Central Forefoot Research Articles

Impact of foot progression angle on spatiotemporal and plantar loading pattern in intoeing children during gait

Intoeing in children is a common parental concern, but our understanding of the impact of foot progression angle (FPA) in these children leaves remains limited. This study examines the relationship between FPA and plantar loading pattern, as well as gait symmetry in children with intoeing. The sample included 30 children with intoeing caused by internal tibial torsion, uniformly divided into three groups: unilateral intoeing, bilateral mild intoeing, and bilateral mild-moderate intoeing. The relationship between FPA and plantar loading pattern, and gait symmetry within and among groups were assessed using dynamic pedobarographic and spatiotemporal data. Results indicated a significant correlation between FPA and peak pressure, maximum force, and plantar impulse in the medial and central forefoot, and also the medial and lateral heel zones for both bilateral intoeing groups. Significant differences were observed only in subdivided stance phase, including loading response, single support, and pre-swing phases, between the unilateral intoeing and bilateral mild intoeing groups. These findings suggest that FPA significantly affects the forefoot and heel zones, potentially increasing the load on the support structures and leading to transverse arch deformation. While children with intoeing demonstrate a dynamic self-adjustment capability to maintain gait symmetry, this ability begins to falter as intoeing becomes more pronounced.

The effect of personalized orthopedic insoles on plantar pressure during running in subtle cavus foot.

Objective: This study aims to investigate the patterns of plantar pressure distribution during running for patients with subtle cavus foot (SCF) and determine the impact of personalized orthopedic insoles with forefoot wedge on plantar pressure distribution in patients with SCF. Methods: Sixteen undergraduate participants (8 with SCF and 8 with normal arches) were recruited based on arch height index measurements. Two full-length insoles were personalized for each SCF based on plantar pressures during running, an arch support insole (ASI) and an arch support with forefoot wedge insole (AFI). Foot pressure data collected during different insole conditions in running, analyzing ten regions of footprints for peak pressure and pressure-time integral. Results: Higher peak pressures were observed in patients with SCF at the medial forefoot (p = 0.021), medial heel (p = 0.013), and lateral heel (p = 0.025), with a higher pressure-time integral also noted at the medial forefoot (p = 0.025), medial heel (p = 0.015), and lateral heel (p = 0.047) when compared to normal arches. Compared with without-insole, both the AFI and the ASI reduced peak pressure at the medial (AFI p = 0.011; ASI p = 0.024) and lateral heel (AFI p = 0.028; ASI p = 0.032). The AFI reduced peak pressure at the medial heel (p = 0.013) compared with the ASI. Both the AFI and the ASI reduced pressure-time integral at the medial forefoot (AFI p = 0.003; ASI p = 0.026), central forefoot (AFI p = 0.005; ASI p = 0.011), medial heel (AFI p = 0.017; ASI p = 0.005), and lateral heel (AFI p = 0.017; ASI p = 0.019). Additionally, the ASI reduced pressure-time integral at the big toe (p = 0.015) compared with the without-insole. Conclusion: These findings demonstrate that during running in patients with SCF, plantar pressures are concentrated in the forefoot and heel compared to the normal arch. The personalized orthotic insoles can be used to effectively redistribute plantar pressure in patients with SCF running. Incorporating a forefoot wedge to specifically address the biomechanical abnormalities associated with SCF may enhance the effectiveness of orthopedic insoles.

Comparative Analysis of Three Types of Therapeutic Offloading Diabetic Shoes With Custom Made Insole on Plantar Pressure Distribution in Severe Diabetic Charcot Foot.

