# Can the supination resistance test help determine the effects of foot orthoses on the foot and ankle biomechanics during walking?

Eléna Payen, Ahmed Dami, Kelly Robb, Nader Farahpour, Pier-Luc Isabelle, Jacques Abboud, Gabriel Moisan

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## ► To cite this version:

Eléna Payen, Ahmed Dami, Kelly Robb, Nader Farahpour, Pier-Luc Isabelle, et al. Can the supination resistance test help determine the effects of foot orthoses on the foot and ankle biomechanics during walking?. Multidisciplinary Biomechanics Journal, 2025, 49th congress of the Société de Biomécanique, 10.46298/mbj.14543. hal-04738030v2

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Submitted on 31 Jan 2025

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# Can the supination resistance test help determine the effects of foot orthoses on the foot and ankle biomechanics during walking?

Eléna Payen<sup>a*</sup>, Ahmed Dami<sup>a</sup>, Kelly Robb<sup>b</sup>, Nader Farahpour<sup>c</sup>, Pier-Luc Isabelle<sup>a</sup>, Jacques Abboud<sup>a</sup>, Gabriel Moisan<sup>a</sup>

<sup>a</sup> University of Quebec at Trois-Rivières, Trois-Rivières, Canada

<sup>b</sup> Wilfrid Laurier University, Waterloo, Canada

<sup>c</sup> Bu Ali Sina University, Hamedan, Iran

* Corresponding author: elena.payen@uqtr.ca

Received date: 03/04/2024

Accepted date: 28/06/2024

Publication date: 31/01/2025

**Keywords:** foot orthoses, locomotion, supination resistance test, kinetics, kinematics

© 2025 The Authors

Licence CC-BY 4.0

Published by Société de Biomécanique

## 1. Introduction

Foot orthoses (FOs) are devices commonly used in research and clinical contexts to reduce pain and improve function in patients with musculoskeletal disorders (Naderi et al., 2022). Even though their biomechanical effects on lower limbs have been well documented, their effects on the foot need to be further investigated to provide a more comprehensive view of their mechanism of action (Moisan, Mainville, et al., 2022). Considering the heterogeneous biomechanical responses to FOs therapy, it is also crucial to better identify those who will positively respond to wearing FOs.

The supination resistance test (SRT) is a low-cost, easy to use clinical test to determine the required force to supinate the foot and ankle. The quantitative version of this test is highly reliable (Moisan, McBride, et al., 2022) and its outcome is correlated with foot and ankle biomechanics during gait (McBride et al., 2019). This test could help determine how one will biomechanically respond to wearing FOs by quantifying the force needed to supinate the foot and ankle.

Thus, the objectives of this study were to investigate the effects of FOs on foot and ankle biomechanics during gait, and to correlate these effects with the results of the supination resistance test. The main hypothesis was that FOs would decrease foot and ankle pronation, arch flattening, ankle inversion moments compared to shod, and that lower supination resistance would be associated with greater FOs biomechanical effects.

## 2. Methods

### 2.1 Participants

In this within-subject, randomized cross-over design, a group of 23 flatfooted individuals comprising 16 females and 7 males (age: 24.9 ± 5.1 yr; mass: 72.7 ± 21.0 kg; height: 166.8 ± 9.4 cm; Body mass index: 25.9 ± 6.1 kg.m-2, Foot Posture Index: 8.0 ± 1.9) were recruited.

### 2.2. Tools

A pair of FOs with forefoot-rearfoot posts and a 5° medial wedge were fabricated with a 3.2 mm polypropylene shell. An OptiTrack motion capture system (Natural Point, Corvallis, OR, USA) with 12 cameras (200 Hz) was used to quantify the spatial position of the kinematic markers placed on pelvis, thigh, leg, and foot segments during walking using the modified Oxford foot model. A floor embedded AMTI force plate (1000 Hz) (Watertown, MA, USA), located in the middle of the calibrated space, was used to quantify the ground reaction forces. Midfoot, ankle angles and moments were calculated and statistically compared between shod and FOs with statistical parametric mapping (SPM). The biomechanical effects of FOs on the foot and ankle were also correlated with the supination resistance test using the SPM.regression function.

## 3. Results and discussion

### 3.1. Descriptive data

The mean supination resistance of the dominant leg was 11.9 ± 2.1% of the bodyweight. The mean walking
speed was 1.39 ± 0.14 m.s⁻¹ for the shod condition and
1.39 ± 0.16 m.s⁻¹ for FOs. There was no difference in
walking speed across conditions (p=0.571).

