Heel Inserts Research Articles

Surgical or non-surgical treatment of plantar fasciopathy (SOFT): study protocol for a randomized controlled trial

BackgroundPlantar fasciopathy is the most common reason for complaints of plantar heel pain and one of the most prevalent musculoskeletal conditions with a reported lifetime incidence of 10%. The condition is normally considered self-limiting with persistent symptoms that often last for several months or years. Multiple treatments are available, but no single treatment appears superior to the others. Heavy-slow resistance training and radiofrequency microtenotomy for the treatment of plantar fasciopathy have shown potentially positive effects on short- and long-term outcomes (> 3 months). However, the effect of heavy-slow resistance training compared with a radiofrequency microtenotomy treatment is currently unknown. This trial compares the efficacy of heavy-slow resistance training and radiofrequency microtenotomy treatment with supplemental standardized patient education and heel inserts in improving the Foot Health Status Questionnaire pain score after 6 months in patients with plantar fasciopathy.MethodsIn this randomized superiority trial, we will recruit 70 patients with ultrasound-confirmed plantar fasciopathy and randomly allocate them to one of two groups: (1) heavy-slow resistance training, patient education and a heel insert (n = 35), and (2) radiofrequency microtenotomy treatment, patient education and a heel insert (n = 35). All participants will be followed for 1 year, with the 6-month follow-up considered the primary endpoint. The primary outcome is the Foot Health Status Questionnaire pain domain score. Secondary outcomes include the remaining three domains of the Foot Health Status Questionnaire, a Global Perceived Effect scale, the physical activity level, and Patient Acceptable Symptom State, which is the point at which participants feel no further need for treatment.DiscussionBy comparing the two treatment options, we should be able to answer if radiofrequency microtenotomy compared with heavy-slow resistance training is superior in patients with plantar fasciopathy.Trial registrationClinicalTrials.gov NCT03854682. Prospectively registered on February 26, 2019.

Guidelines for Selecting the Appropriate Heel Insoles on Ladies Flat Shoes with Walking Activity

The interviewed 150 ladies from the central provinces of Thailand prefer to wear flat shoes for performing daily activities. A 54% of the interviewed group prefers to apply heel insoles for releasing stress occurred during the day; especially the ladies who are members of an aircrew or a flight attendant. Some insoles or heel inserts are available in the market without clear product instructions or descriptions, only the trained brand ambassadors have introduced and suggested the specific characteristics of their products. Cost of inserts is depended upon the reliability, the brand designers or the materials of the product. Providing product description clearly on the package can help the customers avoid any confusion and eliminate issue about having trouble getting comfortable when they are wearing shoes with inserts. Applying the technical applications proposed in this research can help to select the appropriate insoles with a reasonable price for minimizing foot pain or extending the walking period tolerance of daily activities where the same or favorite shoes still be applied.

The Effect of a Heel Insert Intervention on Achilles Tendon Loading during Running in Soccer

The Effect of a Heel Insert Intervention on Achilles Tendon Loading during Running in Soccer

The influence of shock-pad density and footwear cushioning on heel impact and forefoot loading during running and turning movements

This investigation explored how shock-pad density and footwear cushioning influences soccer players' biomechanics. Ten participants (20.9 ± 2.5 yrs, 83.2 ± 7.1 kg, UK footwear size 10-11) wore three footwear cushioning conditions (soccer boot, soccer boot with cushioning insole and soccer boot with heel insert). Each footwear condition was tested on two shock-pad densities (55 g/litre and 65 g/litre) beneath a third generation carpet. For each footwear-shock-pad combination, eight running trials (3.81 m/s) and eight turning trials (consistent self-selected speeds) were collected. Pressure insole data were collected to provide a measure of player loading at impact and propulsion. Repeated measures ANOVAs demonstrated no main effects of footwear. The greater surface density did however, significantly increase (p < 0.05) measurements associated with loading during running (first metatarsal peak pressure) and turning (peak impact force, lateral heel and first metatarsal peak pressure). These findings suggest that shock-pad density is important in the regulation of player loading.