Charcot foot deformity, a severe complication of diabetes, involves neuropathy and abnormal peak plantar pressure in the midfoot and forefoot. However, orthotic interventions and shoe modifications are used to address the sequelae of Charcot neuroarthropathy, offering different approaches to managing abnormal peak plantar pressure. To compare the effects of three types of therapeutic offloading diabetic shoes; prefabricated, relasting, and double rocker-modified shoes on peak plantar pressure in the midfoot and forefoot of nonulcerated chronic Charcot foot during walking. A repeated measure design involved 15 participants (40% males and 60% females) with a mean age of 60.73 years (SD=10.50), with Charcot neuropathy. Participants were provided with three types of shoes; prefabricated, relasting, and double rocker-modified shoes, each equipped with the same custom-made insole (CMI). Plantar pressure was recorded while walking on level ground, focusing on the forefoot, midfoot, and hindfoot. The study also investigated additional variables affecting plantar pressure distribution, including the pressure-time integral and contact area. The type of shoe had distinct effects on the distribution of plantar pressure. The double rocker-modified shoe particularly impacted forefoot pressure during the terminal stance phase of the gait cycle. Peak plantar pressure at the forefoot increased by 5.37% with double rocker-modified shoes compared to relasting shoes. Both double rocker-modified and prefabricated shoes reduced midfoot peak plantar pressure by 8.73% and 11.97%, respectively. Similar trends were observed at the hindfoot, with reductions in peak plantar pressure. However, there were no significant differences in regional peak plantar pressure between the types of shoes except for the central forefoot (F (1.61, 22.5) = 5.69, p = 0.014). There were no significant differences in the effectiveness of prefabricated, relasting, and double rocker-modified shoes in reducing and redistributing peak plantar pressure in high-risk areas of chronic Charcot foot.

Effects of foot-ankle exercises on foot-ankle kinematics, plantar pressure, and gait kinetics in people with diabetic neuropathy: Secondary outcomes from a randomized controlled trial

BackgroundFollow-up report of secondary outcomes of a randomized, single-blinded, parallel controlled trial that investigated the benefits of a foot-ankle therapeutic exercise program on foot-ankle kinematics, plantar pressure, and lower limb kinetics during gait in individuals with diabetic neuropathy (DPN). MethodsSixty-six participants with DPN were randomly allocated into a control group (CG; n = 31), which received usual care, and an intervention group (IG; n = 35), which received usual care plus a 12-week group-based foot-ankle exercise program. Outcomes were assessed at baseline and 12 weeks by an assessor blinded to group allocation. ResultsThe generalized linear mixed model and intention-to-treat analysis revealed a greater hip extensor moment at push-off and greater hallux contact area in the IG than CG after 12 weeks. A within-group analysis revealed a larger arch height during stance and higher peak pressure and pressure-time integral at the central forefoot region in the IG after 12 weeks compared to baseline. There were no other significant group difference or changes over time in foot-ankle kinematics or in any other joint moment related to overall lower limb biomechanics. ConclusionThe increases in hip moment at push-off and hallux surface contact area suggest an improvement in the propulsion phase with greater participation of the toes in foot rollover after 12 weeks of a group-based foot-ankle exercises program for people with DPN. Individual face-to-face, longer-term, and more intensive interventions may be needed to positively influence foot-ankle biomechanics and pressure parameters in other plantar areas.

Effect of painful Ledderhose disease on dynamic plantar foot pressure distribution during walking: a case-control study

BackgroundPlantar pressure distribution during walking in patients with painful Ledderhose disease is unknown. Research questionDo patients with painful Ledderhose disease have an altered plantar pressure distribution during walking compared to individuals without foot pathologies? It was hypothesized that plantar pressure is shifted away from the painful nodules. MethodsPedobarography data of 41 patients with painful Ledderhose disease (cases, mean age: 54.2 ± 10.4 years) was collected and compared to pedobarography data from 41 individuals without foot pathologies (controls, mean age: 21.7 ± 2.0 years). Peak Pressure (PP), Maximum Mean Pressure (MMP) and Force-Time Integral (FTI) were calculated for eight regions (heel, medial midfoot, lateral midfoot, medial forefoot, central forefoot, lateral forefoot, hallux and other toes) under the soles of the feet. Differences between cases and controls were calculated and analysed by means of linear (mixed models) regression. ResultsProportional differences in PP, MMP and FTI showed increased values for the cases compared to the controls, especially in the heel, hallux and other toes regions, and decreased values in the medial- and lateral midfoot regions. In naïve regression analysis, being a patient was a predictor for increased- and decreased values for PP, MMP and FTI for several regions. When dependencies in the data were taken into account with linear mixed-model regression analysis, the increased- and decreased values for the patients were most prevalent for FTI at the heel, medial midfoot, hallux and other toes regions. SignificanceIn patients with painful Ledderhose disease, during walking, a shift of pressure was found towards the proximal and distal foot regions, while offloading the midfoot regions.