**3.2. Comparisons between FOs and shod**

During wearing FOs, there was a decrease in mid-
foot dorsiflexion (0 to 4% of the stance phase (%SP),
Maximal Difference (MD)=1.91°; p=0.016, and
11-100%SP, MD=7.16°, p=0.001) midfoot abduction
(28-45%SP; MD= 2.82°; p=0.035), ankle eversion (11-
65%SP; MD=3.19°; p=0.001) ankle abduction (81-
89%SP; MD=1.17°; p=0.026) angles compared to shod.
While wearing FOs, midfoot plantarflexion moment
(0-58%SP; MD=0.08 Nm/kg, p=0.001), ankle adduc-
tion moment (0-10%SP; MD=0.04 Nm/kg; P=0.003,
and 11-100%SP; MD=0.07 Nm/kg; P=0.001) and
ankle inversion moment (0-10%SP; MD=0.01 Nm/kg;
p=0.003, and 11-98%SP; MD=0.05 Nm/kg; p=0.001)
were smaller compared to shod walking condition.

<figure><img src="image_4.png" /><figcaption>**Figure 1.** Kinematic and kinetic differences during the stance phase while shod (black) and wearing FOs (green). \*=significant differences between shod and FOs. Df = dorsiflexion, Pf = plantarflexion, Inv = Inversion, Ev = eversion, Abd = abduction, Add = adduction.</figcaption></figure>

**3.3. Correlations between SRT and FOs effects.**

Greater supination resistance was associated with more
pronounced effects on foot and ankle biomechanics,
implying a positive relationship between the supination

resistance and biomechanical effects of FOs. The most
significant findings were the moderate positive correla-
tions between supination resistance and ankle eversion
(r=0.56) and abduction (r=0.62-0.70) angles, and ankle
abduction (r=0.64) moment, as well as a negative cor-
relation with ankle inversion (r=-0.68) moment. There
was also a moderate correlation between SRT and FOs
effects on midfoot abduction (r=-0.63).

4. Conclusions

FOs provided diverse effects on the ankle and the foot.
They controlled the pronatory forces and movements
in the foot and the ankle joints.

We hypothesized that lower supination resistance would
be associated with greater FOs biomechanical effects.
Contrary to our hypothesis, greater supination resistance
was associated with more pronounced effects on foot
and ankle biomechanics, implying a positive relationship
between the supination resistance and biomechanical
effects of FOs. We found moderate correlations between
supination resistance and the effects of FOs on ankle
inversion and abduction angles and moments. This
will enable us to better understand which participant
with flat feet will benefit the most from wearing FOs.
These findings have the potential to improve orthotic
prescription strategies, potentially benefiting individuals
with musculoskeletal disorders.

Funding

This study was supported by a Discovery Gant from the
Natural Sciences and Engineering Research Council
of Canada (NSERC) to GM (RGPIN-2023-05364).
Financial support did not influence the outcome of
this study. The funder had no role in the study design
or interpretations of data. All conclusions are those
of the authors.

Conflict of Interest Statement

None to disclose.

References

McBride, S., Dixon, P., Mokha, M., & Samuel Cheng,
M. (2019). The relationship between supination
resistance and the kinetics and kinematics of the
foot and ankle during gait. *Gait & Posture, 73*, 239-
245. https://doi.org/https://doi.org/10.1016/j.
gaitpost.2019.07.305
Moisan, G., Mainville, C., Descarreaux, M., & Cantin, V. (2022). Lower Limb Biomechanics During Drop-Jump Landings on Challenging Surfaces in Individuals With Chronic Ankle Instability. *J Athl Train*, 57(11-12), 1039-1047. https://doi.org/10.4085/1062-6050-0399.21

Moisan, G., McBride, S., Isabelle, P. L., & Chicoine, D. (2022). The Keystone device as a clinical tool for measuring the supination resistance of the foot: A reliability study. *Musculoskeletal Care*, 20(3), 570-576. https://doi.org/10.1002/msc.1614

Naderi, A., Bagheri, S., Ramazanian Ahoor, F., Moen, M. H., & Degens, H. (2022). Foot Orthoses Enhance the Effectiveness of Exercise, Shockwave, and Ice Therapy in the Management of Medial Tibial Stress Syndrome. *Clin J Sport Med*, 32(3), e251-e260. https://doi.org/10.1097/jsm.0000000000000926