Effects of heel cushioning elements in safety shoes on muscle–physiological parameters

Safety shoe designs are primarily based on safety requirements. But all-day comfort should not be luxury: Heel strike associated impact loads on joints need to be compensated by active muscular effort and safety shoes should support this protective function of muscle activation. In 10 healthy men, 12 trunk and leg muscles were analyzed with surface electromyography. Subjects walked on a walkway while wearing different safety shoes with the test shoes being equipped with exchangeable cushioning heel inserts according to individuals' body weight. While wearing the optimally cushioned shoes the cumulative muscle activity per distance travelled dropped clearly compared to the regular safety shoes, demonstrating reduced muscular effort. Also, the heel strike associated amplitude peak of back muscles occurred earlier within the stride while wearing the test shoes. Thus weight-balanced cushioning heel inserts in safety shoes proved able to reduce muscle strain, logically delaying muscular fatigue and extending muscular joint protection. Relevance to industryAdjustable heel inserts in safety shoes are suited to improve the health status of employees by reducing muscular effort so that active joint protection can be prolonged.

IN VIVO AND IN VITRO TESTING OF SHOE HEEL INSERT PROPERTIES; A COMPARATIVE STUDY

Abstract Shoe heel inserts (SHI) are a common method of con-servative treatment for various painful disorders like degenerative joint diseases (DJD) and overuse injuries. They are also used to enhance exercise performance in athletes. There is little in the literature to guide ortho-paedic practitioners in relation to optimum material for these SHI. The current study examines properties of three different kinds of off-the-shelf SHI in terms of their performance, endurance and cost. The material properties of inserts were tested on a universal mate-rial testing machine (UTM) before and after mecha-nical degradation (MD) that was performed by a pur-pose built repetitive loading machine (RLM) under compression and shearing forces. The results of mate-rial tests were augmented through subject tests by a pressure sensitive insole system, Pedar ® . The data pro-vided evidence that MD, simulating a normal walking distance of 100 to 130 Km, deteriorated the perfor- Rahim I.U. 1 Associate Professor of Orthopaedic Surgery Avicenna Medical College, Lahore Iqbal M. 2 Associate Professor of Orthopaedic Surgery KEMU / Mayo Hospital, Lahore Hussain F.N. 3 Professor of Orthopaedic Surgery Avicenna Medical College, Lahore mance of all inserts tested in the current study. There were significant changes in the stiffness and elastic hysteresis of inserts and they were less efficient in cushioning heel areas. The SHI were responsible for putting more pressure under the lateral metatarsal hea-ds. The SHI may be effective in symptomatic relief of painful DJD and overuse injuries but should be used cautiously in diabetic patients. Acknowledgements: The authors would like to ack-nowledge Mr. Ian Christie and Mr. Sadiq Nasir for their assistance. The study was funded by Institute of Motion Analysis and Research. The authors have no financial or personal relationships with the companies whose products were evaluated in this work. Keywords: Endurance; Mechanical degradation; Cost; Stiffness; Hysteresis.

Measurement of functional heel pad behaviour in-shoe during gait using orthotic embedded ultrasonography