Diabot: Development of a Diabetic Foot Pressure Tracking Device

Foot-related problems are prevalent across the globe, and this issue is aggravated by the presence of diabetes mellitus. Diabetic-foot-related issues include extreme foot pain, plantar corns, and diabetic foot ulcers. To assess these conditions, accurate characterization of plantar pressure is required. In this work, an in-shoe, low-cost, and multi-material pressure measuring insole, based on a piezoresistive material, was developed. The device has a high number of sensors, and was tested on 25 healthy volunteers and 25 patients with different degrees of diabetes. The working range of the device was observed to be 5 kPa to 900 kPa, with an average hysteresis error of 3.25%. Plantar pressure was found to increase from healthy to diabetic volunteers, in terms of both standing and walking. In the case of the diabetic group, the-high pressure contact area was found to strongly and positively correlate (R2 = 0.78) with the peak plantar pressure. During the heel strike phase, the diabetic volunteers showed high plantar pressure on the medial heel region. In regard to the toe-off phase, the central forefoot was found to be a prevalent site for high plantar pressure across the diabetic volunteers. The developed device is expected not only to assist in the prediction of diabetic ulceration or re-ulceration, but also to provide strategies and suggestions for foot pressure alleviation and pain mitigation.

Socks with an U-shaped 3D discharge element are capable to reduce dynamic plantar pressures under the central forefoot

Cushioning for the central and plantar zone of the forefoot, integrated into the body of the sock, could reduce excess pressures in that zone. The objective of this study was to verify the capacity of a sock with a cushioning element to reduce forefoot plantar pressures relative to the same sock model without that element. Dynamic plantar pressures were measured in a sample of 38 participants (25 women and 13 men) using the FootScan plate system following the two-step protocol. Measurements were made in three situations selected at random – barefoot, wearing control socks, and wearing the experimental cushioned socks. Maximum pressures were analysed in seven zones of the forefoot (hallux, lesser toes, and 1st to 5th metatarsal heads). The zone of greatest plantar pressure was in all situations located under the 3rd metatarsal head. The pressure was lower (p = 0.009) under the 2nd metatarsal head with the experimental sock (10.2 ± 3.1 N/cm2) than with the other two conditions – barefoot (11.8 ± 3.7 N/cm2) and control sock (11.9 ± 4.9 N/cm2). The 3rd metatarsal head presented lower plantar pressures (p = 0.004) with the experimental sock (12.6 ± 3.8 N/cm2) than barefoot (14.5 ± 4.9 N/cm2). The experimental socks, with plantar cushioning, were able to effectively reduce the plantar pressures on the central part of the forefoot. This reduction may lead to less discomfort for subjects suffering pain in this area, It may also result in avoiding the appearance of possible skin lesions associated with excess pressure (such as calluses, corns, or blisters).

Pedobarographic Statistical Parametric Mapping of plantar pressure data in new and confident walking infants: A preliminary analysis

In infancy, plantar pressure data during walking has been investigated through regional approaches, whilst the use pedobarographic Statistical Parametric Mapping (pSPM) has not been reported. Analysis of pressure data using pSPM is higher in resolution and can enhance understanding of foot function development, providing novel insights into plantar pressure changes. This work aims to detail the implementation of the pSPM data processing framework on infants' pressure data, comparing plantar pressure patterns between new and confident walking steps. Twelve infants walked across an EMED- xl platform. Steps were extracted and imported into MATLAB for analysis. Maximum pressure pictures were transformed to point clouds and registered within and between participants with iterative closest point and coherent point drift algorithms, respectively. Root mean square error (RMSE) was calculated within both registrations as a quality measure. Pressure patterns were compared between new and confident walking using nonparametric-paired sample SPM1D t-test. RMSEs were under 1 mm for both registration algorithms. In the transition to confident walking, significantly increasing pressure was detected in the left central forefoot. Implementing pSPM to infants' pressure data was non-trivial, as several phases of data processing were required to ensure a robust approach. Our analysis highlighted the presence of significant changes in pressure in central left forefoot after 2.2 months of walking, which have not been reported before. This can be explained as previous regional approaches in infancy considered the forefoot as whole, preventing detection of changes in discrete anatomical regions.

Effectiveness of a Central Discharge Element Sock for Plantar Temperature Reduction and Improving Comfort.

