Fitting Footwear Research Articles

Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update).

Offloading mechanical tissue stress is arguably the most important of multiple interventions needed to heal diabetes-related foot ulcers. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence-based guideline on offloading interventions to promote healing of foot ulcersin persons with diabetes. It serves as an update of the 2019 IWGDF guideline. We followed the GRADE approach by devising clinicalquestions and important outcomes in the PICO (Patient-Intervention-Control-Outcome) format, undertaking a systematic review and meta-analyses, developing summary of judgement tables and writing recommendations and rationales for each question. Each recommendation is based on the evidence found in the systematic review, expert opinion where evidence was not available, and a careful weighing of GRADE summary of judgement itemsincluding desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability. For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, use a non-removable knee-high offloading device as the first-choice offloading intervention. If contraindications or patient intolerance to non-removable offloading exist, consider using a removable knee-high or ankle-high offloading device as the second-choice offloading intervention. If no offloading devices are available, consider using appropriately fitting footwear combined with felted foam as the third-choice offloading intervention. If such a non-surgical offloading treatment fails to heal a plantar forefoot ulcer, consider an Achilles tendon lengthening, metatarsal head resection, joint arthroplasty, or metatarsal osteotomy. For healing a neuropathic plantar or apex lesser digit ulcer secondary to flexibile toe deformity, use digital flexor tendon tenotomy. For healing rearfoot, non-plantar or ulcers complicated with infection or ischaemia, further recommendations have been outlined. All recommendations have been summarised in an offloading clinical pathway to help facilitate the implementation of this guideline into clinical practice. These offloading guideline recommendations should help healthcare professionals provide the best care and outcomes for persons with diabetes-related foot ulcers and reduce the person's risk of infection, hospitalisation and amputation.

Development of a Manual Measurement Device for Measuring Hallux Valgus Angle in Patients with Hallux Valgus.

Background: Hallux valgus (HV) is one of the most common forefoot deformities, and its prevalence increases with age. HV has been associated with poor foot function, difficulty in fitting footwear and poor health-related quality of life. The aims of this study were to design and develop an easy-to-use measurement device for measuring hallux valgus angle (HVA) in patients with HV and to assess the measurement reliability of the newly designed measurement device. Methods: A manual measurement device for measuring HVA was designed and developed to test on patients with HV. Two measuring methods, i.e., test–retest and intra-observer measurements, were used to evaluate the repeatability and reliability of the newly designed measurement device. In the test–retest measurements, a total of 42 feet from 26 patients with HV were repeatedly measured by the same researcher using the manual measurement device every 3 weeks over a period of 12 months. The measurement reliability of the newly designed measurement device was analysed based on the collected HVA data. In the intra-observer measurements, a total of 22 feet from the same group of HV patients were measured by the same researcher using the manual measurement device and by a consultant using X-ray measurement for comparison. The intraclass correlation coefficient (ICC) was used to determine the correlation of measurements between the manual measurement device and X-ray measurement. Results: The mean of the difference between the two repeat measurements of HVA using the newly designed manual device was 0.62°, and the average of ICC was 0.995, which indicates excellent reliability. The ICC between X-ray and the average of twice-repeated manual measurements was 0.868, with 95% CI (0.649, 0.947) (p = 0.000). When the relationship in HVA between X-ray measurement and manual measurement using the new device was regressed as a linear relationship, the regression equation was y = 1.13x − 4.76 (R2 = 0.70). Conclusions: The newly designed measurement device is easy to use, with low-cost and excellent reliability for HVA measurement, with the potential for use in clinical practice.

Dynamic foot morphology explained through 4D scanning and shape modeling

A detailed understanding of foot morphology can enable the design of more comfortable and better fitting footwear. However, foot morphology varies widely within the population, and changes dynamically as the foot is loaded during stance. This study presents a parametric statistical shape model from 4D foot scans to capture both the inter- and intra-individual variability in foot morphology. Thirty subjects walked on a treadmill while 4D scans of their right foot were taken at 90 frames-per second during stance phase. Each subject’s height, weight, foot length, foot width, arch length, and sex were also recorded. The 4D scans were all registered to a common high-quality foot scan, and a principal component analysis was done on all processed 4D scans. Elastic-net linear regression models were built to predict the principal component scores, which were then inverse transformed into 4D scans. The best performing model was selected with leave-one-out cross-validation. The chosen model predicts foot morphology across stance phase with a root-mean-square error of 5.2 ± 2.0 mm and a mean Hausdorff distance of 25.5 ± 13.4 mm. This study shows that statistical shape modeling can be used to predict dynamic changes in foot morphology across the population. The model can be used to investigate and improve foot-footwear interaction, allowing for better fitting and more comfortable footwear.