The ability to measure the functional behaviour of the plantar heel pad is clinically relevant in dystrophic or pathological heel conditions and may help to inform the design and development of interventions that attempt to restore normal function. In this study we present a novel technique which utilises orthotic heel inserts with an embedded ultrasound (US) transducer to allow the functional, dynamic behaviour of the heel pad to be measured in-shoe during gait. The aim of this study was to demonstrate feasibility of the technique, determine the reproducibility of measurements, and to compare the effects of two orthotic inserts: (i) a flat orthotic heel raise and (ii) a contoured heel cup insert on the behaviour of the heel pad during gait. Dynamic compression of the heel pads of 16 healthy participants was recorded during treadmill walking and combined with plantar pressure measurements to allow stiffness and energy disappation ratio (EDR) to be estimated. Inter-session reliability of the US measurements was found to be excellent (ICC2,1=0.94–0.95), as was inter-rater reliability (ICC2,1=0.89). Use of the heel cup insert significantly reduced the maximum compression of the heel pad (p<0.0001) as well as the overall stiffness of the pad (p<0.001). There was no change in EDR (p=0.949). In-shoe embedded US is a reliable method to establish person-specific functional geometry of plantar soft tissues. Use of a contoured heel cup reduces the compression of the mid portion of the heel pad.

Influence of minimal heel inserts on rearfoot movement, running economy, mechanical parameters and muscular activity during distance running

Influence of minimal heel inserts on rearfoot movement, running economy, mechanical parameters and muscular activity during distance running

Pressure-relieving properties of various shoe inserts in older people with plantar heel pain

Plantar heel pain is one of the most common musculoskeletal conditions affecting the foot and it is commonly experienced by older adults. Contoured foot orthoses and some heel inserts have been found to be effective for plantar heel pain, however the mechanism by which they achieve their effects is largely unknown. The aim of this study was to investigate the effects of foot orthoses and heel inserts on plantar pressures in older adults with plantar heel pain. Thirty-six adults aged over 65 years with plantar heel pain participated in the study. Using the in-shoe Pedar ® system, plantar pressure data were recorded while participants walked along an 8 m walkway wearing a standardised shoe and 4 different shoe inserts. The shoe inserts consisted of a silicon heel cup, a soft foam heel pad, a heel lift and a prefabricated foot orthosis. Data were collected for the heel, midfoot and forefoot. Statistically significant attenuation of heel peak plantar pressure was provided by 3 of the 4 shoe inserts. The greatest reduction was achieved by the prefabricated foot orthosis, which provided a fivefold reduction compared to the next most effective insert. The contoured nature of the prefabricated foot orthosis allowed for an increase in midfoot contact area, resulting in a greater redistribution of force. The prefabricated foot orthosis was also the only shoe insert that did not increase forefoot pressure. The findings from this study indicate that of the shoe inserts tested, the contoured prefabricated foot orthosis is the most effective at reducing pressure under the heel in older people with heel pain.

The effect of heel inserts and foot orthoses in older people with plantar heel pain

Background Plantar heel pain is one of the most common musculoskeletal conditions affecting the foot and it is commonly experienced by older adults. Contoured foot orthoses and some heel inserts have been found to be effective for plantar heel pain, however the mechanism by which they achieve their effects is largely unknown. The aim of this study was to investigate the effects of foot orthoses and heel inserts on plantar pressures in older adults with plantar heel pain.

Kinematics and Kinetics of the Lower Limbs of a Walking Shoe with a Plate Spring and Cushioning Elements in the Heel during Walking

The purposes of this study was to investigate the biomechanical influence of the walking shoe with a plate spring in the heel and interchangeable heel cushioning elements. Eighteen subjects walked in three conditions: 1) the walking shoes Type A-1 with a soft heel insert, 2) the Type A-2 shoe with a stiff heel insert, 3) a general walking shoe(Type B). Ground reaction forces, leg movements, leg muscle activity and ankle, knee and hip joint loading were measured and calculated during overground walking. During walking, the ankle is a few degrees more dorsiflexed during landing and the knee is slightly more flexed during takeoff with the Type A shoes. As a result of the changes in the walking movement, the ground reaction forces are applied more quickly and the peak magnitudes are higher. Muscle activity of the quadricep, hamstring and calf muscles decrease during the first 25% of the stance phase when walking in the Type A shoes. The resultant joint moments at the ankle, knee and hip joints decrease from 30-40% with the largest reductions occurring during landing.