U-shaped plantar cushions could help reduce stress affecting the central forefoot without the need for an orthosis, but they are yet to be integrated as an element in socks. The objective of this study was to verify the effectiveness of a sock with a central discharge element in terms of plantar temperature and comfort. The sample comprised 38 subjects (13 men and 25 women). Their plantar temperatures were measured with a thermographic camera in a basal situation and after each of two 10-minute walks around an indoor circuit during which they wore either control or experimental socks at random (the same design, weight, and fiber, but with the plantar cushioning element added). After the walks, each subject responded to a comfort questionnaire (five-point Likert scale), blindly scoring the two socks. The highest temperatures (28.3 ± 2.7 °C) were recorded in the zone of the second and third metatarsal heads. With the experimental socks, the observed temperature increase in the central forefoot zone was significantly less than with the control socks (31.6 vs. 30.6 °C, p = 0.001). The subjects found the experimental socks to be more comfortable than the controls (4.63 ± 0.5 vs. 4.03 ± 0.5, p < 0.001). The discharge element included in the experimental socks was effective since it reduced the contact zones and excess friction with the ground, thereby lessening overheating by more than 1 °C. Furthermore, the experimental socks were perceived as being more comfortable by the subjects who had mild and occasional foot discomfort.

Classifying sitting, standing, and walking using plantar force data.

Prolonged static weight-bearing at work may increase the risk of developing plantar fasciitis (PF). However, to establish a causal relationship between weight-bearing and PF, a low-cost objective measure of workplace behaviors is needed. This proof-of-concept study assesses the classification accuracy and sensitivity of low-resolution plantar pressure measurements in distinguishing workplace postures. Plantar pressure was measured using an in-shoe measurement system in eight healthy participants while sitting, standing, and walking. Data was resampled to simulate on/off characteristics of 24 plantar force sensitive resistors. The top 10 sensors were evaluated using leave-one-out cross-validation with machine learning algorithms: support vector machines (SVMs), decision tree (DT), discriminant analysis (DA), and k-nearest neighbors (KNN). SVM and DT best classified sitting, standing, and walking. High classification accuracy was obtained with five sensors (98.6% and 99.1% accuracy, respectively) and even a single sensor (98.4% and 98.4%, respectively). The central forefoot and the medial and lateral midfoot were the most important classification sensor locations. On/off plantar pressure measurements in the midfoot and central forefoot can accurately classify workplace postures. These results provide the foundation for a low-cost objective tool to classify and quantify sedentary workplace postures.

The Difference of In-Shoe Plantar Pressure between Level Walking and Stair Walking

Category:Basic Sciences/Biologics; OtherIntroduction/Purpose:Stair walking is one of common activities of daily living. It is more demanding than level walking and can aggravate discomfort of the foot, such as Morton’s neuroma, plantar fasciitis, Achilles tendinitis, pressure related-ulcer, and etc. Therefore, analysis of increased pressure in specific plantar area at stair walking can be used as a risk assessment of foot discomfort and basic data in the clinical field. The purpose of this study is to analyze plantar pressure distribution and pressure patterns during gait cycle at stair walking compared to level walking.Methods:Fourty healthy male adults were recruited. Radiologic measurements and gait analysis were performed to check participants’ normality, and 35 healthy males with 20-28 years old were included. They performed level walking (18 meters walkway), stair (26 steps stair, height:16.7cm, depth:29.8cm) ascending, and descending in same type of running shoes.Measurements of in-shoe plantar pressure including peak pressure, pressure-time integral (PTI) were done by Pedar-X system. The sole was masked in 7 segments (hallux, 2nd-5th toes, medial forefoot, central forefoot, lateral forefoot, midfoot, heel region) to analyze properly. Percentages were assigned in relation to the size for each mask segment. Statistical analysis was performed using repeated measure ANOVA, and Bonferroni post hoc test was done.Results:PP in all regions except for the midfoot were higher during level walking than stair walking. During stair descent, PP in all the regions except for the midfoot were generally lower than other types of walking, but it was the highest in the midfoot region. PTI in the medial and central forefoot was higher during stair descent than level walking. PTI in the central and lateral forefoot, and the midfoot was higher when stair ascending than level walking. PTI in the heel region was the highest during level walking, followed by stair ascent, stair descent.Conclusion:The risk of aggravation of discomfort in the midfoot area increases when stair descending. The medial region of forefoot bear high pressure load during stair descent, and the lateral region of forefoot and the midfoot region bear high pressure load during stair ascent. This is the first study to show plantar pressure patterns during level and stair walking in the large healthy gender-controlled population. We recommend that patients with pressure related foot lesions in the forefoot or midfoot avoid stair walking.

