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Piri E, Jafarnezhadgero A, Dehghani M. Effects of Insole Type and Fatigue on the Electrical Activity of Lower Limb Muscles During Running in Men With Foot Pronation and ACL Reconstruction: A Clinical Trial. jrehab 2026; 26 (4) :572-605
URL: http://rehabilitationj.uswr.ac.ir/article-1-3700-en.html

Objective The purpose of this study was to investigate the effects of different types of insoles and fatigue on the electrical activity of lower limb muscles during running in men with foot pronation (FP) at different post-anterior cruciate ligament reconstruction (ACLR) times.
Materials & Methods In this randomized clinical trial, 30 men with ACLR-FP, along and 10 healthy men, participated. A wireless surface electromyography (EMG) system was used to record the electrical activity of lower limb muscles during different phases of running. The participants were evaluated wearing four different insoles (control shoe, placebo insole, arch support insole, and double-density insole) before and after fatigue induced using a treadmill and assessed based on Borg’s Rating of Perceived Exertion scale. Data were analyzed using repeated measures analysis of variance (ANOVA) and the Bonferroni post-hoc test, considering a significance level of P≤0.05.
Results Under the placebo insole use condition, the fatigue-group interaction effect showed a significant increase for the biceps femoris (BF) during the loading response phase (P=0.038; effect size [d]=0.200) and for the gluteus medius (GM) during the mid-stance phase (P=0.048; d=0.019). Under the arch-support insole use condition, the fatigue-group interaction effect demonstrated a statistically significant increase for the BF during the mid-stance (P=0.045; d=0.019) and push-off (P=0.040; d=0.020) phases. Under the double-density insole use condition, the fatigue-group interaction effect showed a statistically significant decrease for the tibialis anterior (TA) during the mid-stance phase (P=0.039; d=0.001); for the gastrocnemius (GC) during the push-off phase (P=0.035; d=0.217); and for the TA during the deceleration phase (P=0.002; d=0.100).
Conclusion It seems that both fatigue and the use of different insoles can alter the neuromuscular activity pattern in men with ACLR-FP. The arch-support and double-density insoles have greater potential to mitigate the negative effects of fatigue and improve muscle electrical activity, particularly in patients in the early post-ACLR period (<6 months).