Effects of modified short-leg walkers on ground reaction force characteristics

Background Although short-leg walkers are often used in the treatment of lower extremity injuries (ankle and foot fractures and severe ankle sprains), little is known about the effect the short-leg walker on gait characteristics. The purpose was to examine how heel height modifications in different short-leg walkers and shoe side may affect ground reaction forces in walking. Methods Force platforms were used to collect ground reaction force data on 10 healthy participants. Five trials were performed in each of six conditions: lab shoes, gait walker, gait walker with heel insert on shoe side, gait walker modified with insert on walker side, equalizer walker, and equalizer walker with heel insert on shoe side. Conditions were randomized and walking speed was standardized between conditions. A 2 × 6 (side × condition) repeated analysis of variance was used on selected ground reaction force variables ( P < 0.05). Findings The application of a walker created peak vertical and anteroposterior ground reaction forces prior to the normal peaks associated with the loading response. Wearing a walker introduced an elevated minimum vertical ground reaction force in all conditions except the equalizer walker when compared to shoe on the shoe side. Peak propulsive anteroposterior ground reaction forces were smaller in all walker conditions compared to shoe on walker side. Interpretation The application of heel insert in gait walker with heel insert (on shoe side) and gait walker modified (on walker side) does not diminish the minimum vertical ground reaction force as hypothesized. Wearing a walker decreases the peak propulsive anteroposterior ground reaction force on the walker side and induces asymmetrical loading.

The in-shoe heel inserts: Friend or foe?

The use of shock-absorbing heel inserts in shoes by people suffering from heel pain has long been advocated (Milgrom et al., 1992; Voloshin and Wosk, 1981). The symptomatic relief of heel pain with the use of such inserts under the plantar surface, especially in over use injuries, has been documented (Pratt et al., 1986). The use of these shock-absorbing heel inserts, which are available off-the-shelf, has been seen to be on the increase due to the widespread popularity of a growing exercise culture.

The effects of off-the-shelf in-shoe heel inserts on forefoot plantar pressure

Off-the-shelf heel inserts are used widely without adequate scientific information regarding their effects upon the forefoot. The aim of this study was to assess whether the use of in-shoe heel inserts affects the plantar pressure distribution under the forefoot. Thirty-five asymptomatic volunteers consented to participate. Six brands of off-the-shelf heel inserts were tested. Subjects walked along a 10 m walkway with no inserts and then with each pair of inserts, in a randomised order. The Pedar ® system was used to record in-shoe plantar pressure data. The results confirmed that heel inserts increased pressure under the metatarsal heads and altered the biomechanics of the foot even in asymptomatic subjects. The findings suggested that heel inserts should be used with caution especially in people predisposed to foot problems. The classification of these inserts as an over-the-counter product may need to be reviewed.

Off-the-shelf in-shoe heel inserts: does cost matter?

Objective:A growing exercise culture has lead to an increase in the use of off-the-shelf heel inserts. While there are a variety of designs in a spectrum of cost ranges, probably...