Plantar pressure distribution in hallux valgus feet after a first metatarsal proximal crescentic osteotomy with a lesser metatarsal proximal shortening osteotomy

BackgroundPlantar pressure distribution after the first metatarsal proximal crescentic osteotomy (FMPCO) with lesser metatarsal proximal shortening osteotomy (LMPSO) for hallux valgus with metatarsalgia has not been previously described. MethodsThe pre- (Pre) and postoperative (Post) groups comprised of 18 patients who underwent unilateral FMPCO with LMPSO; fifteen healthy volunteers constituted the control (C) group. For each of the 10 regions, peak pressure (Peak-P), maximum force (Max-F), contact time (Con-T), contact area (Con-A), and force-time integral (FTI) were measured. ResultsThe mean Peak-P of the second metatarsal head was significantly lower in the Post group than the Pre group. The mean Peak-P, Max-F, Con-T, and FTI were not significantly different between the Post and C groups. The mean Con-A was significantly lower in the Post group than the C group. ConclusionFMPCO with LMPSO may improve the plantar pressure of the central forefoot comparable to healthy subjects.

Influences of high-heeled shoe parameters on gait cycle, center of pressure trajectory, and plantar pressure in young females during treadmill walking.

This study aimed to investigate the influences of high-heeled shoe (HHS) parameters on gait cycle, center of pressure (COP) trajectory, and plantar pressure in young females. Twenty healthy adult females were recruited to participate in this study. Subjects walked on a treadmill at a fixed speed (1 m/s). Overall, six pairs of HHSs were evaluated, presenting two heel types (thin and thick) and three different heel heights (low: 3 cm, medium: 6 cm, and high: 8.2 cm). Subjects also wore flat shoes (heel height: 0.2 cm) as the control group. The gait cycle, COP parameters, peak pressure (PP), maximum force, contact area (CA), and force-time integral (impulse) were measured. The comparison between these parameters when the volunteers wore thick heel and flat shoes at different walking conditions indicated that thin heels caused a significant increase in the pre-swing parameter, CA, and PP of the first toe and first metatarsus. Increased heel heights yielded smaller gait line lengths, single support lines, and smaller hindfoot areas. By contrast, increased anterior-posterior positions and plantar pressure parameter values were noted for the forefoot. Data analyses showed significant differences in the plantar pressure distribution associated with heel height and heel type at increased pressure in the first metatarsal and central forefoot region and decreased pressure in the midfoot and heel sections, thus increasing anterior shift. The results presented herein may allow for the design of HHSs with reduced adverse health effects on the wearer.

Plantar Loads of Habitual Forefoot Strikers during Running on Different Overground Surfaces

The objective of this study is to investigate plantar loads characteristics of habitual forefoot strike runners while running on different surfaces. Twenty-six runners (age: 28.2 ± 6.8 y, height: 172.9 ± 4.1 cm, weight: 67.7 ± 9.6 kg, BMI (body mass index): 22.6 ± 2.8 kg/m2, running age: 5.0 ± 4.2 y, running distance per week: 14.6 ± 11.7 km) with habitual forefoot strike participated in the study. Runners were instructed to run at 3.3 ± 0.2 m/s on three surfaces: grass, synthetic rubber and concrete. An in-shoe pressure measurement system was used to collect and analyze plantar loads data. Running on the synthetic rubber surface produced a lower plantar pressure in the lateral forefoot (256.73 kPa vs. 281.35 kPa, p = 0.006) than running on concrete. Compared with the concrete surface, lower pressure–time integrals were shown at the central forefoot (46.71 kPa⋅s vs. 50.73 kPa⋅s, p = 0.001) and lateral forefoot (36.13 kPa⋅s vs. 39.36 kPa⋅s, p = 0.004) when running on the synthetic rubber surface. The different surfaces influence plantar loads of habitual forefoot strikers and runners should choose appropriate overground surface to reduce the risk of lower extremity musculoskeletal injuries.

Effect of Running Speed and Midsole Type on Foot Loading in Heel-Toe Running.