Investigating the effects of appropriate fitting footwear on functional performance level, balance and fear of falling in older adults: A comparative-observational study

The aim of the study was to assess the characteristics of footwear altogether and to compare the effect of appropriate-fitting and ill-fitting footwear on functional performance, balance, and fear of falling (FoF) in older adults. Individuals who wore appropriate-fitting (n = 61) or ill-fitting footwear (n = 92) were enrolled in the study. Footwear was evaluated using the Footwear Assessment Scale (FAS). The participants were assessed using the Berg Balance Scale (BBS) for balance, the Timed Up and Go test for functional performance and the Activities-specific Balance Confidence scale for FoF. Tests were conducted twice for each individual with or without footwear. Differences between the groups were analyzed using the MANOVA for scores of balance, performance and fear of falling and Chi-squared test for homogeneity. The Paired t-test was used to compare test scores with or without footwear. It was concluded that appropriate-fitting footwear improves balance, reduces fear of falling and may affect functional performance positively.ClinicalTrials.gov No: NCT04151654

First Dorsal Metatarsal Artery Flap for Coverage of Distal Foot Wounds: A Case Discussion and Narrative Review

Reconstruction of distal foot and toe wounds present a challenging problem, as defects in this area are often associated with exposed tendons and bones, making split skin grafts impossible in many cases. There is also a need for any flap to achieve a smooth and nonbulky contour to allow for wearing of footwear and acceptable esthetic results. The first dorsal metatarsal artery (FDMA) flap has been increasingly described as a functional and effective method of managing relatively small distal foot and toe defects. We present a case study of our patient who underwent FDMA flap coverage of a big toe dorsum wound, and we also present a review of the literature. Of the 13 papers and 46 cases in the published literature, all flaps survived. Authors report good functional outcomes, with patients regaining ambulation and fitting footwear owing to the flap’s thin and pliable contour. Complications reported include 5 cases of superficial distal tip necrosis, all of which healed spontaneously. We conclude that the FDMA flap is a reliable, reproducible, and suitable coverage option for small distal foot, webspaces, and toe defects. They are relatively easy to perform and associated with good reported outcomes. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update).

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the use of offloading interventions to promote the healing of foot ulcers in people with diabetes and updates the previous IWGDF guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical-scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, we recommend that a nonremovable knee-high offloading device is the first choice of offloading treatment. A removable knee-high and removable ankle-high offloading device are to be considered as the second- and third-choice offloading treatment, respectively, if contraindications or patient intolerance to nonremovable offloading exist. Appropriately, fitting footwear combined with felted foam can be considered as the fourth-choice offloading treatment. If non-surgical offloading fails, we recommend to consider surgical offloading interventions for healing metatarsal head and digital ulcers. We have added new recommendations for the use of offloading treatment for healing ulcers that are complicated with infection or ischaemia and for healing plantar heel ulcers. Offloading is arguably the most important of multiple interventions needed to heal a neuropathic plantar foot ulcer in a person with diabetes. Following these recommendations will help health care professionals and teams provide better care for diabetic patients who have a foot ulcer and are at risk for infection, hospitalization, and amputation.

Footwear characteristics in people with inflammatory arthritis in Singapore.

BackgroundFoot problems are common in people with inflammatory arthritis. Despite suitable footwear having the potential to alleviate pain, improve mobility and maintain independence, previous studies have found many people with inflammatory arthritis wearing poorly fitting and inappropriate footwear. Footwear styles and characteristics have not been reported in a Singapore inflammatory arthritis population. The objective of this study was to identify current footwear styles and characteristics of footwear worn by people with inflammatory arthritis in Singapore.MethodsOne-hundred-and-one participants with inflammatory arthritis were recruited from the rheumatology outpatient clinic of a large public hospital in Singapore. Disease and clinical characteristics were recorded. A patient-reported outcome included current foot pain. An objective footwear assessment of style, age of shoe, fit and construction was conducted.ResultsThe majority of participants were Chinese women with a mean (SD) age was 52.0 (15.0) years old and a mean (SD) disease duration of 9.3 (0.3) years. We found 50 % of participants (n = 51) reported footwear problems. Sandals (n = 27, 26 %), flip-flops (n = 19, 19 %) and moccasin type (n = 19, 19 %) was the most common footwear choice. Evaluation of footwear characteristics found that there was a lack of motion control features. Only 32 (32 %) participants had correctly fitting footwear with regard to length, width and depth. No participant was wearing therapeutic footwear.ConclusionThis study provides the first insight into footwear preferences of people with inflammatory arthritis in Singapore. Use of slip-on and poorly fitting footwear was found to be common in people with inflammatory arthritis. Further research on footwear preferences in Southeast-Asian communities needs to take into account cultural habit and preference, socio-economic status, footwear options and affordability.

Footwear mismatch – do we wear correct-sized shoes?

Correct fitting footwear is essential for good foot health. Ill-fitting footwear can lead to pain, foot pathology, reduced foot function, inefficient gait and a risk of falls (Menz & Lord, 1999). I...