Changes in Ground Reaction Forces in Modified Short-leg Walkers during Gait

It has been shown that short-leg walking boots alter kinematics, joint kinetics and ground reaction forces (GRFs) during gait. The altered GRF variables may be associated with the increased heel height on the walker side compared to the shoe side. By modifying the walking boots, it was hypothesized that the diminished heel height difference between the walker side and the shoe side would restore GRF characteristics closer to those in normal walking. PURPOSE: To examine effects of heel height modifications on the walker and shoe sides on GRF characteristics during level walking. METHODS: Ten (four males, six females) subjects performed five level walking trials in each of six randomized conditions: lab shoes (Shoe), Gait walker (GW), Gait Walker with heel insert (GWHI), Gait walker modified (GWM), Equalizer walker (EW), and Equalizer walker with heel insert (EWHI). A force platform (1200 Hz) and a seven-camera motion analysis system (120 Hz) were used to collect GRF during the testing session. Visual 3D and customized computer software were used to obtain GRF data. A two-way (2 × 6: side × condition) mixed design ANOVA was used to examine selected peak GRF related variables and post hoc comparisons with an alpha level (p < 0.05) adjusted for multiple comparisons through a Bonferroni procedure. RESULTS: The application of a walker created a peak GRF prior to the normal peaks associated with the loading response in both vertical and anteroposterior GRFs. Wearing a walker introduced an elevated minimum vertical GRF in GW (0.88 BW), GWHI (0.89 BW), GWM (0.89 BW) and EWHI (0.88 BW) compared to Shoe (0.82 BW) on the shoe (left) side. Peak propulsive GRFs were smaller in all five walker conditions (0.13 - 0.15 BW) compared to Shoe (0.20 BW) on the walker side. The same peak was smaller in GWHI, EW and EWHI on the walker side compared to the shoe side whereas it was greater on the right side than the left side in Shoe. CONCLUSION: The application of heel insert in GWHI and GWM (on shoe side) does not diminish the minimum vertical GRF as hypothesized. Wearing a walker decreases the peak propulsive ground reaction force on the walker side and induces asymmetrical loading.

Heel Pain-Basketball

1050 HISTORY: A 10 year old female basketball player presents with right heel pain that began 9 months ago when she stepped on a pebble playing basketball barefoot. It bothers her with prolonged walking or after 5 minutes of running. She limps after running. Pain is present first thing in the morning but does not awaken her at night. She has no left heel complaints. She has been taking 800 mg of Advil before practices and games with no relief. An earlier evaluation had found normal calf flexibility and the recommended viscoelastic heel pads improved symptoms somewhat. PHYSICAL EXAMINATION: She walks with an antalgic gait. Her right heel is broadened compared with her left heel. She has slight right calf atrophy and mild heel cord contractures with only a few degrees of dorsiflexion noted bilaterally. No ankle effusion is present. She has a cavus foot type with normal ankle and subtalar motion. There is tenderness about the entire posterior calcaneus. Her skin is normal in appearance and distal sensation and circulation are intact. DIFFERENTIAL DIAGNOSIS: Neoplasm/lipoma/cyst Calcaneal apophysitis Calcaneal fracture Retained foreign body Puncture wound with low grade infection TEST AND RESULTS: Lateral and axial views right heel Calcaneal apophysis widened at the lateral and proximal aspects Apophysis slipped superiorly and laterally Comparison left heel views Normal appearance FINAL/WORKING DIAGNOSIS: Slipped right calcaneal apophysis TREATMENT AND OUTCOMES: Pneumatic Air Cast walking boot with viscoelastic heel insert. Secondary to continued pain in boot, crutches used and weight bearing as tolerated. No sports or gym class Aggressive stretching, stationary bike, therapeutic strengthening exercises stared after 3 weeks. Gait retraining to stop her from coming down hard on heel strike. Weaned out of boot while indoors to sneakers, Air Cast stirrup and silicone heel pad after 1 month. Still using boot for outside activities. Participated with medical limitations in National Basketball championship after 7 weeks. Wore lateral stabilizing brace secondary to continued peroneal weakness. Family moved to Houston and transferred care at 10 weeks. Long-term follow-up 2 years later, no further symptoms. Still growing and still playing highly competitive basketball.

Usefulness of an insole with subtalar strapping for analgesia in patients with medial compartment osteoarthritis of the knee