The purpose of this study was to explore the immediate effects of running speed and midsole type on foot loading during heel-toe running. Fifteen healthy male college students were required to complete 3 running trials on an indoor 45-m tartan runway at 4 different speeds (3, 4, 5, and 6m/s) using 2 different running footwear types (engineering thermoplastic polyurethane elastomer, polyurethane elastomer; and ethylene vinyl acetate, vinyl acetate). The ground reaction force and plantar pressure data were quantified. Significant speed effects were detected both in ground reaction force and plantar pressure-related data (P < .05). Vertical average loading rate was significantly less, and time to first peak occurred later for the polyurethane elastomer compared with vinyl acetate footwear (P < .05). The peak pressure of the heel, medial forefoot, central forefoot, lateral forefoot, and big toe was significantly less when subjects wore a polyurethane elastomer than vinyl acetate footwear (P < .05). Overall, our results suggested that, compared with the vinyl acetate footwear, the special polyurethane elastomer footwear that is adhered with thousands of polyurethane elastomer granules was effective at reducing the mechanical impact on the foot.

Difference of walking plantar loadings in experienced and novice long-distance runners

Twenty-five participants were recruited as the experienced runners group (ten: frequency ≥ 4 times/week and distance ≥ 40 km/week, for over 1 year) and the novice group (fifteen: frequency ≤ 2 times/week and distance ≤ 10 km/week, for less than 1 year). The peak Meta loading showed that the novice runners were significantly larger than the experienced runners ( p ≤ .001). The occurring time of peak Meta loading was significantly delayed compared to the experienced runners ( p = .050). Peak Foot balance was higher in the novice runners group ( p ≤ 0.001). This study highlighted the findings of the potential differences of plantar pressures and foot functional parameters during walking in experienced runners and novice runners, specifically the contact duration of phases during stance, toes functions and medial-lateral loading shifting (foot balance) and metatarsals (central forefoot) offloading.

Effect of stud shape on lower limb kinetics during football-related movements

Different football shoe designs used under the same turf condition can impact athletic performance and influence the risk of injury. The purpose of this study was to investigate the effect of different shape studs of football shoes on lower limb kinetics during straight-ahead running and 45° left sidestep cutting movements. Twelve male football players were recruited from university football teams. They were asked to perform six trials using straight-ahead running and a 45° left sidestep cutting movement on artificial turf while wearing football shoes with the following three stud configurations: knife stud, triangle stud and round stud. The contact time of knife stud was longer than triangle stud and round stud. In the straight-ahead running task, the ground force in the direction of movement of knife stud and round stud was lower than triangle stud. The peak pressure on the lateral forefoot (5 metatarsal region) in knife stud was higher than triangle stud and round stud in the cutting movements. The peak pressure and force–time integral on the medial (1 metatarsal region) and central (2–4 metatarsal region) forefoot in triangle stud were smaller than round stud. The different stud shapes of firm ground soccer shoes have little effect on the traction force. Knife stud has a higher risk of fifth metatarsal bone injury. The triangle stud shows good explosive force and provides the ability to change direction quickly. The round stud generally produces the minimum peak vertical ground reaction force and has a good capability of changing direction among the three shoes.

Differentiating Sitting, Standing, and Walking Through Regional Plantar Pressure Characteristics.

Prolonged static weight bearing (WBR) is thought to aggravate plantar heel pain and is common in the workplace, which may put employees at greater risk of developing plantar heel pain. However, objective measures of physical activity and sedentary behaviors in the workplace are lacking, making it difficult to establish or refute the connection between work exposure and plantar heel pain. Characterizing loading patterns during common workplace postures will enhance the understanding of foot function and inform the development of new measurement tools. Plantar pressure data during periods of sitting, standing, and walking were measured in ten healthy participants using the F-Scan in-shoe measurement system (Tekscan Inc, Boston, MA). Peak and average pressure, peak and average contact area, and average pressure differential were analyzed in ten different regions of the foot. A two-way repeated measures analysis of variance (ANOVA) assessed the posture by foot region interaction for each measurement parameter; significant effects of posture by foot region were identified for all five measurement parameters. Ten foot region by measurement parameter combinations were found to significantly differentiate all three postures simultaneously; seven used pressure measures to differentiate while three used area measures. The heel, lateral midfoot (LM), and medial and central forefoot (CFF) encompassed nine of ten areas capable of differentiating all postures simultaneously. This work demonstrates that plantar pressure is a viable means to characterize and differentiate three common workplace postures. The results of this study can inform the development of measurement tools for quantifying posture duration at work.