Foot type symmetry and change of foot structures from sitting to standing conditions

Method Based on standing AHI, 68.1%, 24.5%, and 7.5% of the study subjects’ left foot was categorized into planus, neutral, and cavus foot types, respectively. An asymmetrical foot type was observed in 28.6% of subjects in sitting and 23.6% standing conditions. Foot length increased from sitting to standing conditions; this change was significantly greater in cavus and neutral foot type groups than the planus group. In contrast, arch height flexibility (AHF) was significantly greater in the planus group than both cavus and neutral foot type groups. Results Results of this study suggest the importance of controlling for weight bearing status when assessing foot structure or fitting footwear. Given that about a quarter of participants demonstrated an asymmetrical foot type, findings also suggest the importance of assessing both feet independently. Table 1.

Computerized girth determination for custom footwear manufacture

Good fitting footwear requires matching not just the linear dimensions of feet but their girths as well. Footwear fitters have been using manual measurements for a long time, but the development of computerized techniques and scanner technologies have now made automatic determination of different foot dimensions feasible. The resistance to using such computer measurements has been the lack of trust in the accuracy of the data. This paper proposes an approach to obtain the necessary girths of feet in order to customize footwear. The proposed approach attempts to simulate the manual measurement procedures, and its effectiveness is assessed through an experiment with 15 foot castings. The results show that the simulated measurements can be within 5 mm of the manual measurements if the measuring locations can be correctly identified. Linear regressions show that the differences between the manual measurements and the simulated measurements can be modeled with the addition of a systematic error term of less than 4 mm. The computerized acquisition of foot dimensions is a useful way forward for custom shoe manufacturers.

Footwear Characteristics and Foot Problems in Older People

Background:Foot problems are common in older people, however the contribution of incorrectly fitting footwear and heel elevation to the development of foot pain and deformity has not been fully evaluated. Objectives: To examine the relationship between footwear characteristics and the prevalence of common forefoot problems in older people. Methods:Presence of foot pain and deformity were identified in 176 people (56 men and 120 women) aged 62–96 years (mean 80.09, SD 6.42) using a questionnaire and clinical assessment. Shoe fit was determined by comparing length, width and area measurements of shoes with foot measurements. Past and present use of high heels in women was documented, and heel elevation of footwear was measured. Results: Most subjects wore shoes narrower than their feet. Women wore shoes that were shorter, narrower and had a reduced total area compared to their feet than men. Wearing shoes substantially narrower than the foot was associated with corns on the toes, hallux valgus deformity and foot pain, whereas wearing shoes shorter than the foot was associated with lesser toe deformity. Wearing shoes with heel elevation greater than 25 mm was associated with hallux valgus and plantar calluses in women. Conclusion: Incorrectly fitting footwear is common in older people and is strongly associated with forefoot pathology and foot pain. These findings highlight the need for footwear assessment in the management of foot problems in older people.

Variations in foot volume before and after exercise.

Foot volume measurements were taken on 12 feet of nine female intercollegiate volleyball players (mean age of 20 years) before and after a 2-hr rigorous practice session. No significant difference was found between foot volume before and after exercise. A slight reduction in the foot volume after exercise was noted in comparison with the foot volume before exercise. These findings suggest that fitting footwear with extra space in front of the longest toe to accommodate changes in foot length associated with foot volume increases following exercise is not necessary. However, providing extra space in front of the longest toe during shoe fitting should still be considered in order to accommodate anterior sliding of the foot during athletic activities.

Injury in Ballet: A Review of Relevant Topics for the Physical Therapist

Currently, there is a need for a review of the literature on ballet injury as it pertains to the physical therapist. Relatively few articles have reviewed ballet injury prevalence and mechanisms of injury. The purpose of this paper was to provide a thorough literature review of the prevalence of ballet injury and mechanisms of injury. Environmental factors and footwear relating to ballet injury were also reviewed. The literature indicated that 65-80% of ballet injuries are in the lower extremity, 10-17% occur in the vertebral column, and most of the remaining percentage are upper limb injuries (5-15%). The etiology of common lower limb conditions included an incorrect turnout; soft tissue imbalances; reduced quadriceps performance; "rolling in of the foot;" inversion sprains; and frequent pliés, pointé, and demipointé work. Spinal conditions were reported to result from hyperextension and hyperlordosis of the lumbar spine as well as the psoas insufficiency syndrome. It was revealed that inappropriately fitting footwear lead to various foot conditions and abnormal lower kinetic chain biomechanics. Environmental factors, such as the dance surface, also have implications in ballet injury. The author concluded that ballet injuries have a multifactorial etiology that primarily involves the interplay of compensatory biomechanics in the spine and lower extremity, environmental factors, and footwear. In addition, some clinical recommendations have been made regarding the physical therapy management of ballet injuries.

Correctly fitting footwear

Correctly fitting footwear