To assess the effect of an insole with subtalar strapping on patients with medial compartment osteoarthritis (OA) of the knee. Novel lateral wedged insoles with elastic subtalar strapping (the subtalar strapping support group) and ankle supporters with a lateral wedged heel insert (the sock-type ankle support group) were prepared. Eighty-eight female outpatients with knee OA were treated with 1 of the 2 insoles for 8 weeks. Femorotibial angle was assessed by standing radiographs with and without unilateral insole use for each subject. Symptoms of knee OA were evaluated according to the severity index of Lequesne et al at baseline and at the final assessment. Participants wearing the insole with subtalar strapping (n = 42) demonstrated significantly decreased femorotibial angle (an average of change: -3.1 degrees +/- 2.5 degrees, P < 0.0001), but a significant difference was not found in the sock-type ankle support group (n = 46; -0.4 degrees +/- 1.1 degrees, P > 0.05). In the subtalar strapping support group, pain during bed rest with full extension of the knee (P < 0.0001), pain after getting up (P = 0.04), pain on getting up from a seated position (P = 0.021), maximum distance walked (P = 0.009), and aggregate severity score (P < 0.0001) were significantly improved compared with baseline. In contrast, significant symptomatic improvement was detected only in the aggregate score (P = 0.016) in the sock-type ankle support group, but not in any of the 10 specific categories. The lateral wedged insole with subtalar strapping induces correction of the femorotibial angle and symptomatic relief in patients with varus-deformity knee OA.

Inter-examiner and intra-examiner agreement for assessing simulated leg length inequality using palpation and observation during a standing assessment

Osteopaths commonly assess leg length. Inequalities in leg length are associated with an increased incidence of low back pain, adaptive muscle shortening, ligamentous and capsular hypomobility and degenerative joint disease. Accurate detection of leg length inequality could allow early preventative intervention. Several clinical methods of assessing leg length are documented, yet few show convincing reliability. The aim of this study was to determine the inter-examiner and intra-examiner reliability of the standing assessment of leg length inequality using heel inserts to simulate leg length discrepancy. Twenty-seven subjects (mean age=23) were examined by eight examiners. Assessment of leg length was performed by palpation of iliac crests, posterior superior iliac spines, greater trochanters and gluteal folds with the subjects standing. Examiners indicated whether leg length was equal or if there was a longer leg on the left or right. Subjects were assessed with no heel insert and heel inserts of 0.5cm and 1 cm in their shoes. Each insert intervention was examined twice on each subject by each examiner. Zero, 0.5cm and 1cm interventions demonstrated inter-examiner percentage agreement of 52.5% ( K=0.27), 53.9% ( K=0.28) and 63.4% ( K=0.19) respectively. Zero, 0.5cm and 1cm interventions demonstrated intra-examiner percentage agreement of 58.4% ( K=0.35), 60.7% ( K=0.34) and 63.5% ( K=0.14) respectively. The results of this study indicate that examiners are unable to reliably detect simulated leg length discrepancies of 1cm or less by standing assessment.

The Influence of Heel Fit on Rearfoot Motion in Running Shoes

Prior research into eversional control in running has reported the occurrence of calcaneal slipping, defined as the difference between calcaneal and heel counter eversion within the shoe. Inadequate heel fit has been proposed to explain the observed slippage. Therefore, the purpose of the current study was to investigate whether eliminating excess space around the calcaneus by narrowing the heel counter or by introducing heel inserts could minimize eversional slipping of the calcaneus within the shoe and, in so doing, improve eversion control of the calcaneus. Three-dimensional rearfoot kinematics of 20 subjects running on a treadmill at 3.8 m · s−1 were recorded using a three-camera Vicon movement analysis system. ANOVA analyses of the angular displacement data revealed a significant (p &lt; .05) reduction in maximal eversion of the calcaneus in shoes with a narrower heel fit though the heel counter of the same shoes displayed more eversion than their wider counterparts. Calcaneal eversion in the shoes with a wider heel counter, however, could be reduced significantly (p &lt; .05) using heel inserts. Maximal relative eversion (referenced to the value at heel strike) and eversional velocity were only affected by the heel inserts, the latter, however, not significantly. All these results show that heel fit affects the eversional behavior of the calcaneus during ground contact and that running shoes equipped with a rigid heel counter will improve rearfoot control, thus only reducing the risk for overload injuries if a snug heel fit used.