The Difference of In-Shoe Plantar Pressure Between Level Walking and Stair Walking

Category:Basic Sciences/BiologicsIntroduction/Purpose:Stair walking is one of common activities of daily living. It is more demanding than level walking and can aggravate discomfort of the foot, such as Morton’s neuroma, plantar fasciitis, Achilles tendinitis, pressure related-ulcer, and etc. Therefore, analysis of increased pressure in specific plantar area at stair walking can be used as a risk assessment of foot discomfort and basic data in the clinical field. The purpose of this study is to analyze plantar pressure distribution and pressure patterns during gait cycle at stair walking compared to level walking.Methods:Fourty healthy male adults were recruited. Radiologic measurements and gait analysis were performed to check participants’ normality, and 35 healthy males with 20-28 years old were included. They performed level walking (18 meters walkway), stair (26 steps stair, height:16.7 cm, depth:29.8 cm) ascending, and descending in same type of running shoes.Measurements of in-shoe plantar pressure including peak pressure, pressure-time integral (PTI) were done by Pedar-X system. Only measurements of right steps were used to exclude the effect of the dominant foot. The sole was masked in 7 segments (hallux, 2nd-5th toes, medial forefoot, central forefoot, lateral forefoot, midfoot, heel region) to analyze properly. Percentages were assigned in relation to the size for each mask segment. Statistical analysis was performed using repeated measure ANOVA, and Bonferroni post hoc test was done.Results:Mean peak pressures in all regions except for the midfoot were higher during level walking than stair walking. During stair descent, mean peak pressures in all the regions except for the midfoot were generally lower than other types of walking, but it was the highest in the midfoot region. Pressure time integral (PTI) in the medial and central forefoot was higher during stair descent than level walking. PTI in the central and lateral forefoot, and the midfoot was higher when stair ascending than level walking. Pressure time integral (PTI) in the heel region was the highest during level walking, followed by stair ascent, stair descent.Conclusion:The risk of aggravation of discomfort in the midfoot area increases when stair descending. The medial region of forefoot bear high pressure load during stair descent, and the lateral region of forefoot and the midfoot region bear high pressure load during stair ascent.This is the first study to show plantar pressure patterns during level and stair walking in the large healthy gender-controlled population. We recommend that patients with pressure related foot lesions in the forefoot or midfoot avoid stair walking.

Immediate effect of visual, auditory and combined feedback on foot strike pattern

BackgroundA growing body of literature supports the promising effect of real-time feedback to re-train runners. However, no studies have comprehensively assessed the effects of foots trike and cadence modification using different forms of real-time feedback provided via wearable devices. Research questionThe purpose of the present study was to determine if a change could be made in foot strike pattern and plantar loads using real-time visual, auditory and combined feedback provided using wearable devices. MethodsVisual, auditory and combined feedback were provided using wearable devices as fifteen recreational runners ran on a treadmill at self-selected speed and increased cadence. Plantar loads and location of initial contact were measured with a flexible insole system. Repeated measures ANOVAs with Bonferroni adjusted pair-wise comparisons were used to assess statistical significance. Results and significanceA significant effect of condition was noted on location of center of pressure (p < 0.01). Bonferroni-adjusted post-hoc comparisons showed that feedback conditions differed from baseline as well as the new cadence conditions, however did not differ from each other. A significant interaction effect (region x feedback) was found for plantar loads (maximum force P < 0.001). Significant effects of feedback were noted at the heel (P < 0.001), medial midfoot (P < 0.001), lateral midfoot (P < 0.001), medial forefoot (P = 0.003), central forefoot (P = 0.003), and great toe (P = 0.004) but not at the lateral forefoot (P = 0.6) or lateral toes (P = 0.507). SignificanceThe unique findings of our study showed that an anterior shift of the center of pressure, particularly when foot strike modification was combined with 10% increased cadence. We found lower heel and midfoot loads along with higher forefoot and great toe loads when foot strike modification using real-time feedback was combined with increased cadence. Our findings also suggest that auditory feedback might be more effective than visual feedback in foot-strike modification.