Abstract
BackgroundSeveral footwear design characteristics are known to have detrimental effects on the foot. However, one characteristic that has received relatively little attention is the point where the sole flexes in the sagittal plane. Several footwear assessment forms assume that this should ideally be located directly under the metarsophalangeal joints (MTPJs), but this has not been directly evaluated. The aim of this study was therefore to assess the influence on plantar loading of different locations of the shoe sole flexion point.MethodTwenty-one asymptomatic females with normal foot posture participated. Standardised shoes were incised directly underneath the metatarsophalangeal joints, proximal to the MTPJs or underneath the midfoot. The participants walked in a randomised sequence of the three shoes whilst plantar loading patterns were obtained using the Pedar® in-shoe pressure measurement system. The foot was divided into nine anatomically important masks, and peak pressure (PP), contact time (CT) and pressure time integral (PTI) were determined. A ratio of PP and PTI between MTPJ2-3/MTPJ1 was also calculated.ResultsWearing the shoe with the sole flexion point located proximal to the MTPJs resulted in increased PP under MTPJ 4–5 (6.2%) and decreased PP under the medial midfoot compared to the sub-MTPJ flexion point (−8.4%). Wearing the shoe with the sole flexion point located under the midfoot resulted in decreased PP, CT and PTI in the medial and lateral hindfoot (PP: −4.2% and −5.1%, CT: −3.4% and −6.6%, PTI: −6.9% and −5.7%) and medial midfoot (PP: −5.9% CT: −2.9% PTI: −12.2%) compared to the other two shoes.ConclusionThe findings of this study indicate that the location of the sole flexion point of the shoe influences plantar loading patterns during gait. Specifically, shoes with a sole flexion point located under the midfoot significantly decrease the magnitude and duration of loading under the midfoot and hindfoot, which may be indicative of an earlier heel lift.
Highlights
Several footwear design characteristics are known to have detrimental effects on the foot
Wearing the shoe with the sole flexion point located proximal to the metarsophalangeal joints (MTPJs) resulted in increased peak pressure (PP) under MTPJ 4–5 (6.2%) and decreased PP under the medial midfoot compared to the sub-MTPJ flexion point (−8.4%)
Wearing the shoe with the sole flexion point located under the midfoot resulted in decreased PP, contact time (CT) and pressure time integral (PTI) in the medial and lateral hindfoot (PP: −4.2% and −5.1%, CT: −3.4% and −6.6%, PTI: −6.9% and −5.7%) and medial midfoot (PP: −5.9% CT: −2.9% PTI: −12.2%) compared to the other two shoes
Summary
Several footwear design characteristics are known to have detrimental effects on the foot. In recognition of the association between footwear characteristics and foot problems, several footwear assessment forms have been developed to assist with the optimum selection and fit of footwear These tools are based on available evidence, they van der Zwaard et al Journal of Foot and Ankle Research 2014, 7:20 http://www.jfootankleres.com/content/7/1/20 recommend shoe characteristics based on clinical experience that are currently unverified [10,11]. One of these characteristics is the position of the sole flexion point in the sagittal plane relative to the metatarsophalangeal joints (MTPJs). We hypothesised that the more proximally-located sole flexion points would (i) increase the pressure–time integral of the forefoot due to premature heel elevation, and (ii) cause a lateral shift in loading across the MTPJs due to changes in the windlass mechanism during propulsion
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