who were symptomatic for lower extremity pain . Clinical and radiographic findings confirmed the presence of structural malalignment of the foot . INTERVENTION Semirigid orthotics were fabricated for each subject , and like footwear provided . MAIN OUTCOME MEASURES Surface electromyogram activity from the tibialis anterior , medial gastrocnemius , vastus medialis , vastus lateralis , and biceps femoris was collected during treadmill running at self-selected speeds for orthotic and nonorthotic conditions . Root mean square values were averaged across 10 cycles , normalized to time and expressed as a percentage of the nonorthotic condition . RESULTS Paired t test results showed statistically significant changes ( p<.05 ) for the biceps femoris ( -11.1 % ) and tibialis anterior ( + 37.5 % ) muscle groups during the orthotic condition . Electromyographic activity in the medial gastrocnemius , vastus medialis , and vastus lateralis with orthotic use was not significantly different from the nonorthotic condition . CONCLUSION Although subjects ' electromyographic responses to orthotic use were highly individualized , the findings of this study may enhance our underst and ing of muscle activity changes associated with positive outcomes from orthotic use PURPOSE The purpose s of this project were to assess the effect of four different shoe inserts on the path of the center of pressure ( COP ) , to quantify the effect of these inserts on selected knee joint moments during running , and to assess the potential of COP data to predict the effects of inserts/orthotics on knee joint moments . METHODS Kinematics for the lower extremities , result ant ankle and knee joint moments , and the path of the COP were collected from the right foot of 15 male subjects while running heel-toe with five different shoe inserts ( full or half with 4.5-mm postings ) . RESULTS Individual movement changes with respect to the neutral insert condition were typically small and not systematic . Significant changes for the path of the COP were registered only for the full lateral insert condition with an average shift toward the lateral side . The mediolateral shift of the COP was not consistent for the full medial and the two half-shoe inserts . The subject-specific reactions to the inserts ' intervention in the corresponding knee joint moments were typically not consistent . Compared with the neutral insert condition , subjects showed increases or decreases of the knee joint moments . The correlation between the individual COP shifts and the result ant knee joint moment was generally small . CONCLUSION The results of this study showed that subject-specific reactions to the tested inserts were often not as expected . Additionally , reactions were not consistent between the subjects . This result suggests that the prescription of inserts and /or orthotics is a difficult task and that methods must be developed to test and assess these effects . Such methods , however , are not currently available BACKGROUND Some types of foot orthoses have been research ed for their effect on lower limb electromyographic muscle activity during walking . However , foot orthoses with high levels of medial rearfoot wedging ( ' inverted ' foot orthoses ) have not been investigated . METHODS In a cross-sectional study , asymptomatic participants with a pronated foot type ( n=15 ) were each issued with a pair of 0 degrees , 15 degrees and 30 degrees inverted custom-made foot orthoses . After four weeks of habituation to the orthoses ,  surface electromyography  was used to measure the onset and maximum EMG amplitude of tibialis anterior , peroneus longus , medial gastrocnemius and soleus muscles using five conditions [ barefoot , shoe-only , 0 degrees , 15 degrees and 30 degrees inverted foot orthoses conditions ] . FINDINGS A statistically significant increase in tibialis anterior maximum EMG amplitude occurred using the shoe only ( 30 % increase ) , 0 degrees ( 33 % increase ) , 15 degrees ( 38 % increase ) and 30 degrees ( 30 % increase ) inverted orthoses conditions compared to walking barefoot ( P<0.01 ) . Peroneus longus maximum EMG amplitude increased significantly using the 15 degrees inverted orthosis condition compared to walking barefoot ( 21 % increase , P=0.04 ) . INTERPRETATION Footwear and orthoses can significantly alter the maximum EMG amplitude of leg muscles during walking . Foot orthoses appear to increase peroneus longus EMG amplitude compared to footwear alone . However , the level of medial rearfoot posting within an orthosis does not appear to significantly alter maximum EMG amplitude . The individual responses to foot orthoses are highly variable . The changes in EMG amplitude with the use of foot orthoses and shoes may have clinical implication Objective : The objective of the current study was to analyze the influence of a short-term and long-term custom foot orthotic ( CFO ) intervention on the lower extremity dynamics in a group of female runners with a history of overuse running knee injury . Design : Descriptive laboratory study . Setting : University of Massachusetts Biomechanics Laboratory , Amherst , MA . Participants : This study included a group of female recreational runners ( 15 to 40 km per week ) who had a history of overuse running knee injury in the 6 months leading up to the study . Intervention : Semi-rigid , custom foot orthoses manufactured from a neutral suspension cast and design ed to meet the specific needs of each subject . Subjects wore the custom foot orthoses during all running activities for a period of 6 weeks . Main Outcome Measures : Three-dimensional ankle and knee dynamics were collected while subjects performed over-ground running trials with and without a CFO intervention . Data were collected before and after a 6-week CFO intervention during all running activities . Results : For ankle parameters , short-term intervention led to significant decreases in maximum values for rearfoot eversion angle and velocity , impact peak , and loading rate . Ankle inversion impulse was also significantly decreased during the loading phase . At the knee , maximum knee external rotation moment was significantly increased when subjects wore the custom foot orthoses . Conclusions : The 6-week intervention led to subjective changes , including a significant decrease in pain . An improvement in symptoms did occur with the 6-week intervention . In addition , dynamic results revealed that custom foot orthoses have an immediate effect on dynamics and that this influence occurs only when orthoses are worn in the footwear . The short-term CFO intervention led to significant decreases in rearfoot kinematics ( maximum eversion angle and velocity ) but no changes observed in knee kinematics . The kinetic analysis revealed that these subjects exhibited significant decreases in maxima for ankle inversion moment and angular impulse during the loading phase , impact peak , and vertical loading rate with short-term , CFO intervention . At the knee , the CFO 
    Output:
    
In the shock attenuation paradigm , it was found that non-posted moulded and posted moulded orthoses produced large reductions in loading rate and vertical impact force when compared with a control and to a posted non-moulded orthosis .
The neuromotor control paradigm seems to be the least conclusive in its outcome .